Transterrestrial Musings

Comments

By the way, where are the people who claim to believe in the Precautionary Principle on this one?

Posted by Bob Hawkins at March 22, 2005 05:28 PM

I'm not sure why you say this is torture. Lot's of old people die this way when some system or other gives out.

You and I have higher brain functions, so we know and act on starvation and dehydration signals. Depriving us would be torture. I'm not so sure that is the case with someone in her state. Are you?

Posted by Alfred Differ at March 22, 2005 05:44 PM

You and I have higher brain functions, so we know and act on starvation and dehydration signals. Depriving us would be torture. I'm not so sure that is the case with someone in her state. Are you?

I don't know for certain what "her state" is. Why do you think you do?

If it's not completely vegetative, then she may be suffering greatly, for no good reason.

Posted by Rand Simberg at March 22, 2005 06:04 PM

>> You and I have higher brain functions

How high up is "hungry"? Do earthworms feel it?

> If it's not completely vegetative, then she may be suffering greatly, for no good reason.

Actually, she may be suffering for the most important reason of all - to do otherwise would make a bureaucrat look bad. If she started singing and dancing, they'd be obligated to strangle her immediately.

Posted by Andy Freeman at March 22, 2005 06:35 PM

It comes down to the laws on the books. (And stiff-necked doctors who take their oath a bit too literally.)

If a Doctor does something that kills a person, they have violated the Hypocratic Oath and have most likely violated the law in the jurisdiction where thay practice.

Why that makes letting someone (or someone's body, since we're assuming vegatative state) starve to death better than a quick "shut it down" shot I don't know.

Posted by Fuloydo at March 22, 2005 06:36 PM

The majority of doctors who have actually examined her have determined that she is in PVS - Permanent Vegatative State. Patients in a persistent vegetative state (PVS) have severe brain damage and are in a state of "wakefulness without awareness." She has been in this state since 1990 (approximately 15 years!). Her family is in denial of her condition instead of moving on and accepting what has happened. Nothing will ever bring her back and I'll believe what the majority of doctors are saying.

Posted by Tom C at March 22, 2005 06:42 PM

...I'll believe what the majority of doctors are saying.

It's nice to see someone so mindlessly obedient to authority. It makes for a much more docile population, that will cause no trouble...

Posted by Rand Simberg at March 22, 2005 06:55 PM

Here is the official report prepared by Jay Wolfson, personally selected by Jeb Bush to prepare a report, for the Governor.

http://abstractappeal.com/schiavo/WolfsonReport.pdf

Posted by Bill White at March 22, 2005 07:12 PM

Just from what I have read - no experience having one or inserting one - anesthesia is not usually required. "The passage of a gastric tube is not painfull, but it is unpleasant because the gag reflex is activated during insertion."

A gastrotomy tube is done surgically -- " While the patient is deep asleep and pain-free (general anesthesia), a small incision is made on the left side of the abdomen. A small, flexible, hollow tube (catheter) with a balloon or flared tip is inserted into the stomach. The stomach is stitched closed around the tube and the incision is closed."

Posted by john at March 22, 2005 09:30 PM

Rand, I think you're being inconsistent here. On one hand, you state that she deserves "one more bite of the apple" to get her fair day in court, which means prolonging her life (her husk?) until that's completed. Your hope is that this might "better bring to light her true condition" but I think you're possibly in denial. If hard evidence existed that would show that she wished to be kept alive (and that's all we are considering here) then it would have made it to the public domain by now. At the end of the new trail, all that will occur is that both sides will claim their righteous position.

Let's say that after a new trial, the court decides that Terri isn't in a PVS condition and that this can't be used as a reason to end her life. It doesn't get us any closer as to what "her" wish is, even if she retains some cognitive ability. In fact, one of the most effective tortures known is one of complete sensory deprivation. Terri condition puts her very close to that situation with the added horrors and indignities of bodily meltdown injuries and carny show freak status.

So, while you rightly are concerned about the physical pain she may be under via the starvation, others are equally concerned about the mental anguish she may be in from having to live a life not worth living.

For what it's worth, I would prefer that she die a natural death rather than euthanizing her. My hope would be that they would administer whatever drugs were needed to insure that she didn't suffer from it.

Posted by Sailfish at March 22, 2005 10:13 PM

Rand,

I have no idea what her mental state is. I'm no doctor. I doubt many of us do either. I think you are being irresponsible, though, in using such emotionally charged words like 'torture.' It's your site and you can say what you want, but I feel I have to call you on this one. You are contributing to the overly emotional drama in a negative way.

Posted by Alfred Differ at March 23, 2005 01:38 AM

the legal bottom line

Despite all the debate and claims by various parties as to whether Teri would have wanted to die in her present condition, isn't it finally up to the husband to decide regardless of Teri's true wishes? In other words isn't this a case of what the husband says must go since, absent any living will, he has the only legal right to decide? That the husband can say live, die or whatever based purely upon his whim?

This isn't a "right to die" case, it's a right to kill case. All I can say is, be carefull whom you marry.

Posted by Brad at March 23, 2005 02:23 AM

Brad, it is my understanding that, in such cases, the spouse's rights do trump the parents. I have not seen a compelling argument that justifies the right of anyone else to intervene, whether motivated by parental love, emotion-driven religiosity or a political agenda. None of us has access to the women's medical records, but none of us has any reason to dispute the consistent diagnosis that has been made for 15 years.

According to reports, her husband has at least one witness to her statement rejecting life support. I've not seen any reports that her parents can provide any evidence to the contrary. Also, during a Q&A, a member of her medical team stated that most of the cerebral cortex has been replaced by spinal fluid. No matter what her parent's may sincerely desire, then, she is not aware of their presence, will not improve, and cannot respond to treatment because there is, in fact, no organ to treat.

All very, very sad and, ultimately, the result of our limited medical abilities (we can sustain a body but we cannot regenerate that body's brain.)

Posted by billg at March 23, 2005 07:15 AM

Rand,

As pointed out, the Hippocratic Oath is what professionally prevents Doctors from aiding the process of death. So, giving her copious amounts of potassium chloride would not be allowed. I don't know what prevents them from providing anaesthesia.

I suspect using anaesthesia would also stop much of the dramatic arguments in the case.

As for adding and removing the feeding tube... I don't know for that procedure, but my wife is an endoscopy RN. For those type of procedures, they use Versed (so you won't remember). She says that the patients still respond to the discomfort in the OR, but they make sure (i.e. add more Versed) that later in recovery, they have no recollection. Some patients, usually doctors needing a procedure, will opt for no meds.

I guess when Terry dies, she will have no recollection. One thing I'm convinced of, vegetative or not, she seems to instinctly respond to stimuli at some level. I would think starvation would be a stimulis... just because she can't then feed herself, doesn't mean what is left of her mind doesn't realize something is terribly wrong.

Posted by Leland at March 23, 2005 07:18 AM

Doctors can administer drugs that supress the brains hunger mechanism. Also, I guarantee you that she is already on morphine either through an IV push or by sublingual drops. She might be thirsty but otherwise not dehydrated because they can still give her an IV of saline solution right? The only tube I've heard mention of being removed so far is the PEG tube (feeding tube). Otherwise many patients are put on a no liquids order in preperation of a procedure or test. All the patient can have are ice chips to keep their mouth wetted down.

Also I couldn't post this comment at first because the questionable content filter didn't like the word m e d i c a t i o n .

Posted by Josh "Hefty" Reiter at March 23, 2005 07:43 AM

> Also, I guarantee you that she is already on morphine either through an IV push or by sublingual drops.

How do you know this?

Posted by Andy Freeman at March 23, 2005 07:55 AM

Interesting link to the blog post about cortex and spinal fluid. Too bad we have no way of establishing the credibility of this report or of the reports it is challenging.

I've had the miserable experience of making a similar decision about a parent. I know that I cannot conceive of altering my decision, or of allowing intervention by strangers, based on the opinion of an uninvolved third party who says he has seen one cat scan or one x-ray.

My bottom line is that this is an issue between the Schiavo spouses, period. For everyone else, it is none of our damned business.

Posted by billg at March 23, 2005 08:43 AM

billg you miss my point

It doesn't matter what Terri wants or wanted. Since the husband has the legal power he can have her killed by his command at his mere whim. What if Terri truly wanted to live? It doesn't matter because the husband has total power in this case.

Posted by Brad at March 23, 2005 08:57 AM

I'm with Andy, how does Josh, know that information to guarantee it. If that is true, it would certainly silent some of the blowhards talking about this subject. I agree that what Josh suggests sounds logical, and would be sensible. The problem is that there is no verification of it. I guess with HIPPA, there really shouldn't be either.

Posted by Leland at March 23, 2005 10:45 AM

As noted above, the facts are here:
http://abstractappeal.com/schiavo/WolfsonReport.pdf
Read it before jumping to any conclusions.

Posted by Toren at March 23, 2005 10:58 AM

No, Brad, I'm not missing the point. The decision was made by her, not her husband. The husband says she told him, more than once, that she did not want to be artificially sustained. Either you believe the husband or you don't. In the absence of any evidence to the contrary, I believe him.

What she neglected to do was to commit this to writing. If she had done that, Brad, would you still argue that her husband could still "have her killed" by following her legally binding decision? Remember, this is a person who would have died years ago if she had not been artificially sustained.

In any case, my position is that the decision rests solely between these two spouses and that no one else -- you, me, her parents, politicans -- have any right to intervene in that decision.

Posted by billg at March 23, 2005 12:38 PM

If her brain is indeed damaged beyond repair, is it really a good idea to keep the woman stuffed with tubes and on morphine until her body dies?

The final decision is being given to the person, or failing that, the relatives. Not the State or the doctors.

I find it curious that a libertarian is in favour of State mandatory artificial life support on terminal cases, but is probably fine with allowing people to smoke.

I can sympathize with the Catholic Church's tenet that life must be maintained at all costs (ignoring the hypocrisy from them on this subject for a bit).

But I do not think it is worthwhile for the State to try to forcibly prevent citizens from hurting themselves, or in cases like this.

Posted by Gojira at March 23, 2005 05:00 PM

billg still missing the point

One more time. Terri left nothing written to express her will about her present condition. THEREFORE whatever her wishes were, it doesn't matter. It isn't Terri who is making any kind of choice, it is her husband who is making the choice. That's the point.

The husband has chosen death. Whether Terri would have wanted it that way is academic because absent of proof it has no legal force. Absent of proof the husband has all the power to decide.

This isn't a "decision between two spouses" it's a decision made by the husband.

Look at it another way. Say that Terri did want to die and left nothing written to prove it. Because of the power granted to the husband he could choose life in spite of Terri's wish. It is completly up to him to choose life or death.

In a situation rife with so much ambiguity is it right to kill Terri? And killing her in such a way that is a crime to do to a dog? The law gives the husband the power to do it. But is it right?

Posted by Brad at March 23, 2005 08:00 PM

Brad, her husband says she told him she would reject life support. I have no way of knowing if she did or not. I'm certain this is a common situation. Most people, especially young people, do not think about that issue and do not put their decision in writing. (Note that Schiavo's parents apparently can produce no written statement contradicting her husband's recollection of her wishes.)

Let me make my position clear:

1. I don't believe society -- courts, politicians, etc. -- has a right to intervene in this situation. I've not seen a convincing argument to the contrary. In the circumstances of this case -- no written statement -- I've no issue with the parents bringing suit. However, I do find efforts to exploit and manipulate this tragedy -- by churches, religious groups, and assorted politicians -- to be reprehensible.

2. In the absence of a written statement, the decision should rest with the nearest living and competent relative, i.e., the spouse. If the spouse is not living, then any surviving parent or other family member. (If the roles in this case were reversed -- if the Schiavo parents insisted she verbally stated her rejection of life support nd her husband was suing to maintain that support, I'm curious if positions would change.)

3. I believe death occurs when the brain ceases functioning or is permanently damaged beyond the point of permitting conscious awareness. (I'm not a doctor and I don't trust the reports we're seeing, on either side, to determine if this is the case with Schiavo.)

4. I believe that if a person is, in fact, unaware and could not survive without artificial life support, it is incorrect to call death following removal of life support a "killing". The cause of death, in those cases, would be the illness, not the removal of life support.

5. These are always ugly heart-wrenching situations in which a family's hopes often run counter to physicians' diagnoses. From the outside, it is easy to argue that life support is often futile and maintained only to meet the family's emotional needs. But, I know from experience, that from the inside it always looks different.

Posted by billg at March 24, 2005 06:37 AM

I believe that if a person is, in fact, unaware and could not survive without artificial life support, it is incorrect to call death following removal of life support a "killing". The cause of death, in those cases, would be the illness, not the removal of life support.

Whether or not she's unaware seems to continue to be in dispute. And she's not on "life support," unless you consider an infant that must be fed to be on "life support." Someone on life support generally dies almost as soon as the switch is turned off.

Mrs. Sciavo has no fatal "illness" from which she's suffering, and if fed, will live for many years more. If she dies after removing her tube, she will die of starvation and dehydration, as would anyone when not provided with food and water for many days. There is no "illness" that will kill her (other than the illness from which every human and other animals suffer--the ongoing need for regular water and nutrition), despite your attempt to redefine what's going on here.

Posted by Rand Simberg at March 24, 2005 06:55 AM

It is sad that many fail to understand the difference, much less the significance, between "Life Support" and "Feeding Tube".

Posted by Leland at March 24, 2005 07:07 AM

billg

Wow. Your definition number 3 is really interesting. According to that people in comas are dead. Since there are cases where people recover from comas (and yes I know the Terry case is not a coma) I guess that by your definitions that is proof of life after death!

Posted by Brad at March 24, 2005 08:45 AM

Brad: A comatose person usually does not have major brain damage. Irreversible brain damage is often caused by stroke, or degenerative brain diseases.

Some people may take years to come out of a coma, or never come out. I personally know two persons which were in a coma for some days.

She is definitively not like a baby. A baby at least can manifest when he wants to eat. A baby is healthy, just not fully developed. The woman is sick, some say beyond repair.

I prefer to not have State mandated decisions for borderline matters like this and delegate them to the citizens instead.

Posted by Gojira at March 24, 2005 12:36 PM

Rand, Brad, first,I'm not redefining anything. You are. I categorically reject your characterization of this as "killing". If the brain no longer functions at a recognizably human level and if there is no hope that those functions will return, I hold that the human being is already dead.

I don't know if Schiavo's condition meets the definition I just stated. You don't know if it meets your definition. But, that is irrelevant, because we have no role to play. Our definitions don't count. This is none of our business. Society and government have no right or reason to intervene.

Putting aside hysterical rants about starting down the road to Auschwitz penned by agenda-driven polemicists, the reason society must not acquire the right to intervene in such matters is because the right to determine when an individual's life is artifically maintained against his or her wishes also encompasses the right to end an individual's life when he or she has opted for artificial maintenance. (Not being a Republican member of the Texas legislature, I don't want the state to have that authority. Presumable, Republican Texan legislators hear directly from God.)

These decisions are made by the thousands every day around the world; I've had to make one myself. I can conceive of no circumstance in which I would have agreed to allow anyone else to intervene.

Posted by billg at March 24, 2005 04:58 PM

Quote from Billg > "If the brain no longer functions at a recognizably human level and if there is no hope that those functions will return, I hold that the human being is already dead. "

I'm sure you are not considering this, but what is the "human level"? Who does define the "human level"? The thing is, Rand defined what he considers a "human level". Your definition of "human level" is different and more stringent than his. Decades ago, many people had a defintion probably more stringent than yours. Then people would consider those with Cerebral Palsy and Down's Syndrome less than the "human level".

Posted by Leland at March 24, 2005 06:01 PM

Leland, my point is that, in regard to Schiavo, my opinion doesn't count. Nor does Rand's. The only opinion that counts is the one person who is now legally responsible for articulating Schiavo's wishes: her husband's. If he thinks that amounts to "killing", then he's the one who has to live with it. Not me, not you, not Rand, not the Bush brothers, not the other 300 million Americans. This is a private matter between spouses and none of the rest of us have any damned business interfering.

Posted by billg at March 25, 2005 11:07 AM

Uh Bill, this is a blog. Opinions are a frequent thing here. I wouldn't expect anything less from Rand or his commenters.

But you know, Rand's opinion does count. So does mine and others. Good or bad, Congress has figured that out. Maybe they might just make some law that guides people in legal fashion between what is "life support" and what is "feeding tube". And if a person doesn't die immediately (lets start with a day) when pulled off the system, then denying them basic things like food and water seems rather inhumane.

Posted by Leland at March 25, 2005 05:32 PM

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