Saturday, March 19, 2005

The Terri Schiavo Case

The sad case of Terri Schiavo brings important medical-ethical issues to the fore. But this is not a hard case. As a general principle, when there is reasonable doubt about an incapacitated person's wishes regarding life-support and when someone is willing to pay for continued support, the presumption should be in favor of life and a spouse should not be able to terminate it. In this case, there is no written proof that Terri Schiavo expressed a wish not to be kept alive. All we have is her husband’s and one or two other persons' say so. Not good enough. In fact, according to Terri Schiavo’s parents, “When he [husband Michael Schiavo] promised the malpractice jury back in 1993 that he would take care of Terri for the rest of his life, Mr. Schiavo said nothing to the jury about Terri not wanting to be sustained on anything ‘artificial.’”

Not only was Michael Schiavo awarded money by a jury for her perpetual care, it has been reported that others have offered to pay for her life-support. Add to these facts that ten years ago Michael Schiavo commenced a romantic relationship with another woman whom he describes as his fiance, has had two children with that woman, and has announced that he has “moved on” with his life, and his wish to disconnect his wife from feeding and hydration tubes becomes suspect and indeed irrelevant. The Florida courts long ago should have excluded Michael Shiavo from the matter, declaring that he has a conflict of interest, and recognized Terri Schiavo’s parents as her guardians.

The fact is, we don't know what Terri Schiavo would say she wants if she could speak for herself. But there should be a presumption in favor of preserving life unless that presumption is overcome by an advance directive.

It might be argued that in her condition, Terri Schiavo is no longer a person and thus has no interests. But what is the difference between a former person (non-person) and a severely impaired person? Does the desired disposition dictate which term we use? Language is often more prescriptive than descriptive.


At 5:16 PM, Blogger Lee Killough said...

Here is a radio interview (MP3) of Terri's brother, Bob Schindler, and family lawyer, Pat Anderson, that was recorded by a friend of mine this week.

At 9:34 PM, Blogger Mira de Vries said...

It is clear that there is a horrific feud going on between the parents and the husband. We should be careful not to take sides.

The idea that the husband has a conflict of interest while the parents don't is unfair. Surely no one is suggesting that the husband should have stayed celibate for fifteen years. Now there is a new family which also has interests. This may be affecting not only the husband's point of view, but also that of the parents, who clearly resent the new family.

I'm not for a moment suggesting that Mrs. Schiavo should be allowed to die for the benefit of the new family. I'm only pointing out that there is no party without a conflict of interest.

Does Mrs. Schiavo truly respond to environmental stimuli, as her parents claim? Or are they fighting acceptance of the reality that she is no longer? Or are they using their daughter to punish the new family?

Perhaps no one can know the answer for sure, which would certainly be a reason to continue the life-support, but I don't think the issue is as clear-cut as you suggest.

At 11:26 PM, Blogger Nicolas Martin said...

Being careless, I'll side with the conflict of interest known as love. I agree that there should be a "presumption in favor of preserving life."


Don't the physicians who are caring for Mrs. Schiavo want to disconnect her? How can the woman be kept alive if the state does not compel the doctors and the hospital to keep her on support? Why should the state have such power?

At 12:01 AM, Blogger Nicolas Martin said...

Too bad nobody remembered to bring a video camera to this event.

Terri Schiavo Tried to Tell Parents' Attorney She Wanted to Live

Barbara Weller, one of the attorneys for Terri's parents Bob and Mary Schindler, told reporters about her visit with Terri on Friday.

"Terri, if you would just say, 'I want to live,' all of this will be over," she told the disabled woman.
Weller said Terri desperately tried to repeat Weller's words.

"'I waaaaannt ...,' Schiavo allegedly said. Weller described it as a prolonged yell that was loud enough that police stationed nearby entered the hospice room.

"She just started yelling, 'I waaaannt, I waaaannt,'" Weller explained.

At that point, police removed Weller from Terri's hospice room and, later, her feeding tube was removed.

At 7:21 AM, Blogger Sheldon Richman said...

I am not saying I agree with the parents' decision or that we know that their position is untainted by vindictiveness. All I'm arguing for is a presumption in behalf of the preservation of life. It does not follow from this that the taxpayers should be compelled to maintain life-support. I understand that private money has been offered to support her.

At 10:21 AM, Blogger Mira de Vries said...

Sheldon, surely the right to life is not contingent on the willingness of a third party to pay for it?

In Libertaria, where the state has no power except to protect citizens' right to life, liberty, and property, the technological possibility of life-support systems will force us to take another look at the definition of life.

At 10:43 AM, Blogger Sheldon Richman said...

The right to life cannot mean that others (absent a contract) have an obligation to sustain that person's life. That would be slavery. It means only the right to take non-coercive actions to maintain one's life.

At 10:44 AM, Blogger Sheldon Richman said...

It would be hard to come up with a group of people more cynical than the the Republican leadership in the Congress. This is from today's Washington Post:

"In a memo distributed only to Republican senators, the Schiavo case was characterized as 'a great political issue' that could pay dividends with Christian conservatives, whose support is essential in midterm elections such as those coming up in 2006."

At 11:13 AM, Blogger Mira de Vries said...

Sheldon said: "The right to life cannot mean that others (absent a contract) have an obligation to sustain that person's life."

In Mrs. Schiavo's case, that would mean that the husband has an obligation to sustain her life at whatever cost, as it is understood by the marriage contract. On the other hand, he has no obligation to sustain the life of his common-law wife, as state law prohibiting bigamy prevents him from making a marriage contract with her.

My conclusion is that as long as the state interferes so heavily in our private lives, we cannot always apply libertarian principles to the right to life.

At 8:54 PM, Blogger Nicolas Martin said...

mira de vries wrote: "[S]urely the right to life is not contingent on the willingness of a third party to pay for it?"

You mean, I assume that the right to remain alive should not depend on third party support. But why not?

Does Mrs. Schiavo retain the right to indefinitely force others to maintain her on life support? Does that right extend to doctors who think it unethical to keep her alive? Does it extend to her family, even in the event they decide she should not be sustained artifically? Does it extend to all people who pay taxes?

If an adult has a right to live at the expense of others, should this right be confined just to medical interventions?

Does someone who, due to handicap, cannot generate the income to feed or house himself have the right to compel others to support him? If a person is so impaired that he cannot bring food to his mouth, does he have the right to compel others to put the food in his mouth? If so, is this a right that can be exercised only indirectly, such as by having taxpayer money pay for an assistant, or can it be exercised directly, such as by having the police compel his neighbor or family to attend to his needs?

If you believe that the family or taxpayers can be compelled to support a right to life, does that also mean that they are obliged to provide assistance, directly or indirectly, to all elderly persons who haven't the financial, mental, or physical wherewithall to care for themselves?

I'm interested in more details on this positive right that you are apparently propounding. What are its boundaries? I can't see how it could be limited to medical care: food and shelter are just as critical for survival. And I don't see why it requires a redefinition of life or of ethics.

At 11:39 AM, Blogger Mira de Vries said...

I have great faith that in a libertarian society, people (not everybody, but sufficient) will feel responsible for each other's lives, and rally to the rescue when needed. If I didn't, I wouldn't be a libertarian.

In our current society, which, I don't have to point out to you, isn't libertarian, the state takes this responsibility upon itself. Private citizens are actively discouraged and even prevented from helping each other, for instance because they are not licensed to do so.

As a libertarian living in a maxarchy, I find that not all dilemmas are easily solved by rigid principles.


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