President Bush and Congress intervene in “right to die” case
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7493.687-a (Published 24 March 2005) Cite this as: BMJ 2005;330:687
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The Schiavo case raises some worrying aspects which have mostly been left out of the public eye. These include issues relating to the husband's apparent conflict of interest, as well as a Court order denying attempts at providing her with "food and water by natural means".
The husband, who is the legal guardian stands to inherit monies left over from negligence claims which were earmarked to provide for the care of Terri Schiavo until her death. He has also started a family with another women, with whom he has fathered two children. Surely, there is enough doubt raised about his conflict of interest that mechanisms should be in place to minimize his influence on her fate.
Regardless of the genuine difference of opinion between differing doctors about the certainty of the PVS diagnosis, most of the previous cases involving withdrawal of tube-feeding relied on the argument that such artificial nutrition and hydration is a non-beneficial medical therapy. With the issuance of a Court order denying "food and water by natural means", we have now paved the way for starving to death any person with a disability, which others have deemed makes that person's life not worth living. If Terri could not swallow, attempts at feeding her by mouth could only hasten her death through aspiration, laryngospasm etc. Yet if she can swallow (and attempts at swallowing has been alleged), then there is no argument about withdrawal of therapy, because if she can be say spoonfed, then all such arguments about non-beneficial medical therapy are invalidated and she should continue to be given ordinary food and drink.
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In ruling that Terri' feeding tube be removed and she be allowed to starve to death Judge George Greer has in effect ruled that she is brain dead. If so why then did he not take his decsison to its logical conclusion and instruct that her organs could be harvested before they deteriorated and her heart had stopped beating?
It is particularly pertinent that it is the majority leader of the Senate, Bill Frist, who has been leading this Congresional initiative to, "uphold human dignity and affirm a culture of life." As a former heart transplant surgeon he has used beating hearts harvested from donors who had been declared brain dead to give life to others. Might he have had second thoughts about the ethics of his former practice?
It is most unwise making legal decisions about Terri when the nature of consciousness is far from clearly defined (1), the legal definitions of brain death open to question (2), and current management of acute intracranial pathology and associated neuropsychiatic disorders leaving much to be desired (3). Given the current state of affairs might it have been better if Judge George Greer had ruled therapeutic nihilism (4) illegal and ordered her doctors to consider all rational options for treating her (5) even if there was no evidence to support them and they had never been tried before even in animals?
The heart of the issue would seem to be freedom of doctors to do what they have rational reasons for believing might be in the best interests of their patients with informed consent. Although for centuries the rule this professional independence is being usurped by the courts in our increasingly regulated profession. Whilst there were very good reasons for introducing regulations in the past the need becomes redundant when outcomes are audited and open to scrutiny and patients are given the freedom of choice. More importantly, as Terri's case is showing, regulation can become a serious impediment not only to the doctor/patient relationship and the ability to deliver excellence in patient care but also to advances in management.
The sooner Terri's tube is reinsertd and her doctors are given the freedom to offer her and her family innovative if risky options the better.
1. Body-mind split and brain death Richard G Fiddian-Green bmj.com, 23 Dec 2002 eLetter re: Patrick Bracken and Philip Thomas Time to move beyond the mind-body split BMJ 2002; 325: 1433-1434
3. REDFLAGSDAILY.COM - DR. RICHARD FIDDIAN-GREEN www.redflagsweekly.com/fiddian_green.html
2. Might "brain death" be reversible? Richard G Fiddian-Green (11 October 2002) eLetters re: David J Hill, Peter Hutton, Peter Nightingale, Saxon Ridley, and Alasdair Short Diagnosing brain death BMJ 2002; 325: 836
4. Therapeutic nihilism Richard G Fiddian-Green (11 October 2002)
Fostering therapeutic nihilism in the recipient? Richard G Fiddian-Green (15 October 2002) eLetters re: David J Hill, Peter Hutton, Peter Nightingale, Saxon Ridley, and Alasdair Short Diagnosing brain death BMJ 2002; 325: 836
5. What about treating Terri Schiavo? Richard G Fiddian-Green bmj.com, 27 Oct 2003 eLetter re: Fred Charatan Governor Jeb Bush intervenes in "right to die" case BMJ 2003; 327: 949-b
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Dr Seidler asserts that "By all the medical evidence available after numerous examinations by eminent physicians, Terri Schiavo is brain dead". This is clearly untrue, even to a non-physician who lives on the other side of the Atlantic.
Lack of spontaneous respiration is one of the necessary criteria for brain death (and brain stem death). Terri Schiavo is breathing spontaneously. She is not on a ventilator.
As I understand it, some physicians are saying that Ms Schiavo is in a persistent vegetative state; others are disputing that.
People contemplating ripping up their Donor Cards should be assured that no physician is seriously claiming that Ms Schiavo is brain dead.
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Fred Charatan's article on Terri Schindler-Schiavo is pervaded by two problems: erroneous information and lack of impartiality (and probably the last problem is the cause of the former one).
As Cheril Eckstein pointed, Terri Schindler-Schiavo has not been “on a life support machine”. If, as advocates of terminate her life pretend, a tube connected to her only at meal times for nutrition is such a device, then the feeding bottle of a toddler is “a life support machine”, too. Both are devices required for nutrition in persons that lack the ability for eating by themselves.
Terri Schindler-Schiavo is not “terminally ill”. She doesn’t have a disease that will take away her life independently of the therapeutic measures carried out. As a matter of fact, she enjoys the good health of a limited person that requires support only for the limitations caused by her inabilities but no vital support (she is not on mechanical ventilation or on ventricular support devices). ¿Are all limited persons “terminally ill”?
Terri Schindler-Schiavo is not on trance of death due to her “disease”. Discapacities are not terminal illnesses. She is not a “right to die case” because she is not dying. The controversial issue on withdrawal vs. withholding medical treatment in the intensive care unit when confronted to terminally ill patients has no application in this case. She is not in intensive care because she doesn’t require it. She is, now, going to die due to the actions of persons like her, with the difference that the range of actions they can perform is a broader range than hers, they have skills she hasn’t (ostensibly the capability of denying her food and water).
The controversial issue on passive vs. active euthanasia has no application in this case, too. By the case ¿what would be the difference between removal of her feeding tube (action that will leave her to death in weeks) and applying her a massive doses of a poison (action that will leave her to death in seconds) except time an quantity of suffering?
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Terri's Schiavo's condition can only be judged by those who have personally seen and examined her. The hasty and pompous decisions and pronouncements made by so-called "Bioethicists" need to be questioned. With a family willing to take care of her....efforts should be made to give her family jursidiction and not her husband, who has another family.
People with disablities are rightly concerned about the implications of the courts re. this decision. Morals and ethics need to be protected......not literal interpretations of the law. On humanitarian grounds, there needs to be immediate intervention.
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At a time when the US society was idle and with no contentious issues, the prolife-proabortion controversy came into existence .The rhetoric snowballed and moved in different directions. Time and again, each got energised by a particular issue. What we encounter in the case of Terry Schiavo is another milestone in this ongoing animosity. When, where and how the US society will resolve the prolife - proabortion controversy is conjectural.
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Last week, the week before Easter, the President took the almost unprecedented step of cutting short his holiday to ‘save’ the life of a woman as it ebbed away in a hospice in Florida.
Compare this if you will to the parable of Karla Faye Tucker executed in 1998. In 1983, aged 23 and under the influence of drugs and alcohol, she participated in the axe murder of a man and a woman. She was sentenced to death by a Texas jury and after 15 years of legal wrangling asked George W Bush the governor of Texas for clemency. “Please don’t kill me,” she said. The Governor mocked her plea instead. Many believed that Karla had rehabilitated and was no longer a threat to society. Karla desired mercy from Texas. She wasn’t asking for freedom; only to spend the rest of her life in prison working her special ministry to other inmates.
Dark haired and pretty, Karla Faye was a human being and a born again Christian. There was no mercy; clemency was denied. The governor did not ‘err on the side of life’. There were no serious questions or substantial doubts for the smirking politician. The law, the courts and society made no ‘presumption in favour of life’. On February 3 1998, Karla Faye Tucker was given a lethal injection and humanely killed like a sick animal. She was 39 years old.
Meanwhile, with the help of his presidential brother, Jeb Bush, the Governor of Florida is embarked on a mission to resuscitate the brain- dead. Terri Schiavo is 41 and after 15 years of legal wrangling her life will end deprived of food, water and dignity. Terri Schiavo is innocent.
Karla Faye Tucker and Terri Schiavo are the contemporary example of living and dying the American way: the picture is not pretty. George W Bush is a Christian and a powerful believer in the sanctity of life. Chosen by the American people to lead the world to freedom and democracy, his message is worrisome indeed.
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Poor Fred Charton has got it wrong. By all the medical evidence available after numerous examinations by eminent physicians, Terry Schiavo is brain dead. She has no sensations and will not suffer from what has emotively been described as starvation, now her gastrotomy tube is removed. The fact that she is still alive after six days without sustenance reflects poorly on the palliative care team loking after her. She was not receiving food through her PEG tube but rather an expensive, scientifically produced replacement for food, costing a great deal.
Surely effective doses of morphine would have brought this sorry saga to a more hasty end. Alas, the doctors treating Terri will be probably scrutinised intensively and no opioids will be allowed.
Most families are thankful for a peaceful and rapid end to years of suffering. As one senior nurse put it "We treat them too well. They go on and on for years causing untold suffering for their families"
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I agree with Cheryl in her views that Terri is so healthy that the only way for her to die is to withdraw food and hydration. In my past reading of this case, Terri had developed life threating infections and was not given antibiotics. She fought off infection on her own. We must be very careful here in what we do as a society when someone does not meet society's level of acceptable standards. As Cheryl points out, there are many who depend on tube feeding for their sustinance. Are we to deny those persons sustinance. Do we say to those persons "You are not perfect and cannot contribute to society so we will not feed you and you will die" or "we are just tired of dealing with you in this physical state". Could this be another form of euthanisia? We all agree that Terri is severly brain damaged and perhaps with the right kind of therapy she may improve somewhat. She breathes on her own, she has waking and sleeping cycles and shows some interaction with visitors. To live in a hospice for 15 years is not appropriate...most persons who use the services of a hospice have less than six months to live. Terri should be give the chance to become the best person she can under her circumstances. Maybe she will improve, maybe not. However, by allowing Terri to experience rehab early on, perhaps she may have been able to learn to eat again. If that was the case, then this would have never been an issue.
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One isolated high-profile case
While it is imperative to establish ethical, moral and legal stands on the right to live or die, it is equally important to look around and see the vast number of the world population dying due to preventable causes.
Terri Schiavo is a single person whose medical state is disputed and publicised. Personally, I would prefer to see that amount of publicity and finance go into useful ventures such as improving health or education standards.
As people, well-informed or otherwise, we have to learn to agree to disagree. I cannot see why there has to be such a spectacle put up for one individual person's life.
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