Right-to-die vs. How-to-die

Great Debates
1

The current case in Florida with Terri Schiavo ( current cite ) has me rather appalled. Not that they are considering letting her die but rather how they would let her die (if it comes to that).

Why won’t the state/doctors allow her to be euthanized if the decision is made to terminate her life? Is the state so philosophically shallow to suppose that if they order her feeding tube removed and let her starve to death that they are somehow “clean” of the act rather than if they take a pro-active measure in ending her life?

It seems beyond reason to allow this to progress this way with (what I assume is) the notion that allowing her to starve to death is simply allowing nature to take its course. While that may be technically true it seems to dodge the notion that there will be any other result besides her death (e.g. she will pop awake and start feeding herself).

If anyone thinks that Terri still possesses some consciousness then allowing her to starve to death is hideous in the extreme. If we go with “persistent vegetative state” (i.e. no consciousness) we might suppose there will be no stress to Terri as there is nothing there to register her starving. However, even wiht that you have the effect on friends and family and anyone else taking care of her watching someone waste away over the course of a week or two.

As a society do we really fool ourselves into believing that this is preferrable to euthanizing the poor woman? We can all feel better somehow knowing that society did not actively take a person’s life?

I am not debating here whether or not Terri should have her feeding tube removed (FTR my opinion is if she truly is in a persistent vegetative state I think she should be allowed to die…if she actually has the consciousness of a 6-11 month old as others suggest I am against it…since I personally do not know which is true I fence sit). The debate I am looking for here is over how, as a society, we allow or help people to end their life in circumstances such as this.

Note – Assisted suicide for clearly conscious people who are terminally ill will complicate this debate more than just using Terri’s case but if you must bring it in feel free to do so.

2

I think cleary the issue in this case is that passive euthanasia is a lot less easy to abuse as a blanket policy than active. You can’t passively make someone unable to live without assistance, and no one has any control or authority to make it so. But once you allow active killing, it’s hard to see where to draw the line or dole out the authority to decide.

3

Oh, and the above reasoning is, I should note, an example of using people as means to an end. I’m often amused that many people believe they hold it to be a high principle of morality that one life must not be used as a means to benefit another. But at the same time, they support the ethic of detterence punishment or the above argument about how allowing extra suffering is the price we pay for avoiding policies that lead to abuse. Both of those are using individuals as means to benefit other individuals.

4

How is removing her feeding tube knowing full well it will result in her death fundamentally any different than administering a lethal dose of whatever they use to send her on her way? End result is the same…just timeframes that differ.

I can appreciate the issues of who has authority to decide in this but presumably someone, somewhere, sometime does have to decide. Such cases are thankfully rare but obviously do happen so it needs sorting out. In Terri’s case there have been many court battles and multiple doctor’s opinions and so on so at least in this case it is hardly an impulsive rush to pull the plug.

5

I think Apos was simply trying to point out passive vs active involvement in the death, not disagreeing. From a society perspective that is the difference. Having said that, as you point out, it is not really a practical one, as the end result is the same. People like to think that they are taking some sort of moral high ground by not actively killing her, when really the end result can’t possibly be any different, and honestly as some have pointed out, clearly a cruel way to die.

As the person dieing isn’t making the decision, I have always thought this case is extremely cruel and heartless, of course florida can pat themselves on the back for taking the morale high ground and not allowing a painless form of death.

6

I’m confused: did you not read my post? Morally, I agree that they are no different. But in terms of pragmatic policy, I also concede that policies that allow for active euthanasia are more open to abuse than passive. That was my point, and I thought it was quite clear to begin with.

7

I do not follow the reasoning that active euthanasia is more open to abuse than “passive” (as passive still requires action).

Removing Terri’s feeding tube is an action someone must consciously undertake and in this instance they know full well it will result in her death.

Injecting Terri with something that will kill her is likewise consciously undertaken and done with full knowledge it will result in her death.

Where is the second option open to more abuse than the first? Presumably such an action (either action) is only taken after it has passed legal scrutiny…otherwise either would be murder. Therefore the protections for either action would seem to be exactly the same.

8

Because in the first case, there is no doubt at all that the individual cannot survive on their own: they die because of the failure of their own body. In the second case, that’s never actually tested. The exact same injection can be given to anyone regardless of the level of viability, and there’s no good place to draw a line. Like it or not, like birth in abortion, tested viability is a clearer place to draw a line that isn’t likely to move.

9

I may have my facts wrong but I believe there is a discrepancy in how this is being reported. CBS stated today that life support was removed. To my knowledge, her body is fully functional, requiring only that she be fed. That is a far cry from a vegetative state. If she is in some form of coma or is severely retarded then this changes everything. It is not a passive form of death if a sentient person’s basic requirements of food and water are not met because of an injury.

From what I’ve seen she appears to respond to stimuli. If this is accurate then the state should take on the roll of protectorate. It would be nice if SHE was given the same legal due process afforded prisoners. This case has revolved around her husband as much as it has her. The case needs to be about HER.

Again, I could be wrong but I would rather have my parents represent my best interests than a cheating spouse. Her husband should be dismissed as guardian due to conflict of interest.

10

You are.

  1. Terri is in a PVS (persistent vegetative state). Her higher brain functions are gone, since where her grey matter used to be has long filled up with spinal fluid. She almost literally has no brain. Her cerebral cortex, the “lower brain”, is still functioning (IIRC). This part is the one that rules involuntary processes.

  2. Those videotapes are a few minutes of hours and hours of footage. The footage was carefully chosen to support the Schindler’s (parents) POV. Any appearance Terri has of “reacting” to what is going on around her is easily pure coincidence.

  3. Michael met his current love after Terri had been in her PVS for five years. Unless it’s reasonable that Michael continue to make love to Terri and take her out to the movies, I think he’s entitled to a little companionship. Terri has not been any kind of a wife to him at all for 15 years.

You can find cites for all of this stuff here, here and here. The Doper doctors and nurses who have weighed in on this subject so far are practically unanimous that Terri is, for all intents and purposes, brain-dead. They’ve seen it before.

11

You’re siting this debate site as a medical reference point for a person’s life? That’s funny on a number of levels. If you read all your own links you would see that there are medical personnel directly involved with Terry Schindler who think differently then the blog doctors you are siting. While I appreciate hearing from someone with a medical background it cannot be taken as anything diagnostic unless they have examined the person directly.

If you read up on PVS you will find, like many illnesses, that it has levels of severity. It is not an up or down injury. It is not a given that this woman is beyond hope. Terri has never been given the opportunity for any real therapy. She may indeed be severly retarded. In which case we, as a society, will be executing the mentally handicapped for the crime of low IQ.

As for her husband, there are no laws against impregnating other women when you’re married. However, his wife is currently not in a position to challenge his behavior. It would be nice if he did the honorable thing and divorced her. Considering his current relationship with another woman, he should be removed as Terri’s guardian.

12

You clearly don’t understand the medicine of this case at all. For one thing, Terri Schiavo’s body is NOT fully functional. It is incapable of performing a vital function–that of taking in nourishment. Eating is a vital function, just like breathing and circulating our blood. If we stop doing any of those things, we die. There are treatments that will perform these functions for us, and those treatments are life support. Thus the feeding tube is life support, just like a ventilator.

For another thing, I suggest you go look up what a vegetative state is.

For another thing, she is NOT sentient. The part of her brain that made her sentient died, was swept away by the body’s clean-up crew, and has been replaced with fluid.

For yet another thing, removing a feeding tube is indeed a passive form of death. Yes, her basic needs for food and water are going unmet. When we disconnect a ventilator, that patient’s need for oxygen is going unmet. We’re not depriving someone of something they would be able to have if it weren’t for our interference, we’re just no longer going to extraordinary measures to compensate for their body’s failings.

[sub]Bolding mine[/sub]

The operative word here is appears. I’ve got a watch that appears to be keeping perfect time when you look at it under the proper circumstances. It absolutely doesn’t keep perfect time, though, because there’s no battery in the thing. And that’s Terri Schiavo–a watch with no battery that still sometimes appears to be keeping time.

I deal with euthanasia issues, both active and passive, every working day of my life, and there is a world of difference between denying or withdrawing treatment and actually euthanizing a patient. Withdrawing care isn’t shortening life, but rather a refusal to artificially prolong it. The difference may seem somewhat subtle, but it’s very important. Pushing the blue juice, however, is artificially shortening life. In the former case, the patient is going to die without intervention. The lungs or the heart will stop, and the patient will die. In the latter case, the patient won’t die without your intervention. The heart and lungs will keep right on going, and the patient will live. It might not be a pretty life, or a long one, but the patient will live, at least for the time being.

13

Heh.

Reminds me of a sad case where a family had reached the agonizing decision to take their father off the ventilator rather than continue with the increasingly heroic efforts to reverse his multiorgan system failure. Problem was, he was being chemically paralyzed to improve the efficiency of the ventilator. One of the nurses objected, because extubating a chemically paralzyed patient could be considered ‘active’ euthanasia. So we had to try and calculate what the half life of the particular paralytic drug was in a patient in both hepatic and renal failure (involving consults with pharmacy, nephrology, and GI), then stop the drip and wait 4 half-lives before pulling the tube. During which time his ventilator became increasingly difficult to manage since his chest muscles were tensing up and his abdominal pressures were rising. Just wretched. The family was understandably upset.

14

You may inform yourself right here. It’s an objective site with links to all of the actual court decisions instead of demented propaganda from her nutcase parents.
i

She doesn’t have a cerbral cortex. She is brain dead, It is indeed a “down” injury. It is absolutely a “given that she is beyond hope.”

Bullshit. Read the court transcripts. She has gotten every kind of therapy possible. There is no longer any point. No amount of therapy can regrow a brain.

No, she is not retarded, she is brain dead. What part of “she doesn’t have a cerbtal cortex” do you not understand? In order to be mentally retarded, you need a cerbral cortex.

Wrong. We are taking a corpse off of artificial life support. She is not handicapped. She is brain dead.

His wife is dead.

It’s not for you to decide what the honorable thing is.

This is a complete non-sequitur. What the hell does one thing have to do with the other? He has remained legally married to Terri’s corpse because it’s the only way he can ensure that her wishes are carried out and protect her from her insane, fanatical parents. He has suffered a lot for doing so and has nothing at all to gain.

And can we please have a moritorium on all the shrill, disingenuous moralizing about whether a man is allowed to start another family if his wife has been brain dead for years? It’s hollow, it’s desparate and it’s irrelevant to the case.

15

Magiver, according to what one Doper said, the woman can’t even eliminate her bodily wastes on her own. (She has to have a catheter and have her rectum stimulated in order to defecate). She can no longer swallow her own spit and breaths through her mouth-which has lead to severe tooth decay.

She feels no pain anymore. I would imagine in her condition, it’s probably more stressful for her body to metabolize all the nutrients going into her than it would be for her to starve to death.

Let this woman go.

16

How is it very important? You didn’t explain this. The fact is that in practical terms it is the same result. Yes, people try to justify it to themselves this way, but there is no real difference and it is a matter of semantics the deliberate end result is death in both cases. If an active method is more humane, then it should be an option.

The only issue that I can see is that it is verified that this would have been the wishes of the patient, but fact is this is just as true of passive methods. Note I am not saying lets go randomly killing people, but rather if they are going to die anyway, lets have the option of providing the easiest method to the patient, not just what makes people feel more comfortable.

This example is the reason that in some cases(such as this) that active euthanasia seems more humane than passive. As shown here, even the view of what active may be is clearly subject and therefore meaningless. For practical purposes nothing is gained from passive methods but the psychological comfort of society. In some cases passive methods seem horrid, when a more humane result could be gained by an active method.

17

Yes this is a good point. While someone may agree or even disagree with this case, no one really has the right to judge the husband. He clearly is doing what he is doing because he want to follow his wife’s wishes. He has battled this for years to his own detriment, suffering, and lost finances. He could have gotten out years ago if all he wanted was to be rid of her.

It should also be pointed out that he has recieved and turned down MILLION DOLLAR offers to turn over his rights to the wifes parents. This is not about gain for him in any way.

He is doing what he believes is right, because it is what his wife would want.

18

I have to go with jeffh3000 on this and wonder what subtlties you (crazycatlady) are talking about.

I can see an argument being made in an assisted suicide versus living will that prevents extraordinary measures. I do not think Terri Schiavo’s case falls in that category. Stop feeding her or give her a lethal injection will achieve exactly the same result and everyone knows it yet we somehow feel better as a society to let her starve to death as it is “natural”?

Frankly I find the notion of unplugging a ventilator so a person suffocates to death or stopping feeding so a person starves to death far more abhorrent than “pushing the blue juice”. When the end outcome (death) is 100% apparent to everyone and the clear best course of action is to stop fighting to keep the person alive as it is doing no one any favors…least of all the patient…why wouldn’t it be in society’s best interest to ease their passing as much as possible (quick and painless or as near to painless as possible)?

Terri may not suffer at all regardless of the method of her passing (whenever and however it occurs) as there is no consciousness left to register any of it. There are still people around her who love her and I cannot think watching the person you love waste away over the course of two weeks is beneficial to them. On a broader level our society needs to grapple with this…more than ever as medicine will probably only get better at saving people who would, in the past, have died yet only manage to leave them on the knife edge between life and death.

19

My knowledge of this woman’s plight is very limited as I only recently have been hearing about it. What a maelstrom of ethical and moral debate it has produced.

I was 16 when my father suffered his first stroke and was in a coma for 2 months. He was rehabilitated after 2 years to the point of walking assisted with a cane (he was in a wheelchair most of the time), and could make sounds in a frustrating attempt to speak. He suffered a second stroke while he was a resident at an auxillary hospital. It became quickly apparent to his doctors that my father was beyond any rehabilitation. He was breathing on his own but being fed by a tube and iv fluids. My mother made the decision to have his feeding tube removed after consulting with the medical staff. I don’t remember my mother telling me any details and I never asked. I just stopped visiting him in the hospital because I wanted to remember him as he was and not as an emaciated shell of my father. He was 52 when he died.

Back to the Schiavo case,

I can feel her parent’s sorrow in not wanting the feeding tube removed as this will undoubtedly result in her death within a of couple weeks. What I don’t know is the real reason they want her kept alive. Is it because of a religious belief in the sanctity of life at all costs or is it because of a selfish, spiteful desire to punish Terri’s husband for ‘betraying’ her by wanting to get on with his life? He is the best person, as my mother was, to make an informed decision on the life of his wife. I have no doubts about that.

20

The cutoff is three months. After that, a PVS is considered permanent.