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March 21, 2005

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TexasToast

Kleiman said he would support "pulling the plug" in all three cases. Thought that might be important.

BTW, as AM said in the prior thread, the federal court will only change the result if there is a fundamental federal right or if the fact finding by the florida courts is fatally flawed.

Judicial activism anyone?

The Apologist

Gee whiz Minuteman, I hope I'm never on the wrong side of your blog. That was brutal. Kinda fun to watch though.

From a distance. (Don't wanna get any blood on me.)

TM

Hmm, I actually tried to dial it back a bit. Looks like it's back to Anger Management. Troubling...

ChasHeath

As with the OJ trial and various other media massacres, I haven't followed the news on this.

But it does seem unusual to make a federal case out of this. Where is the conservative precent of transfering responsibility from states to the federal level? If this belongs in federal court at all, why was an act of congress necessary to get it there?

Walter E. Wallis

If Terri had left a written living will, there would be little argument about allowing her to die. The argument is whether her husband is accurately conveying his wife's wishes. Unless a whole bunch of doctors have lied, Terri is dead.

Willis Walton

Of course, some people would like to kill Stephen Hawking too.

Terri is certainly not dead in any meaningful sense. Her brain is not dead. Her heart is beating strongly. Her kidneys still work, at least until her body is so starved of fluids that they shut down irrevocably. This is what the ghouls are hoping for. A party with champagne over the corpse of Schiavo. What death-seeking behavior!

Neil

Why does it matter if, in all three cases, he says he would have pulled the plug? What he, and most liberal bloggers, have been arguing is that it is the family's decision to make--in the Hudson case, the decision of the mother and despite this post, her wishes were ignored.

gt

Tom, when in doubt, just ask.

I don't see what you find so confusing about Kleiman's position. As Kleiman points out the Right's position makes no sense. All three cases involved family members wanting to keep alive relatives that competent doctors said had no chance of improving. In all three cases the law spelled out what to do and how to do it, however imperfect the result. In all three cases the relatives were not satisfied by the outcome. But only in Schiavos' case did the GOP think it necessary to intervene.

Why?

And as others have pointed out if you think that Schiavo should live, and since that depends at least in part on Medicaid payments, why propose Medicaid cuts. Who else do you think should be denied Medicaid benefits so that Schiavo may remain in PVS?

Steve Stafford

It is always amazing, to me, what a society of death some of the left in this country embrace, unless the subject is convicted murders or terrorist.

TM

In all three cases the relatives were not satisfied by the outcome. But only in Schiavos' case did the GOP think it necessary to intervene.

Why?

Should we arrange to have a private reading of this post just for GT?

Let me try a different tack - since I attempt to answer that very question in my post, did you make any attempt to find it?

What did you suppose I was getting at when I wrote this:

So, in the case of Sun Hudson, medical ethicists weighed the case of a terminally ill infant in (possible) pain with no hope of recovery, and elected to suspend respiration - that is well within the guidelines of medical ethics set by the Pope, Protestant churches, and, if we can believe these Brits, the Jewish faith. Is anyone inclined to argue that all of these criteria are met in the Terri Schiavo case?

I hope that helps, but I suspect it won't.

And as others have pointed out if you think that Schiavo should live, and since that depends at least in part on Medicaid payments, why propose Medicaid cuts.

So now Schiavo is on Medicaid? What happened to the million dollar malpractice award? And is there any evidence that she is on Medicaid, or is that just another extension of the Kleiman "alternative reality"?

Matt

Good catch! Oliver Willis has posted more about this case than he did about the Iraq war.

TJ Jackson

As this case goes on I am amazed by those who would sentence someone to death with so little regret or thought. The excuses I have seen at some blog sites are at best uninformed. The question I have is would the husband still wishg his wife dead if money were not involved? The statements of the Democrats are beyond the pale considering their actions in Miami when the Gonzalez child was being sent to Cuba disregarding the wises of his mother.

mcg

I just want to point out just how strict the Texas law is. It is not sufficient for a doctor, or his hopsital's review board, to believe that further care is futile. Even if they beleive so, they are obligated to continue care if they reasonably believe that another hospital in the state will do so---presumably until the patient can be trasferred to that hospital.

Thus by contacting 30 hospitals, St. Luke's was following the law. So did the hospital treating Sun Hudson. In the latter case, over 40 hospitals were contacted, and none accepted him.

The Terri Schiavo case is different of course because there is consent on the part of Terri's legal guardian (her husband). The Texas law, on the other hand, is constructed to handle cases where consent is not given but the doctors are unwilling to continue treatment under the belief that it would be unethical to do so.

John Burgess

Actually, Michael Schiavo is not the person responsible for deciding to terminate his wife's medical care. He gave that right up to the Florida courts. After numerous trials and hearings, as well as medical examinations, the court decided that Terri Schiavo would not want her "life" continued in its current state. Go back to the court documents and read them, rather than some blogger's recollection of the impression s/he got from some other blogger.

Abstract Appeal a Florida attorney's blog, keeping his opinion about the case to himself, but speaking eloquently on Florida law. He provides, at the above link, links to most of the pertinent doucments in the case. They'll take the better part of an afternoon to read in their entirety, but if you don't read them, then you're not talking from any factual basis.

JWG
Actually, Michael Schiavo is not the person responsible for deciding to terminate his wife's medical care. He gave that right up to the Florida courts.
Yeah, the court went out and forced itself upon poor Michael to make sure he would kill his wife. Your statement is an attempt to twist reality into a legal knot. The court would not be involved if he didn't initially request her starvation.
TM

I'm with JWG on this. If the husband wanted to keep her alive, is anyone arguing that the court would be killing her anyway? Of course not.

Or without his evidence, would the court have decided that Terri would prefer to die? Again, of course not.

MattR

Tom - Your response to GT included this quote from your original post:
So, in the case of Sun Hudson, medical ethicists weighed the case of a terminally ill infant in (possible) pain with no hope of recovery, and elected to suspend respiration - that is well within the guidelines of medical ethics set by the Pope, Protestant churches, and, if we can believe these Brits, the Jewish faith. Is anyone inclined to argue that all of these criteria are met in the Terri Schiavo case?

Actually, I think that you could easily argue that the same level of care was made in deciding the Terri Schiavo case. Whether or not it meets the medical ethics set by any religious group is irrelevant to me. What is relevant is that in the Schiavo case multiple impartial judges listened to expert testimony from both sides and made a decision based on that info. I really don't see how going through the Florida process is any different than going through the Texas process.

As GT said, all three cases invlovled a patient with no hope for recovery. All three cases went through their respective legal proceedings. In all three cases the families were unhappy with the result. But in only one case did Congress intervene. Why?

s.

Actually, I think that you could easily argue that the same level of care was made in deciding the Terri Schiavo case.

Agreed. And you could easily argue that (a) Terri might possibly be in pain (one of the neurologists who examined her said that there was evidence that suggested that she might be in pain, and that the feeding tube was causing her pain; (b) that she has no hope of recovery (all neurologoists agree that if parts of her brain have been replaced with fluid, the brain can't grow back and she will never get any better; (c) it's been deemed ethical to let a person in this condition die (the Supreme Court and the AMA agree that it's ethical to suspend medical treatment to include hydration and nutrition in the case of an incompetent patient who has expressed the desire not to be kept alive absent brain function).

So, I hope this blog will address again why the Schiavo case needed government intervention when similar cases didn't.

gt

I think MattR and s. both made the point I wanted to. I don't think your post addresses them or me.

As for Schiavo I read in a couple of news reports that Medicaid pays about $80K a year for her. Not sure if its correct.

dsquared

I think Kleiman's point is actually pretty well made.

Thus by contacting 30 hospitals, St. Luke's was following the law

I'm guessing that if this had been Bill Gates' baby - or even a baby with a large malpractice award trust fund - one of those 30 hospitals would have been willing to take the chance. So, in other words, whether or not you get switched off in the USA depends on how rich you are. Perhaps it's years of sucking on the NHS teat, but that sounds rather brutal to me.

TM

I'm guessing that if this had been Bill Gates' baby - or even a baby with a large malpractice award trust fund - one of those 30 hospitals would have been willing to take the chance.

You've got me - I can't do a PET scan of the members of the ethics committee to prove that they were motivated solely by the medical futility of further aid.

My casual acquaintance of medical ethics tells me that there is a prohibition against quackery - even if Bill Gates offers to donate a billion to your hospital, if there is no hope you are supposed to say so. As to what people do, who knows?

And are the rich really able to do things differently - who knew? I wonder if a rich Brit would fly a loved one to a more market-oriented country for medical care? I have been told it only happens all the time for all sorts of medical procedures, but what do my friends in England know? Is there someone out there who thinks that all rich Brits just wait patiently in line while their kids suffer? I am fascinated.

TM

OK, for MattR, s, GT, et al: The difference between the level of outrage with the Texas and Florida cases is not driven by family consent, it is driven by medical futility.

In Texas, right-to-lifers participated in a grand compromise in which they agreed to accept the fact that sometimes people die even in hospitals, and that sometimes further medical care is not appropriate.

The Texas rules for futile medical care were (I have read somewhere) simply an attempt to codify what is done in every hospital in the country at some time or another - there are patients who can not be saved, and there comes a time when medical ethics require (encourage? suggest?) an end to further treatment. In the Texas cases, the issue was not parental or family consent, the issue was futility.

Terri Schiavo has not been found by a court to represent a case of medical futility. She is being terminated under a different concept - that patients have a right to refuse treatment and die in dignity.

The controversy in her case revolves around whether this is really what she wants, and whether the court has addressed this properly. It is NOT a futility case; folks are not outraged (exclusively) about the futility, or lack thereof; they are outraged bacause it is far from clear what her wishes might have been, in what has moved forward as a voluntary termination case.

Now, that is a big difference, although obviously, it will remain very important for folks like Kleiman to pretend otherwise.

Forbes

Come on folks, Terri Shiavo is not brain dead, she is not on life support, and she is not terminally ill. And yet because she is not able to feed herself, her husband--who is certainly in violation of his marital contract--wants to starve her to death. The woman is disabled, but she is very much alive. And the argument is put forward that there is no state interest to protect the most vulnerable of us from further harm.

The parents had asked assume guardianship so as to relieve Michael of the burden, allowing him to move on with the new family he's already created. Michael's preferred course of action is her death so can inherit the ~$700,000 remaining in Terri's malpractice trust.

Are we to propose forthwith, that the state has no interest in protecting those not brain dead, not on life support, and not terminally ill?

If not, where do we draw the line at man's inhumanity to man?

(TM, you might want to remove yourself to that secure, undisclosed location.)

I can personally speak from the other side of the coin, having been critically injured in an auto accident as a child. The doctors told my parents that they did not expect me to live. Should the efforts to keep me alive been discontinued? Because I was suffering, or in pain? I thank the heavens no one even contemplated such ghastly thoughts. Sadly, that no longer is the case.

TM

TM, you might want to remove yourself to that secure, undisclosed location

My current motto - let the other guy move to his secure, undisclosed location.

And Forbes, that is a great personalstory. Was your case really one of medical futility that took a miraculos turn, or were the doctors just laying out the ghastly alternatives to your parents?

And before anyone draws an anology between Forbes and Sun Hudson, remember, Sun Hudson had a nearly-always fatal genetic defect, was kept going for five months on a respirator, ans was being treatd by experts who eventually deemed his case to be futile.

dsquared

I wonder if a rich Brit would fly a loved one to a more market-oriented country for medical care?

I'm a rich Brit, and we do have private medicine in this country - my kid sees a dermatologist outside the NHS - but not so much at the life-support machine end of things. I doubt the matter arises because I doubt that any aeroplane would take on the litigation risk of a high-dependency patient, but in any case, the two episodes Kleiman dug up suggests that it's a much more routine matter on your side of the pond.

TM

I doubt the matter arises because I doubt that any aeroplane would take on the litigation risk of a high-dependency patient...

Up the ante, D! I am taking private planes, and personal yachts!

dsquared

If you had a private yacht big enough to hold an intensive care ward on it, and a private plane to fly you out to it and staff for all of them, I would probably say "look Professor Krugman, just bloody freeze yourself already".

TM

My plan exactly.

jack

It's funny that anyone would think that money--or the lack tereof was such a great problem. Hospitals will find the monry or operate at a loss if they think there's hope. They do this all the time.

In many transplant offices there are people whose task it is to find ways to pay for the transplant and aftercare of organ recipients--but that doesn't stop the transplant from taking place. Once you're on the list, and matched to an organ, it's go time. A life is more important than cash.

Aaron

Terry Schiavo is in a persistant vegitative state- not a coma. The parts of her brain where her personality was has died and been replaced by fluid. There is absolutely no hope of recovery, and she is not concious nor will she ever be. She apparently does make random ticks and movements but not as a concious reaction.

mark marshall

Aaron, Terri is in PVS only like every other severely retarded person is in PVS. The inability to swallow is a muscular function akin to the curling of the hand. She hasn't even been tested in that regard since '93. Many children with cerebral palsy cannot feed themselves and have no hope for "normalcy". Should the parents decide that the child wouldn't want to live that way, then off they go to the Dehydration Hospice? How much longer before the left actually proposes making soylent green out of our dried "unfortunates".

Sean

The controversy in her case revolves around whether this is really what she wants, and whether the court has addressed this properly. It is NOT a futility case; folks are not outraged (exclusively) about the futility, or lack thereof; they are outraged bacause it is far from clear what her wishes might have been, in what has moved forward as a voluntary termination case.

The LeanLeft post that you reference says that in medical terms, treatment is considered futile when "no possible treatments [could] produce benefits." The court has found this to be the case for Schiavo, as has just about every doctor who has examined her. This means that if she were in Texas, the hospice where she lives could choose to stop feeding her, even if she had said, before she became brain dead, that she would want such treatment continued indefinitely.

You're right that people aren't discussing Schiavo's case as a futility case, but the point that Kleiman and others are making is that it is a futility case, and that as such, President Bush in the past supported legislation that would allow hospitals to terminate life support for patients like Schiavo in situations that are even more problematic than the one that currently exists.

It's all laid out pretty well in the New York Times article that you quote above (which, incidentally, doesn't make a single claim that you've disputed).

TM

Well, the Houston Chronicle is quite different:

Schiavo case differs from 2 situations in Houston

Texas' 1999 statute wouldn't resolve such a dispute in Florida

Terri Schiavo's medical condition and her family's disagreement over whether to continue treatment make her case distinct from recent ones in Houston, where an infant was taken off life support and a woman had her severely brain-damaged husband moved from a local hospital to keep him alive, legal and ethics experts said Sunday.

...In Texas, hospital ethics committees can decline treatment only when it would be futile. Schiavo's condition would not be considered futile under the Texas law, experts say.

The Texas law "allows doctors to stop treatment when ... treating is not going to help at all," said John A. Robertson, the Vinson and Elkins chair at the University of Texas School of Law in Austin and author of The Rights of the Critically Ill. "In Florida, the feeding tube will keep Terri alive, so it is not medically futile in that treatment won't work at all."

Nikolouzos' brain damage, on the other hand, is so severe he cannot breathe on his own or move, according to Dr. David Pate, St. Luke's chief medical officer. Over his wife's objections, the hospital's ethics committee decided to remove his breathing tube, setting in motion the 10-day period in which his family could move him to another hospital under the 1999 law.

Look, if the family and husband wanted her kept alive, she would be - saying that this could have been tried as a futility case is interesting, and speculating on the outcome is interesting, but it was *not* tried as a futility case, it was tried as a voluntary termination by patient request type of case.

MattR

Mark - It is so wrong to compare Terri's condition to that of a severly retarded person. At best, she has virtually no cerebral cortex left. There is no level of consciousness and no emotions or feelings in Terri's case.

MattR

Tom - I don't really know how to make my point clearer. You are correct that Terri's case has not been found by the court's to be one of medical futility. But you seem to imply that her case is obviously not futile as a result. The reality is that the judge agreed with the medical testimony provided that Terri is in a PVS with no chance for recovery. So, even though the Texas and Florida cases are not absolutely identical, the circumstances are very, very similar. We have families disagreeing over the diagnosis of their loved ones. They want to continue treatment despite the statements by medical professionals that it will do no good. Why are the medical ethics committees and courts in Texas able to figure this out, but the decisions of doctors and courts in Florida should be second guessed? Why did Congress not err on the side of life, as President Bush put it, and allow the Texas patients the ability to bring their cases to federal courts?

RedCharlie

From the top:
Mr. Kleiman's theme is that right to lifers are hypocrites for rallying to Terri Schiavo's cause while ignoring these two cases

But then our minuteman goes on to say that there was no hard evidence that finacial reasons played any part in the decisions to terminate care in the two Texas cases. While I think Kleinman and LeanLeft would both agree that there is too much hyperbole on both sides, neither would say that the core hypocrisy of the right stems from a double standard that treats patients differently due to personal wealth. (Also, several posters here cite Michael Shiavo's greed as proof of his iniquity. This is only relevant, however, to evaluting his testimony of Terry's wishes. Murder is wrong whether the motive is financial,personal, or simple cruelty.)
So, what do Kleinman, LeanLeft, etc. see as the fundamental hypocrisy? Let's watch our minuteman get it almost exactly backwards:

So let's see - pretty much everybody got on board with what seemed to be a sensible compromise, and now, two years later, the right-to-lifers are being excoriated for working within a system they helped to design. Odd.

The problem is not right-to-lifers working within the system (after all, they actually help craft the Texas Futile Care law); the problem is the Republican party making political hay by vilifying the very arduously and extensively litigated (and "ethicated") Schiavo case. Are judges, doctors, and hospital ethical committees in Texas that much more knowledgeable and trustworthy? Our minuteman makes much of due process in the Texas cases, but doesn't mention that the Schiavo case has gone thru a great deal more "due process".

Those who object to making Terry Schiavo into a political bludgeon are not horrified by "sensible comprimise(s)", instead we recoil at the spectacle of DeLay and Frist diagnosing Schiavo from the halls of Congress. We are indignantly told that the circumstances of Terry Schiavo differ from those of Sun Hudson and Spiro Nikolouzos, as I am sure that they do, just as the circumstances of Hudson and Nikolouzous differ from one another. We are told that Sun Hudson was in pain, as if that justfied killing him as "merciful", and we are also told that Terry Schiavo can feel pain, as evidence of her mental state and humanity, seemingly to portray killing her as "murder". But nothing justifies the Congressional Circus that we are witnessing.

I am neither a doctor nor a medical lawyer, but I can read, and according to chapter 166.002, paragraph 9, "'Irreversible condition' means a condition, injury, or illness:
(A)that may be treated but is never cured or eliminated;
(B)that leaves a person unable to care for or make decisions for the person's own self; and
(C)that, without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal."
The next paragraph defines "Life-sustaining treatment" as including both "mechanical breathing machines" (which Sun Hudson needed) and "artificial nutrition and hydration" (which Schiavo needs). The law address not only the case where the family wants to continue care (as with Hudson and Nikolouzos) but the hospital does not, but also the case where the physician is willing but the family (or whoever holds medical power of attorney, i.e. Michael Shiavo) does not want to continue care (see chapter 166.046).

Clearly all three cases fall under the same criteria of needing "life-sustaining treatment" for "irreversible conditions". (As does Forbes' childhood trauma, if the doctors concerned truly thought her condition were irreversible and she needed life-sustaining treatment). Willis Walton comments that Schiavo "is not dead in any meaningful sense" and Forbes wrote that "Schiavo is not brain dead" but Hudson was also alive, and Nikolouzos is also still alive. Doubts exist as to the mental state of Hudson and Nikolouzos (reflex movement, non-meaningful sounds, etc. aren't proof of consciousness) and doubts exist as to Schiavo's consciousness (reflex smiles and motions aren't proof of consciousness). Doctors (and a court) in Texas decided Hudson and Nikolouzos's cases were irreversible. Doctors and courts in Florida decided that Terry Schiavo's condition is irreversible.

All this is too say that if Terry Schiavo were in Texas, her case would fall under the Texas Futile Care law, and would be adjucated in a similar way as to what has happened in Florida. This is not to say that the cases are the same, or that the same conclusion would be reached in Terry Schiavo's case if she were in Texas. But still, the same process would apply, and again, that process would be very similar to what has happened in Florida.

I am not here to argue that Terry Schiavo is capable of recovery or no. I am not here to argue that her feeding tube should be withdrawn or not. Frankly I don't believe that it's my decision to make any more that it's the decision of DeLay or Frist. My opinion is that in the lack of any written living will, Terry Schiavo or any similar patient should be kept alive if any member of her immediate family (parents, siblings, spouse) wish her to be kept alive. But that is just my opinion. I also would personally not wished to be kept alive in Terry Schiavo's state, especially if I were partially conscious. But that is just my personal preference.

The Texas law is a fairly decent law. I don't mean to suggest that it or Florida laws on the subject are perfect, but these issues are a matter for legislatures (federal or state) and courts to decide. If we really care about the issue, we will support "sensible compromise(s)" like our minuteman suggests. What helps no one--but politicians--is political grandstanding with private "de novo" bills that address one tabloid worthy case (i.e."husband seeks court's approval to kill wife") while ignoring the much larger and murkier set of similar (but not identical) cases.

Joe Mealyus

MattR: "Why are the medical ethics committees and courts in Texas able to figure this out, but the decisions of doctors and courts in Florida should be second guessed?"

This question seems kind of odd, since if JOM's points above are correct, the committees and courts in Texas would not "figure this out" in the same way the courts in Florida have. At least not by the principles by which they "figured out" the other two cases being discussed.

MattR

Joe - I am not claiming the Texas courts would have come to the same conclusion as the Florida courts did (although as RedCharlie states, Terri's condition meets the criteria for being considered futile). I am saying that in both cases there was a process to make a determination and that process was followed. The specifics of the cases and the laws are different, but the respect for the process should be the same. There is nothing unique about Terri Schiavo's case that justifies Federal intervention in her case but not in the other cases.


To clarify - in my original post I meant "allowed to figure things out" rather than able. I was referring to the fact that the state went through the process without outside interference.

Joe Mealyus

I think the answer to MattR's general question (why the Schiavo case) is that Schiavo case, in particular the courts' seemingly disingenuous embrace of Michael Schiavo (whose role is minimized by the Abstract Appeal guy linked above, and maximized in the Dahlia Lithwick articles linked by JOM, confusingly), have created the opportunity for, in Mickey Kaus's words, "a legitimate protest against what appears to be a disingenuous machinery of euthanasia lawyers are busy establishing under the guise of a "right to die."

RedCharlie

And TM, I would suggest reading the law itself instead of relying on the Houston Chronicle. (Don't distrust the "liberal" media only when you disagree with it)

Chapter 166.033. "FORM OF WRITTEN DIRECTIVE" of the Texas Futile care law clearly states:
"If, in the judgment of my physician, I am suffering with an irreversible condition so that I cannot care for myself or make decisions for myself and am expected to die without life-sustaining treatment provided in accordance with prevailing standards of care: I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible;
OR
I request that I be kept alive in this irreversible condition using available life-sustaining treatment."

It is not necessary for the patient to be terminal in 6 months to fall under the Texas Futile Care Law. And although it is obvious that Schiavo's case is not terminal, it is not so obvious that Nikolouzos is terminal in 6 months.

Joe Mealyus

"The specifics of the cases and the laws are different, but the respect for the process should be the same."

If we take two death penalty cases, one where we think the court has acted impeccably, one where we have strong concerns with some of the court's decisions (if not its fundamental outlook), our "respect for the process should be the same?"

MattR

Joe - I agree about the death penalty cases and reviewing issues when there are concerns. However, that is not the case in this situation. The people who don't agree with the Florida courts have a problem with the decision made, not the method used to reach it. There is no amount of research, deliberation, etc that the court could have done before ruling for Michael Schiavo that would change their criticism. I vehemently reject the notion of the courts' "disingenuous embrace of Michael Schiavo". If you have some proof to back it up other than the whining of her parents and the religious right, I would love to see it.

Sid Rose

Michelle and others are missing a critical point here (one cited by Wesley J. Smith in his book _Forced Exit: the Slippery Slope from Assisted Suicide to Legalized Murder_. The termination of Sun Hudson marked the first time in U.S. history that a judge has ordered the removal of life support from a child _against the wishes of a parent_. Who gave the state the right to play executioner _in loco parentis_? The Texas legislature, with the blessing of National Right to Life, and the signature of Governor George W. Bush.

I don't know what has me more upset: that the pro-life movement would sign off on such a law, or that "conservatives" would fall over themselves to defend it.

RedCharlie

Joe M, your respect for the process should not be predicated on its outcome. That's one of the basic principles of law. You don't agree to uphold the process only if it turns out the way you like it.

If you don't like the way it turns out, you write your state representative, congressman, etc. and suggest that they amend the laws for EVERYONE (not for just the juicy headliners). I, for example, would support legislation that would respect the wishes of any member of the immediate family (parents, siblings, or spouse) that wished to keep the patient alive in the absence of any written declaration to the contrary on the part of the patient.

But yeah, "due process" is everyone's right. We have to respect that.

Hegemon

President Bush claims that where there is doubt, we should err on the side of life; that's a great justification for ending the death penalty -- which condemened over 10,000 innocents nationwide to Death Row, men who lost a decade or more of their lives in jail before being exonerated for crimes they didn't commit.

If Republican politicians really cared so much about a "Culture of Life," we'd see increased funding for education and environmental protection -- even the passage of national healthcare -- because a "Culture of Life" must be built upon a healthy standard of living that applies to all Americans.

This whole sick affair isn't about promoting a "Culture of Life," it's about the GOP pandering to a small group of extremists; trying to pretend otherwise is just dishonest.

Joe Mealyus

MattR: "There is no amount of research, deliberation, etc...."

MattR: "The people who don't agree with the Florida courts have a problem with the decision made, not the method used to reach it."

RedCharlie: "[Y]our respect for the process should not be predicated on its outcome."

It's not. I am agnostic on the outcome - I have not been persuaded either way what should be the fate of Terry Schiavo. I am generally against state-sanctioned killing of all varieties, though I can see making an exception for the truly brain-dead, a fact which yet seems to be at some issue in this case.

No, it's the process that bothers me. I have not read a persuasive defense of the (ongoing) decision to keep Michael Schiavo (despite his apparent financial conflicts and apparent de facto ex-husband, not husband, status) in a role which apparently eclipses that of the parents. And do I think much weight (if any) should be put on the testimony of a doctor who is part of the "right to 'die'" movement? No I do not, but that is what has happened here. (This also applies to doctors who have established a bias in the opposite direction).

Finally, there's the reasoning of the judge. Is that part of the outcome, or part of the process? I'm not sure, but given the sort of outside attention that this case has attracted, the fact (if it is one) that there is a definitive medical test (MRI) that has not been performed seems indefensible.

Bottom line: I think Kaus has it right about the euthanasia machinery, and I am not certain that we don't have a judge who is volunteering to be a cog in that machine.

Btw, if the right-wingers are being hypocritical in not taking up the case of Sun Hudson, that is of zero relevance to the Schiavo case (but of relevance to the case of the right-wingers).

(Apologies to JOM for over-posting - I will desist).

Casey

I really despise this story. I'm currently scared witless about Peak Oil and it frustrates me that all anyone can talk about is the religious right's latest political foootball. I don't know where all you crackhead Rush Limbaugh fans get off thinking that all we lefties want Terri Schiavo to die. I'm a lefty and I want her to live. I think every lefty in the world wants Terri to miraculously get well and start tap dance lessons, if for no other reason than to kill this stupid story. On a more serious note, I think that since Terri didn't write her wishes down, she deserves to be punished with an undignified life of force-fed days hooked up to as many tubes and wires as needed to keep her heart beating, like a Borg pet or something.

TM

Red Charlie - I haven't even peeked yet, but since I have the direct quote from the Texas ethicist on my side, and your excerpt of the law as a hint, I can guess what we will find - their is a list of treatments thatI, as a patient through a written directive or by way of a guardian, can forego;there is a second list of treatments thatthe hospital can withhold. The twolosts won't be the same.

And based on the guidelines of the Pope and the Protestant churches, my guess is that we will see that a patient can voluntarily refuse to be fed (controversial to Catholics, OK with Protestants, and as in your excerpt), but that the hospital can not choose to withhold feeding.

Warnign - if I am right,I am going to be insufferable. Well, even more so.

Quote frm ethicist, per the Chronicle:

The Texas law "allows doctors to stop treatment when ... treating is not going to help at all," said John A. Robertson, the Vinson and Elkins chair at the University of Texas School of Law in Austin and author of The Rights of the Critically Ill. "In Florida, the feeding tube will keep Terri alive, so it is not medically futile in that treatment won't work at all."

Maybe this guy is just flat wrong. Let's see.

As for MattR - we do seem to be stuck on a treadmill. You gave this summary:

The specifics of the cases and the laws are different, but the respect for the process should be the same.

Well, in Texas,the right-to-lifers were part of the process of drafting a bill that passed unanimously. In Florida, they have been fighting the Schiavo thing since it went to the courts, and have never seemed to accept a process where the husband can ge guardian in such an odd case.

Well, I have to go read the statute (again - yesterday seems like last month right now).

gt

TM,

Well then, when can we expect the GOP and conservatives to support laws taking away the right of a man or woman to be the legal guardian of their spouse and pass it on to other relatives?

Talk about intrusive in-laws!

TM

Hmm. A quick glance suggests that I will need to move to Plan B. It does appear that the ethics panel may decide unilaterally to withhold any life-sustaining treatment, including nutrition/hydration.

However, what is missing is the guidelines under which the ethics committee makes its decisions. BTW, this is defensible, since ethical guidelines may change, presumably, so why codify them?

That leaves my expert quote dangling - he says Schiavo would not be covered, and he ought to know, but what are the guidelines?

gt

Tom,

You may want to add this to your reading list.

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

I haven't read it but found it here:

http://www.dailykos.com/story/2005/3/22/194615/400

gt

And this:

http://abstractappeal.com/schiavo/infopage.html

The more I read the more clear it becomes what a circus the GOP has made of this.

TM

OK, lots of different gropups seem to have guidelines,and I won't be surprised to see that Texas has its own standards. However, here is:

CEJA Report D – A-91
Decisions to Forgo Life-Sustaining

.pdf version

Google cache

They have a helpful discussion on both permanently unconscious patients and infants, so the Schiavo, Sun Hudson, and Spiro cases are all covered.

For unconscious patients: they first look to an advance directive, then to the wishes of a surrogate. Eventually, we get this:

When a permanently unconscious patient does not have an advance directive and previous preferences or values are either not clear or not ascertainable, or when the patient was never competent, there must be a determination of the patient's best interests. However, since a patient in a persistent vegetative state does not experience any pleasure, pain or suffering it seems that the patient would have little interest in living or dying.

...Since there is no objective way to ascertain what would be in the best interests of a permanently unconscious patient, any previous preferences of the patient should weigh heavily on the surrogate's decision, even if the patient was never competent or if the preferences were not very clear. When there are no previously expressed preferences that could be used to guide the decision maker, there will be little direction other than the decision maker's impressions about what would be best for the patient.

When the best interest standard must be used for a permanently unconscious person the surrogate's decision should not be challenged as long as the decision is based on true concern for what would be best for the patient. Due to the complexity of decisions for permanently unconscious patients, an ethics committee should be available, whenever possible, to help the
surrogate and protect the patient's interests.

Well, that is clear as mud. I'll say this -it seems as if, in the Schiavo case, if Michael has wanted Terri kept alive it would be hard to imagine these guidelines being invoked to overrule him.

As to Spiro, he was in much worse physical shape, was on a respirator, was 68 years old... who knows? Maybe my ethics expert was just saying that Terri was far enough away from "futile" that they would have respected a guardian's wishes. In fact, skipping ahead to the "Who Should Decide" section, I find this:

When a health care provider challenges the decision of the family, an ethics committee should first verify that the challenge is based on a belief that the decision is clearly not what the patient would have decided; or when the best interest standard must be used, the committee should verify that the family's decision is clearly not a decision that could reasonably be judged to promote the patient's well-being. If this is the case, the ethics committee should try to ensure that the health care provider and the family understand each other's reasoning. In particular, efforts should be made to ensure that the family understands the medical information. If the conflict is intractable the dispute should be referred to the courts.

As to Schiavo, I stand by my position that an ethics committee would not have overruled a family member who insisted she be kept alive.

As to Sun Hudson, here we go:

Unlike the permanently unconscious patient, a newborn does not have previous interests, but does have clear present and future interests. Present interests include achieving pleasure, avoiding pain and discomfort, and being alive. Specifically, the pain caused by a therapy should be weighed against the pain resulting from forgoing the therapy. Future interests include, having at least some amount of agency, or ability to act at will; being able to develop personal relationships; and having future happiness and pleasure outweigh future pain and suffering.

"Futile" would cover his situation; I guess the "Who Should Decide" excerpt covers the Sun Hudson case as well.

Sorry, I can't rally a big finish just now.

Mark Kleiman

OK, Tom, time's up. I've corrected my errors. When are you going to retract your lies? (I'd use a politer term, but you've now been on notice for more than 24 hours that Talk Left had repudiated your misuse of his words and have updated twice without correcting.)

I didn't say what you said I said, Kevin Keith at Talk Left didn't say what you said he said, and
Prof. Tom Moore, who helped draft the law and whom you cite as an authority, says that the Texas law signed by Bush would have allowed Schiavo to die
:

Thomas Mayo, an associate law professor at Southern Methodist University who helped draft the Texas law, said that if the Schiavo case had happened in Texas, her husband would have been her surrogate decision-maker. Because both he and her doctors were in agreement, life support would have been discontinued.

The special law in the Schiavo case is completely inconsistent with the principle behind the Texas law. So Mr. Bush's pretense about "erring on the side of life" can't be taken seriously; he and his buddy Tom DeLay just worked up a charade to please their political base and drive their policy failures and ethical problems off the news pages.

That was my original point, and it is correct.

Time to back off.

MattR

As to Schiavo, I stand by my position that an ethics committee would not have overruled a family member who insisted she be kept alive.

I guess we are gonna have to agree to disagree. After reading the guardian ad litem's report, I have little doubt an ethics committe would agree she was "futile". I should say that I am in support of the Texas statute. I just think it is hypocritical to get upset about one set of cases but not the other. I have a feeling the real reason for the difference is becasue there is video that shows Terri appearing to be more alive than she is. But that is what happens when you show 30 seconds of an hour plus tape.

TM

Time's up? On notice of what? Presumably you are referring to some of our very cordial e-mails, but there has not been any specificity yet about what I said about LeanLeft (which wasn't much):

And HUGE PROPS to LeanLeft, who actualy delves a bit and realizes that Kleiman is making this up.

Well, I had delivered the "make it up" charge at the start of the post. And I did see this at LeanLeft:

I think Kleiman misses the central problem.

...I think he plays into the right-wing tendency to simply discount facts - especially scientific knowledge - as if they were merely matters of opinion that can be discarded when inconvenient...

...He also misses the point high, wide, and handsome with this whopper...

Help everyone out - just print right here what you think I said that was a lie. Maybe that will start the clock. Or the laughtrack.

That was my original point, and it is correct.

Sure it was. Stuff like this just got in by accident:

But the notion of letting the health-care providers decide, after doing a careful biopsy of the patient's wallet, strikes me as pretty damned outrageous. And it seems to me that the Right-to-Lifers ought to agree, though apparently anti-abortion groups had no problem with it when Gov. George W. Bush signed the Texas Futile Care Law.

I am not sure that putting the claim about your "original point" in the same comment that accuses me of lying is a persuasive tactic. But it does reinforce my "make it up" point, so, uhh, bring it on. Or Make It Up.

RedCharlie

TM, don't worry, take it from my personal experience that being insufferable is more dependent on personality than being right or wrong in any particular case :)

I can't say whether or not the Hudson case or the Nikolouzos case was obviously more futile than Schiavo's case is, but that's not my point. I merely point out that Schiavo's case would fall under the jurisdiction of the Texas Futile Care law, regardless of what John A. Robertson or other talking heads have to say about it. And under Texas Law the physician and the guardian have the legal basis for determining futility.

I also can't say whether or not an ethics panel would overrule a family member in Schiavo's case, if that family member had medical power of attorney. Since Michael Shiavo has that authority, the real question is whether or not an ethical committee would, at the request of the physician, overrule a family member who insists she not be kept alive. Interestingly, that is certainly a possiblity that exists under Texas law and does not seem to exist under Florida law.

Joe M., as I wrote above, I personally think that without explicit legal documents either giving the wishes of the patient (an "advance directive" in the terminology of the Texas Law) or giving explicit medical power of attorney to another person (like the spouse) to make the decision in such case, well, I think any member of the immediate family (parents, siblings, spouse, adult children) should have the right to object to termination of care. So in this point, I think I agree with you. I'm not so happy with the process that gave Michael Shiavo exclusive power to terminate care or not.

But if one disagrees with the process, the appropriate response is to try to change that process. For example, one could urge the adoption of something like the Texas Futile Care law in Florida or one's own state or at the Federal Level. You could also support giving any family member a legal veto over termination of care in the circumstances outlined above. Turning Terry Schiavo into a political bludgeon, however, is not appropriate.

Villifying Michael Shiavo is also not relevant nor appropriate. Imagine if someone was trying to overdose you on Morphine because they really sincerely honestly believed it would be "good" to put you out of your everyday suffering. Would their (misguided) sincerity excuse their actions? Would it make it okay? Assuming that the Texas Children's Hospital sincerely wished to end Sun Hudson's suffering, would that sincerity excuse their actions should it turn out that they had misdiagnosed him? Would it be okay to kill Terry if she actually can recover and really wanted to be kept alive in a PVS if Michael's motives turn out to be pure after all?

Motive is a question relevant to crime. The question here is whether or not Michael Shiavo has the right to terminate care for Terry. This is not a criminal trial. He has been repeatedly found to have this right (and if you don't like it, see above suggested forms of redress). So it doesn't matter what his motives are. I think most would agree that it would be bad or immoral if my boss decided to fire me and all my other fellow employees for no particular reason, leaving us financially desperate and without healthcare. But I wouldn't dispute that my boss has the right to do so.

And here I have to agree with gt that encroaching on the legal rights of married couples is, in general, not a good idea. I would certainly choose my wife to make this decision for me before my parents or my siblings, even though I love them all, and they me. But I had better go ahead and put it down in writing if I truly don't want to become a "Borg pet." (And anyway, if anyone has sufficient grounds to want me dead, it would be my wife. The fact that I'm still breathing is irrefuteable proof of her love and forgiveness ;-)

Finally, I have to agree with Casey that the most appalling thing about this whole deal is that there are much more pressing matters about which our government should be showing leadership and to which our media should be paying attention. The Schiavo case is generating an enormous amount of hot air, but I would suggest looking elsewhere for effective answers if one is serious about promoting a "Culture of Life."

I, for one, have spent far too much time on this issue today. I will strive to give it a rest from here on. (Anyone for a Texas Futile Blogging Law??)

dsquared

I am right up for "give it a rest from here on". I've just remembered that American laws don't apply to me.

TM

TM, don't worry, take it from my personal experience that being insufferable is more dependent on personality than being right or wrong in any particular case :)

LOL. Red, you are only guessing about yourself, but I have vast personal experience at being both wrong and insufferable.

More from Red:

I merely point out that Schiavo's case would fall under the jurisdiction of the Texas Futile Care law, regardless of what John A. Robertson or other talking heads have to say about it. And under Texas Law the physician and the guardian have the legal basis for determining futility.

Yes, that was a good catch. I expet that Robertson could plead "abbreviated, out of context quote".

I also can't say whether or not an ethics panel would overrule a family member in Schiavo's case, if that family member had medical power of attorney.

Well, I can say, but how can I make it stick? That segues to MattR - I suspect an ethics committee would not dispute a determination by a guardian that Terri S was "futile". However, you seem to be going further and saying that (under TX law) the healthcare providers might *overrule* the family members and force a termination of Terri S against her/their wishes. No one seems to think that would happen in FLA, BTW.

IMHO, the key is this bit from the ethics guidelines:

When a health care provider challenges the decision of the family, an ethics committee should first verify that the challenge is based on a belief that the decision is clearly not what the patient would have decided; or when the best interest standard must be used, the committee should verify that the family's decision is clearly not a decision that could reasonably be judged to promote the patient's well-being.

If Teri S had left clear instructions that she be be kept alive through non-extraordinary means, and specified feeding/hydration as non-extraordinary, do you *really* think that in TX they would over rule that in her current state? Do you have any supporting examples? Do you agree that the family would *not* be overruled in FLA if their interpretation of her wish was to keep her alive?

And it is possible that our expert John Robertson was addressing that narrower point.

And re the proposed "Texas Futile Blogging Law" - easy for you chaps to say, but if I drop this subject, I have to resume obsessing about Social Security reform. All paths forward are bleak...

Appalled Moderate

TM:

I think the Courts are putting you back on that Social Security road, as they continue to refuse to rewrite Florida Law.

I think what is getting lost in the egregious moral outrage being expended on this topic is that Courts are loath to overturn findings of fact in a judicial proceeding, if there is no evidence that the process itself is flawed. Appellate judges are happy to tell their lower brethern that they know more about the law. But, as they were not in the courtroom when matters of fact were being presented, they do not want to overturn the judge's findings on an assumption that they know more about the facts of the case. For this same reason, the Courts dislike overturning decisions based on stupid actions by juries, even in instances where the death penalty has been applied.

Most of our congress-folk are lawyers, and the ones who are not are advised by flocks of them. It is hard to imagine they did not forsee this result when they passed their bit of legislation. I'm sure some acted in a sincere belief that the vote was worth taking, because it gave Terry Schiavo one last shot at life (whether she would have wanted it or not). It seems that Tom Delay and some others, I'm afraid, messed in what is, after all, a private tragedy, because they felt they had a God given opportunity to gain political advantage.

TM

I was actually very intrigued by the religious freedom argument, which is one for the theologians:

(1) if Catholic Church doctrine changed *after* she entered a PVS (it seems to have changed in 2004)

and (2) if she was a devout Catholic who wanted to avoid sin;

Would it be a sin for folks to cary out her now-sinful desire to be terminated, if such a desire was not sinful when she enunciated it?

Now, add (3) if she had said things like "I would never want to go against whatever Church rules were in the future";

does that change the answer to (2)?

Well, one might think these were new questions left unanswered in the 2000 hearing. But maybe not.

Appalled Moderate

TM:

The issue about desiring to be a good Catholic is not referenced in the 2000 decision . That would give the later courts considering the issue no basis to pursue that line of inquiry. That's probably fortunate: can you imagine a US court trying to rule on what a good Catholic would do?

TM

That would give the later courts considering the issue no basis to pursue that line of inquiry.

Well, the new bill does say "de novo" - if they need the facts, and the earier court did not establish them, go get them.

Well, its easy to type that - so far, not many judges are biting.

Joe Mealyus

Nice apology to Mark Kleiman. A guy who at 4:12 PM, says "The brain scans clearly show that the entire cerebral cortex has been replaced by spinal fluid," then at 4:42 PM, quotes the USA Today with great approval: "Nowhere did they [the Founders spelling out the powers of Congress] include the right to play doctor," is not someone you want to mess with.

gofigure

President Bush's involvement with the Terri Shiavo matter is questionable as it is now. There is another possible reason that he is involved and he isn't telling anybody. He could find the words to tell us if he tried. President Bush jumps to the aid of Terri Shiavo’s family in a move that contradicts his history in his home state of Texas. I have a possible reason. Despite the fact that I believe that the country has lost its collective sense of morals, I do not believe that President Bush is not a good spokesman for the country on any level. Regardless of his ability, intelligence, desires, intentions, or the intensity of his convictions, the man is not well spoken. When he opens his mouth, he is not a good representative of this country. He stammers, loses his focus, and allows his eyes to drift off into space. He doesn’t even look like he’s trying to find the right words. He looks lost. Almost like …. his brain has ceased functioning.

Right or wrong, I suddenly can imagine how Terri Shiavo’s husband could feel the way he does. After all of this time, you begin to believe that the small things aren’t signs of life. No matter what anyone else feels, you know, from this moment forward, things aren’t going to get better.

I think that President Bush was advised to jump into action. If Terri Shiavo’s family does not win their case, then President Bush might lose a similar battle. If anyone can make the case that he is actually in a persistent vegetative state and that his actions do not truly indicate a functioning reality, they can petition to withhold his food until complete biological shutdown is certain.

I don’t have a firm stance, one way or the other, regarding Terri Shiavo’s situation. This is a horrible and tragic time for her and her family. There are valid points on either side. Within my own family, I have faced a very similar situation. There is still no resolve in this matter.

I do not know what the resolution for the Shiavo family will be. I wish upon both sides of this matter, grace and peace. I am sorry for both sides that President Bush has gotten involved in this matter. The fact that he is involved complicates matters for Terri Shiavo’s husband. The fact that he is involved does not help matters for her parents. It is sad that when we need concrete answers, we can’t get him to give us any. When we need him to be calming and smooth, he isn’t.

To his defense, the liberals are not helping matters. This should not be a political matter. The family has enlisted the aid of various branches of the government for help; they are doing what any parent would do for their child. They are using any means necessary to do what they believe is right for their child. This issue is disastrous. Not only is this a highly emotional topic, it is the political game. Sadly, both families are being used to fight a much larger battle. It is like watching my children fight. They don’t need to have strong feelings about anything in particular in order to have a good fight. They simply need to not like each other for that point in time. The fight can be about anything. The topic, whatever it may be, is simply an excuse to get after one another. The scariest part of all of this is that the issues that the politicians are fighting about have real consequences for real people. Sometimes, I truly believe that they couldn’t care less. As long as they are on the record for doing something, they are, “fighting the good fight.”

Toobis

Dear friends, since we are all waiting for a bloody miracle here and Easter Sunday is fast approaching, maybe Terri will rise from the dead. But until then, the only thing that could possibly help matters along would be to hold a pillow over her head for a few minutes or to send her into a much too deep, narcotic induced slumber. While admittedly cruel, it's far better than starving her to death. In retrospect that 'diet' she tried; i.e., eating whatever you want for dinner as long as you have "two fingers for dessert," the undeniable cause of her problems, seems to have not been such a good idea in the first place. A lesson well learned; albeit a bit late, for the "soon to be” dearly departed.

T. Daugherty

In all of our legitimate arguing over life v. right to die, let us not forget that we should each be in charge of our own destiny, rather than the state become the autocrat. Let each individual decide for themselves and for those that have not made that decision, let their loved ones come to an agreement. Rather, let us argue about who of those loved ones should make that decision. A collective group? Or, next of kin? According to the bible, the husband is next of kin. According to nature, the mother and father are the bow for which the arrow came forth. Maybe, all those who loved Terri should argue over the end result, but certainly, the state should never be a part of that.

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