Annihilating Terri Schiavo

Commentary Magazine ^ | 6-1-05 | Paul McHugh

[bvw]

Good. Now what do I do with all these bibs I bought to wear in public?

[SJackson]

Be nice! :>)

[veronica]

Be nice! :>)

[beezdotcom]

She suffered frequent bedsores, and,

But, but, we heard so much about how Michael cared for her and wouldn't LET her get bedsores. But, but...

[Jim Noble]

The problem is that we execute documents without making our wishes known to those around us

The problem is that 80% or more of persons who execute "advance directives" revoke them when they are sick (i.e., they change their minds). If people under 40 all made advance directives, this number would be 95%+.

Therefore, respecting someone's "wishes" without regard to the clinical scenario is incompetent at best, if not negligent.

It is not obvious that brain-injured persons (who cannot "change their mind") should be held to the letter of their "prior wishes", since those prior wishes in expressive patients have almost no substance.

[TheSarce]

BioDeathicist Ping to Terri's list.

Ohioan from Florida's ping list, v.5-19-05

[Robert A Cook PE]

Sounds likeit was written by a professional from the husband's legal team (er, promotions department) and TV advisor.

The "facts" and "summaries" and conclusions work only if you believe everything Schiavo said was true.

And very little of that can be verified, and much of the rest has already been proven as false.

[Knitting A Conundrum]

I thought he disagreed a lot with what they did to Terri. Did we read the same article?

[Knitting A Conundrum]

I think he dislikes that people think life is unworthy of life:

So what, our imagined M&M conference leaders might ask, can one learn from this story? When I first considered this question along with several other doctors and nurses experienced in hospice care, we were nonplussed. Although we had treated hundreds of patients like Terri Schiavo, none of us had experienced a failure like this one. Our first thought was that other matters must have been at work—old resentments, unacknowledged jealousies, envy, bitter conflicts over money—to generate the kind of abuse of a patient so visible here. Only gradually, with publication of the reports, decisions, and interviews, did the explanation become clear.

As soon as Terri Schiavo’s case moved into the law courts of Florida, the concept of “life under altered circumstances” went by the boards—and so, necessarily, did any consideration of how to serve such life. Both had been trumped by the concept of “life unworthy of life,” and how to end it.

[SJackson]

The problem is that 80% or more of persons who execute "advance directives" revoke them when they are sick (i.e., they change their minds). If people under 40 all made advance directives, this number would be 95%+…Therefore, respecting someone's "wishes" without regard to the clinical scenario is incompetent at best, if not negligent…It is not obvious that brain-injured persons (who cannot "change their mind") should be held to the letter of their "prior wishes", since those prior wishes in expressive patients have almost no substance.

I don’t think it’s incompetent or negligent, but you’re right. That’s why I mentioned making our wishes known, probably better stated as explaining the reasons underlying your decision on an ongoing basis, enabling the proper decision to be made. For example, I’d have little doubt what decision to make for an observant Jew or Catholic, who’s explained the religious basis for his decision to maintain nutrition. That's not likely to change. Someone who made a decision ten years ago based on “who wants to live like that” and never revisited the issue, you’re right, their decision might not be clear.

[Abby4116]

I thought he disagreed a lot with what they did to Terri. Did we read the same article?

That's what I was thinking. I got the message, that, even though some of his facts are wrong, he is on the side of life - and that bioethicists are defining the quality of life - at the expense of the medical practitioners who are being forced to oppose that which they are taught.

[SJackson]

Sounds likeit was written by a professional from the husband's legal team (er, promotions department) and TV advisor.

Were that the case, she'd still be alive. I think you need to read the article more carefully. It’s clear to me that he argues that we’re creating a culture of death which no longer recognizes the value of life, particularly the inherant value of life under altered circumstances.

[Knitting A Conundrum]

That's what I thought too. He thinks that brain damaged people are not "vegetables," unworthy of life, but real people who deserve some dignity in how they are cared for. I think he really really dislikes the culture of death that thinks that brain damaged equals brain dead, so why don't we kill them.

[SJackson]

I thought he disagreed a lot with what they did to Terri. Did we read the same article?...That's what I was thinking. I got the message, that, even though some of his facts are wrong, he is on the side of life - and that bioethicists are defining the quality of life - at the expense of the medical practitioners who are being forced to oppose that which they are taught.

You're right, his conclusions are clear. What I think bothers people is is recitation of her condition, which was clearly dismal. Emotionally it plays into that "I wouldn't want to live that way" feeling which I think is widely held, and is misinterprited as argueing that her life was valueless.

[planekT]

I thought his conclusions were clear as well.

[Goodgirlinred]

Excellent post. I do have one point I would like to bring up. Terri should have been turned every one to two hours, she should have had passive range of motion exercising, and she should have had complete oral care twice a day with swabbing to moisten her mouth in intervals. That should have prevented some of the pressure sores, lessened the severity of the contractures, and prevented or lessened the tooth decay. That is good nursing care.

Otherwise, I agree wholeheartedly with the good doctor. Just because Michael "lost hope" should not have been a reason to terminate Terri's life. He could have divorced her, turned over her guardianship to her parents, and gone about his life.

[Knitting A Conundrum]

But there's that time when he was dealing with the brain damaged scientist, who came out with an entire sentence. He knows that we don't know what's going on in brains like this.

But it is sad, and dismal, hard on the families...but I don't think he thinks these lives are worthless.  Unlike the court and Michael Schiavo.

He was also critical of the lack of testing they did on Terri.

I like what he said here: - It also speaks to what is entailed in the professional art of medicine—the art, that is, of identifying, differentiating, curing, rehabilitating, defending, and, in the words of the Hippocratic oath, “benefiting” the sick. Given that doctors and nurses naturally align themselves with life, and are trained to care for whatever life brings, including “life under altered neurological circumstances,” it is only to be expected that they would reject and shrink from actions that aim to kill---

He also doesn't like what is going on with the growth of the culture of death:

---All this has resulted in a steady diminution in the bonds of implicit trust between patients and their doctors and its replacement, in some cases by suspicion or outright hostility, in many other cases by an almost reflexive unwillingness on the part of doctors to impose their own considered, prudential judgments—including their ethical judgments—on the course of treatment.----

This is what he says about the growth of bioethicists:

The monuments to the bioethicists’ principles include Do Not Resuscitate (DNR) orders, the euphemistically named Living Wills, and the legalization of physician-assisted suicide in the state of Oregon. These are not all the same thing, to be sure, and sophisticated arguments can be advanced for each of them; cumulatively, however, they are signposts of our own culture of death. (emphasis added.)

His conclusion makes it absolutely clear how he feels: The more this culture continues to influence our thinking, the deeper are likely to become the divisions within our society and within our families, the more hardened our hatreds, and the more manifold our fears. More of us will die prematurely; some of us will even be persuaded that we want to.

From the title, to the conclusion, he says life is worth living.  He hates how contemporary thinking has taken away his right as a life-affirming physician to "Do No Harm."  And he thinks it's awful.

[SJackson]

He also doesn't like what is going on with the growth of the culture of death:

If you didn't read the thread, you might like THE SLIDE TO AUSCHWITZ written by C. Everett Koop several decades ago.

[Knitting A Conundrum]

Missed it the first time around (must have been posting silliness when little jerimiah pinged me! and it got lost.) Thanks.

[Saundra Duffy]

To read later.