THE LIBERTARIAN ENTERPRISE
Number 315, April 17, 2005

"It won't be long now!"

Dead Wrong
by Lady Liberty
ladylibrty@ladylibrty.com

Special to TLE

I suspect there's not a person in the world with access to mass media that doesn't know about the sad case of Terri Schiavo. And of all of those people, I don't imagine there's a single one that doesn't have a strong opinion—one way or the other—on the matter. Here's mine:

I support in no uncertain terms the so-called "right to die." I think pulling the plug on brain dead patients should be standard, not optional, medical treatment. I think that doctor-assisted suicide for terminal and suffering patients is not only okay, but is the most compassionate thing to do if that's what the patient decides he wants. In fact, I've never understood why suicide of any kind is illegal. What are the authorities going to do, put the corpse in a jail cell? Under most circumstances (mental illness aside), I consider suicide to be a cowardly and extraordinarily selfish act. But if we have the right to life, liberty, and the pursuit of happiness, then surely we ought to have the right to decide on our own death!

The problem with poor Terri Schiavo is that she wasn't brain dead, so "pulling the plug" (respirator, etc.) wasn't an option. She also wasn't terminally ill, and so doctor-assisted suicide was out of the question (forget for a moment she couldn't choose that option for herself). The only way that Terri was going to die in the near term was to take some proactive measure that didn't somehow circumvent the law. That measure was found in the contention that a feeding tube might be defined as artificial care, and its removal guaranteed death albeit at a slow and painful pace.

Terri's husband maintained that she would not have wanted to live by artificial means. The courts upheld that contention despite the fact that Terri never wrote it down. In Florida, an oral statement of those wishes is sufficient, and Michael Schiavo had a couple of relatives who bolstered his claims that those were Terri's wishes. As such, it's impossible to say that the courts in Florida and at the Federal level ruled wrongly when they decided that the feeding tube should not be restored. The judges rendering the decisions adhered to the law, as they are supposed to do (never mind that there are just as many instances where any number of judges ignore the law all together).

Of course, when Florida law suggests that an oral statement as to one's wishes under such circumstances is sufficient, it relies on several factors that I tend to doubt were present here. First, the law assumes that the people claiming to have heard such statements really know what the patient would have wanted, and that they do have the patient's best interests at heart. Secondly, the law assumes those same people won't lie about what they claim to have heard. Although there's no way we can no for sure that Michael Schiavo was or was not telling the truth, there are some pointed pieces of evidence that suggest he may not have been.

When Terri was first stricken, it was obvious that the loss of oxygen to her brain—however it occurred—had caused catastrophic damage. (Terri's parents say they think her husband might have tried to strangle her; her husband says she suffered from an eating disorder and her heart stopped as the result of a potassium imbalance. Interestingly enough, if Terri did have an eating disorder, her condition might still be laid directly at the feet of a husband who purportedly once told her that if she ever got fat, he'd leave her.) At the time, Michael Schiavo fought tooth and nail to get some medical settlement money so that he could see his wife rehabilitated as far as was possible under the circumstances. In fact, he repeatedly promised that he'd use the money to care for her as long as she lived, and even that he'd spend some of it to go to school to become a therapist so he could care for her himself.

It might be forgivable when, after some years without results, a man might finally acknowledge that perhaps there was less hope than he originally harbored. But Michael Schiavo's timing was more than a little suspect when, up until he received the settlement, he claimed to want to care for his wife. Yet after the settlement money was safely in the bank, Mr. Schiavo announced that there was no hope for Terri's "meaningful recovery" and that the feeding tube should be removed forthwith. Later testimony indicated that Schiavo had put an early stop to therapy for his wife, and that he had, in fact, actively prevented anyone from trying to do anything even remotely therapeutic for her. The settlement money, of course, wasn't Michael Schiavo's. It was to be used for Terri's care. But if she were to die, her guardian would get the funds. And that guardian was—you guessed it—Michael Schiavo.

It seems that Terri's husband also conveniently glossed over his wife's religious beliefs. Terri was described as being "a devout Catholic" by members of her family, but as "not devout" by her husband in a recent interview with Larry King. Devout or not, as a Catholic, suicide is out of the question. So is, as it happens, the removal of nutrition and hydration. While the Catholic church has, in recent decades and with the advent of extraordinary medical advances, determined that certain types of care may be discontinued or foregone when death is imminent and inevitable, it has specifically stated that this does not include the removal of feeding tubes. Even not-so-devout Catholics aren't likely to toy with what the church would consider a significant sin. (The Pope himself, who had issued statements pleading for the restoration of Terri's feeding tube, ironically ended up being supported with a feeding tube during the last days of his life.)

There are those who support Michael Schiavo's determination to remove his wife's feeding tube, commenting on such things as "quality of life." Those same people suggest that a number of doctors have said that Terri Schiavo's brain was so damaged that she had no cognitive abilities left to her. (Some other doctors and Mrs. Schiavo's parents disagreed, but their testimony was largely disregarded as essentially being wishful thinking or mistaken interpretation of reflexive behaviors on Terri's part.) That's an interesting argument since quality of life is dependent on recognizing that one is alive. If Terri truly was not cognizant, then her quality of life wasn't bad. It didn't, in fact, exist at all for her. So suggesting a poor quality of life as a reason she should die is a specious argument at best.

The same contingent that lobbied for the feeding tube to be removed has also said that dehydration is painless and that, in fact, it can result in euphoria as death nears (contrary to those claims, death by dehydration is extraordinarily cruel and was, in fact, the subject of heinous experiments during World War II). Yet both pain and euphoria are also dependent on at least some minimal cognitive abilities At best, we could hope that Terri's demise caused her no pain (though there is some evidence that even among those in a persistent vegetative state there might be some feeling). After all, that would be the case if, as was said, her cerebral cortex was essentially gone. And yet the hospice was giving her morphine at the end. Why would morphine be prescribed if there was no pain? And if there was pain, how can anyone claim she had nothing left of her brain function? It's an interesting catch 22 for Mr. Schiavo's position, isn't it?

Maybe Michael Schiavo really did love his wife as his lawyer claims he did. Maybe the tears he cried at her death were true tears of loss rather than relief. But there are also a number of reasons that Mr. Schiavo would have wanted Terri dead and gone, not least of which were his live-in lover and their two children. Of course, Mr. Schiavo also stands to inherit what's left of Terri's settlement money, but by all accounts there's not much left. (Sadly, and with more than a little irony, much of the money intended for her care was spent on legal fees trying to get permission to withhold that care.)

The best indicators as to motive may be found not only in the timing of Michael Schiavo's legal battles, but in his attitude toward Terri's family. Whether he liked them or not, his treatment of them near the end of Terri's life was appallingly cold. He had police prevent their access as Terri drew her last breaths (his lawyer said the family could spend as much time as they liked with the body afterward apparently in an attempt to show Schiavo's reasonableness, but to deny a mother the ability to hold her child's hand as she dies defies any semblence of humanity). And then he refused to tell the family where and when Terri's remains would be interred and she would be memorialized (a judge has since issued a court order telling Schiavo he must give the information to Terri's family).

Lawyers are also trying to put a positive spin on the fact that Mr. Schiavo finally agreed to an autopsy for his wife, something the parents had been requesting for some time. What the lawyers haven't bothered to say is that it is Schiavo's insistance on cremation (another contradiction to Terri's Catholicism which, while now accepting of cremation, traditionally requires a body be buried intact and which is what her parents strongly preferred) that mandated an autopsy, not his sudden change of heart or willingness to prove anything.

There will always be some question as to Mr. Schiavo's actions based not merely on suspicions that may or may not have merit, but given that his wife didn't put her own wishes on record prior to becoming incapable of expressing those wishes for herself. If the tragic life and death of Terri Schiavo showed us anything, it gave each and every one of us good reason to put our own wishes in legally verifiable writing. Even if you tell loved ones what you want, if they truly love you they're not going to be thinking clearly as they contemplate your very serious medical condition. The kindest thing to do for their sake—and the thing that will make most certain that your own wishes be honored no matter what the heightened emotions or family feuds under such duress—is for you to prepare a Living Will for yourself.

Different states have different requirements for Living Wills; some standard forms include an indication that the subject does want feeding tubes removed under specified conditions. If you oppose that measure for yourself for personal or religious reasons, the standard forms can be altered accordingly. I personally would never choose to die as Terri did, but if you do, that's your business and your wishes should be honored. (I might, as a friend of mine suggested he would want, support the removal of a feeding tube followed immediately by a lethal injection provided an advance directive exists. If we claim we care so much about human life, the least we could do is treat it with a minimum of the dignity and kindness we show our beloved pets!) My reservations where Terri Schiavo is concerned is that, for religious reasons alone, I suspect that those were not her wishes. Other questionable timing and actions merely add fuel to that conviction.

Among many who supported the withdrawal of the feeding tube are those who condemned the federal government for getting involved and making at least an attempt to get the feeding tube reinserted. "It's a private matter!" they cry. "The decision is the husband's to make!" While I agree it's a private matter—and while you know how I feel about government involvement in just about anything!—there was some doubt in this case as to whether the removal of Terri's feeding tube was a medical mercy or a legalized murder. It's government's constitutional role to protect the lives of its citizens, and the fact that it made some effort to at least determine whether this was mercy or murder was (for once) a legitimate and constitutional function. I agree completely with President Bush's assertion that we must "err on the side of life" when there's any doubt whatsoever.

As to whether the Schiavo case really was mercy or murder, we may never know with certainty. I hope for the sake of the soon-to-be second Mrs. Schiavo, it was the former. I also hope that she, too, has learned something from the lessons of the last 15 years in the life of her predecessor. If she has, she'll be among the first to be sure she has a Living Will on file. Given who she's marrying, I'd also personally suggest to her that someone other than her husband-to-be has a copy of it, just in case...


REFERENCES

Larry King interview transcript

Some say dehydration is painless

PVS patients may feel pain

Michael Schiavo grief-stricken

Autopsies required in cases of cremation

Living Wills

Some living wills specify feeding tube removal



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