End of Life Care - Lessons from Terri Schiavo

First of all, let me offer my deepest sympathies to the Schiavo and Schindler families. May you reconcile in time and commemorate what was happy rather than what divides.

The case of Terri Schiavo lends itself to the discussion of two end of life issues, the appointment of a custodian and the proper level of end of life care.

What sticks in the craw of some people is the fact that Michael had found another relationship and was still making custodial decisions about his wife's care. The facts of the matter bear out, however, that he made these decisions not for his own sake, but because of what Terri wanted. It took great bravery to do what he did, despite offers to cut and run from his wife's family and from a rather well monied right-wing lunatic fringe.

Be that as it may, one could forsee a rule that said that if a spouse were to move on while the other spouse lingers, care would devolve to someone else. Whether that someone should be family members who disagree with the status quo is another matter. In the case of Mrs. Schiavo, giving control of her care to her parents would have been absolutely the wrong choice. It would seem better as a general case, when the spouse is disqualified and the family disagrees, to give the care to an appointed gaurdian who shares the wishes of the patient - which is to say that everyone should have a living will appointing such a gaurdian and a backup gaurdian.

Such a procedure has a downside, in that it makes it look like the courts are ordering the killing of one of its citizens, making its enactment unlikely. On sober reflection, giving that the family was clearly wrong as well, perhaps the best case was the one that occurred, appearance of conflict or not.

The best answer, of course, is to rethink how we keep people alive. Outcomes research has shown that, except for cases of cardiac disease and certain accidents, when people are brought back from the grave by CPR and electric shock, the outcome is often grim. This is especially the case when someone is suffering from a chronic terminal illness, such as cancer. In these cases, the prognosis is rarely good. This leads to the possibility of a new general rule for end of life care.

When someone, like Mrs. Schiavo, is only alive due to heroic measures - meaning that they were dead - and their were dead long enough for their brains to die, leaving them in a persistent vegetative state, then perhaps the operative rule should be to remove all support right away, including nutrition. The fact that the person was dead at one time must enter into the picture, differing such cases from that of people who are given artificial sustenance as part of a long decline, such as is the case with Pope John Paul II. If this is done, regulating who is to have gaurdianship becomes a moot point. This is not promoting a culture of death, it is recognizing that death has already occurred. If those with religious sentiments wish to use this time to offer last rights and absolution, that is appropriate. Soon after that, however, the patient should be allowed to slip away.

For Mr. Delay and Mr. Bush of Florida, if you wish to use the Schiavo case to change law, then address this issue of care for those who have already flatlined. Don't go messing with our marriages or with judges who have already acted inside of the constitutional right of patients to deny medical care, which has already been adjudicated at the highest levels.

Terri Schiavo

As I write this the family has exhausted its appeals (yet again) and is trying one more time to assert their daughter is not in PVS. If you are reading this, you already know this, so let me go on to my impressions of this little drama which has captured our national psyche.

Evidence has come out recently that the Republican leadership in Congress has latched onto this issue as a way to rally its base. This is hardly a surprise. How can you tell that Tom Delay is pandering to his base? His lips are moving. The sad fact of the matter is that the law sending the measure to the federal courts was deliberately crafted not to work, leading to its inevitable failure and yet another chance for conservatives to claim that the courts are "out of control." As Thomas Frank has ably concluded in What's the Matter with Kansas? this leads to a call for more conservative judges, which then abandon social issues and instead rule on economic issues in a way that favor business at the expense of consumers and workers. If the foot soldiers on the right knew how they were being manipulated, they would think again about what their leadership is asking them to do.

The problem is, of course, that this movement works on a visceral rather than an intellectual level. The appeal to save Terri's life is largely an emotional one. The fact that Michael Schiavo has fathered two children with another woman has also touched a nerve with them. Demonizing the husband gives the issue added appeal, even though he has faithfully cared for her for these past years. The doctors who have examined her have concluded that her cerebral cortex has liquified. In effect, she is asleep and will never wake up. Michael has to be admired for sticking to his guns and honoring his wife's wishes. It would have been far easier to walk away and let her parents have their way.

As a father, I can understand the love they have for their daughter. However, as a husband I can understand Michael's position even more. The parents have been ill advised by the Church, who as usual is speaking about an area of medical ethics it does not seem to understand. While it is not obvious that medically provided nutrition and hydration is an extraordinary measure, using such to prolong the life of someone who has no higher brain, let alone higher brain function must be entirely appropriate. Until two years ago, the Church agreed. However, for whatever reason, Rome is seeking the extremes in search of a "consistent" pro-life ethic - as they have done so misguidedly with birth control. Historically, it was considered quite legitimate to withhold food from the dying. One would think that if someone cannot eat and cannot think that it is better to entrust them into God's hands. With the upcoming Easter season, one would hope that that the Church would remember that Terri will one day rise with Christ and that letting her die will hasten the time when her spirit can meet the Lord.

Some say that Terri should be kept alive to offer witness. In the Catholic tradition, when someone is suffering, they can offer witness to their faith through adversity. Terri Schiavo can offer no such witness, since she is not suffering. Offering witness is a conscious choice. She has no conciousness to make such a choice. She is an exhibit, rather than a witness, and what her case is exhibiting is how some in the Curia have gone to extemes. The Lord cannot allow such insanity for much longer in his Church.

In last night's Supreme Court filing, the Schindler's asserted a religious freedom right to restore her feeding tube. The body of Catholic doctrine, going back 400 years, does not support their assertion. More than that, had they succeeded on this motion, the effect would have been to use the state to impose their opinion of Catholic doctrine on their daughter and her husband, thus setting the idea of religious freedom on its ear. Earlier filings indicate that they are worried for Terri's soul. First, Terri's soul is not their problem and second when Terri expressed the desire not to be maintained against her will the Pope had not spoken about nutrition for patients in a persistent vegetative state. Note that no new doctrine has been promulgated since then. The parents are attempting to keep their daughter alive because of a speech, probably written by a young conservative priest, for a group of other pro-life priests. The deposit of the faith actually goes the other way on this issue. We do not make morality by sound-bite.

Let us all pray for Terri Schiavo. Rather than praying for the reconnecting of her feeding tube, however, let us pray for God's will for her rather than our own. If her parents and their supporters would only pray in this way, the nation would be spared a public airing of their family tragedy which has gone on for far too long.

When we were at St. Matthew's Cathedral for Mass on Palm Sunday, we encounted a protestor for Terri. This woman seemed quite distraught over Terri's circumstances. I doubt whether this woman had ever met Terri, yet her case seemed to be dominating her life. To her, and to all those committed people like her who have taken this personal tragedy on as their own, I have one thing to say in conclusion. GET A LIFE! As Jesus said to the weeping women on his way to crucifixion, do not weep for me, but for yourselves. There is plenty of calamity in our future (how can their not be with this administration in power). Let us worry about that, rather than Terri Schiavo.

Bankruptcy Reform

Yesterday the Senate passed bankruptcy reform legislation. This legislation has long been on the wish list of the credit card companies, which is tied in with the rest of the financial sector. The Republican majority turned back several amendments which would have made the legislation somewhat more reasonable. We have found out that Trent Lott has nothing on Bill Frist when it comes to being a real you-know-what when given enough votes in the majority.

One of the strengths of the two party system is the ability of one side to moderate the other. This check seems to have failed in this case. Aside from debtors, there are two major losers here: the Republican Party and bankers, who are driving like lemings into the sea.

This new legislation is one of those things that people are going to notice, particularly those social issue Republicans who are a paycheck or two away from disaster. Even if they themselves don't file for bankruptcy, they will have a friend or relative who will and there will be no doubt as to who is to blame for the harsher treatment of debtors. It may turn out that the Republicans have done to themselves what Terry McAuliffe was trying so desperately to do to them, associate them with the economic elite. These folks don't care if someone wealthy gets to keep more of their money, but when you start messing with the down and out, folks are going to notice.

The credit card companies and banks are also losers here. They are likely correct that people do game the bankruptcy system when overusing credit cards. They aren't going to be doing that anymore. When the impact of this legislation is felt people are going to stop using their cards in a big way. Other forms of consumer debt will also go down, including those nasty mortgage lines of credit. You can only take someone's house once before they get wise to you.

The passage of this legislation is one of those seminal events which will prove the addage that necessity is the mother of invention. Debtors will seek different instruments, such as those I have proposed in the Musings from the Christian Left. In Europe, unions provide credit services to their members. I predict that employee owned firms will begin to provide some of the same services, blurring the line between the credit union and the firm. Services that could be provided include educational loans, mortgages and payroll lines of credit.

For more information on how this can occur, go to my site at:
http://www.christianleft.net/21stCentury/PayEquity.html
http://www.christianleft.net/21stCentury/InterIndependence.html

The Ten Commandments

The issue is not whether the United States acknowledges God. God does not need us to acknowledge Him for His sake but for ours - and He certainly does not need forced acknowledgement directed by the state. This issue is also not about activists federal judges, as Miller and Scalia would have you believe. This case and all such cases are about the inability of state governments to protect the rights of minorities (religious, racial, sexual) and the responsibility of the federal government to do so under the Fourteenth Amendment. The Fourteenth Amendment codifies the settling of this question at Appotomax, Virginia in 1865, something my fellow southerners are loathe to admit.