argh Hit “reply” too soon. You are also ignoring the fact that vital parts of Terri’s brain are liquefied. They no longer exist. There is a pouch of spinal fluid where once there was grey matter. Do we need to draw you a picture?
I’ve been (mentally) working on a longer post explaining all this, but I’ll try to sum it up.
As a doctor, I cannot give a patient a treatment with the intention of causing death, at least not in most states. This is considered active euthanasia, and violates the principle of nonmalfeasance (“first, do no harm”).
However, a patient is generally under no obligation to accept or continue any medical treatment, even if it is life-sustaining. This is the principle of patient autonomy, or the idea that patients should ultimately make their own decisions regarding care. (There are exceptions, of course, mostly relating to public health dangers, but it’s generally true in cases like this.)
Therefore, it is not considered unethical to discontinue a treatment if it is believed that the patient would want it discontinued, even if the result is death. But it is still widely considered to be unethical, and it is illegal in 49 states, to give any agent that would specifically cause death. A thin line, but an important one.
FWIW, I agree that in a lot of cases, a nice big IV push of potassium would be preferable to dragging it out, but I don’t think our current environment of medical ethics is ready for it. Maybe within my lifetime.
I take it you didn’t see the bit immediately after that went through the patient dying without intervention in one case and the patient living without intervention in the other case? It’s not the same, any more than me giving a homeless guy a couple bucks is the same as him reaching into my purse and filching a couple bucks. Yes, the end result in both cases is that he’s got a few dollars that used to be mine, but the means are just as important as the end result.
If pulling Terri Schiavo’s tube is the same thing as putting a bullet in her brain, then your failure to send money to those organizations that feed children in Africa is the same as you hunting a kid down and taking food away from him. The end result is the same–kid goes hungry, maybe even dies of malnutrition. Is your culpability in the child’s hunger or death the same in either case? I would say not, because there’s an ethical gulf between not actively helping someone and actively harming them.
I agree that it’s a travesty to allow humane euthanasia for animals but not for humans. The fact that my dog can die with more dignity than I’ll be allowed to give my human loved ones is absolutely barbaric. But our society as a whole isn’t ready for human euthanasia, no matter how horrible the options might be. Withdrawing care, sliding into that ethical gulf between intervening to cause life and intervening to cause death, is the best we can do for right now.
The site you posted is one of the better sites I’ve seen. I’ve still yet to read about any tests regarding brain activity. Nowhere does it state her cerebral cortex is completely destroyed or what, if any activity it produces. The only reference to cognitive activity was the swallow test and the assumption was that it takes some cognitive capacity to actively swallow food. There was no attempt to pursue any brain function during the dream state which should indicate any vestige of brain activity.
Guardian Ad Litem Jay Wolfson seemed to do the best job of all the appointed GAL’s and appears to understand that it will take an agreement of medical diagnosis between the Schindlers and Michael to bring this to a conclusion. Mr. Schiavo’s decision to withdraw the feeding tube was in contrast to the Schindler’s wishes for their daughter and no attempt was made on his part to bridge the gap.
Finally, if my moral judgements (standards) are different then yours regarding Mr. Schiavo’s behavior as husband than that is just too damn bad. That’s how I feel.
I hope this case serves as a catalyst for people to take the time to fill out a living will. There is a national registry for them that might be worth checking out.
http://www.mysteries.pwp.blueyonder.co.uk/6,2.htm
Scientists have no clear knowledge of how the brain and consciousness works. What they have is theory, and experience. While experience can not be discounted, each individual is unique. No one knows what she is capable of or not capable of for certain. Give her a chance.
Despite my posts I’m not in disagreement with you on letting her go. I had not given any thought to a living will prior to this case.
Theory and experience = no knowledge?
Give her a chance to do what? The same thing she’s been doing for the last 15 years? You not knowing and everybody else not knowing are, in my experience, very different things.
I wanted to write that big bioethics-related post, but it has already been done for me by Hilzoy of Obsidian Wings.
I can’t disagree with a word of it.
Thanks for the link DoctorJ, as you say, well-written, sensible and something I can totally agree with.
As for the difference between a lethal injection and removing nutrition and hydration…one means that someone is a murderer, the other means that a it has been decided that a patient should no longer receive life-prolonging treatment.
Like the difference, as Hilzoy says, of a cancer patient not getting one last, futile round of chemo, and someone shooting them in the head. Same outcome, totally different things.
Folks, it’s not about life or death, it’s about autonomy.
Anyone who has seen someone die from lack of nutrition and hydration, in my case, a person with Alzheimers who could no longer swallow (and whose family were smart enough not to request PEG feeding), knows that it’s not a bad way to go. Really.
I agree 100%, you said exactly what I have been thinking.
Matley23 her family has offered to take over the expense and work of taking care of her, but the husband who will inherit a great deal of money says no.
The situation is not as it seems, more consideration should be given.
As for knowledge, Socrates said: "the only true knowledge is knowing that you don’t know anything. Perhaps you do know the unknowable, it is not for me to judge, but I think she deserves all the chances possible.
Michael Schiavo has appeared on a number of TV programs since Friday, and each time he has said the same thing: He doesn’t stand to inherit any money when Terri dies.
Terri’s parents have been able to spend the past 15 years with her, offering stimulation and attempting to get a response. Doctors who have examined her say there is no cerebral function; doctors who have never seen Terri in person say she may be functioning,solely on the basis of videotape excerpts.
As somebody who works daily with videotape, I have to tell you that you can’t make any judgment based on a tape that’s been edited, especially one that’s been put together with bias in mind.
This case has been through courts for years, been heard by 19 judges, and gone to the Supreme Court of the United States (which has refused to hear the case, which says a lot).
Just how much more consideration should be given?
My understanding is that a million dollars was paid for malpractice. This money was paid to Terri, and is being used for her treatment. If Terri dies the remaining money will go to Michael. But if Michael allows her parents custody, then the money will follow Terri. at least that’s the way I understand it.
I would not believe anyone who votes for the death of another human being that is awake and reacting to her family. If the judges see fit to kill Terri, over the protests of her family, who will be next, the insane, the autistic. Never such power should be in the hands of government, it is a decision for the family.
Now I believe in a Higher Intelligence and know that man is spiritual. No one can know the power of the spirit or the intent. No doctor really knows for certain about Terri, most doctors work with percentages. My doctor told me I had only a 5% chance of living more than six months. That was 18 years ago.
Throw in the towel if you wish. But you are no judge of Terri’s condition anymore than I.
Michael should respect the wishes of her family.
How much more consideration? Seventy times seven of course.
The money has been used to pay for Terri’s care. It is just about gone. The amount left in the settlement is in no way enough to make a fight like this worth it.
On the other hand, Michael has been offered millions of dollars to give up his guardianship, and he has consistently turned it down.
She is not reacting to her family. Listen to the audio clip linked to in one of the pit threads, and you’ll see what the family thinks qualifies as “interacting”. The videos you’ve seen on TV are the result of heavy video editing after waving a balloon at her for four hours. She is wakeful without consciousness, which is characteristic of a PVS.
Michael is her family. He is her husband.
I have been watching this on TV since the beginning, I can’t say you are wrong, because I don’t know. But I have never heard what you post.
I don’t go to the pit for any reason, to nasty down there to believe anything.
Her mother, father, has spent more time with her than Michael, they know her better. He should respect them.
I would leave her to God, not the government.
That’s all I have to say.
This is not true in either respect it’s the courts who have made the decision, not Michael Schiavo.
Leaving her to God means unhooking the tubes instead of continuing to artificially animate a corpse.
I take it you’re not married. It’s not about how long you’ve known someone, but rather how deeply you’ve known them. My parents have known me 18 years longer than my husband, but they never can and never will know me 1/10th as well as he does. Part of it is that he resonates with me in a way they never have and never will. They are, after all, the people that the luck of the draw handed to me, while he’s someone I hand-picked to share my life with. But part of it is that he’s spent more time around the adult me. They’ve had fairly frequent visits, phone calls, and a few summers at home since I’ve become an adult. He’s had almost daily contact with me throughout that entire time.
Yes, my parents know far more about the person I was at age 4, or 10, or 16 than he does. But that’s really pretty irrelevant, because I’m not the same person now that I was at any of those times, and it’s the person I am now who makes my major life decisions. If I were to suffer massive hypoxic brain injury right now as I type this, my treatment would have to be determined by what the person I am now would want, not what the person I was when I lived with my parents would have wanted. And my husband is the one who knows the person I am now better than anyone else in this whole round world.
They don’t know her better… she is brain dead, therefore can’t interact with them. They can spend all the time with her in the world and it doesn’t change the medical facts.
You certainly can’t talk of respect. If the family had the least bit of respect for their daughter or the husband instead of their own selfish interests, they would have let her go long ago. The family has clearly stated that they don’t care what the wishes of their daugher would be, as they said they just don’t want to let her go. This is wrong
Well, as an aside, I should note that I do actually donate to world hunger organizations. 
You have demonstrated my point perfectly here. This is my point, you are using moral arguments. As you show, one can define morality any way we want, connecting the dots as they wish, which is what creates the problem. As I said before, it is all a matter of semantics. We need to look more at the practical reality of the situation, if the end result is exactly the same, then passive vs active should not make a difference.
As you say, society is simply not ready for human euthanasia. I certainly realize this fact, however I find it unforunate and impractical. It is a result of perceived moral issues, which may change with time, rather than medical fact.
Let’s clarify that to say “parts of North American society simply are not ready for human euthanasia”. Oregon has a doctor-assisted suicide law on the books. The Netherlands does too-- and my wife’s great-uncle took advantage of doctor assisted suicide not terribly long ago, after his quick decline from Lou Gehrig’s disease.
And granted, while most doctors work with percentages, no doctor in the Schiavo case is. The documentation I’ve read shows quite clearly that Terri Schiavo does not respond to anything-- and hasn’t in 15 years. Her cerebral cortex is gone, shrunken to nothingness, and her skull is full of spinal fluid. Some of my colleagues have watched four hours of videotape the Schindlers use in an attempt to prove she is responsive-- they found it painful to see people in such an incredible state of denial.
Should Michael listen to Terri’s family? No he shouldn’t-- as her spouse, he has the legal right to make a decision about ending heroic treatment, a right her parents lost when their daughter was married. In addition, Terri made her wishes about not wanting to live in a PVS state clear enough in oral declarations to Michael, and her friends, for multiple courts to rule she would not want to live in her current state.
It’s not like her decision is unusual. An ABC News poll, a Fox News poll, and a CNN Usa Today Gallup poll all show an overwhelming majority of Americans would pull the plug on Terri Schiavo if they were in charge of her care, and show they would not want to live in similar circumstances.
Allowing her to starve/die of dehydration may seem incredibly cruel, but if the patient is incapable of feeling anything, it really isn’t. Let’s face it-- if the person could react to the lack of food and water, they wouldn’t be in a PVS and left to die, and if they can’t feel anything, they can’t feel anything.
It is also a decision that is made hundreds, if not thousands of times each day in the U.S. Given the option, I think many more people would prefer euthanasia. After all, people put dogs and cats to sleep every day! And I really think the Schiavo case will result in two things: more people getting living wills, and more euthanasia laws on the books.