I guess it's post msnbc articles day for me today

[smg01]

Here's a little Q&A with a Roman Catholic bioethicist regarding end of life issues. I'm not Catholic, so I found it interesting to see the perspective he offered in the context of RC teachings. He also raises the issue of regarding death as an unmitigated evil that I'd been rolling around in my head. He addresses it more articulately than the thoughts that I'd managed to piece together.

Comments

[mircalla35.livejournal.com]

Hey, I read that too, and that struck me as well! It's true, it does seem slightly contradictory that Christians would be presenting death as the worst thing that could happen to Terri, because according to doctrine that is simply not true. There's heaven and God's presence and all that good stuff. Not that that means it's okay to speed people on their way to their reward in most circumstances, but in this case she would be trading her half-life (or quarter-life, or eighth of a life, or whatever) for something so much better. Which is not to say that we should speed anyone along the way just because their lives are hard...oh, shoot, even mock-discussions with Jesuits made my head hurty. Point is, Terri's not in there, and finally letting the shell of Terri go would mean that she will finally be at peace, and that's not a bad thing.

However, I was wondering -- if Terri expressed her desire not to live like that to her husband and friends, and the courts are acting on those wishes in ceasing care for her, does that constitute suicide according to Church doctrine? Because then her death would be an unmitigated evil, because she would not go to heaven, right? Of course Christians siding with the Schindlers are saying that that isn't what she wanted, so they think it's murder and not suicide, so Terri, if she was a good Catholic and all, would go to heaven. Oh damn my head just exploded. I have too many thoughts and none of them make sense, oy.

[suzannemarie.livejournal.com]

It's such a tough issue because the answers probably seem a lot clearer when someone you love isn't involved. I know that I think that 15 years in a coma, on a feeding tube, with no improvement is long enough. But even being 100% sure that removal is the right thing, if it were someone I loved, it would be hard to be completely at peace with it.

Sometimes I wonder if all of the medical technology that's now available is a good thing. 99% of the time I'd say that it is. But on the other hand, it also seems that it means that more and more we humans have to make decisions that perhaps we were never really meant to make. I think there comes a time when Nature herself gets to have the final say. Personally, I think that reaching the point of letting go and letting nature take it's course is neither suicide nor murder (though the feeding tube issue is certainly more complicated than conventional life support). I don't envy anyone who ever has to make that decision and I sincerely hope that I never have to.

If nothing else, this case surely illustrates how important it is to be very, very clear about your own wishes and to have those wishes in writing to the extent possible.

[cindywrites.livejournal.com]

She's not in a coma. Even Michael Schiavo's side acknowledges/affirms that. What's at issue, or, what the Schindlers have tried to put at issue is that three doctors said she was in a persistent vegetative state (awake but not aware) and two doctors said she was not in that state, but was minimally conscious.

I agree with your final point though. If nothing else comes out of this, that will.

[suzannemarie.livejournal.com]

I've been reading your posts at your own LJ and recognize that we're not in agreement on this particular issue. What I keep coming back to is that every doctor who has raised the diagnosis of minimally conscious has done so after a range of zero to minimal personal physical contact with the patient.

Every single court appointed doctor and all three guardian ad litums reached the same conclusion after extensive examination and time spent with the patient and family. These are doctors appointed by the court to fact find for the court and ad litums appointed to protect the interests of the patient. One of the litums that I heard interviewed talked about how he spent several weeks trying to find any evidence that Terri was responding to things in ways that her parents believe that she is. He couldn't find find any. I just cannot believe that all of these professionals are part of a court conspiracy orchestrated by Michael Shiavo to kill Terri.

We can't see into the hearts and minds of the individuals involved here, so, to great extent we're left to inject our own values and beliefs into the story. Here are mine. Personally, I don't like death. I hope my own and that of the people I love is many, many, many years distant. But, there are things worse than death. Living on and on in a state breathing unawareness while those who love me are held hostage to that state of being would be a horror to me. Fifteen years is more than long enough to investigate whether there are therapies and treatments that will reverse the condition. If it hadn't been found in that time, I would want to be let go.

Ultimately, though, it doesn't really matter what I think about the situation surrounding Terri Shiavo. In the end, after the courts have had their say, and court of public opinion has had it's say, it still comes down to the family and the need for them to find their own way to deal with the situation and the fallout from it. It's sad, troubling, depressing to watch this play out for others in such a public manner. I guess in the end, the only positive thing that I can take from this whole situation is, as I said earlier, the vital importance of thinking these issues through for ourselves and making sure that our desires are known and clearly understood by people who may someday be faced with having to make their own difficult decisions.

In this entire situation with the Shiavo family, I see a lot of victims and no heroes. Certainly there are no winners. This is an awful, wrenching family decision made obscene because it's playing out in the courts on a national stage. I feel a little dirty watching all of this and seeing these intensely personal issues out in public view as it were. And I feel a little icky commenting on it. Although it didn't seem to stop me from making this ridiculously long post about it....

[cindywrites.livejournal.com]

it still comes down to the family and the need for them to find their own way to deal with the situation and the fallout from it. It's sad, troubling, depressing to watch this play out for others in such a public manner. I guess in the end, the only positive thing that I can take from this whole situation is, as I said earlier, the vital importance of thinking these issues through for ourselves and making sure that our desires are known and clearly understood by people who may someday be faced with having to make their own difficult decisions.

In this entire situation with the Shiavo family, I see a lot of victims and no heroes. Certainly there are no winners. This is an awful, wrenching family decision made obscene because it's playing out in the courts on a national stage. I feel a little dirty watching all of this and seeing these intensely personal issues out in public view as it were. And I feel a little icky commenting on it. Although it didn't seem to stop me from making this ridiculously long post about it....

Here, we're in complete agreement.

I think you are mistaken about the doctors' opinions. Five doctors testified in the trial. Two were hired by Schiavo, one appointed by the court, and two were hired by the Schindlers. All examined her, and reviewed her records. The Schindlers' doctors reportedly spent significantly more time with her, than the Schiavo and Court-appointed doctors. Schiavo's and court's doctors rendered a diagnosis of PVS. The Schindler doctors did not.

The judge then made a finding of fact that she was in a PVS, which is well within his legal and moral bounds to do. After that finding of fact, he ignored all subsequent testimony (sworn affidavits/depostions to the contrary), including those by healthcare professionals who had worked with Mrs. Schiavo, and testify to behavior she would not be able to exhibit if she were in a PVS. Judge Greer is still well within his legal bounds, but I question the moral bounds.

Judge Greer has ordered the removal of a feeding tube from someone who is not dying (which would change the whole thing for me, morally), based on 2 things:

(1) His own finding of fact that she is in a PVS;

(2) His own finding of fact based on hearsay, that Mrs. Schiavo would refuse food, if she had the ability, despite good evidence it is against her religious beliefs, and testimony of friends and family that it was contrary to her known nature to make such statements.

Death is irreversible. Since she's had no meaningful therapy for a dozen years, since her husband is now living as the de facto husband of another woman, I think there is enough question here, that morally speaking, the correct way to approach this would have been to:

a) Re-establish speech, physical, and occupational therapy for a minimum time period (maybe three months, but I'm pulling that number out of a hat, because it seems reasonable)

b) Perform new swallow tests, a few times, over the course of therapy

c) Order a PET Scan

i Much has been made of the fact that Mrs. Schiavo did not have an MRI after the PVS diagnosis was rendered. It is disputed by Schindler-supporters whether or not had one. There seems to be documentation from July of '91, indicating she did.

She could not have an MRI now, without removing a shunt in her brain. That shunt has been there for over a dozen years. I believe (am not certain) that it was part of a treatment that called for it to be removed after 3 mos. I believe (am not certain) that Schiavo disregarded doctors orders on the treatment protocol. Regardless, I think it would be unkind to Mrs. Schiavo, to subject her to the surgery required to remove the shunt now, just for tests, when she could still have a PET scan.

d) Appoint a team of neurologists specializing in PVS, to oversee her therapy, tests, review her records, examine her, and render a decision on the PVS.

After that, if PVS is confirmed, anyone who contests the removal of her feeding tube will only be doing so on the basis that they cannot believe we have the right to remove basic nutritional support from anyone. It's their right to believe it, but it's not Florida law.

[cindywrites.livejournal.com]

Under "C" where I have an italicized, lower-case "i", I was trying to indent, but it just looks like I'm quoting. Just to be clear, it's just bad coding on my part.