HOW HE SEES IT Americans shouldn't tolerate killing Schiavo
By now much has been written about the legal maneuvering and the political posturing prompted by the Terri Schiavo case. Like the flames of hell, much of that discussion has given off heat but not light. I am neither lawyer nor politician to contribute to that particular colloquy. Rather, I am a physician, one with several decades of experience in taking care of very sick and dying people. I write, therefore, not to discuss the law and lawsuits that swirl about Terri's hospital bed, but rather to talk about the vulnerable young woman lying in that bed.
In our training, doctors learn that we rarely can base good treatments on faulty diagnoses. Yet in this critical area of proper diagnosis, Terri's case is murky at best. While Terri is often described as being in a persistent vegetative state (PVS), there is reason to doubt the accuracy of that claim. PVS patients do not at all respond to their environments, but videotape of Terri shows apparent interaction with visitors. Neither MRI nor PET scans, diagnostic studies that can provide valuable adjunctive evidence in difficult cases, has been performed on Terri. Perhaps most disquieting of all is the fact that the doctor who made the diagnosis of PVS after a brief examination is better known for his advocacy of euthanasia than for his diagnostic acumen.
Terri is not attached to any machine. There is no plug to pull. What she does receive from her caregivers -- until recently, at least -- is the same thing that we all receive: food and water. True, in Terri's case it is delivered via a tube in her stomach. Whether she even still needs that tube, however, is unknown; her husband has forbidden any attempt to assess her ability to take spoon feeding.
Disabled, not dying
Terri has no terminal illness. She is disabled, not dying. Withholding food and water, therefore, is not a measure to allow her to die. It is intended to cause her to die. In this case, the withholding of food and water cannot be considered a palliative measure, since food and water do not cause Terri any symptoms. It is illogical to argue that a woman in PVS -- by definition unable to react to her environment -- feels discomfort from food and water. Alternatively, it is illogical to argue that a woman responsive enough to feel discomfort from food and water would not feel far worse distress from thirsting and starving to death.
Patients certainly have a right to refuse medical treatment, either directly or by proxy. I endorse that right. But food and water are not a medical treatment. The sustenance Terri receives by tube is morally and nutritionally indistinguishable from the formula that babies drink in their first months of life. If we find the idea of withholding feeding from a disabled baby repugnant, we should find the idea of starving Terri Schiavo to death no less so.
Well, then, it might be asked, don't people have a right to refuse food and water? To ask that is to ask whether people have a right to suicide. Even if one accepts that there is such a right, clearly it is one that cannot be exercised by proxy. In this regard, suicide is not unique. A person cannot marry by proxy, nor can he bequeath property that way. Similarly, the right to suicide, if it exists, is one that must be exercised by the individual, not his agent. There is a name for the attempt to commit suicide by proxy. It is called homicide.
Moral sentiment
Ah, but now I see that I have wandered into the realm of law, not medicine. Perhaps that was inevitable. For all its arcane strutting, the law, especially law concerning the care of sick or disabled people, must be based on the actual reality of their situation. Moreover, in a democracy the law must be based on the moral sentiment of the people. It must be a reflection of their culture. Americans are a feisty and independent people, to be sure. But they are also a compassionate people. When they know the true facts of the situation, they will not long countenance the most unmerciful mercy killing of an innocent disabled young woman.
X Dr. Chevlen is co-author, with Wesley J. Smith, of "Power Over Pain" (International Task Force 2002). He practices medical oncology at St. Elizabeth Hospital, Youngstown.