More On Schiavo

Though the Terry Schiavo saga has been covered for nearly a year on some of the smaller blogs out there and only recently has received mainstream media attention, I have had no interest in it. I still don't. But there are a couple of points I would like to make.

One of the more confounding contributions to the arguments being made has been the video from a few years ago released by the family showing Schiavo smiling while her family members attempted to interact with her. Our natural instinct is to treat facial expressions such as smiles and grimaces as reactive, uniquely human phenomena, but in a persistent vegetative state (PVS), they don't mean the same thing as they do for the rest of us. In this case, looks are truly deceiving. Understandably, parents would give much more credence to these largely automatic expressions than would strangers, even with the knowledge that their daughter is in a PVS.

There was a patient on service once when I was on the trauma surgery wards in a similar PVS. Come to think of it, I don't know why he stayed on the service for such a long time; ordinarily he would have been transferred to another service once his acute issues were treated. He was a man in his mid-20s who had been involved in a devastating motor vehicle accident. In the course of determining his long term future care, his mother was adamant that he go home with her. The physicians and social workers on staff tried to convince her that he ought to go to a skilled nursing facility because she would likely not be able to provide the type of care he required - respiratory care to prevent pneumonias, skin care and frequent position changes to prevent bedsores, proper nutrition, etc. His mother's response was he needed to be around her, and that "his face lights up whenever he sees me". I had often been in the room when his mother was visiting and had never seen his facial expression change around her or anyone else other than in random fashion, but that's how she interpreted her effect on him.

As with many other topics, such as abortion and the Iraq War, I am deeply suspicious of views that strongly favor one side or the other. I am especially struck by the callousness of some of the criticism of the parents. Even a month after 9/11, family members of some victims held out the possibility that their loved one was alive but simply not found yet, perhaps recovering in hospital somewhere, perhaps wandering the streets looking for home. The hope we cling to in times of crises against the longest of odds is even more pronounced when parents long for the recovery of a child. Few of us expect our children to die before we do, and it's a perfectly understandable reaction for Schiavo's parents to hold out hope that their daughter might someday be her old self again and to make sure that she doesn't suffer needlessly. It doesn't make them evil, but rather loving parents. They deserve our empathy and compassion, not our bile.

I also don't think that Schiavo is any sort of "test case" for issues of physician-assisted suicide and euthanasia. It's too rare a circumstance and the facts surrounding it are too clouded to have much impact on the kinds of decisions most of us may be making in the future. For those us who desire more autonomy in our future end-of-life choices, this is not the case on which to bang the drums.

My personal thoroughly limited reading of the facts (and I fully reserve the right to be wrong) is that not only has Schiavo been in a PVS for nearly 15 years, but she also has severe cerebral cortical tissue loss and encephalomalacia proven by CT scan, and if that is true, she has essentially zero chance of any recovery. However, there are enough ethical, legal, and metaphysical issues that play upon the situation, and there is enough controversy surrounding the facts themselves for me to say "I don't know" about what the outcome should be.

Share this

I started out p-o'd at the

I started out p-o'd at the husband. As time has gone on, I realize that EVERYONE in the case is in an incredibly horrendous and tragic situation. Unfortunately, making a judgement as to who's in the wrong requires knowing what we can't know:

-If Terry did state that she would have preferred to die, her husband is fighting for her wishes; if not, he's a total bastard.

-The parents have had to look at their daughter in a terrible state for years, and are faced with her imminent death, and due to circumstances that are (to their minds) absolutel abhorrent

- The judge may well be in a postiion where the law he's sworn to uphold contradicts what he himself believes to be right. I doubt Solomon himself would care to be in these shoes.

The only thing I am sure

The only thing I am sure about this case is that I am glad I'm not the judge.

Brian, Your point of view is

Brian, Your point of view is acknowledged. I am not a dictatorial rationalist. But at some point you have to give reason it’s due. Since science and technology got us into this situation, I don’t think that we can dispense with reason to get us out of it. What if the parents said, “.O K. we will consent to having the percutaneous enterogastrotomostomy feedings discontinued? But first we want this doctor to come in and apply leaches.”

We are living in an unprecedented time. What if Terri had lived one hundred years ago? Someone in her condition would have never survived. Now we have technology that can greatly improve the life of some patients and can prolong the death of others. Since we already have the technology we now have to provide the reason and good will. The parents may believe that Terri’s body must be kept alive incase the brain improves and the husband may believe that Terri would never have wanted to live this way or that she is silently suffering. Since good will has broken down in this particular family, there is no other recourse than litigation. Once that process is complete the parties should accept it. I just don’t believe that the legislative arena is the proper place for these controversies. I especially don’t like the matter being influenced by partisan pressure groups and politicians. That is all I am saying.

Micha, I did not mean that

Micha,

I did not mean that it is not a matter for court arbitration, but rather objecting to the idea that "at some point public officials should do their duty and stop pandering to irrationality".

(A) It is not their position (nor that of the state) to judge the rationality/irrationality of any given aims/goals, and
(B) Wishing that state actors stop 'pandering to irrationality' has some frightening implications for liberty, given that a great deal of our ideological opponents believe our program in toto is irrational, and stranger still given that a substantial proportion of the population believes that desiring to go into space or participate in the private space industry is 'irrational'. I'd rather not see public officials stop pandering to that particular 'irrationality' (such as it is, or may be).

My real point is that I don't think it is proper to consider the Schindlers' position as irrational; their goal is to keep their daughter's body alive; they believe that she herself might come back to consciousness/sentience; and making sure that the body remains alive is instrumental to the final goal. And ultimately it makes them feel better to keep on keeping on, and its their highest valued alternative use for their resources, so it seems rather rational to me. Being that the hope for recovery is not related to the proximate issue (keeping the body alive for both instrumental and expressive purposes), its irrelevant whether or not that is medically possible with regards to determining rationality or irrationality.

Brian, If this is not a case

Brian,

If this is not a case for the courts to decide, then who should decide it? Should the parents and the husband just fight it out fist-to-fist?

On Schiavo Jonathan Wilde on

On Schiavo
Jonathan Wilde on the Catallarchy Blog has written the most sensible piece there is on Terry Shiavo....

Why should the Schindlers

Why should the Schindlers dance for the sovereign any more than you should, Dave, to prove that the sovereign should 'indulge' their 'irrationality'?

It is not up to the courts to indulge or not indulge, for it is not with their proper sphere of power to make such proclamations. Unless one is ready to admit that the courts actually own us and we live, breathe, and exist subject to their good will.

“and it’s a perfectly

“and it’s a perfectly understandable reaction for Schiavo’s parents to hold out hope that their daughter might someday be her old self again and to make sure that she doesn’t suffer needlessly. It doesn’t make them evil, but rather loving parents. They deserve our empathy and compassion, not our bile.” Jonathan Wilde

To a point you are right. The daughter’s blood relatives do deserve sympathy. But at some point public officials should do their duty and quit pandering to irrationality. Irrationality is not benign. I have several experiences with relatives who have behaved like these folks. You bend over backward to help them understand the situation but if your conclusions don’t conform to their fixed ideas they go into attack mode. They accuse everyone involved of being a jerk or a crook. They play up anything that supports their point of view but simply choose to ignore the massive preponderance of evidence that does not. They keep carrying their crusade to higher levels, the press, their congressman, etc. until they run out of money or support. This kind of situation happens all the time. This is just much bigger than usual and plays to the advantage of national political pressure groups.

Gary: you are correct, of

Gary: you are correct, of course. Thank you.

Lisa Casanova, Well, one of

Lisa Casanova,

Well, one of the claims of the parents' is that only Michael Schiavo testified as to her wish to die in this sort of situation, but that's not true; at least two other witnesses made similar claims under oath and on the stand.

And the answer is, maybe. Depends on their legal resources, etc.

Its interesting to note that one of the parents' doctors claims that she is not in PVS after asking her a battery of ~180 questions, none of which the videotape shows she answered to.

:juggle:

There's one thing I wonder

There's one thing I wonder but haven't seen addressed. Everyone seems to be saying that the case turns on the fact that she did not make her wishes in such a situation clear. But would it matter if she had? Say I have an accident and end up in a condition similar to this one, and I have left an advance directive clearly stating that I do not wish to be maintained in a persistent vegetative state if there is no hope for my recovery. My spouse asks that a feeding tube be removed and I be allowed to die. Would my parents be able to contest this on the grounds that they don't believe I am really in a vegetative state without hope of recovery? Couldn't they still have the same endless fight, turning on the question of whether I am actually in the state in which I have said I would not want to be maintained, so my advance directive does not apply? It seems to me that even if a person makes their wishes clear, the exact same tragic situation could still ensue if someone does not believe (as her parents do not) that the person is in a vegetative state beyond hope of recovery.

Jeff Darcy, You mean the

Jeff Darcy,

You mean the elder Schindler's I think.

_____________

The basic problem with the video is that it is edited so as to make Terri look far more responsive to stimuli than she is. There are hours of this video available, but the family created a four and a half minute version full of abrupt cuts (a classic propaganda device) and short snippets.

Michael Schiavo stands to inherit nothing from her death. And if anyone has been attacked personally, its been him, a man who visits her nearly every day and apparently went to nursing school to learn how to help her.

BTW, the whole line of "I don't care but I am going to make statements anyway" line is just completely disingenous. Given that folks are going to comment on the case, at least read the guardian ad litem report before you do so. It reveal just how many myths are behind the parents' claims.

:wall:

I'm not totally

I'm not totally unsympathetic to the family, but they've been shoving this story in our face for so long... and it has been THEM drumming up the media frenzy and what not. You can only play on people's emotions for so long. What's been happening is that we as a nation have let this whole situation be blown completely and totally out of proportion. Of course the life of a family member will be the most important thing in the world to that family. That doesn't mean that it should LITERALLY be made the most important thing in the world. Everybody needs to chill - I couldn't even listen to All Things Considered yesterday without half the program being devoted to Terry. I've lost patience.

They deserve our empathy and

They deserve our empathy and compassion, not our bile.

I agree. I actually don't see that much bile directed at the parents themselves, though that might be because I don't hang around places where bile crowds out reason. I can understand the elder Schiavos' feelings, having been in a somewhat similar situation myself. I disagree with them, but recognize that they are doing what they think is best. It's the ghouls in Washington, tromping on the states' rights they use as an excuse for myriad other misdeeds and letting insurers in Texas but not a spouse in Florida make life-support decisions in such circumstances, who deserve our deepest contempt.

I don’t really care to

I don’t really care to find out or get into a discussion about them.

Then why mention them? If it's just a "potential" then why aren't other potentials mentioned as well? If you can claim that Michael Schiavo is potentially acting out of an ulterior motive, would we not be remiss to note that you might also potentially be doing so? I don't think it's at all unreasonable to wonder about the reasons for introducing such a prejudicial phrase into the debate.

"Poisoning the well" implies

"Poisoning the well" implies that I have an agenda wrt Michael Schiavo. I assure you I do not. I don't know enough about the facts of the case to figure out whether the accusations against him are true, hence the use of the word "potentially". And I don't really care to find out or get into a discussion about them.

What's more "potentially

What's more "potentially nefarious" about the financial incentives in this case than in any other? Without a specific accusation being made, that looks like nothing more than well-poisoning.

It’s not that rare a

It’s not that rare a circumstance. I don’t have any hard numbers handy, but I’ve read several places recently that there are as many as 35,000 PVS cases out there.

The rarity refers not just to the PVS but to the PVS, uncertainty of facts, and potentially nefarious financial incentives combination.

It's not that rare a

It's not that rare a circumstance. I don't have any hard numbers handy, but I've read several places recently that there are as many as 35,000 PVS cases out there.

The harsh criticisms of

The harsh criticisms of Terri's parents I believe are people venting anger at the involvement of the government in the case. In particular George Bush, as he signed legislation in Texas while Gov. to allow hospitals to terminate life support for patients with no insurance. Extreme case, extreme reactions?

A very good wake up call for Americans to get a living will.

http://greatscat.blogspot.com

http://greatscat.blogspot.com/2005/03/this-was-going-to-be-michigan-stuff.html

Any thoughts?

I agree that the parents are

I agree that the parents are only doing what they feel is right WRT Terri, but this cuts both ways: there's been a lot of blatant attempts at smearing Michael Schiavo, often through outright lies by the parents themselves. This is not a pleasent experience for any of the parties involved, but there's no question here that the parents have been the ones playing dirty for the past several years.