June 16, 2005

A KINDER, GENTLER KILLER


Annihilating Terri Schiavo
(Paul McHugh, Commentary, June, 2005)

Terri Schiavo was examined by qualified neurologists. Most of them concluded that she fit into the rather amorphous group of severely brain-injured patients defined as being in a “persistent vegetative state” (PVS). This diagnostic category encompasses individuals with cerebral diseases of various kinds who, though only dimly wakeful, retain the life-sustaining functions of respiration, blood circulation, and metabolic integrity.

It is perhaps because such patients display so lowered a state of vigilance that, in striving to define their condition, neurologists lighted upon a metaphor contrasting vegetation with animation. I remember teasing the admirable clinician who first coined this term that I had seen many patients but few carrots sleeping, waking, grunting, or flinching from pain. Although the term “vegetative” does distinguish what is lost from what remains in such a patient’s capacities, it can also have the unfortunate effect of suggesting that there is something less worthy about those in this condition.

As for the adjective “persistent,” it is perfectly precise, and makes no prognostic claim (as would, say, the term “permanent”). It simply describes the patient’s history. What we know from experience is that, as with most neurological impairments, patients “persisting” in this state of blunted consciousness for more than eighteen months are generally unlikely to recover.

The neurologists who coined the diagnostic category PVS did so out of the best of clinical motives. In particular, they wanted to distinguish it from the “brain-dead” state, where no functional capacities—to breathe, to swallow, or to respond—remain. With “brain death,” a patient evinces no response to any stimulus. Brain monitors show no activity. Heart and viscera can carry on their automatic activity only with the aid of mechanical, ventilator-driven respiration, and will cease when it is discontinued.

By definition, then, PVS is not death hidden by machinery. It is human life under altered neurological circumstances. And this distinction makes all the difference in how doctors and nurses think about it and treat its sufferers. [...]

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.

I use the term “life unworthy of life” advisedly. The phrase first appeared a long time ago—as the title of a book published in Germany in 1920, co-authored by a lawyer and a psychiatrist. Die Freigabe der Vernichtung lebensunwertes Leben translates as “Lifting Constraint from the Annihilation of Life Unworthy of Life.” Terri Schiavo’s husband and his clinical and legal advisers, believing that hers was now a life unworthy of life, sought, and achieved, its annihilation. Claiming to respect her undocumented wish not to live dependently, they were willing to have her suffer pain and, by specific force of law, to block her caregivers from offering her oral feedings of the kind provided to all terminal patients in a hospice—even to the point of prohibiting mouth-soothing ice chips. Everything else flowed from there.

How could such a thing happen? This, after all, is not Nazi Germany, where the culture of death foreshadowed in the awful title of that book would reach such horrendous public proportions. But we in this country have our own, homegrown culture of death, whose face is legal and moral and benignly individualistic rather than authoritarian and pseudo-scientific. It has many roots, which would require a long historical treatise to unravel, with obligatory chapters considering such factors as the growth of life-sustaining and life-extending technologies and the dilemmas they bring, the increasingly assertive deprecation of medical expertise and understanding in favor of patients’ “autonomous” decision-making, the explosion in rights-related personal law and the associated explosion in medical-malpractice suits, and much else besides.

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. In the meantime, a new discipline has stepped into the breach; its avowed purpose is to help doctors and patients alike reach decisions in difficult situations, and it is now a mandatory subject of study in medical and nursing schools.

I am speaking of course about bioethics, which came into being roughly contemporaneously with the other developments I have been describing. To the early leaders of this discipline, it was plain that doctors and nurses, hitherto guided by professional codes of conduct and ancient ideals of virtue embedded in the Hippocratic oath or in the career and writings of Florence Nightingale, were in need of better and more up-to-date instruction. But, being theorists rather than medical practitioners, most bioethicists proved to be uninterested in developing the characters of doctors and nurses. Rather, they were preoccupied with identifying perceived conflicts between the “aims” of doctors and the “rights” of patients, and with prescribing remedies for those conflicts.

Unlike in medicine itself, these remedies are untested and untestable. They have multiplied nevertheless, to the point where they have become fixtures in the lives of all of us, an unquestioned part of our vocabulary, subtly influencing our most basic attitudes toward sickness and health and, above all, our assumptions about how to prepare ourselves for death. 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.

Hospital administrators are generally pleased with bioethicists and the rationalizations they provide for ceasing care of the helpless and the disabled. By the same token, their presence is generally shunned by doctors and nurses, whose medical and moral vocabulary draws from different sources, and whose training and experience have disposed them in a different direction. To most doctors and nurses, in any case, the idea that one can control the manner and pace of one’s dying is largely a fantasy. They have seen what they have seen, and what they know is that at the crucial moments in this process, no document on earth can substitute for the one-on-one judgment, fallible as it may ultimately be, of a sensible, humane, and experienced physician.

Contemporary bioethics has become a natural ally of the culture of death, but the culture of death itself is a perennial human temptation; for onlookers in particular, it offers a reassuring answer (“this is how X would have wanted it”) to otherwise excruciating dilemmas, and it can be rationalized every which way till Sunday. In Terri Schiavo’s case, it is what won out over the hospice’s culture of life, overwhelming by legal means, and by the force of advanced social opinion, the moral and medical command to choose life, to comfort the afflicted, and to teach others how to do the same. 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.

One of the unfortunate results of our preoccupation with the modern lodestar of evil–Nazi Germany-is a difficulty in recognizing evils that do not conform to its stereotype. We have all been trained to keep our eyes well-peeled for psychopathic racist demagogues with funny moustaches and perhaps also thuggish commissars trying to wipe out demonized social classes. But the modern war on the dependent and inconvenient does not fit into these models and many have difficulty it understanding its source, which is not a hatred of class or race, but the increasingly closely-held and defiant conviction that we have an absolute right to enjoy our individual material freedom to the fullest and that there is something grossly unjust and hateful about anything or anyone that thwarts us.

This week’s release of Terri’s autopsy results is being heralded as a vindication of her former husband and proof she would not have recovered. Few ever held out much hope she would, which is why so many were praying for her. The horror felt by so many was that so many others thought that was the sole issue and could see nothing beyond it. And as Dr. McHugh so eloquently explains, that wasn’t the issue for those dwindling members of the medical profession who believe they are called to save and protect life as they find it, not to destroy it through pseudo-scientific, amoral bafflegab. The thought that we may ever live see the day when when such moral grounding and nobility of vocation is gone with the wind is almost too chilling and depressing to bear.

There were, of course, no mobs trashing the streets and howling for Terri’s death, no political jeremiads against the terminally ill and no sick jokes about omelettes and broken eggs. That isn’t the way the culture of death, which is a logical endpoint of our broader therapeutic culture, operates. Its cold-hearted, selfish rationalism always comes wrapped in ersatz empathy and compassion (certified professionally in courses and workshops) for those it seeks to destroy or marginalize. Its tools are not storm troopers and secret police, but the mis-use of scientific language to confuse the decent, open and scrupulously well-documented bureaucratic process, psychological manipulation through ceaseless counseling and dialogue and, ultimately, judicial fiat. Unlike with the totalitarian horrors, the victims of the culture of death can often take comfort in knowing their executioners will be there holding their hand and weeping at the final moment, assuring them everyone is praying for them and that theirs was indeed a tough and tragic case. But die they must, and die they will.

Posted by Peter Burnet at June 16, 2005 7:14 AM
Comments

Great post, Peter.

I am continuously struck by the fact that people confuse PVS with brain death. I think, or perhaps I insist on thinking, that this is a positive sign and that our culture is fundamentally sound. Unfortunately, the last few years have proven that no slope will go unslid.

Posted by: David Cohen at June 16, 2005 7:58 AM

Peter:

This has nothing to do with some "culture of death," and everything to do with personal autonomy.

When considering your end of life decisions, whose choice do you prefer to have sway, yours, or someone else's?

Posted by: Jeff Guinn at June 16, 2005 8:13 AM

Mr.Guinn: The point was that it wasn't the end of her life.

Posted by: Buttercup at June 16, 2005 9:01 AM

Jeff:

Someone Else's. Hang on to the choice fairy tale if you must, but it is meaningless for many reasons, mainly because without an objective moral and leagl prohibition, institutions and even family members will resent and decline the burden--perhaps citing an offhand remark made in the pink of health years earlier to justify their compassion and assuage any receding guilt as the loved one dies slowly from hunger and thirst.

Posted by: Peter B at June 16, 2005 9:13 AM

Perhaps someone will explain why, other than as a tool to bash Bush and religious Christians, liberals and the media are so pro-Michael Schiavo and so anti-the Schindlers.

Why the media hands-off Schiavo's new family? Nary a picture of them that I saw anywhere. No smarmy stories of their romance, no pictures of their cute kids. Why the sudden coyness about exploiting tragedy in the interest of increased circulation. Not even the supermarket tabloids showed us his other family while showing us plenty of religious nutcases parading around holding candlelit vigils, etc.

In my opinion, this poor girl's tragic story will be used as an exemplar for liberals who are readying a euthanasia clause to package with their national health program if they ever get in power again

Posted by: erp at June 16, 2005 9:24 AM

The Joan Didion essay in the NY Review of Books
was (as is usual for her) careful about what
are facts and what are opinions with regard
to the Schiavo case:

http://www.nybooks.com/articles/18050

"That this was a situation offering space for legitimate philosophical differences seemed obvious. Yet there remained, on the "rational" side of the argument, very little acknowledgment that there could be large numbers of people, not all of whom could be categorized as "fundamentalists" or "evangelicals," who were genuinely troubled by the ramifications of viewing a life as inadequate and so deciding to end it. There remained little acknowledgment even that the case was being badly handled, rendered unnecessarily inflammatory. There was an insensitivity in the timing of the removal of the feeding tube, which took place on the Friday before Palm Sunday, meaning that the gradual process of dying coincided with a week that for Christians has specifically to do with sacrificial suffering and death. "Oh come on," someone said when this was mentioned on a cable show. There was a further insensitivity in the fact that the tube was removed at all. If the sole intention is to terminate feeding and hydration, there is no need to remove a gastric feeding tube. All anyone need do is stop plunging the formula into the tube. Hospitals routinely leave gastric tubes in place long after patients have progressed to oral feeding, because any later need to replace the tube (after the incision has begun to heal and scar tissue to form) can be difficult and require surgery. In this case, in the absence of some unusual circumstance that remained unreported, the sole purpose of actual removal would seem to have been to make any legally ordered resumption of feeding difficult to implement."

Posted by: ted welter at June 16, 2005 10:22 AM

Jeff - You're close - it's about the spirit of selfishness. The desire for autonomy is driven by selfishness, and the culture of death is driven by selfishness. Michael Schiavo was driven by his selfish desire to be rid of Terri, to inherit her trust fund, and to be viewed as a widower and noble carryer-out of his wife's wishes, not as a divorcee who callously abandoned his wife. The abortion movement is driven by the selfish desire not to have one's plans disrupted by the obligation to care for a child. The desire for autonomy is the desire to be free to serve one's own desires.

Posted by: pj at June 16, 2005 11:55 AM

If so many prayed so hard, why didn't she get better?

Posted by: Harry Eagar at June 16, 2005 2:42 PM

Harry,
To quote Dennis Praeger, "God is not your butler."

Posted by: David Rothman at June 16, 2005 3:14 PM

Peter B:

Which is precisely what happened in this case: Whoa, I think years ago we were watching a movie and she said she wouldn't want to live like that; I guess that's determinative, pull the plug.

Posted by: Matt Murphy at June 16, 2005 3:55 PM

Also, I don't know if this is true or not, but supposedly the coroner is a close friend of Judge Greer and the Schindlers asked for a second coroner. Greer reportedly denied that request.

Posted by: Matt Murphy at June 16, 2005 3:57 PM

culture of death is driven by selfishness.

So is American style capitalism and materialism, which makes the American consumer economy part of the culture of death. The "spirit of selfishness" is the heart beat of the American economy. At least it explains why the Vatican is so at odds with American culture.

Posted by: at June 16, 2005 4:08 PM

Sheesh, Matt, chill a bit. Your 2nd e-mail makes it far too easy for people to conclude you're a crank and dismiss your 1st...

Posted by: b at June 16, 2005 4:28 PM

But here's a question I have about the autopsy results--the claim is that she was blind, as demonstrated by massive damage to the optical regions of her brain. So what was going on with the videos of her eyes tracking things? Those videos are the reason why I just can't accept that there was nobody home anymore. The pushback was that there usually was no such behavior (that the videos were cherry-picking rare moments) and that when there was, it was mere reflex. But how could there possibly be such reflex behavior if her brain was unable to take visual input? Anyone seen anything attempting to explain this?

Posted by: b at June 16, 2005 4:42 PM

b:

Maybe so, but if it's true he was Greer's friend then I think that's worth some attention, don't you?

Posted by: Matt Murphy at June 16, 2005 4:50 PM

b:

Per your second point, that's exactly what I've been wondering. And no, I haven't heard any explanation for it.

Kind of amusing to think of George Felos, who didn't want any video cameras to record Terri's demise while he assured us she was strikingly beautiful as she passed away, telling us that the Schindlers cherry-picked the video evidence.

Posted by: Matt Murphy at June 16, 2005 4:54 PM

Personally, I would never spend a cent but for the good that my spending does for the workers of the world. That my unselfishness condemns me to wallow in sybaritic splendor is simply my cross to bear.

Jeff: Would that it were so easy.

Let's start with the hypothetical that, one day at breakfast, Michael shot Terri in the head. When questioned about this, he says that he suddenly remembered that, 10 years ago, she had said to him, "If you ever find me drinking prune juice at breakfast, promise that you'll shoot me." Michael then goes to live with his second family.

Now, I assume that we object to this and would expect Michael to be prosecuted. If I'm wrong in that assumption, then you might as well stop reading here, because the gulf is too wide. If I'm right, then our unhappiness stems from a combination of the following factors:

1. We're not sure Terri really said it.
2. We're not sure Terri really meant it when she said it.
3. We're not sure Terri had given the statement the serious consideration it deserved before deciding she really meant it.
4. We're not sure that, when she said it, she really understood what the life she was rejecting was like.
5. We're not sure that she hadn't changed her mind in the ten years that elapsed.
6. We disagree with her choice.
7. Her life at the time of her (hypothetical) death was taking the usual and expected course.

Now, this hypothetical is obviously far from what really happened, but it is useful in helping us focus on what really matters to us and, for those of us who are bothered by her death, what really bothers us.

If she really said it, and really meant it, and was appropriately counseled and understood her decision, then are we content to defer to her "personal autonomy" to the extent of letting Michael off the hook? I'm very interested in your answer to that. My answer is no. I'm positive that, had Michael and Terri gone to a judge together seeking permission for Michael to lock away and starve a healthy Terri, because she was unhappy at aging and to allow Michael to get on with his life and marry the mother of his children, the judge would not have agreed. So, it seems to me, it isn't actually personal autonomy that's at issue here. What's at issue is that society now thinks that Terri's life -- bed ridden, blind, in a persistent vegetative state -- is not worth living. Indeed, that the only rational response to such a state is assisted suicide by starvation.

There are those of us who disagree. We think that there are other rational responses. And when all the other doubts are added, along with her parents' willingness (desparation, in fact) to care for her, we reject this court ordered killing. Finally, when we see all the energy expended by Michael's supporters to make sure that Terri was killed, and when we consider our recent experiences with the slippery slope, we find ourselves compelled to object all the more strongly.

The bottom line here, Jeff, is that the government decided that Terri's was a life not worth living. What if it decides that other lives are not worth living? That premature babies are not worth saving? That profoundly disabled people are a drain on our resources? The time to stop this slide is before it starts.

Posted by: David Cohen at June 16, 2005 4:57 PM

Andrew McCarthy also wrote a good article about this in NR back in April, in which he gave a rough sequence of events.

He noted that, while she was alive, the only way to ensure that Terri was in a PVS as it is tightly-defined by Florida statute would have been to conduct functional magnetic-resonance imaging or positron-emission tomography scans, both of which were denied (it is believed that the error rate for PVS diagnosis is about one-in-two). He also criticized Judge Greer for illegally appointing himself Terri's guardian after the guardian ad litem ruled in Terri's favor. According to McCarthy, Greer then reviewed the correctness of previous decisions he had made, and refused to hear from pro-Terri witnesses or medical experts.

An appellate court then rewrote Florida law to impose on Greer an easier standard to prove PVS, and Greer took at face value the words of a Michael Schiavo-hired neurologist who believes Alzheimer's patients should be killed off. When Congress directed that the judgment be reconsidered de novo (the Constitution gives Congress the power to set jurisdictions for lower courts), it ended up in the hands of an old Greer colleague who totally ignored his instructions and ordered that the feeding tube stay removed.

Rule of law? I don't think so.

Posted by: Matt Murphy at June 16, 2005 5:31 PM

Harry:

Once again, you single-handedly pin both Maimonedes and St. Augustine to the mat. Go, guy, go.

Matt:

The rule of law, which Jeff raises frequently, is not a doctrine that validates anything a judge says, either legally or morally. It simply says we are governed by laws, not men, and that our leaders must act through law and not on personal fiat, caprice or whim. In the Schiavo case, both sides scrupulously followed the doctrine. It might have been an issue had Gov. Bush sent in the National Guard, but he didn't. I should also add that there is a very strong firmament in both Anglo-Saxon legal tradition and international law that law is built on morality, not relativist positivism, and that baseline morality trumps law in the end, although it is a tradition that is currently gasping for air. But the point is that the rule of law says nothing about either the legal or moral validiity of any given judicial decision.

David:

Nice.

Posted by: Peter B at June 16, 2005 6:46 PM

Peter B:

Thanks for the informative post.

However, that still leaves us with the matter of what is the appropriate descriptive terminology for actions taken by a court that rewrites statutes, flagrantly disregards evidence pointing in a certain direction, and ignores dictations from superior bodies.

I suppose "rule of law" was the first term that popped into my head, as to what precisely had been violated. I'll use another term if there's one out there.

Posted by: Matt Murphy at June 16, 2005 7:27 PM

If she really said it, and really meant it, and was appropriately counseled and understood her decision, then are we content to defer to her "personal autonomy" to the extent of letting Michael off the hook? I'm very interested in your answer to that. My answer is no. I'm positive that, had Michael and Terri gone to a judge together seeking permission for Michael to lock away and starve a healthy Terri, because she was unhappy at aging and to allow Michael to get on with his life and marry the mother of his children, the judge would not have agreed. So, it seems to me, it isn't actually personal autonomy that's at issue here. What's at issue is that society now thinks that Terri's life -- bed ridden, blind, in a persistent vegetative state -- is not worth living. Indeed, that the only rational response to such a state is assisted suicide by starvation.

I don't understand how you can compare a situation where someone wishes to have feeding removed when they are in a PVS with no hope for recovery to one where someone would request to be put to death if they were old or disappointed that there was no prune juice. I guess you hope to shock the immoral majority into seeing how a person making such a request must be loony or suicidal, and to acquiesce to their wishes would be an act of criminal nagligence. I'm sorry, but you are wrong. The majority of people, myself included, believe that to wish to be allowed to die in such a state is a normal, commonsense thing, and is nothing like a desire to commit suicide. They are not comparable. Indeed the majority of people, myself included, would think that for someone to wish to be kept alive in such a state, ad infinitum, would be the odd, nonsensical thing.

Your side continues to claim that your position is not equivalent to vitalism, but I can really see no difference. To disagree about where to draw the line is one thing, but to argue that those who are just to the other side of the line that you draw are no different than Nazi death camp guards is moral idiocy.

Let me offer another cautionary note in reply to your slippery slopism. I would offer that the moral slander that your side is using to tar those that disagree with you, the moral equivalence made between rational end of life decisions and premeditated murder, is the real slippery slope in this case.

Posted by: Robert Duquette at June 16, 2005 7:54 PM

Matt:

B#llsh*t?

Posted by: Peter B at June 16, 2005 7:54 PM

David:

Your hypothetical carries a pejoritave burden that makes it far less than informative, and possibly irrelevant. Had he pulled the trigger, been the direct agent in her near demise, then he would have been unfit to act afterwards as her guardian. That is so far from what was actually the case that I am very hard pressed to see what can possibly gained from the hypothetical, as it is scarcely analagous to what happened.

But I'll run with it anyway. No, we aren't sure that Terry said it, or meant it, or understood, or changed her mind.

We only have her legal guardian's word to go on. That, and the law. (Mr. Schiavo, by the way, won't inherit some great trust fund, and turned down a far larger sum of money to relinquish guardianship to her parents. That's the problem with demonizing your opponent; you tend to get the rug yanked out from under you.)

That was the sole basis for the courts' decisions, so far as I know. However, if you can find somewhere in any of the decisions, that some conclusions were based on "life not worth living," than I will quickly concede my error.

If you can't provide that, on the other hand, than your bottom line conclusion is simply unsupported.

I am convinced that if Mr. Schiavo's and Terry's parents roles were completely reversed, Terry would still have the feeding tube, because the courts would have arrived at the same decision: the legal guardian has precedence.

Therefore, this has nothing to do with "culture of death" or a runaway court system. The various courts followed the law as it is written and the facts provided.

Buttercup:

This is very much an end of life decision, one that will become much more common. Even 50 years ago, Terry wouldn't have survived the initial event, and we now, thanks to materialism, have ways to keep people alive far beyond what God's plan would include.

So What This is All About is very much personal autonomy, and that is the very point that has been so thoroughly dodged here.

Anyone here for forcing transfusions upon Jehovah's Witnesses, or modern medicine upon Christian Scientists?

Posted by: Jeff Guinn at June 16, 2005 8:22 PM

Robert:

You know, if Terri Schiavo had told everyone in her town every day for twenty years that she wanted her mother to inherit her jewelry, but never wrote it down, her mother wouldn't have had a hope in court, even if all of them had been there to testify in court on her behalf. That has been well-settled law for ages, and there are good reasons for it. But you think a hearsay chat from years ago testified to from someone who has long left her and has a financial and emotional interest in her death is enough to condemn her to a painful and barbaric death on the grounds that she wished it? Geez, do you guys ever take responsiblity for your beliefs or have you become so adept at pontificating about freedom and individual choice that you can't see clearly anymore?

You continue to talk of choice and wishes when, not only is there no credible evidence of such, but what evidence there is so ancient and anecdotal as to be meaningless. It is obscene to talk about Terri's wishes in this case, and the fact that your side continues to trumpet that issue in the face of reason and even scientific rationalism is chilling.

Robert, there are pictures of Terry's joy when she was visited by her mother. Her whole family begging for the privelege of caring for her. It is hard not to believe you and Jeff aren't in the grip of some kind of unidirectional imperative that supercedes all notions of human life and dignity. The convenience of your views is just too suspect.

Posted by: Peter B at June 16, 2005 8:23 PM

Jeff and Robert: You misunderstand my hypothetical. It is neither a trap nor a description of what happened. I'm not trying, here, to second-guess the court or model its thinking. It is an attempt to focus on what it is about the Schiavo case that is so bothersome.

Isn't it clear, as Robert admits, that Terri's death is only acceptable because of her condition? Indeed, Robert warns against slippery-slopism, but says that "for someone to wish to be kept alive in such a state, ad infinitum, would be the odd, nonsensical thing", which is exactly the slope I'm worried about.

What those are the other side of this mess refuse to realize is that, every day, people in Terri's state who have clearly stated their preferences or people whose loved ones all agree are allowed to die (as you wince at the more straight-forward killed). No one protests. No special laws are passed. The President doesn't jet back from Texas. Most of us accept that, at that point, the decision to die is rational and should be permitted, even if we do not think it logically compelled.

But where there is a question, we should always opt for life.

Posted by: David Cohen at June 16, 2005 9:03 PM

Peter:

You are the lawyer, you tell Robert and me. In a contest of opinion between two parties regarding the intent of a third who is no longer, and will never again be, in compo mentis, whose opinion wins, the legal guardian, or the other party?

Because that is what was judicially at stake--not the content of the opinion, but, in the event of a contest, which opinion predominates.

Further, you should check your facts better. Michael Schiavo turned down a sum far larger than he stands to inherit--he had no financial interest in her death; in fact, he acted against interest.

Given the money he declined, perhaps his emotional investment had nothing whatsoever to do with money, and everything to do with what he was firmly convinced Terry desired in the event.

Which, speaking of seeing things clearly, is a serious consideration that has been singularly lacking in virtually all posts on this subject.

I continue to talk about choices, because Mr. Schiavo declined a considerable sum to see what he took as her choice was carried out, and because there are a great many out there who deeply desire to impose their choice upon the rest of us.

In that there is absolutely no "unidirectional imperative."

Posted by: Jeff Guinn at June 16, 2005 9:44 PM

Aye aye, David. Too bad there aren't any examples of that sort of thinking in the OT.

I am not too interested in the legal arguments.

To me it's clear enough: either she was already dead and just twitching animalistically, or she wasn't and it was murder.

Now the hard part: define death.

I think brain death is a nice, unequivocal standard.

It seems clear enough that all this woman's higher mental functions, and, according to the coroner, some of the lower ones as well (like being able to control your gullet/windpipe flap) were gone.

Was she dead enough? Yeah.

I think it is nice that people prayed for her, so long as they understood they were praying to make themselves feel better, not Terri Schiavo.

If they thought they were praying to make Schiavo better, they were mistaken, weren't they?

Posted by: Harry Eagar at June 16, 2005 9:45 PM

Harry: Read the Talmud. You'd be surprised what you can find in the Old Testament.

Brain dead is dead. No court need get involved and the family can't force the hospital to keep the pumps going. Whatever else is true, it is clear that Terri wasn't brain dead. She was breathing on her own, which is incompatible with brain death. I was just astonished that the judge wasn't interested in learning whether she could swallow on her own. I find it hard to believe that the state should be involved in starving to death a person who can breath, who can be hand-fed and who has family willing to care for her.

Prayer is tough and I'll never understand it let alone be able to explain it, but I do get that it is more about G-d than about us.

Posted by: David Cohen at June 16, 2005 11:28 PM

We killed her to make ourselves feel better. She was teaching us what it means to be human...that simply can't be allowed.

Posted by: Noel at June 16, 2005 11:32 PM

Jeff Guinn:

Yes -- or possibly he just wanted her dead so he could "move on" with his new life with another woman. We have reports from hospice workers and a former girlfriend that he wished her dead and used derogatory language towards her.

That testimony comes from parties who may have an axe to grind, but note also this: during a 1992 malpractice suit he gave no hint that she wanted to die and furthermore promised to take care of her for the rest of her life. Soon after that, he "remembered" that she wanted to expire in such a circumstance, and fought an almost decade-long legal battle to ensure that she did. Considering that he had already started a new family and that Terri's actual desires must have been rather nebulous since Michael's putative interpretation of them changed over time, it's hard to believe that his wife's wishes were his sole or even primary consideration in pursuing this result so doggedly.

There was always the possibility, in light of the family's wishes, to have someone else declared the guardian -- but when the guardian ad litem asked that he be given the honors because of Michael Schiavo's involvement with another woman (and because a remembrance of a long-ago conversation hardly fits the "clear and convincing evidence" Florida law requires), Judge Greer threw out the opinion and declared himself caretaker.

Posted by: Matt Murphy at June 16, 2005 11:55 PM

Harry Eager:

Let's turn around that last sentence: If she had miraculously recovered, say, the ability to speak halfway-coherently after millions of people prayed for her, would you put any stock in the arguments of people who said that prayer had clearly worked?

Posted by: Matt Murphy at June 17, 2005 12:01 AM

Robert, there are pictures of Terry's joy when she was visited by her mother. Her whole family begging for the privelege of caring for her. It is hard not to believe you and Jeff aren't in the grip of some kind of unidirectional imperative that supercedes all notions of human life and dignity. The convenience of your views is just too suspect.

Peter, the autopsy results clearly disprove any notion that Terri was capable of feeling joy or any other emotion by the visitations of her mother, or even being aware of the presence of her mother or anyone else. It is natural and understandable for her mother and close family members to believe otherwise based on their experience with her. We don't fault people for being in a state of denial regarding the true facts of their loved one's medical conditions. But don't think that you can tar anyone and everyone with the stain of inhumanity who, not being related or acquainted with her, can accept the facts as they are.

The autopsy also pretty much put to rest any notion that she was capable of experiencing pain. I can accept that you disagree with this, but I am troubled that you cannot see that I and others who hold this view do so out of some ulterior motives such as a love of personal convenience that trumps our sense of responsibility to others. What makes you so quick to question the motives of those who disagree with you?

You accuse us of abandoning all notions of human life and dignity, but seem to forget that the notions that Jeff and I share in regards to this case are pretty much the majority view. If you are using the word notion to mean accepted norms, then it is oxymoronic to say that a majority view goes against the accepted norms. The majority view is the accepted norm. The majority can be wrong, of course. But if you are going to try to persuade the majority that it is wrong, you can't follow a line of argument that simply says "you are beyond all notions".

The majority seems to accept the notion that human life is something more than just the functioning of the digestive, respiratory and pulmonary systems of the body. It sees conscious brain activity as an essential requisite component, and accepts that the permanent and irreversible cessation of such conscious brain activity is the proper boundary between life and death. It doesn't draw this line out of some love of "convenience", or moral laziness, but out of a basic, intuititive grasp of what defines life. Can't you at least accept that this position is honestly and sincerely held, even if it is wrong?

Posted by: Robert Duquette at June 17, 2005 4:09 AM

What a ghastly case. I do have sympathy with the view that if you base the decision on the patient's wishes, you should have a written living Will.

But Peter, why do you insist on introducing this queasy Nazi comparison for scientists, and for those who disagree with you on these moral dilemmas, all the time? It's hysterical, offensive and absurdly disproportionate.

'Scientists' are just people who have a particular specialism in some aspect of how the physical world works. They're not Nazis, and they're not evil geniuses intent on destroying human civilisation. Sorry, but get over it.

Posted by: Brit at June 17, 2005 4:29 AM

Robert:

You keep bouncing back and forth between the issue of her wishes and the nature of her medical state. Which is it that is determinative to you? I'm not qualified in any way to express a view on what she could or couldn't feel or do, but I do know there was professional controversy about it (isn't it a little macabre to be using the results of an autopsy to validate a previous medical opinion justifying killing her? Do you seriously believe there was any chance the coroner would have concluded: "Uh-oh!")and I'll just rely on David and Dr. McHugh for the proposition that PVS is nothing like brain dead. That should be the end of it. If you and Harry continue to fudge that distinction by making remote amateur judgments of her condition based upon other people said she could and could not feel, you are just projecting and moving straight into "a life worth living" territory.

Would your view have been any different if evidence had shown Terri had expressed views against killing those with PVS? The autopsy didn't have much to say about that, did it? Let's at least try to agree what the issue is here.

Jeff:

A guardian of one who is mentally incompetent is charged with managing his or her affairs in accordance with what is in his or her best interests. I am unaware of any role previously expressed wishes play in determining whether that responsibility in being exercised lawfully and in good faith. Wishes, especially previously expressed ones, have no bearing on personal care, property disposal or inheritance or anything else. So why are you so anxious to make Terri's wishes the make or break issue here? The evidence was outrageously flimsy and self-serving, there was no formal legal document. That is the end of it in all other testamentary issues, why not this one?

Brit:

I don't know why you think I'm blaming scientists for this one. I'm blaming a materialist and relativist cultural mindset. I'm not frothing at the mouth or organizing guerilla resistance, but I do believe the culture of death is real and not hyperbole and I don't believe Terri's case is a one-off or that "common sense" alone will keep us from establishing increasingly dark practices. I have a little experience with seeing what a health decline can do within a family and how hearts can harden over care responsibilities and money pretty quickly. Do you not see that if we don't grab onto some very firm objective rules and standards here (as opposed to telling ourselves soothing stories about wishes and playing amateur neuroscientist), we are headed into the development of de facto duties to die rather than cause anyone expensive demands?

Posted by: Peter B at June 17, 2005 7:18 AM

Matt:

May have an axe to grind?

Perhaps a little background is in order.

Following the initial event that caused her severe brain damage, Mr. Schiavo chucked his career and went to nursing school so he could provide personal care for his wife, figuring that to be the best way to help her.

After seven years of doing do, he concluded that Terri was irrevocably gone.

As it turns out, he was right.

My point from above still stands: this has nothing to do with some "culture of death." It was a singular case extremely fraught for all the parties.

What has also been singular is the degree and extent of nasty, baseless, vilification that often spewed from those backing Terri's parents.

And it serves as an operational example of irony: those who desire to impose their notion of end of life upon all of us simply succeeded in greatly increasing the number of people making sure matters remain in their own hands by having living wills.

Posted by: Jeff Guinn at June 17, 2005 7:27 AM

Peter:

No, I don't really see that.

Medical science increasingly enables us to artificially keep people alive, with no prospect of recovery or improvement, who would otherwise die (whom God wants to die?).

When the question becomes "who decides when to pull the plug?", you say the state. Others say the patient or those who love him. It's a horrible dilemma, and both former and latter has valid arguments, and the answer is probably somewhere in the middle: the patient where possible, but not necessarily always.

But I can't see why your opening gambit is to portray those who take the latter view as the moral equivalent of Nazis. It's an utterly nonsensical comparison.

On the science issue, I think you generally have an unfounded fear and loathing of scientists and all who resemble them.

Posted by: Brit at June 17, 2005 8:12 AM

Brit: People in Terri's condition are "allowed to die" all the time and no one says "boo." Whatever it was about Terri's case that struck people wrong, it wasn't simply what Robert calls animism.

Posted by: David Cohen at June 17, 2005 10:15 AM

You keep bouncing back and forth between the issue of her wishes and the nature of her medical state. Which is it that is determinative to you?

Both. If she were not in a PVS, or if there were any reasonable hope of recovery or improvement, then pulling her feeding tube should not be an option. Seeing as there is not a universal agreement as to where the line between life and death should be drawn in these cases, it should not be in the hands of the state to decide that the tube should be pulled or should not be pulled, but should be decided according to the wishes of the person as best determined by a will or next of kin.

I am not making an amateur diagnosis, but relying on the opinions of many experts in the field who are in agreement with the findings of the court and who have been vindicated by the autopsy results.

Speaking of bouncing back and forth, what is your determinative position on this, whether the wishes of Terri were properly represented, or that her wishes are of no bearing since the pulling of a feeding tube is wrong in any situation where a patient can maintain a pulse on her own?

Posted by: Robert Duquette at June 17, 2005 11:02 AM

Robert: But what should the default be when the person's wishes aren't clear?

Posted by: David Cohen at June 17, 2005 11:34 AM

Brit/Robert:

Others say the patient or those who love him

...wishes of the person as determined by a will or next of kin

Good to see you two roaring in to defend tradional family values, but what's love got to do with it? Leaving aside the issue of whether Michael Schiavo fit those definitions in any but the most technical of senses, do you honestly see family members as an authoritative source of information on relevant wishes absent any written document from the actual victim? Boy, talk about reviving the old "unity of person" doctrine of marriage! Can you not see how you would open the floodgates to abuse and abandonment if you went with that?

Brit, I don't want the state to make any decisions. I want it to set clear, universal limits through law, not conduct inquiries into the purity of a spouse's love. A living will may be fine for brain dead conditions and terminal cancers, etc, but for the gazillionth time, that wasn't Terri. PVS and brain-dead are technical concepts with presumably objective definitions--you can't just declare one to be the same as the other because both make you squirm.

Can you guys please answer David's last question about where the default presumption should lie. And one of mine. If I at a healthy age of forty make a living will saying that I want to be starved to death if I am ever afflicted with Alzeimer's, should my family pay any attention when I contact it at eighty? Should they be obliged to or do we leave them the choice?

Posted by: Peter B at June 17, 2005 12:17 PM

Peter:

Your reasoning completely guts personal autonomy, in that you eliminate the possibility of someone deciding before the fact what kind of care they are willing to accept in the event they can no longer--as in ever again--express an opinion.

Clearly I disagree that someone's idea of "best interests" can override previously expressed intent.

In the Schiavo case, there was no documented evidence of her intent. So far as I know, and you haven't yet corrected me, the courts simply applied existing law in precisely the same way they would if someone died intestate. In other words, her best interests were what she had presumably expressed them to be, and the court was bound to award presumption to her husband.

It is unfortunate that the evidence of intent was flimsy, but that wasn't, so far as I know, what was before the courts to decide.

As for self-serving, I haven't yet seen anything to match the grotesque vilification of Mr. Schiavo. Unfortunately, when basing one's case upon such vilification, one's rationale entirely collapses when the vilification's object turns out to be nothing like the beast painted.

I am anxious to make her wishes the issue here, because that is what is at stake. There are those who desire to impose medical care upon others, even in the face of clearly expressed refusal of such care.

In LA, roughly 1986, there was a woman suffering a degenerative disease that left her a quadraplegic in continuous, untreatable pain. She conciously decided she no longer wanted to be fed.

Why did she need to go through several court battles to overcome theologically exercised buttinskys who intended to force upon her care she didn't want?

Because personal autonomy, not culture of death, is what this is about.

The Road to Serfdom is paved with good intentions.

Posted by: Jeff Guinn at June 17, 2005 1:11 PM

Matt, since your hypothesized conundrum has never, ever arisen in actual practice, I don't have to worry about it, do I?

But if you come up with a miracle, I will.

David, I read the autopsy report. She was NOT capable of being hand-fed. The autopsy says she would have aspirated the food and strangled.

Posted by: Harry Eagar at June 17, 2005 2:00 PM

Jeff

In the Schiavo case, there was no documented evidence of her intent. So far as I know, and you haven't yet corrected me, the courts simply applied existing law in precisely the same way they would if someone died intestate. In other words, her best interests were what she had presumably expressed them to be, and the court was bound to award presumption to her husband.

I haven't the slightest idea what you are talking about. Intestasy has nothing whatsoever to do with wishes, whether expressed directly or through a spouse. There are no presumptions in favour of anybody. Boy, you sure seem determined to find a way to give spouses the absolute right to dispose of people.

Posted by: Peter B at June 17, 2005 2:11 PM

Peter, David:

I think the default presumption should lie with the person who is legally presumed to best be in the position to know--the spouse.

You don't get to trumpet the sanctity of marriage on one hand, then trample it when an outcome doesn't meet your requirements.

And, no, I can't see how that opens any floodgates, certainly no more more than the sanctity of marriage opens the floodgates of wife beating and child abuse.

For a living will in particular, and personal autonomy in general, to have any meaning whatsoever, then we must be able to, in advance, stipulate under what conditions we refuse further care.

We allow that to conscious people, after all.

Therefore, if I direct my survivors to cease nutrition when it is clear Alzheimer's has left me permanently insensate to my surroundings, then I that is what they should do.

Will they? Who knows. I certainly won't.

But you should think carefully about where else your reasoning very directly goes. A completely conscious Jehovah's Witness prefers death to a blood transfusion.

You going to force him?

If not, why not?

Posted by: Jeff Guinn at June 17, 2005 2:11 PM

Harry:

Have you ever heard the story of how Roger Bacon was listening to a group of clerics argue how to use theology to determine how many teeth a horse has, and how he shocked them by suggesting they just go outside and count them?

I dunno, it just popped into my head when I thought of modern medical gurus starving someone to death and then conducting an autopsy to see if they could have been fed.

Posted by: Peter B at June 17, 2005 2:24 PM

Jeff Guinn:

That wasn't what Mr. Schiavo said -- he said he was going to study nursing so as to take care of her for the rest of her natural life. So far as I know, he didn't say anything about expecting recovery.

His point wasn't that he had concluded her case was hopeless and thus wanted the feeding tube disconnected -- it was that he suddenly remembered that she had expressed a wish not to live under certain circumstances. He remembered this, of course, after he had money in hand and a new family. That's at least prima facie suspicious.

In light of that, you can't just conclude that all those awful things that people who have worked with Mr. Schiavo say about him are automatically baloney. That he turned down money may simply indicate that he wanted to move on (besides, he had cash aplenty from the malpractice suit), and if there's any truth to what those three hospice workers (who all signed affidavits) and one former girlfriend said about him, he very much wanted Terri gone.

Also, please note what I wrote above about the legal details. The fact that the evidence was flimsy was a damn good reason not to proceed, considering that Florida law has a "clear and convincing evidence" standard as to the patient's wishes. There's no way a snippet of conversation contradicted by other parties fits that standard -- but, in the usual manner of activist judges, an appellate court rewrote the requirements so that the Schindlers had to prove she might get better. There was nothing about that in Florida law (the appeals court said the Schindlers would have to offer evidence that "increased cognitive function" was a possibility, but if any cognitive function exists then the patient is not in a PVS as defined by Florida law).

Congress took note of this and also took into account that Judge Greer had illegally appointed himself Terri's guardian. They used their Constitutional power to define the jurisdiction of lower courts and ordered that the case be reconsidered de novo, but the judge assigned to the case (a former Greer colleague) overlooked all that and kept the feeding tube removed.

Combine a willful judiciary with the culture of death and you've got no shot. No wonder conservatives are upset.

Posted by: Matt Murphy at June 17, 2005 2:34 PM

Harry:

There are certainly examples of people getting better in situations where every medical authority said their chance of recovery was precisely zero. As a materialist, you're free to disregard those very few cases and I carry some mental sympathy for your decision to do so: I'm not naturally predisposed to the miraculous. You should just be aware that this happens on occasion and that few people on this site think you would reexamine your beliefs if Terri had partially recovered but remained bedridden.

Posted by: Matt Murphy at June 17, 2005 2:49 PM

Peter:

Touche.

Posted by: Matt Murphy at June 17, 2005 2:52 PM

Peter:

Please don't confuse my ignorance of legal nuance with some deep desire to get rid of people. First, you would be attributing to malevolence that which is best explained by ignorance.

Given the choice between relying on spouses on the one hand, and government on the other, I will go with the spouse every time.

Matt:

Based upon what I read elsewhere, he had actually completed nursing training, and was heavily involved in her care and therapy for seven years before concluding, correctly, that what had made that body Terri was irrevocably gone.

I might be wrong; but so might you.

In any event, I think it is completely irrelevant.

She had utterly no cognitive funtion at all, and the point Mr. Schiavo had to make was, based on his knowledge of her, whether she would have wanted to continue breathing in this state, or if she would elect to refuse further treatment.

I must admit to complete innocence regarding the contents of the 20-some odd court decisions. Until doing so, I am extremely reluctant to conclude that every one of them was an activist judge salivating at the thought of putting Terri under.

As for Congress, they took note of a chance for rampant grandstanding, and jumped all over it. Unfortunately, they failed to note that the vast majority of Americans have little tolerance for Congress poking its nose in individual's lives.

But as far as dying intestate goes, each state has its own laws that determine who inherits the estate, regardless of any ongoing dispute among survivors. I was comparing that legal pre-determination with the presumption who is best positioned to claim knowledge of the person's wishses. If I was wrong to make that comparison, than I apologize--after all, I claim absolutely no legal expertise.

Posted by: Jeff Guinn at June 17, 2005 3:12 PM

'S funny, Peter, Matt. I was minded of Buckland in the Naples (I think it was) cathedral, where the miraculous appearance of saint's blood on the floor was noted, as it had been by the faithful for centuries.

Buckland dipped his finger in and tasted the Peter, your Baconian example is amusing in light of the confident belief among many American Christians that men have 13 ribs, women 14, as explained in Genesis. I know of a professor who keeps a skeleton in his classroom to inspire a certain skepticism in his more rustic students.

And while your distinctions about prayer do not resonate with me, at least we here are all agreed that it wasn't about Terri Schiavo, was it?

Matt, extraordinary claims demand extraordinary proofs. That doctors make wrong diagnoses does not prove a miracle.

Posted by: Harry Eagar at June 17, 2005 3:38 PM

Peter:

If you read my posts without imposing your assumptions on them, you'll notice that I didn't comment on how I think these cases ought to be decided.

I suggested that you think twice before implying that those who don't share your views are the moral equivalent of Nazis.

Posted by: Brit at June 17, 2005 5:01 PM

Harry: Genesis doesn't say anything of the sort.

Posted by: David Cohen at June 17, 2005 5:04 PM

The people I grew up among thought (and still think) it did.

So, it's time for another heresy hunt! Whee!

Incidentally, regardless of what Genesis says, if you get rid of science-based teaching and replace it with what Orrin wants, that's what you're going to get -- men with 13 ribs, 6,000-year-old planets.

If there was ever a God, the most determined lesson he ever offered to Man was not the Bible but the Millerites. But Man -- at least, most of him -- didn't take the point.

Posted by: Harry Eagar at June 17, 2005 8:05 PM

Sorry for the very late reply; I've been at work (yes, I work very odd hours).

Okay...

Jeff Guinn:

1.) I simply fail to understand why the motives of the husband are irrelevant. If, in his role as guardian, he was conflicted in his decision-making by a new life with another woman -- which is certainly consistent with spending many years taking care of his wife before deciding to "move on" -- then that was supremely relevant (as the guardian ad litem realized). Also relevant was his decision to deny either a PET scan or an MRI rather than a simple CT -- which could have sealed the PVS matter had it been allowed (that we now know she probably had PVS makes no difference -- the standard is what did we know and how did we know it when the feeding tube was pulled).

2.) Thomas Sowell provides a concise, easy-to-understand dissection of the "many judges backed the result" argument here.

3.) The actions taken by Congress would have been simple grandstanding if they hadn't been taken in response to judicial highhandedness -- and also if they hadn't gone against any number of public opinion polls. Indeed, considering that any halfway-sentient Republican could read the polls and could also tell that the media was not going to report the kind of facts I mention above, this qualifies as one of the few acts the GOP has taken in recent years that can be termed courageous.

Harry:

Let us take as an example the very few cases to make it all the way through the accreditation process at Lourdes, which is extremely stringent because the Church doesn't want to get caught with its pants down. Basically, if you have a claim, you must make it through one medical bureau (only a minority of whom are Catholics), then another, then a canonical commission. The assembled panelists must agree that there is no existing or hypothetical scientific cause for your cure. These are not, of course, simply the judgments of one doctor -- these are panels of experts talking.

It's pretty obvious if you read the questionnaires used or consider the complexity of the process that this involves some rather serious evidence. They don't confirm just anyone's story: in fact, skeptics organizations constantly send people to fool the system, and so far as I know, they've never been successful.

Now, a skeptic (let's say this is you) cannot possibly be acquainted with the particulars of every case, but probably explains away these occurrences by noting that in a world of sickness, there will always be odd events at the periphery which defy explanation. A skeptic will also ask why God is so eager to cure stuff like impetigo and tuberculosis but will not, say, regenerate a severed spinal cord.

This is a reasonable argument. It might even be correct. But it's also a function of a particular worldview. Nobody can be acquainted with the facts of every circumstance that pops up, and most people presume in advance that certain things are true and base their judgments on those assumptions. This framework can survive considerable battering.

My point isn't to argue about who is right or wrong. The point is that, when faced with something that looks like a miracle, you assume there must be a material explanation (no offense, but I highly doubt a Schiavo recovery would have caused you to reconsider anything). Likewise, when religious people pray for a result and don't get it, they assume that it "wasn't meant to be" or "wasn't God's will." They have explanations, you have explanations.

Posted by: Matt Murphy at June 18, 2005 2:30 AM

Well, Brit, we seem to be moving from the obligatory Nazi reference to the obligatory "How dare you liken me to a Nazi!" retort. I'm afraid to you have to point out to me where I implied those who disagree with me are Nazis, because I see it nowhere.

On the other hand, the fact that one is a nice person who sincerely believes his dearly held views are enlightened and beneficial is quite irrelevant to their wisdom and consequences. Evil and error don't always come in the form of hate-filled, monocled fanatics consciously determined to destroy. I suggest you forget my comments and ponder Dr. McHugh's insights into bioethics (born of first hand experience)and where it will inevitably lead us, especially if everyone keeps assuming each high profile case is a one-off and that some kind inherent common sense is all we need to keep our balance. I don't think history will back you there.

Posted by: Peter B at June 18, 2005 6:55 AM

I'm referring to your comment in the original post. You introduce Nazis in the first paragraph, and in the third:

"Its cold-hearted, selfish rationalism always comes wrapped in ersatz empathy and compassion (certified professionally in courses and workshops) for those it seeks to destroy or marginalize. Its tools are not storm troopers and secret police, but the mis-use of scientific language to confuse the decent, open and scrupulously well-documented bureaucratic process, psychological manipulation..."

Why introduce the image of storm troopers into this discussion, exactly?

Posted by: Brit at June 18, 2005 9:36 AM

Actually, Harry, in the first chapters of Genesis we get clear, albeit poetic, references to the Big Bang, evolution, the development of the human faculty for critical reasoning, the use of general anesthetic, reconstructive surgery and cloning. By implication, we get what seem to be references to stem cells (why a rib?) and the fact that a woman could be cloned from a man, but not vice versa (we need to assume that Adam (and thus Eve), prior to the Fall, had a perfectly clean genetic code not subject to transcription errors).

In fact, it's a little worrying that so much that was hidden from human comprehension for so long has now become clear. Either these are the End Times, or there's a lot still hidden that we can't see.

Posted by: David Cohen at June 18, 2005 10:55 AM

Matt:

The reason I say Mr. Schiavo's motives are irrelevant is because they have nothing to do with the issue at hand.

Even if his motives were as pure as the newly driven snow--and given the sh*tstorm he could have avoided by simply walking away, there is at least reason to suspect he isn't nearly the monster some have so shamelessly painted him--the issues would still be there.

You need to read some of the comments by, oh say, Bill Frist, before you reject the grandstanding charge. He and others of similar standing made assertions as to her condition that can, only with great application of charity, be considered grotesquely ignorant.

The Schiavo affair, along with a recent post of Peter's regarding resource driven triage (where, to echo Brit's complaint above, my suggestion that it wasn't culture of death, but rather zero-sum economics at work, was met with a disgusting ad hominem), both raise serious issues that simply didn't exist 50 years ago.

I find it ironic that the malicious vilification surrounding this tragedy came solely from one side--the side that holds themselves up as moral arbiters.

Go figure.

Posted by: Jeff Guinn at June 18, 2005 11:00 AM

Can you guys please answer David's last question about where the default presumption should lie.

I would agree with Jeff's answer above.

And one of mine. If I at a healthy age of forty make a living will saying that I want to be starved to death if I am ever afflicted with Alzeimer's, should my family pay any attention when I contact it at eighty? Should they be obliged to or do we leave them the choice?

That is a decision for the voters of a state to decide. The question is where to draw the line where life should be preserved at all costs and where it shouldn't, depending on the judgement of (1) a written will, or (2) the decision of a spouse or guardian. There is a point up to which personal autonomy should not decide - we don't acquiesce to people's desires to kill themselves if they are healthy but depressed. In my opinion the state must protect the lives of people who have some remaining capacity for conscious thought, or there is a reasonable hope for the recovery of that capacity in the future.

As to whether you are obligated to obey the wishes of your 80 year old father who has stated in his will that he be denied food after he passes that "point of no return", I'd say yes. What is the purpose of a will if it cannot be enforced?

Now, can you answer some questions that I have posed to you previously?

(1) Can't you at least accept that this position is honestly and sincerely held, even if it is wrong?

(2) Speaking of bouncing back and forth, what is your determinative position on this, whether the wishes of Terri were properly represented, or that her wishes are of no bearing since the pulling of a feeding tube is wrong in any situation where a patient can maintain a pulse on her own?

Posted by: Robert Duquette at June 18, 2005 12:40 PM

Jeff Guinn:

So Frist said there was some possibility she might get better, albeit slightly? Plenty of doctors (including some who examined her) were saying likewise, which was at least semi-plausible without an MRI or PET scan.

Again, Mr. Schiavo's motives matter from a legal standpoint if they were base -- if he was misrepresenting his wife's beliefs or was conflicted by life with another woman, that simply matters, as the guardian ad litem realized (sorry to repeat myself).

I think people "vilifying" you are genuinely concerned that people with good motives are being led to a path that will have an end result they won't like. It certainly wouldn't be the first time that has happened.

(I'll be at work until 9 p.m. tonight. I think we're at an argumentative impasse, so this is my final post. See you later.)

Posted by: Matt Murphy at June 18, 2005 12:48 PM

Brit:

Now it is your turn to lighten up. The point, which the article made clear, is that you don't need conscious malevolence to commit evil or head towards catastrophe. Don't think all is well just because there are nice people at the helm. The point was originally made by Hannah Arendt, who showed that not even most of the Nazis were Nazis as we have come to stereotype them. If agreeing with that is the same to you as calling everyone who disagrees with me a Nazi, you need a holiday.

Jeff:

You come here knowing that most of the posters are religious to varying degrees, yet you frequently delight in mocking them simplistically and attributing all manner of horrors and atrocities to their beliefs. You are forever whining like a broken record about how this or that moral position impinges on your quite mundane and completely self-regarding freedoms without taking any apparent interest in what the wider societal effects are or are likely to be, especially on those without your comforts and talents. Even though you got your wish and Terri was starved, and you are well aware of how anquished many felt about it, you seem to really put the blame on us for being gauche and causing such a unsvaoury fuss. You are still sniffing about how mean and close-minded everyone is being and taunting about how intolerant those who aren't too keen on killing the disabled are. You express all kinds of legal views that are not, in your words, "lacking in nuance", but, with respect, are completely off the wall, and you evince absolutely no interest in learning anything about them. One would think one of your convictions would at least be interested in all the legal and evidentiary complications surrounding the issue of informed consent and ensuring abuse was prevented, but no, you just keep insisting the simple production of a marriage licence is a right to starve a mentally incapable spouse. There seems to be nothing at all about this story which moves you in any way, except your own personal fears. You keep repeating that it is better for a spouse to decide than the government, even though no one here is argung that the government should decide and never has. Really, Jeff? A separated spouse? A spouse who hates his spouse? A spouse who stands to inherit? A spouse challenged bitterly by the children? If I read you correctly, you don't care about any of that and you don't want to know. If that is your notion of freedom and tolerance, you are welcome to it.

Robert:

1. Yes, obviously. And also that such views can beand are often held by decent people. That is the point of the post. Do you think honesty and sincerity have any bearing on their validity?

2. I don't know. The problem with living wills is the whole issue of whether the consent was solemn and informed or not--that's why the law demands such strict procedures for testamentary gifts. I really doubt that most people making living wills reflect on the difference between PVS and brain dead (or coma, senility, etc.). They just don't want unecessary agony prolonged uselessly, and in some cases the elderly don't want to be a burden. Also, I imagine most are thinking: "Switch off the machine", not "Starve and dehydrate me slowly."

The Schiavo case was a moral and legal abomination. But I can't tell you exactly where is the line is that will work in all cases. At the very least there has to be a strong pro-life default position and very clear and specific wording in any living will. There has to be a prohibition against applying them in cases other those restricted conditions that are truly hopeless and truly cause suffering. Also, living wills should expire after a few years at most unless renewed in writing. It is absurd to think our views on this remain constant throughout our lives.

Posted by: Peter B at June 18, 2005 2:05 PM

David, it isn't so clear to me, even 'poetically,' whatever that means. You don't get stem cells out of a rib. At least, not yet.

(Apology long post coming, but Matt asked an interesting question.)

Matt, in fact there are plenty of opaque events (often dismissed as 'hysterical conversion' and the like) that we materialists cannot explain.

We do not pretend to be able to explain everything. (Although, as a very strict materialist, I suspect that, in principle, everything COULD be explained according to regular -- but not invariable, because decay rates of uranium, for example, are regular but not invariable -- observations.)

My problem with Catholic miracles is the same one I have with psychic discoveries at Duke: If you want a miracle, why pussyfoot around about it?

Jesus didn't. He just stepped out and walked on water.

The Lourdes investigations may be more rigorous than the Duke cardturning experiments, but the Duke experiments are conducted in a rigorous framework where -- the Dukies say -- even almost infinitesimal statistical differences are supposed to be significant of, say, telekinesis.

The Lourdes approach is the same only different. It demands huge differences -- life v. death, in fact -- but the framework it operates in is not rigorous at all.

Extraordinary claims demand extraordinary proofs. I said that above, and it's a common shibboleth of the skeptics.

In common parlance, it's a useful argument, but in strict analysis, it's not really true, though.

If the framework is rigorous enough, ordinary proofs suffice.

This is what makes quantum mechanics so very weird. It's framework is extremely rigid -- to within one part in 10 billion -- but the proofs offered are quite ordinary, and are accepted (if not entirely understood) in consequence.

My example of Buckland (which got garbled) is typical of religious proofs: as weird as QM but within a framework so ridiculously loose that offered proofs fall apart at a taste.

The attempt to bring proofs of a deity into natural science present science with a conundrum: If we could prove god acting in nature, then he wouldn't be supernatural, would he?

Religious scientists, like Roy Clouser, are much beset by this, but as a materialist, I would not be. Should a deity (defined for here as a non-regular actor in nature) be discovered -- could not be done statistically, would have to be discovered some other way -- then we materialists would -- with great surprise -- deal easily enough with that.

It's the alternative v. scientific medicine proposition: If the apparently flaky treatment can be shown, rigorously, to work, then the scientists can adopt it and it's no longer 'alternative.'

That deities operate in nature arbitrarily but naturally is a common belief. That's what Greeks thought, for example.

Many, perhaps most Christians in America, say they still think this, though the actionsin-nature are less dramatic nowadays. But when we get down to cases, a careful look always produces equivocal results.

To get back to Mrs. Schiavo: evolutionists can understand how damage to a later evolved part of her brain could have left an earlier evolved part functioning.

Had her stroke (or whatever it was) affected the limbic brain, the frontal cortex would have shut down immediately, even though entirely undamaged, and this political dispute would never have arisen.

I cannot see how these facts (and I believe they would be undisputed by anybody, though not mentioned often) can be squared with the 'Terri was still alive because some part of her brain was still working' version.

Posted by: Harry Eagar at June 19, 2005 4:54 PM

Harry: There's a Jewish tradition that, after the sixth day, G-d stopped creating. All miracles thereafter have natural mechanics.

Posted by: David Cohen at June 19, 2005 6:25 PM

Peter:

Please do me a favor and read what I write before accusing me of things.

In particular, "Even though you got your wish and Terri was starved," is complete nonsense. I have specifically told you that my preferred outcome was that Terri's wishes be honored, WHATEVER THEY WERE, and that in the absence of documentary evidence, then follow the law.

In other words, had the Mr. Schiavo's and Terri's parents roles been reversed, and she were still on a feeding tube, that would be the correct outcome.

Also, if you are going to accuse me of mocking them simplistically, please give an example or two. I certainly can't remember doing so; and I can certainly remember not ever wishing to do so.

The blame I am assigning is twofold: First, the attacks on Mr. Schiavo have been absolutely disgusting, and completely unmatched going the other way. Second, by wasting so much effort on ad hominems, the essence of the issue was completely ignored. If there has ever been a case of heat without light, this is certainly it.

I admit my legal assertions are not based on any particulary expertise. Fine--educate me. I've posed this same issue to you several times, precisely because you are an expert, and I am not. Rather than rant, it is time to employ that expertise.

What moves me about this story is that there are a significant number of people who take it upon them selves to make this sort of decision for the rest of us, while failing to acknowledge that they are at serious risk of fetishizing a pulse rate.

Oh, and one other thing. The horrors and atrocities of sectarianism speak eloquently for themselves. There's a reason "religious" and "hatred" so often find themselves joined at the dipthong.

Posted by: Jeff Guinn at June 19, 2005 9:15 PM

Jeff:

No, that won't work. It's true that you start with the concept of wishes. But in saying that: a)Schiavo's motives were irrelevant and only his formal legal status as her spouse was important; b)the law must presume he knows best; and c) the law must act on that presumption, you are setting up what lawyers call a legal fiction. In other words, you want the law to start with a pious declaration that her wishes should govern but then lock itself into a rote formula to determine them without serious inquiry and independent of what they actually, objectively were, or even if she had any. I assume that is why you seem completely untroubled by, and uninterested in, the problems of burden of proof, conflict of interest and credibility. It's not her actual wishes you want but the automatic application of a non-discretionary legal formula that makes Schiavo the determinant, whatever the surrounding circumstances. I accept you are advocating this all in good faith, but you can't keep pretending it has much to do with her wishes.

Posted by: Peter B at June 19, 2005 10:18 PM

Harry:

Interesting post. A few thoughts...

-- I don't want to give the impression that I thought materialism could explain everything; I mentioned Lourdes because I thought perhaps those events didn't fit into the materialist model. My point was that materialists mostly appear to assume that the world can be explained entirely by natural causes, even if they don't know everything about those causes yet. I know you're willing to concede the latter part of that formulation.

--Which brings us to the question of the natural versus the supernatural. Perhaps the reason miracles never occur entirely within those tightly-defined circumstances you speak of is because if they ever did, they would become natural events and God has better things to do than be calibrated by scientists. Personally (sorry to introduce metaphysical speculation here, but I think it's worthwhile) I always thought that if God's existence were proven beyond a shadow of a doubt, the whole free-will concept would be considerably diminished. Even many believers -- maybe most -- have smidgens of doubt here and there: that's why one of the psalms says the sinner assures himself there really is no God. Imagine knowing with scientific certainty that God exists and is watching your actions every second.

-- I understand that J.B. Rhine's experiments at Duke have been pretty thoroughly demolished, but again I'm unaware of any fully-appraised Lourdes cure that has been proven to be bogus. I know that Lourdes may not be the ideal experimental station, but I must say I don't think it can be described as "not rigorous at all." Faced with the inherent limitations of the situations involved, I have a hard time seeing how it could get more rigorous.

I don't think Lourdes constitutes "proof" of miracles, but I also don't think God's failure to answer prayers proves He doesn't exist. Such things are only suggestive events and we all have explanations for those things that don't fit our worldviews. Considering that panels of medical experts will testify that science as currently constituted cannot explain at least a few of the cures brought before them, Lourdes seems to me to be a stronger suggestive event than most.

I should perhaps mention that I hovered close to agnosticism as a teenager (Maimonides might have called me "perplexed") and I retain a relatively-wide skeptical streak that still leaves me fuming when, say, I see a "psychic" on TV (interestingly, my parents sporadically attended a "psychic church" when they lived in southern California; I've apparently bucked a family trend). Since I'm acquainted with both sides of the religion-materialism matter, I tend not to think of "proofs" in either direction, but rather consider certain things simply "interesting." Lourdes strikes me as rather intriguing. So does the historical case of Joan of Arc or Fatima. I think the survival of the Jewish people into the twentieth century and the humongous contributions they've made to the world despite their small size constitute the strongest evidence that God exists (although I remember reading that a historian of science, maybe Joseph Needham, outlined reasons why monotheism holds a culture together and contrasted that with the Chinese experience).

Again, I doubt miracles can be proven in a laboratory or are even meant to be. We merely have suggestive circumstances. That, and explanations dependent on our viewpoint.

Posted by: Matt Murphy at June 20, 2005 5:23 AM

Harry:

One other thing -- please be honest -- if, pursuant to my earlier post, Ms. Schiavo had started speaking in monosyllables and regained some conscious motor movement after being prayed for by so many, would you have re-examined your atheism? Wouldn't you probably just doubt that PVS had been correctly diagnosed or eventually shrug if off because it didn't fit the tight experimental standards you have in mind for such things? I mean, if the stuff at Lourdes can be disregarded I don't see what would have made this case so different.

I won't doubt you if you say you would reconsider your beliefs (well, not to your face, anyway!), I just find that hard to believe.

Posted by: Matt Murphy at June 20, 2005 5:35 AM
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