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March 26, 2005

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Joe Mealyus


Thanks for printing that Marshall quote. It's nice to see something from the left one can agree with so completely. "Nothing sacrosanct" about the Florida legal regime - so different from the he's-her-husband-dude commentary that has seemed to dominate. "[F]rom what I can tell" - a qualifier put there for a reason, if ever one was.

The only place I'd disagree with him is the "larger political purposes this is being put to" - I think the R generals were following the soldiers, not the other way around. (This is an issue the natural instinct of all politicians is to wimp out on - especially given that pertinent medical information could come out in the future to make one side or the other look bad).

Thank God for Tom Harkin, if nothing else. I wonder if in 3 years (after much quiet legislation and/or rule-changing) there will be a state in the country where a Michael Schiavo is even remotely possible.

Warmongering Lunatic

I don't get the criticism of the Congress. IMO, it's not a bad precedent for the Congress, when it has reason to believe someone's Constitutional rights are being violated by a state, to order a Federal review of the case.

Which is all the very narrow Schiavo bill did.

Ridolph

I think that Terri's parents have convinced themselves that she is still in there, trying to communicate with them. It's sad, but since she's moving around, making noises, moving her eyes, and all that, they think that must mean that she's trying to get through. It's not true, but it's understandable.

TM

I agree. I suppose that is one reason that medical ethics leaves the choice up to the patient or the surrogates.

I had missed it, but Krauthamer was good, and similar to Marshall:

...The problem is that although your spouse probably knows you best, there is no guarantee that he will not confuse his wishes with yours. Terri's spouse presents complications. He has a girlfriend, and has two kids with her. He clearly wants to marry again. And a living Terri stands in the way.

Now, all of this may be irrelevant in his mind. He may actually be acting entirely based on his understanding of his wife's wishes. And as she left nothing behind, the courts have been forced to conclude, on the basis of his testimony, that she would prefer to be dead.

That is why this is a terrible case. The general rule of spousal supremacy leads you here to a thoroughly repulsive conclusion. Repulsive because in a case where there is no consensus among the loved ones, one's natural human sympathies suggest giving custody to the party committed to her staying alive and pledging to carry the burden themselves.

Let's be clear about her condition. She is not dead. If she were brain-dead, we would be talking about harvesting her organs. She is a living, breathing human being. Some people have called her a vegetable. Apart from the term being disgusting, how do they know? How can we be sure of the complete absence of any consciousness, any awareness, any anything "inside" this person?

... Given our lack of certainty, given that there are loved ones prepared to keep her alive and care for her, how can you allow the husband to end her life on his say-so? Because following the sensible rules of Florida custody laws, conducted with due diligence and great care over many years in this case, this is where the law led.

For Congress and the president to then step in and try to override that by shifting the venue to a federal court was a legal travesty, a flagrant violation of federalism and the separation of powers. The federal judge who refused to reverse the Florida court was certainly true to the law. But the law, while scrupulous, has been merciless, and its conclusion very troubling morally. We ended up having to choose between a legal travesty on the one hand and human tragedy on the other.

There is no good outcome to this case. Except perhaps if Florida and the other states were to amend their laws and resolve conflicts among loved ones differently -- by granting authority not necessarily to the spouse but to whatever first-degree relative (even if in the minority) chooses life and is committed to support it. Call it Terri's law. It would help prevent our having to choose in the future between travesty and tragedy.

TM

The Times is very interesting, and finally makes itself useful by doing some reporting from around the nation.

Tom Mayo gets quoted again, too.

Even as Doctors Say Enough, Families Fight to Prolong Life By PAM BELLUCK

BOSTON, March 26 - For years, when families and hospitals fought over how to treat critically ill patients, families often pressed to let their loved ones die, while hospitals tried to keep them alive.

But in the last decade or so, things have changed.

Now, doctors and ethicists say that when hospitals and families clash, conflicts often pit families who want to continue life support and aggressive medical care against doctors who believe it is time to stop.

"The most common case that comes before the ethics committees," said Dr. John J. Paris, a bioethicist at Boston College, "are families now insisting on treatment that the doctors believe is unwarranted."

Extraordinary medical advances have stoked the hopes of families. Also, more patients and families feel empowered to make medical decisions, and some are skeptical of doctors' interpretations or intentions.

... Some are wary that doctors may be truncating treatment because of soaring medical costs, and Dr. Dianne Bartels, associate director of the Center for Bioethics at the University of Minnesota, said: "Sometimes there's also mistrust of the medical system. A doctor might have said, 'Your husband's never going to make it,' and he's already survived two or three times, so why should they believe the doctor?"

Thomas W. Mayo, an associate professor at Southern Methodist University law school and an author of the Texas law, cited another reason.

"There are more specialists with less contact with the family," Mr. Mayo said. "As patient volumes have increased and reimbursement rates cut to the bone, there's less incentive for everyone in the system to provide that. When a stranger says, 'Well, there's nothing we can do other than turn things off,' you're hearing that from someone you have no reason to believe other than he's wearing a white coat."

The Texas law, signed in 1999 by Gov. George W. Bush, allows doctors to remove life-sustaining treatment over the objections of families, provided an ethics committee agrees and the hospital gives the family 10 days to see if another facility will accept the patient.

Dr. Robert L. Fine, an author of the law and the chairman of the clinical ethics committee at Baylor University Medical Center in Dallas, said that life support could be withdrawn even if a patient's living will specified otherwise, but that ethics committees would give great weight to such a document.

Well,theycouldhave had more on the broad support for the Texas law (passed unanimously) and the involvement of all groups in drafting it.

vadkins

How is it that Josh Marshall can decide (and you agree with)this:
"As for the medical questions involved -- specifically, Shiavo's level of awareness or consciousness -- from what I can tell, every independent doctor who has examined her has put her in the PVS category. Those who don't turn out to be either quacks or doctors who didn't do a complete examination."?

The column at nationalreview.com by Reverend Robert Johansen titled, "Starving for a Fair Diagnosis" (URL: http://www.nationalreview.com/comment/johansen200503160848.asp) states that Ms. Schiavo was never given an MRI or PET scan that according to 15 (at least) neurologists are required before diagnosing PVS. In the article Rev. Johansen says that when a neurologist named Dr. Morin learned that Ms. Schiavo had never had an MRI or PET scan he said, “That’s criminal,” he said, and then asked, in a tone of utter incredulity: “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?” He drew a reasonable conclusion: “These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information.”

The level of ignorance of this case by people is astounding to me. It wouldn't really matter if the stakes weren't so high. This intellectual carelessness is going to end up getting many baby boomers killed/murdered in 20 or 30 years from now-if not sooner.

vadkins

MisterPundit

Excellent post Tom, and I completely agree with this :

My basic position has been, the legal result - a husband effectively ordering the termination of his spouse over the objections of the mother, father, brother, and sister - shocks the conscience, or my conscience, anyway.

To me, that is EXACTLY the problem here. I have a tough time accepting that Terri is going to be put to death even though there are people - her own parents - who are volunteering to look after her until she dies naturally.

Toby Petzold

Mister, your characterization of what's going on as Terri Schiavo being "put to death" is simply pejorative. What satisfaction is there in persisting with fruitless treatments or indefinite care when it was already determined a long time ago that her wish was to die with dignity? This notion that it is morally superior to keep Terri Schiavo alive by artificial means excludes the legitimacy of her own free will. She has no will to exercise now, but she once did in this particular regard, according to her husband who, in the eyes of the law, is her next of kin. That is a Biblical relationship. So if we're going to be self-consciously Judeo-Christian about the nature of our society's laws, let us contemplate the union of one man and one woman ---and what's so important about observing the sanctity of that.

gt

Tom,

Terri's husband is not ordering her termination. If you use such loaded language any reasonable debate is impossible.

It is Terri's wishes, as determined by the trial, that are driving this.

Now you may think that the finding of what Terri wanted is wrong. That's fine. But that's why we have courts and appeals. I suspect everyone who is on the losing side of any trial thinks they have been wronged. Are conservatives going to pass special laws for all of them?

Or maybe you think, as many have said, tha when in doubt one should always err on the side of caution and rule to keep the tube. If so conservatives and the GOP should propose to change the laws governing these case so that anyone who doe not have a written will is automatically be presumed to want to continue living. When can we expect that?

And it is very strange that you would equate Krauhammer's vile and disgisting screed to Josh's postings. Krauthammer claims, wtih no other basis than his biases, that Terri stands in the way of her husband, practically accusing him of wanting her dead. Has he not heard of divorce? If Michael wanted to he could have left Terri long ago. It is in fact a testament to his fidelity that he is trying to fulfill the last and only wish he can for his wife, to die in dignity and peace.

Patrick R. Sullivan

Don't quit your day job, to become a professional logician, GT.

TM

Terri's husband is not ordering her termination. If you use such loaded language any reasonable debate is impossible.

It is Terri's wishes, as determined by the trial, that are driving this.

Debate is impossible? Gosh, I find myself debating every day with folks who are either uninformed or married to their talking points (sometimes both).

Let's see - Michael S. initiated this action, gave the key evidence, and could stop it today simply by appearing on CNN (or are you interested in arguing that a court would reject his tearful "spare my wife" plea. Pease don't).

So maybe "effectively controlled" would be better than "effectively ordered" (which is what I wrote, and I put "effectively" in there to distinguish from "actually, or literally" ordered - thanks for noticing).

However, I don't think the differecne is so great that one phrase is true yet the other is beyond the pale. However, I may not be much of a judge of liberal sensitivities.

Now you may think that the finding of what Terri wanted is wrong. That's fine. But that's why we have courts and appeals. I suspect everyone who is on the losing side of any trial thinks they have been wronged.

Sort of sidesteps the question - I think *this* outcome is wrong. Your view is what - you won't form an opinion on this one unless/until you form an opinion on every case in the world?

We won't be hearing many more opinions from you, I guess.

As to why we have courts of appeal,I am not saying the decision is ilegal, or contrary to FLA law - I am saying it is WRONG. Does that distinction elude you? Did it elude liberals in the 60's, when discrimination in the South was legal and routinely upheld by the courts?

And it is very strange that you would equate Krauhammer's vile and disgisting screed to Josh's postings. Krauthammer claims, wtih no other basis than his biases, that Terri stands in the way of her husband, practically accusing him of wanting her dead. Has he not heard of divorce?

Uh huh. This would stand in contrast to the calm, informed discussion about Tom DeLay's or Bill Frist's motives.

Perhaps Krauthammer has heard of love at first sight (With respect to the "other woman")? Control freaks? Greed, revenge, who knows? In the whole gamut of human emotion, GT, is it really your position that love and devotion are the only imaginable explanations for Michael Schiavo's actions?

I think that says more about your imagination (or the imagination of whoever is scripting Dem talking points) than it does about Krauthammer, or this case.

Well, questions you ducked:

(1) do you feel good about this outcome of the case?

(2) do you think that no more sensible "right to die" law than Florida's could be written?

(3) do you think that a law giving the Federal courts one last look (as passed by a unanimous Senate and an overwhelming proportion in the House) was an outrage?

John Burgess

You're correct that Florida law is not immutable, nor is it perfect. But the law is as it is because of a long process, exceeding 15 years, in which the citizens of Florida, through their elected representatives, hammered out just what they thought the law should be.

The Florida State Senate--a body dominated by Republicans, by the way--tried to unilaterally re-write that law in 2003, with Terri's Law. That law was found to be unconstitutional.

The Florida State Senate, earlier this month, declined to follow that particular legislative road again, voting down what would have been Terri's Law III (the US Congress tried Terri's Law II).

Floridians have the ability to change state law if it does not suit them. But the US Congress and citizens of 49 other states do not have that ability or right. Everyone is welcome to an opinion, of course, but opinions bear no weight in another state's courts, a fact for which we should be thankful. The one exception to this is a narrow range of federally protected rights, which in the Schiavo case were found to be adequately protected.

While I might think that California's fuel and pollution laws need reworking, I have no say in the matter unless and until I move there and get to vote in local elections. Similarly, I'm not really crazy about a lot of the laws in effect in NY City. Not my problem, though, as I'm not going to choose to live under those laws by moving there.

If one feels adamant that Florida's laws need to be changed, one can move down here and qualify to vote. Until then, I'll refrain from telling you what the laws of your state "should" be, and you can do the same in return.

It is an absolutely great thing that 50 states get to create their own laws. It gives us all a much better chance of getting things right. If I dislike the laws in my state, I have political power to try to change them more to my liking. If I still don't like the result, I have the power to pick up a phone and call Mayflower or Atlas.

Paul Zrimsek

In every other state that has a Senate, its members are elected representatives. How are they chosen in Florida?

gt

Tom,

This is a tragedy with no good outcome IMO. But the law is what it is.

What bothers me is that those that wish Terri's feeding tube to remain keep atacking Terri's husband, who is simply following her wishes, or the courts, who are simply following the law.

If conservatives think that lack of a written will automatically default to keeping the tube then change the laws. But don't blame the courts for enforcing what is in the books today.

There is no need to spread vile and disgusting innuendo on Michael Schiavo. If I were to fall into PVS for 15 years I expect my wife will move on but I also hope she will do all in her power to make sure I can die gracefully, after reasonable efforts have been made to try to revive me. If you read the Guardian ad Litem's report you know that Michael spent several years tryng to cure his wife, to the point that the hospice staff hated him for beng so demanding. But after several years he came to accept what doctors had been telling him all along, that there was no hope.

If you dislike the outcome you and others on the Right should not accuse the courts or malign the husband but try and change the laws.

TM

The Florida State Senate--a body dominated by Republicans, by the way--tried to unilaterally re-write that law in 2003,

I am a bit puzzled as to what "unilaterally" means in this context.

If one feels adamant that Florida's laws need to be changed, one can move down here and qualify to vote. Until then, I'll refrain from telling you what the laws of your state "should" be, and you can do the same in return.

Can't help you there. As a citizen of the US, I feel free to comment not only on what happens in the US, but all over the world.

Put another way, I don't intend to wait for democracy in North Korea to criticize their government, or for my right to vote in EU elections before criticizing the French.

And when there are best-selling books titled "What's Wrong With Kansas", well, I guess I am not alone.

BTW, Donald Sensing made the same silly argument (I'm from TN, I shouldn't do FLA), and got trounced in his comments for it, as well.

For the record, I said few days back that I thought terri's Law III (default assumption of "choose life, absent specific written instructions) was a terrible idea - 99.9% of time, families don't need (and often don't have) written instructions.

And for some bonus mocklery of GT - I posted that this NY Times piece was a "Michael basher", but he insisted in the comments that it was fair and balanced.

IMHO, they go even further than Krauthammer's "vile and disgusting" speculation about Micheal S. motives based on nothing but his "biases":

It is easy for most people to assume that blinding love for their daughter drives the parents, who have begged Mr. Schiavo to give them his wife and walk away. But his motives are harder to fathom. Is it stubbornness that drives him, or fervor to commit fully to the other woman in his life, a girlfriend of eight years with whom he has two children? Does he want Ms. Schiavo to die because she is a burden, or because, as he says time and again, he promised her not to keep her alive by artificial means?

Disgusting. Oops, sorry, fair and balanced.


reliapundit

EXCELLENT post that spells out where we're at and why so many of us are upset - but accepting of where we're at.

I am ONLOY really peeeeeeed off that the federal courts seemed to thumb their noeses at Congress, and seemed to me to give this case too little review AFTER this special act was passed for the expressed purpose of getting a de novo hearing.

t seems to me that convictd murderers get more substantial review before thier execution than Terri's folks got. that seems very unfair to me.

on their behalf, i wnt to add how amazzing they are - and ALMOST all their supporters, too.

i mean, lookit: here we got a case that ionvolves questioable laws, questiobale judges, and questionable lawyers and decisions - and a ULTIMATE decisdion that violates their most basoic religious beliefs on their holiest holiday - a decision that has led to the slow torturous death of their daughter - and yet they are obeying the decision.

How tough this must be, and how gallant and brave and true and good of them to alloow for the rule of law even when the law sucks and the law was imperfectly applied.

God Bless the Schindlers - all!

Appalled Moderate

My one thought. There has been a lot of casual demonization of Michael S. The striking thing here is that it would have been extremely easy for him to simply walk away from the problem in any part of this ten year saga. He hasn't.

The question, for those who are rather quick on the moral judgments here, is why? The most plausible explanation is that he is doing (i) what he believes she wanted or (ii) what he thinks is right. These might be the acts of a stubborn man, but they aren't the actions of an evil person deserving of national villification.

TM, I await the possibility of state laws wrought in a climate of emotionalism with a whole lot of trepidation.

Brad DeLong

Re: "My basic position has been, the legal result - a husband effectively ordering the termination of his spouse over the objections of the mother, father, brother, and sister - shocks the conscience, or my conscience, anyway."

Yep. That disturbs me too...

Of course, other things disturb me as well. That she has been allowed to linger for fifteen years with a flat EEG disturbs me. That nurses' time and money that could have gone to curing people has been spent caring for her long after her soul has fled disturbs me. That her parents seem to have no friends: that there is no sign that anyone is helping them come to a recognition that their daughter's soul has long fled, and that it is time to mourn--that disturbs me.

What do I think should be the resolution? God knows--I do not. The best resolution would be for her parents to recognize the gravity and irreparability of their daughter's injuries, and agree that it is time for her to die. But we cannot get there...

ed

Hmmmm.

"Of course, other things disturb me as well. That she has been allowed to linger for fifteen years with a flat EEG disturbs me."

Actually this is something I find curious. How is it possible for Terri to actually move around and yet have a "flat" EEG? Is that actually possible? I've asked a number of nurses, and I plan to ask a couple doctors tomorrow, about this. The nurses have assured me that someone with a flat EEG wouldn't be able to move at all. Frankly that doesn't make any sense at all.

EEGs work through sensors placed on the scalp. The assumption being that any electrical activity will be detected by the sensors. But if there's significant brain damage, is this assumption correct? If the damage is sufficient to make the top 1/2 inch non-functioning, would electrical activity in the deeper portions of the brain show up on sensors applied to the scalp?

And isn't this why MRI/PET scans are/should be required for situations like this?

TM

TM, I await the possibility of state laws wrought in a climate of emotionalism with a whole lot of trepidation.

LOL. Well, the good news is, the Florida State Senate declined to pass the silly Terris Law III. More good news - the price Senate Dems extracted is that Tom Harkin's bill relating this to disabled folks will get a look.

And I am in about 99% agreement with the Prof. My quibbles:

Re flatlining - I have been in a Persistent Blogatative State with a flat EEG for about three years, and no one has come for me.

Her parents have no friends? I didn't know that, although they did move from Jersey (or Philly) down to FLA back when Terri did, I think.

As to counseling her folks to move on - I agree, but I think that the answer there is the same as with "why is Michael so persistent, must be love".

Our adversarial court system does a good job of challenging both sides to make their best case. It does not do a good job of encouraging either side to reflect, or show doubt.

It may well be that neither Michael not the parents were as sure about what Terri wanted seven years ago as they are now, when the lawyers, the competitive urge, and the desire for control have taken over.

As a random example, Bob Somerby still lights up when you slight Al Gore. Bob, it is over. OVER! But that is his position, and he is stuck with it.

Or me and Krugman - at this point, its Kabuki theater for me. If Krugman wrote that it was a beautiful sunny day, I would rip him for his insensitivity to the rising incidence of skin cancer.

My point - if this had been pitched into mediation seven years ago, and everyone's control issues could have been placated, this might have been settled sensibly. This is a bad case for the courts.

Oh, and my proposed legal reform that you have not heard before - the Spousal Benefit Freeze.

For example - in the Schiavo case, Michael announces his belief that termination is the way forward. His spousal benefits and rights (house, Soc Sec, life insurance, rights as guardian, whatever) are then frozen, so that henceforth, they will be evaluated as of the Freeze Date.

Subsequently, he can divorce and remarry without losing his prior rights. So, he can move on while mediating/litigating.

In this example, it would at least partly shut up the folks who say he only wants her dead so he can remarry, and that he is only staying married for (a) the trust (a possible motivator when he initiated this action, but not now); or (b) to preserve his rights as guardian so he can be the control freak we have read about in the fair and balanced Times.

gt

Tom,

Maybe you missed where the NYT reported that :

A month later, on St. Valentine's Day, both sides say, a fight over the award signaled the beginning of their estrangement. The way Mr. Schiavo has described it, he was visiting his wife when the Schindlers walked in and Mr. Schindler asked how much money he would receive from Mr. Schiavo's part of the malpractice settlement.


Fair and balanced.

Tom,

Is it your contention that love and devotion are the only explanations of the Schindler's behavior?

The Sanity Inspector

I think I'm gonna get me a living will like Kevin McGehee's got.

Patrick R. Sullivan

"If I were to fall into PVS for 15 years..."

I'd be happy to provide evidence for the last two years, GT.

Is it just me, or is there a glaring contradiction in the following:

"...time and money that could have gone to curing people has been spent caring for her long after her soul has fled .... there is no sign that anyone is helping them come to a recognition that their daughter's soul has long fled....

"What do I think should be the resolution? God knows--I do not."

Jamie

GT cites the NYT:

A month later, on St. Valentine's Day, both sides say, a fight over the award signaled the beginning of their estrangement. The way Mr. Schiavo has described it, he was visiting his wife when the Schindlers walked in and Mr. Schindler asked how much money he would receive from Mr. Schiavo's part of the malpractice settlement.

Does anyone have a citation for how the Schindlers describe the exchange? Because this point of view sure is handy for Mr. Schiavo. As I understand it (moot though the point may be by now, God be good to Terri), the Schindlers have repeatedly offered - begged - to take over Terri Schindler Schiavo's care, including financial obligation for that care, in spite of having received zilch of the settlement that Mr. Schiavo has reportedly split between Terri's care and his own legal fees.

As for the settlement's being gone and therefore no longer a "motive" for Mr. Schiavo to seek her speedy demise if he were that kind of man, I last heard that there was about $50K left, dwindling with each court filing from the Michael Schiavo side. Isn't the prospect of running OUT of money before the need for care and/or legal fees also runs out still a "motive"?

And finally, I didn't see anywhere in this comment thread the statement that's been in many other places about the nature of the various rulings that have taken place: so far they've only been procedural. No new examination of the evidence, only findings about whether the initial court proceedings that led to the "findings of fact" (regardless of questions about their factual nature, raised at the time and at present) were valid. Meanwhile, an innocent life ebbs, and arguments in favor of its winking out just... seem to lack a whole lot of... I can't think of the word. One more time, right-to-die side: "The court is only enforcing Terri's wishes [sotto voce] as recalled by her effectively ex-husband, his brother, his sister-in-law, and a friend, and as expressed in her healthy early 20s after watching a TV show and at a funeral.[/sotto voce] The evidence meets the 'clear and convincing' standard required by Florida statute, honest it does."

Brad DeLong

Re: Is it just me, or is there a glaring contradiction in the following: "...time and money that could have gone to curing people has been spent caring for her long after her soul has fled .... there is no sign that anyone is helping them come to a recognition that their daughter's soul has long fled...." "What do I think should be the resolution? God knows--I do not."

It's just you. Terminating Ms. Schiavo while her parents still think there's hope strikes me as monstrous. Keeping her alive fifteen years after her soul has fled strikes me as monstrous. Those are the options.

Tim Maguire

As a stem cell researcher, in retrospect, a majority of the bills addressed by our government have been more of the flavor of public appeasment, as opposed to actual scientific/clinical benefit. And your statements above show that the appeasment idea is not working out to well.

However, with the new bills that are being addressed now, they are finally coming to terms with real issues in the stem cell community. Hopefully all legislative members finally arrive on the same page, and the FDA follows suit, so that we can see the realization of stem cell therapies sooner then later.

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