Don't tell me you haven't been discussing this at some point over the past few days:
Terri Schiavo (I'm sorry, but why doesn't the AP have a better quality picture?)To give an inadquate recap of events: Terry Schiavo is in a
persistent vegetative state. Her husband, her legal guardian and
surrogate medical decision maker has been trying to have her
feeding tube removed since 1998. The tube was removed in 2001, but reinserted shortly thereafter while the appeals court considered the case. After 3/5 doctors testify before the court that Terri is in a persistent vegetative state, her feeding tube is again removed in 2003, but again shortly reinserted after Gov. Jeb Bush signs "Terri's Law" and issues a stay ordering the feeding tube be reinserted. The law is declared unconstitutional by the US Supreme Court. The feeding tube is removed for a third time on March 18 of this year, despite efforts by Congress to delay this while they hold a congressional hearing on the matter along with appeals for the US Supreme Court to intervene. In a special Sunday session, yesterday, the US Congress passes a new "Terri's Law," which President Bush signs, transferring jurisdiction of the case to a U.S. District Court for a federal judge to review. That's where we stand.
Before I take a stand on this, let me first point out some points of interest:
- Terri Schiavo had previously expressed a desire never to be kept alive by artificial means, presumably including a feeding tube. Her husband states that his decision on her behalf is what she would want.
- Irony (via NPR commentary): The effort to keep Terri alive is being spearheaded by Bush and conservatives in congress. Her medical care is being funded by (1) Medicaid -- for which Bush and conservatives in congress want to cut spending, and (2) a multi-million dollar malpractice suit -- the likes of which Bush and conservatives in congress want to cut back.
- Persistent vegetative state (PVS) is a heart-breakingly unclear state of being. It's not like a coma, when the person is unconscious and seems to be not-there at all. It's not like being alert and interactive, either. Rather, someone in PVS is unresponsive to stimuli, though they maintain a sleep-wake cycle and will do things like smile, grimace, and make noises, though again, not in response to anything in particular. The picture above is misleading in that it looks like Terri is smiling in response to her mother's kiss, which is probably not the case. Finally, PVS is a condition about which not much is known as to the neurologic and physiologic basis of the condition. That's why there was dissension among the ranks as to whether Terri will come out of this.
- Contrary to your gut reaction, "starving to death" is not terribly inhumane. In my experience and by what has been related to my by countless physicians involved in end-of-life care, you're hungry for about 2 days, and then you don't feel any pain whatsoever. Being resuscitated multiple times via electric shock and having people jumping on your chest? That's an inhumane way to die.
- Right to Life (of which I am a member) is a powerful social and political force in the world. Right to Die is not.
- People prefer to think of dying as heart-lung death rather than in terms of brain death. People prefer to think of personhood in terms of mental capacity rather than in terms of heart-lung capacity. As a result, those who are "brain dead" exist in a limbo when many would consider them still "alive," though many others might no longer believe that there is a "person" there. There are parallels at the other end, in the abortion debate.
The public perception of this whole issue is that the courts are giving Michael Schiavo the power to kill his wife, or, more strongly, that the courts are killing people as evidenced by protests such as these:

(protesters outside the federal court)
But the fine line that physicians and others involved in health care decisions walk is the difference between "killing" and "allowing to die." As medical technology allows us to sustain life (in a heart-lung sense), there has been a backlash in that many people don't want to "live" that way. So there are things like
advance directives, which allow people to try to die a peaceful death.
If Terri Schiavo weren't in PVS, there would be little debate or uproar about the whole issue. Everyday, people across this nation elect not to be sustained by artificial means, including feeding tubes, and no one tries to write a law to prevent their will from being carried out. But the fact that there is disagreement between those who want to act in her best interests makes this now a subject of debate and division.
Back in the day, doctors made most of the medical decisions and the patient went along with it. The abiding concept in medicine at that time was
paternalism, in which the doctor always decided what was best for patients. In those cases, he was usually right, given the patient's lack of expertise. However, some patients want a greater amount of control over their care. Currently, the physician-patient relationship is more of a partnership, with the doctor providing care in accordance with what the patient wants (within reason). I can argue that this has lead to other ethical issues, but that's another debate that I'll leave for later.
In this current climate of "doing what the patient would want," it's interesting that so many still have the impulse to do what they think is in her best interest. Her parents and those in government who have sought to give her parents the ability to keep her "alive," claim to know what is best for Terri. Her husband claims to know what she wants. It's good to have the problem be that everyone wants to act in her best interests, but, at the same time, it's frustrating that the dissent should be so polarizing.
I suppose I fall on the "right to die" side of this divide, though I hate to turn my back on the right to life. Really, I don't think it has to be an all-or-nothing matter, though I think that some of my colleagues in the right to life ranks might disagree. But my take on this issue is that Terri isn't living. She's dying (and wants to die), and we're keeping her alive with our fancy medical treatment.
I'm no neurologist, and I can't tell you if the 2/5 doctors who testified were right in believing that she can get better with therapy, as her parents claim. But it shouldn't matter. We can keep people alive by all sorts of extraordinary (and sometimes ordinary) means. But we've lost sight of the fact that dying is just as natural as living. We strive to ensure that people can live as they wish (within limits), but we are reluctant to ensure that people can die as they wish (within limits).