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Terri Schiavo

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The Wrath
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I was outraged when I heard this morning about the Congress taking the action it did in this matter. What will congress decide to do next when interfering in the personal lifes and matters of a family? I have already stated my veiw as far as what should be done to Terry Shiavo in a previous post.

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That is for her husband to make. 

...

Perhaps her parents ought to take her out of hospice and assume responsibility for her life

That is what they want: however, it's not what her husband wants. So whose wishes should take precedence? Is there a reason why a husband's wishes should trump those of the parents?
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Is there a reason why a husband's wishes should trump those of the parents?

When one marries the spouse would usually take precedence unless some other explicit declaration exists. If the parents can prove the marriage was false or that the husband is acting in malice as some allege then that is different.

I ask myself that if he really acted for money then why not take the recent offer from someone for a million dollars.

More about this case is available at this site.

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Since I am a registered nurse whom is currently employed in a Critical Care setting, I think that I can speak with some authority on this issue. The issue of withdrawal of treatment and/or life support, in reality, is something that happens on a day to day basis. In fact, I'm astounded that this case has reached such high profile and I agree with a previous poster who alluded to the fact that poor Terri has become a political football for (religious) moral conservatives in congress. I'm so happy to read some intelligent and well thought out opinions on this forum after being inundated with all the nonsensical rhetoric I've been hearing in the media. Most notably, the constant referral to the removal of Terri's feeding tube as murder.

I realize that there's a lot of dubious "facts" surrounding this case regarding the husband, his intentions, and the specifics about Terri's actual condition etc... However, we cannot evade the reality of her situation. First off, if she is brain-dead according to the medical definition, the grounds for removal of all life sustaining intervention (ie. feeding tube) would be indisputable. Brain death is death. It is the cessation of all brain functions, including the brain stem (which controls your primitive and basic functions such as breathing). At this point, a person can be kept alive in a physiological sense, but (hence the term), their brain is dead. From what I gather, this is not Terri's situation. However, if she has significant brain damage, especially in the higher parts of the cerebral cortex, it is doubtful whether her consciousness remains intact even in the most primitive sense. This sounds like Terri's situation. In this situation, a person can respond randomly to physical stimuli, but it is NOT considered purposefeful , therefore not a valid criteria for determining consciousness or any level of awareness. I have to explain this to patients' families all the time when they say, "look he opened his eyes, look he squeezed my hand." A doctor or a nurse observing this objectively understands this, but a patient's loved one, due to their emotional state, wants to see their loved one respond purposefully and therefore believes it to be true. I think this is the situation of Terri's parents.

Recently I had a patient who suffered a massive heart attack at 40 years of age. Due to lack of oxygen to his brain, he was severely brain damaged but was fully stable off life support (including breathing on his own). Thankfully his wife was rational and did not engage in the fantasies about miracles that her religious family members did, and agreed to "let nature take it's course" and let him die, whether it was starving, getting pneumonia, or choking on his own secretions.

If there's concern about discomfort, start a morphine drip. We do it all the time. Trust me, in the real world, the line between treatment withdrawal and euthanasia gets pretty blurred - provided the directives are in place for treatment withdrawal. Providing comfort during the dying process (even if it speeds it up) is not immoral...I know it's what I want.

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Thank you for that wonderfully reasoned post, drewfactor. I suppose, then, that the only question, if indeed it still remains, is to what extent is Terri Schiavo brain dead, or as you put it, to what extent can she engage in consciously purposeful activity? I add the "consciously" modifier because in a general sense, all biological activity can be deemed "purposeful," the question with man is whether or not it is rooted in volition, rather than just in biological consequences.

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Thank you for that wonderfully reasoned post, drewfactor.  I suppose, then, that the only question, if indeed it still remains, is to what extent is Terri Schiavo brain dead, or as you put it, to what extent can she engage in <i>consciously</i> purposeful activity? I add the "consciously" modifier because in a general sense, all biological activity can be deemed "purposeful," the question with man is whether or not it is rooted in volition, rather than just in biological consequences.

Thanks for clarifying. You are right. We need to make the distinction between consciously purposeful activity and simply the biological consequences. One way to determine this could also be with an electroencephalogram (EEG) which observes brain waves. Regarding the patient I discussed in my previous post, his EEG showed changes in his brain waves as a response to noises in the room, voices, clapping, lights shined in his eyes etc... To what degree even these responses indicated awareness are difficult to discern even by an "top dog" neurologist. So the question posed to the wife was simply: "Would he want to live this way?" She said "NO." Simple as that. This should have been Terri's fate 15 years ago.

Upon further reflection, I've been thinking about the morality of altruism, and the way that patient's families who are religious are the strongest advocates of keeping people alive in vegetative states. The irony is that religious people necessarily reject reason to varying degrees (in order to have faith), yet it is only because of reason that the life sustaining medical technology exists. On the one hand they denounce (to varying degrees) genetic engineering, medically necessary abortions, and technology to help women get pregnant as "playing God." On the other hand they shrill at the thought of removing life support from an 82 year old with no quality of life to begin with. The contradictions go on and on. TO most of you, this is preaching to the choir, I know.

What I have begun to realize through my own experience, is that the ultimate values this mentality upholds are those of suffering and sacrifice. In Terri's context, you can't even raise the question as to whether she has a quality of life - for her, a subhuman existence rotting in a bed must entail suffering, therefore (according to moral conservatives) it must be sustained. You can't ask the question whether keeping her alive places a burden on taxpayers, insurance companies, health care resources, or family members. Sacrifice for the duty to keep Terri alive at all costs seems to be the moral standard in this debate. Does anyone else see this? Or am I way off the mark?

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Of course, you are right--the moral standard for religionists is, for the most part, the sacrifice of value in this world for a greater good in the "after world." In this particular case it is manifest in the sacrifice of Terri's right to life through the violation of her wishes, as described by her husband, for the "greater good" of "erring on the side of life" (note that erring on the side of death is what they're actually doing, if indeed she is incapable of volition).

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Let me also add that the religionist moral idea might have zero to do with this situation--the conservatives might be taking action for the following reasons:

  • They are trying to muscle in to a position of complete moral leadership of the country for political gain.

    or

  • Trying to set a precedent where the government intervened to save a life, no matter how non-human it was. This would have serious repercussions for abortion, where the government would now appear to be justified in protecting the life of a fetus, considering it is similar to Terri Schiavo in its quality of non-humanness.

    Or both

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They are trying to muscle in to a position of complete moral leadership of the country for political gain.

I think their strategy is to put the Democrats into an embarrassing position and shore up the religious vote for next year's elections. The fact that they are making a mockery of the rule of law and subverting the Constitution and federalism by overturning state laws and courts has apparently gone unnoticed.

Edited by GreedyCapitalist
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This is an off-topic remark, so let me know if you'd like to see it as a separate thread:

Doesn't it seem like GW has deliberately modeled himself as a neo-FDR?

Nevermind that GW, like FDR, is a war president--GW has passed huge increases in welfare-state funding (like FDR's New Deal), AND has made a mockery of the rule of law (like FDR did, when he unsuccessfully tried to add six additional judges of his choosing to the Supreme Court).

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I want to clarify what a braindead person is. This is a person who is only being kept alive by a machine. This woman is not being kept a live by a machine. She is unable to swallow and this is why she is being fed with a tube. I had a son who was severly disabled and unable to care for himself but he still was a human. The main issue is not if this woman's parents should ask that she be kept alive it is rather her husband should have the right to kill her. What most people do not know is Mr. Shavio can not get a divorce as long as she is in this medical state. He wants to be able to move on with the woman he has children with and most likely marry her.

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I appreciate what you wrote. After watching my severely disabled child suffer from Leukemia and knowing that I could stop all his liquids to speed up his death, I know what her parents will go through. This husband does not want the word to know he can not divorce this woman because the law will not permit him to. This is what the case is all about. If the parents say she reacts to them then let that be for them.

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I think Congress should have been addressing the right for Mr. Schavio to have a divorce granted so he could let the parents take care of their child. I could not imagine how hard it has been for the parents to watch their daughter for these past 15 years not get better. I watched my son get worse for 9 months with Leukemia and finally die at the age of 11. It was terrible, but I knew he was in pain and I wanted it to stop. In Terri's case she is not showing any signs of pain.

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As far as I know, Michael Schiavo can get a divorce if he wants to. (Who would contest it?) I'm pretty sure Terri's parents have urged him to do exactly that: get the divorce, walk away and let them care for her. The problem (for him) is, he'd lose the right to determine her care; specifically, to order the tube pulled. He wants that tube removed. Whether because he truly believes that's what she would choose or because of an ulterior motive, that's what he wants, and what he's spent years in court trying to accomplish.

Felipe: you're not the first to compare Dubya with FDR. Columnist/blogger Vox Day (a religionist but still fun to read) regularly refers to Bush as "George Delano."

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I want to clarify what a braindead person is. This is a person who is only being kept alive by a machine. This woman is not being kept a live by a machine. She is unable to swallow and this is why she is being fed with a tube. I had a son who was severly disabled and unable to care for himself but he still was a human. The main issue is not if this woman's parents should ask that she be kept alive it is rather her husband should have the right to kill her. What most people do not know is Mr. Shavio can not get a divorce as long as she is in this medical state. He wants to be able to move on with the woman he has children with and most likely marry her.

Regarding braindeath: exactly as I discussed in detail in my above post. The issue of your son in comparison is incongruous because it is a different situation. I understand your concern because the question becomes: "If we can pull a feeding tube from a disabled person, what does that mean for all the other disabled people? What precedent does it set ? Can we arbitrarily decide to euthanize people deemed to be a burden by parents, society etc..?" The problem here is the slippery slope fallacy and a case of context dropping. The context being Terri was a fully functioning adult before the accident, and the legal implications due to the contractual agreement that is marriage (in which the husband has the say in determining what her wishes).

Edited by drewfactor
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and  the legal implications due to the contractual agreement that is marriage (in which the husband has the say in determining what her wishes).
I can't imagine that being true, however you mean it. A person's wishes are not subject to approval by a spouse, and in all civilized countries, at least, husbands do not own wives so they never get "the say". Mutual consent is required for certain things (in certain states), namely disposal of jointly owned property, and there are other financial responsibility entanglements. Otherwise, husbands have no special rights.
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I can't imagine that being true, however you mean it. A person's wishes are not subject to approval by a spouse, and in all civilized countries, at least, husbands do not own wives so they never get "the say". Mutual consent is required for certain things (in certain states), namely disposal of jointly owned property, and there are other financial responsibility entanglements. Otherwise, husbands have no special rights.

Right. A person's wishes are not subject to approval by a spouse, however, in this context the husband is legally the one who holds the "decision making power" in determining what she would have wanted (given that she is currently unable to state her wishes). If Terri stated that she didn't want to live as a vegetable, her husband could override that wish given that she doesn't have that written down (or vice versa) - hence the current debate. When one gets married, part of the contractual agreement is that in these situations, the spouse takes over legal guardianship. As an aside, this is partly what is driving the gay-marriage debate.

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in this context the husband is legally the one who holds the "decision making power" in determining what she would have wanted (given that she is currently unable to  state her wishes).
Okay, meaning, in this specific instance when Michael Schiavo was granted the guardianship. Now it's quite true that if her wish is undocumented, he could fraudulently misrepresent her wishes. If she never expressed any wish, at least as I understand the Florida statute, then he would not have a legal basis to request an order to pull the plug. He cannot ever override her decision, legally, but he can do so illegally by suppressing evidence of an advance directive -- i.e. he could lie and say "She said she wanted to die" when in fact she said nothing, or even said the opposite. This is true even if she wrote it down. What's important is that the truth never come out, if you're going to commit this kind of fraud. (An interesting side note: if it is proven, after the dust settles, that he suppressed compelling evidence of her contrary wishes, I wonder if he could be prosecuted for "murder by fraud")
When one gets married, part of the contractual agreement is that in these situations, the spouse takes over legal guardianship.
No, I'm pretty sure that's not the case. I know that in the case of my wife and I, no such contractual agreement exists, and I've never heard of anyone making such an arrangement (though it might be possible albeit not as a contract). In each case, when no written document is available, you have to go though the procedure in probate court, and the judge decides on a case by case basis. It is extremely likely, though, that the judge would rule in favor of a spouse if there was no contest and no contrary evidence (e.g. the guy was a serial criminal).
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If there's concern about discomfort, start a morphine drip.  We do it all the time.  Trust me, in the real world, the line between treatment withdrawal and euthanasia gets pretty blurred - provided the directives are in place for treatment withdrawal.  Providing comfort during the dying process (even if it speeds it up) is not immoral...I know it's what I want.

Thank you for pointing this out, as it's a point that is often overlooked. Its not like she is going to sit there and "consciously" waste away. As I understand it, people who have feeding tubes removed are essentially put in morphine-induced comas, and don't feel a thing.

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I don't know if this has been mentioned yet, since I haven't had time to completely read this thread:

Terri Schiavo's state is one which is non-recoverable. Her pre-frontal cortex has essentially turned into useless matter; no person can recover once it has turned to mush. This is what is meant by "vegetative state." She had a heart attack in 1990, and that is when her brain began to be deprived of oxygen--so there is definitely no chance of recovery since the pre-frontal cortext degrades within a few months.

When the pre-frontal cortext is disbanded, there is no capacity to feel emotion, think, integrate senses, or ever be a human being in the essential meaning of the word. The "life" the religionists are protecting is not one of human life, but simply biological life. Nothing about this case would be "murder" of a human being, especially since removing a feeding tube is not force. I think the law should be simple in this regard, and leave it up to the spouse in the case of a vegetative state (I have a feeling this is the current law).

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No, I'm pretty sure that's not the case. I know that in the case of my wife and I, no such contractual agreement exists, and I've never heard of anyone making such an arrangement (though it might be possible albeit not as a contract). In each case, when no written document is available, you have to go though the procedure in probate court, and the judge decides on a case by case basis. It is extremely likely, though, that the judge would rule in favor of a spouse if there was no contest and no contrary evidence (e.g. the guy was a serial criminal).

Hmm..As far as I understand it, the legal guardianship rests on the spouse. Even though you didn't make the explicit agreement with your spouse, if you ended up on life support tomorrow, when doctors ask what "your wishes would be," she is the one who speaks on your behalf. Now, let's say your wife says: "He wouldn't want to be on life support, pull the plug now" but the doctors are convinced of a chance of recovery, it's not like they'll be obligated to pull the plug. Let's say your parents (as in the case of Terri) demand otherwise and the dispute is not settled, then it goes to court I guess.

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In any case, the parents continue to fight fruitlessly and waste time in the legal system, and the legal system continues to do the right thing, in my opinion:

In a 2-1 ruling early Wednesday, a panel of the 11th Circuit Court of Appeals in Atlanta said the parents "failed to demonstrate a substantial case on the merits of any of their claims" that Terri's feeding tube should be reinserted immediately. 

"There is no denying the absolute tragedy that has befallen Mrs. Schiavo," the ruling said. "We all have our own family, our own loved ones, and our own children. However, we are called upon to make a collective, objective decision concerning a question of law." 

Source

There is no way that Terri Schiavo, in her current state, can ever experience any semblance of life, given the fact that her brain has suffered the extensive damage that it has.

Terri Schiavo has a right to die.

Edited by Yes
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