Friday, March 18, 2005

Terry Schiavo

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I have been silent on this matter because I try to avoid media circuses. Also, the Schiavo case touches on my work life, in which I regularly advise hospitals and other health care providers about end of life issues. That's why it's a little more complicated for me to give my opinion about Terry Schiavo.

But this morning's reports pushed me over the edge. The last I heard, at about 1:00 p.m. Eastern time (just as I am typing this post) Terry's feeding tube was to be removed.

This is a moral outrage, as many more qualified than I have commented. I am not sure, however, just how well-understood it is that the Schiavo case may well be a medico-legal-ethical outrage as well.

Take it from me: In close cases involving life-or-death decisions for patients whose ability to decide for themselves is compromised, health providers err on the side of life, unless the wishes of the patient are clear or the patient has legally authorized another person to make decisions on his or her behalf.

I'll say it again: In close cases involving life-or-death decisions for people whose ability to decide for themselves is compromised, health providers err on the side of life. That's the custom and practice in the industry. It is simply what is done. Seemingly only lefty bioethicists in think tanks or living in morally challenged Scandinavian countries think otherwise.

In Terry Schiavo's case, it is not even a close call. No one claims she is brain-dead or even close to it; she may be in a persistent vegetative state ("PVS"), but there's substantial debate about that and very little medical information to go on now. There has been no MRI of her brain and no PET scan. Even assuming she is in PVS, the biggest debate seems to be whether there is clear and convincing evidence that she would wish to have her life end under her present circumstances. I don't know the court file in the case, but all I've heard about in news reports is something about a comment she made once while watching television. The only witness to that comment was her "husband" in name only, whose reliability is being questioned. Terri has appointed no one as her surrogate decision maker.

In other words, there are many more questions than answers about this case. In 20 years of advising hospitals about such matters, I have never seen a case with so many open issues get to the point where artificial hydration and nutrition are about to be withdrawn.

I'd love to write more but alas, I can't today. I hope this story has an ending that helps us all learn to handle such cases better.

The Schiavo family's website is linked here. Please visit. Maybe you will be able to help, or at least learn something.

13 Comments:

Anonymous Anonymous said...

Hedgehog: Part of the problem may lie with our legislatures that seem to confuse artificial nutrition and hydration with ventilation and other support of life functions (eg. see California's form of advance health care directive). By lumping in nutrition and hydration, which are not of the same magnitude, we get poorly written laws that allow judges like Florida's Judge Greer to make asinine decisions to withhold water from the patient! 

Posted by Steve Lambert

Saturday, March 19, 2005 8:08:00 AM  
Anonymous Anonymous said...

Hedgehog: You are clearly more aware of the issues here than I, but one thing that really stood out to me in the discussion of the case on the NewsHour last evening was the fact that it sounded as if the Florida legislature has defined "persistent vegetative state" in what seemed to me to be a rather idiosyncratic--and "loosey-goosey"--way that appeared to focus on decision-making ability of the patient, and excluded medically determinable measures including brain-wave function, etc. Despite my horror at the particular facts of the Schiavo case itself, I began to wonder if the deluge of outrage (which appears well deserved for Mr. Michael Schiavo) has otherwise been misdirected at the courts, when in fact the Florida legislature may have created the legal context in which Mr. Schiavo was able to force the courts to apply such a standard. 

Posted by BlueBuffoon

Saturday, March 19, 2005 8:20:00 AM  
Anonymous Anonymous said...

Bluebuffoon: You make a good point. I am a California lawyer and know little about Florida law on this subject. I any other state of which I am aware, Mrs. Schiavo would not be considered to be in a persistent vegetative state. But even if she were, the really incredible part of this case is the judge's finding that she would have wanted to be killed in her present circumstances. Her "husband" and his lawyer seem especially odious. 

Posted by Hedgehog

Saturday, March 19, 2005 9:24:00 AM  
Anonymous Anonymous said...

Lowell, thank you for your contribution. Your training and perspective are valuable as we work through this, and your clarity on the issues reinforces my disgust with those who would end Terri's life and concern for the precedents their victory will set. Before coming to you I was at holycoast.blogspot.com, where Rick is struggling with his states rights and right to live co-beliefs. To me, it's clear that the life issues are more important than the states rights issues, but this is indeed a case of multiple slippery slopes.  

Posted by Laer

Saturday, March 19, 2005 2:05:00 PM  
Anonymous Anonymous said...

This isn't a states rights case -- but even if it were, would a single judge have the power to declare Florida (or any other state) a euthanasia state?

On an ironic note, A Florida rancher faces 110 felony  counts of animal cruely because he went broke and his cattle are starving.

Here's that story:

http://news-press.com/apps/pbcs.dll/article?AID=/20050319/NEWS01/503190523/1075



 

Posted by Stoo

Saturday, March 19, 2005 6:47:00 PM  
Anonymous Anonymous said...

I'll bet the impetus for Florida defining a PVS didn't come from doctors. Let me guess...it came about because of a civil lawsuit of some kind? I'm guessing PVS is to doctors as insanity is to psychiatrists.

Anyway, good commentary. Hedgehog, I used a chunk of your post for one of my entries here . I figured I had too much to say to contain in a commentary. Please check it out, y'all. 

Posted by Thomas C. Mueller

Saturday, March 19, 2005 8:02:00 PM  
Anonymous Anonymous said...

1. Why can't she be manually fed or given liquids - why no food or liquids at all?
Taking the feeding tube out is one thing, denying all food and liquids by any means is murder isn't it?
2. Why did it take years before her 'husband' said she did not want to live this way?
3. Her friends said she was considering a divorce...certainly an indication that the relationship dynamics were in question,
4. Why can't guardianship be given to her parents so her 'husband' can go on with what he has already determined to be 'his own life'....another woman...2 children...engagement....common-law marriage (By the way, how did he file federal taxes?...joint or single and who was listed as the spouse and dependants?
5. What message is this giving to children today?
6. Could this issue possibly have contributed to the Minnesota school killings?
7. How do people with brain damage view this and what do they think? Are they next?
8. Why has the ADA been so silent? Why is no one calling them or why are they not on the news with statements?
9. What precedence will this now set…anyone who has a ‘loved one’ in ICU or on feeding or other life sustaining means could now say, ‘it was not the wish of this person to be this way, so pull the plug’…let me get the inheritance…let me stop the expenses…forget what the person wants…..whatever
10. Why can’t President Bush just ‘pardon her’?
 

Posted by doc

Wednesday, March 23, 2005 10:22:00 AM  
Anonymous Anonymous said...

1. Why can't she be manually fed or given liquids - why no food or liquids at all?
Taking the feeding tube out is one thing, denying all food and liquids by any means is murder isn't it?
2. Why did it take years before her 'husband' said she did not want to live this way?
3. Her friends said she was considering a divorce...certainly an indication that the relationship dynamics were in question,
4. Why can't guardianship be given to her parents so her 'husband' can go on with what he has already determined to be 'his own life'....another woman...2 children...engagement....common-law marriage (By the way, how did he file federal taxes?...joint or single and who was listed as the spouse and dependants?
5. What message is this giving to children today?
6. Could this issue possibly have contributed to the Minnesota school killings?
7. How do people with brain damage view this and what do they think? Are they next?
8. Why has the ADA been so silent? Why is no one calling them or why are they not on the news with statements?
9. What precedence will this now set…anyone who has a ‘loved one’ in ICU or on feeding or other life sustaining means could now say, ‘it was not the wish of this person to be this way, so pull the plug’…let me get the inheritance…let me stop the expenses…forget what the person wants…..whatever
10. Why can’t President Bush just ‘pardon her’?

Wednesday, March 23, 2005 10:23:00 AM  
Anonymous Anonymous said...

1. Why can't she be manually fed or given liquids - why no food or liquids at all?
Terry cannot swallow on her own.
Taking the feeding tube out is one thing, denying all food and liquids by any means is murder isn't it?
Since she cannot swallow, this is why she is not being given fluids.
2. Why did it take years before her 'husband' said she did not want to live this way?
It did not take years for her husband to decide she did not want to live this way. This has been a long drawn out battle between her parents and her husband.
3. Her friends said she was considering a divorce...certainly an indication that the relationship dynamics were in question,
If her husband didn't truely believe that she wouldn't want to live in a PVS, then why hasn't he just moved on? I think this is a testiment to his devotion.
4. Why can't guardianship be given to her parents so her 'husband' can go on with what he has already determined to be 'his own life'....another woman...2 children...engagement....common-law marriage (By the way, how did he file federal taxes?...joint or single and who was listed as the spouse and dependants?
This case has been going on for 15 year. I don't believe it is too hard to comprehend why he has moved on with his life. The reason guardianship has not been given to her parents is because her husband wanted to fulfill her wishes, but her parents think she will recover.
5. What message is this giving to children today?
Retorical question I assume.
6. Could this issue possibly have contributed to the Minnesota school killings?
Are you kidding?
7. How do people with brain damage view this and what do they think? Are they next?
Not eve worth a response.
8. Why has the ADA been so silent? Why is no one calling them or why are they not on the news with statements?
9. What precedence will this now set…anyone who has a ‘loved one’ in ICU or on feeding or other life sustaining means could now say, ‘it was not the wish of this person to be this way, so pull the plug’…let me get the inheritance…let me stop the expenses…forget what the person wants…..whatever
This is one individual case. There are plenty of people that have their feeding tube removed. ICU is different than PVS. If they could recover then the feeding tube would not be removed.
10. Why can’t President Bush just ‘pardon her’?
Pardon her from what? 

Posted by Whineandroses

Thursday, March 24, 2005 2:40:00 PM  
Anonymous Anonymous said...

Just let her die. She is a useless hull of a person, she was meant to die years ago. Just a waste of vaulable resources. 

Posted by me

Monday, March 28, 2005 1:34:00 PM  
Anonymous Anonymous said...

Just let her die. She is a useless hull of a person, she was meant to die years ago. Just a waste of vaulable resources. 

Posted by me

Monday, March 28, 2005 1:37:00 PM  
Anonymous Anonymous said...

I agree that there is inadequate information concerning Mrs.Schiavo's condition and degree of brain damage, however, I believe most health care providers sustain pateints with similar conditions because of the $2,000+ dollars they make a day. Ethically this case does bring up the legitamacy of spouses or loved ones to make decisions on the life or death of there significant other, but the decision ultimately has to be made. Focusing on the larger debate, wether or not she would have wished to be maintained in this manner, is cyclical and pointless. Either way there is the chance that her wishes will not be obeyed if she is allowed to stay off the feeding tube or has it reinserted. Because of this the spouse, the person likely to know the person best in thier mid to later years of thier lives, should be able to make an educated call on what their significant other would want done.  

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Monday, April 11, 2005 7:17:00 AM  
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