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.