Monday, March 21, 2005

Putting your nose where it doesn't belong

Hard to believe, I know, but I am chairman of my hospital ethics committee. A few weeks ago, as part of a presentation on ethics to the hospital staff, I used the Terry Shaivo case as a source of discussion on the principles of ethics and how they are applied. But first, a few facts, from the public articles and discussions that I could find: 1. There isn't a lot of money involved. There was a 1 million dollar settlement, but most of that has been eaten through with medical bills.

2. 5 independent neurologists have decided that Ms. Schaivo is in a persistant vegetative state.

3. A court trustee observed her for a long time and did not feel that she responded to her environment, not even to the parents when they were there.

A quick discussion of persistant vegetative state(pvs): this is where enough of the brain(or small specific parts) have been damaged so that the patient does not seem to be aware of his/her surroundings, does not respond to stimulation, and does not interact with the environment(no purposeful movement). This is very different than brain death, where the brain is totally not working so that absolutely nothing works(no breathing, no reflexes, no nothing). People in a persistant vegetative state breath, can swallow sometimes, can blink, can have non-purposeful movements, can spontaneously grasp(makes you feel like they are holding your hand when it is really a reflex) and have other signs of life.

Here in the US, a person is allowed to chose treatment, or no treatment. One is allowed to refuse feeding/water. We are also allowed to designate a surrogate, someone to make decisions for us when we are incapable of making one. If there hasn't been a person designated, then the spouse is the person to make the decisions, unless there is a specific reason that the spouse shouldn't be the decision maker.

According to Halacha, the issue is very simple. Halacha is paternalistic in this case, and one is not allowed to refuse food/water. End of story.

However, in the US, it is allowed to refuse food and water, and it is allowed for a surrogate to request no food/water. In this case, the spouse has not been found to be a lacking surrogate, and the request is reasonable by US legal/ethical standards. The parents have no standing. There is absolutely no reason for any court to listen to the parents, unless they are making a claim that withholding food/water is not whata Terry wanted and that there is a good reason that they would know better than the husband. The arguements about how conscious she is are legally immaterial.

There is absolutely no reason for the governer of Florida, the Congress, and the President to be involved. It is a horrible legal precedent. If they dont like the legality of witholding food/water to people in PVS(a position I would agree with) then they should addresss that issue. But getting involved in a proceeding that has proceded legally and fairly just because they dont like the outcome, but dont have the guts to tackle the underlying issue, that is an abuse of power. They should all be ashamed.

Obviously this is a complex issue, and one could argue that the end of saving the life of Ms. Schaivo outweighs the horrific injustice of meddling in settled legal affairs. But they are not trying to change the underlying law. They are just trying to score political points and brownie points with their constituencies at the expense of poor Ms. Schaivo's feeding tube.

interestingly, at my overwhelmingly Catholic institution, on one had a problem with withholding food/water from Ms. Schaivo. There was some uncertainty as to who had her best interests at heart, but the large majority sided with the husband.

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