Allowing to Die

It is hard to imagine a more tragic or tortuous case than that of Terri Schiavo, the thirty-nine-year-old Florida woman whose husband and parents are battling over disconnecting her from the feeding tube that has kept her alive for thirteen years. Schiavo suffered brain damage after a heart attack in 1990, and according to most experts has been in a persistent vegetative state (PVS) ever since. Doctors who have examined her say her brain has been all but destroyed. She had not executed a living will, nor did she identify a surrogate to make decisions about treatment should she be unable to do so herself. Her husband claims that before her heart attack she had expressed the wish not to be kept alive in such a condition. Her parents, who are Catholic, believe she is conscious and capable of making a recovery, or at least of learning, if given therapy, how to swallow food again. They have used the Internet to help rally public support, placing videos of their daughter “interacting” with them on a Web site. The cause has been taken up vigorously by Evangelical Christians, by prolifers, and by some Catholic groups. Yet what her parents claim are the reactions of a conscious person, most doctors argue, are only the ordinary, and meaningless, gestures of a PVS patient.

The legal battle has gone on for years, with the courts repeatedly siding with Schiavo’s husband, despite accusations of nefarious motives made against him by Terri’s parents. (He now has a child with another woman, for example.) Last month the court gave permission to disconnect the feeding tube. Yet no sooner had the feeding tube been removed than the Florida legislature passed a law allowing Governor Jeb Bush to intervene in the case, overrule the courts, and reinsert the tube. Bush, a Catholic convert, may have had a number of motives for his actions, including the need to appease the demands of vocal Evangelicals in the crucial electoral state of Florida. He also appears to think that his decision is consonant with traditional Catholic thinking about end-of-life care. It isn’t.

The church has long emphasized the difference between allowing to die and killing: the need to provide ordinary, rather than extraordinary, means for keeping terminally ill patients alive. Those opposed to removing Schiavo’s feeding tube argue that to do so is to starve her to death, in fact to cause her death. That is not how the Catholic tradition has parsed this difficult moral dilemma. Rather, Catholic tradition recognizes that Schiavo’s underlying condition, her inability to ingest food and water, should be understood to be the cause of her death. To insist that Schiavo be kept alive indefinitely because technology enables us to do so is to embrace vitalism; it is to elevate mere physical existence over all other values. The questions Schiavo’s guardians must answer are, What benefit will she gain, and what burdens is she being subjected to, in being kept alive in her condition? Is the preservation of the life of someone in a permanent vegetative state actually a benefit to that person? Is it a just allocation of limited resources? Traditionally, Catholicism has answered no. Nothing in Schiavo’s case presents a persuasive reason for thinking that teaching is erroneous.

None of these statements is meant to suggest that the decision to take someone off artificial life support is ever easy or simple. Almost inevitably there will be conflicting diagnoses and much ambivalence. Nor are they meant to minimize the question of intent. In making end-of-life decisions, our intent must be to relieve patients of useless and burdensome treatments. Who should make these decisions? The family, not the legislature or the governor. In the case of a married adult, that usually means the spouse. Michael Schiavo’s standing as Terri’s legal guardian is widely recognized in law and medical practice. (Those who question his motives and the court’s decision must concede that there has been no rush to judgment here: Terri has been in this condition for more than a decade.) Most legal scholars expect the hastily passed Florida law to be ruled unconstitutional and the governor’s action to be reversed. It should be, for more than just the reasons stated above.

Medical ethicists view Bush’s actions as potentially disruptive of decades of hard-won precedent. Moreover, in our system, it is the legislature that writes the laws and the courts that decide individual cases. The extraordinary actions of Governor Bush and the Florida legislature are viewed with alarm by many constitutional scholars, who see the overturning of a court decision as an assault on the separation of powers. Politics must inform our lawmaking, but politics should be kept at arm’s length from the bench. The bill authorizing Bush to intervene shows why judges, not legislators, should make determinations in cases like this. The bill was largely the handiwork of Johnnie B. Byrd Jr., the Republican Speaker of the Florida House. Byrd is running for the Republican nomination to the U.S. Senate, and is eager to please the religious right, which has flooded the legislature with e-mails, phone calls, and petitions. Yet, more thoughtful Republicans had doubts about what they had done in intervening in such a private and delicate matter. “I have never had a worse day as a senator,” a Republican who voted reluctantly for the bill told the New York Times (October 24). “You could feel how rotten people felt having to vote on this.”

Not rotten enough.

 


Read more: Allowing to Die II, by the Editors

Related: Caring at the End, by Paul Lauritzen
The Pope on PVS, by John F. Tuohey

Published in the 2003-11-07 issue: 
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