Playing God over Terry Schiavo - Human Condition series

Copyright © 2005 Dorian Scott Cole

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Maybe Terry Schiavo shouldn't be allowed to die. Maybe she should. I'm thinking that perhaps life's decisions have become too difficult and we should just get rid of modern medicine. All medicine is playing God. Let nature take its course. Modern medicine thrusts us onto a stage with roles that many of us are unwilling to accept.

If people are dying, then their time has come and we should just let them die. Why intervene in God's plans? Why cheat the Grim Reaper of his harvest of souls.

After all, we are just a hive of ants, placed here to function, but with no growing responsibility for our future, or that of others, aren't we? Docile puppets?

Without modern medicine, I would have been dead and disabled many times by now. Why is it that we are given knowledge about life and death, but are unwilling to accept responsibility for it? Should we only accept responsibility for extending biological life, but not for assuring conscious and non-suffering life?

Following are many of the current medical questions that we face:

  • Artificial life support - keeping alive those who have no conscious awareness.
  • Inability of millions of people to afford modern medicine.
  • Life extension - burden on young.
  • Death with dignity
  • Who is responsible for determining when life ends?
  • Should we allow stem cell research and organ cloning?
  • Abortion - when does life begin.

These things are all symptomatic of the moral ambiguities, unknowns, and concepts of responsibility that are thrust on us by.... not modern medicine... but by life. Modern medicine just intensifies the problem.

None of us want to give up hope for those who suffer from comas and persistent vegetative states. If a person has consciousness, but can't communicate, we want that person to be given therapy and assistance - every chance possible to regain some function of life. Even for those who seem hopeless, we want therapy and assistance to be given.

We know two things. From studies in which victims of encephalitis are awakened, even though they may have seemed somewhat responsive (sit, walk, follow balloons, etc.) while in this state, they are not truly conscious and have no memories of their state when awakened. At least they aren't suffering, trapped in some shell, but they have no cognitive functions that we would associate with responding in any real way to life (you could say, they aren't there).

Secondly, we know that for a very very high percentage of those people who remain comatose for longer than a couple of months, there is no hope of recovery, and even those few who do recover seldom regain as much cognitive functioning as would represent a whole person. The recovery of an imperfect consciousness by a miniscule few raises the question if life should be prolonged in those who go beyond a few months in a coma or persistent vegetative state.

What about Terry Schiavo? She was given therapy. She cycles normally into a biologically wakeful vegetative state, and can't be shown to be consciously aware of people, although she has basic mental responses to stimuli. The Florida courts, having heard an abundance of evidence from experts representing both sides, concluded that Terry Schiavo is in a "persistent vegetative state" with no hope of recovery.

Clarification: Generalization of the preceding to specific cases is not intended. The medical cases and medical conditions mentioned should not be generalized to apply to all conditions. Medical conditions, even relatively simple ones, rarely fall into a single diagnostic category, but are usually complex with various and multiple causes, areas affected, symptoms, treatments, and outcomes. The preceding indicate that responses may not be indicative of conscious awareness and capabilities, and that medical evaluation should be done by qualified physicians or those trained to evaluate conditions, not by untrained observers.

The battle over Schiavo is cast as a political agenda, a right to life issue, and a struggle over who is responsible for such decisions (right to choice issue). The courts follow the dictates of the narrow focus of the law. The law is not the absolute moral and ethical authority of the land, and the courts defer to those who seem morally responsible. For people to abrogate responsibility for such answers, deferring to the law, does nothing to answer the question. The people involved are responsible for answering those higher questions.

The unanswered questions are really about the purpose of life itself, and the reverence that we must maintain for the life of every individual. Schiavo symbolizes the questions, "What does it mean to be alive?" What does life mean? What is the purpose for someone who is medically "not there" in any conscious form, and for whom consciousness is not a probability - who can not function for herself in any way and is totally dependant on others and artificial means to even keep her body alive... until she dies?

As a practical matter, even if we can formulate answers for ourselves, we are unlikely to ever answer these questions for another person. It is not up to us as individuals to force our opinions, or "absolute" religious doctrine on others. Each individual's purpose is an individual perception, just as the will to pursue actions is a freely given individual choice, and is up to the individual to decide.

In lieu of the person being competent to take responsibility, it is up to the family - those who know the person best - with the spouse taking the preeminent place. The courts have continuously upheld that, and did so in the similar Karen Ann Quinlan case. Excerpts from that case follow:

"Our affirmation of Karen's independent right of choice, however, would ordinarily be based upon her competency to assert it. The sad truth, however, is that she is grossly incompetent and we cannot discern her supposed choice based on the testimony of her previous conversations with friends, where such testimony is without sufficient probative weight. . . . Nevertheless we have concluded that Karen's right of privacy may be asserted on her behalf by her guardian under the peculiar circumstances here present.

. . . . We glean from the record here that physicians distinguish between curing the ill and comforting and easing the dying; that they refuse to treat the curable as if they were dying or ought to die, and that they have sometimes refused to treat the hopeless and dying as if they were curable. In this sense, as we were reminded by the testimony of Drs. Korein and Diamond, many of them have refused to inflict an undesired prolongation of the process of dying on a patient in irreversible condition when it is clear that such "therapy" offers neither human nor humane benefit. We think these attitudes represent a balanced implementation of a profoundly realistic perspective on the meaning of life and death and that they respect the whole Judeo-Christian tradition of regard for human life. No less would they seem consistent with the moral matrix of medicine, "to heal," very much in the sense of the endless mission of the law, "to do justice."

. . . . [W]e herewith declare the following affirmative relief on behalf of the plaintiff. Upon the concurrence of the guardian and family of Karen, should the responsible attending physicians conclude that there is no reasonable possibility of Karen's ever emerging from her present comatose condition to a cognitive, sapient state and that the life-support apparatus now being administered to Karen should be discontinued, they shall consult with the hospital "Ehics Committee" or like body of the institution in which Karen is then hospitalized. If that consultative body agrees that there is no reasonable possibility of Karen's ever emerging from her present comatose condition to a cognitive, sapient state, the present life-support system may be withdrawn and said action shall be without any civil or criminal liability therefor on the part of any participant, whether guardian, physician, hospital or others. We herewith specifically so hold."
- (My thanks to) Julie Van Camp, Professor of Philosophy, Philosophy Pre-Law Advisor, California State University, Long Beach, for the article (which I here legally quote from her publicly available compilation without her knowledge or permission - and through use of the material, nothing is implied about her opinion on this issue - her material was serendipitously located.)

"Although nearly "vegative" and requiring tube feedings and a tracheostomy Karen Ann Quinlan remained in a locked room in a county nursing home. Sequestered from the public and presumed dead by many Karen Ann Quinlan "lived" for nearly 10 years prior to her death in 1985."
- What Ever Happened To... Karen Ann Quinlan? - Bruce Johnson

Congressional intervention is simply a delaying tactic, a strategy to which they admit, to give the parents time for yet another legal appeal. Neither Congress nor the Federal courts can offer definitive opinions on what is the moral thing to do. Congressional intervention will thrust the argument before the US Supreme Court, whose opinion will confirm the right to choice and then throw the matter solidly back into the laps of the people involved, in pecking order: first Shiavo (who can't respond), and then her husband (and if unavailable, then next would be her extended family).

I wish that I could answer the difficult questions about when does life begin, what is life, who is treatable, who should we let die with dignity, and when does life end. I can't. Modern medicine is some help in clarifying issues, and there are moral and ethical guides, but they can't be definitive on most issues. It is up to us. We have to face the tough questions - this is part of the human condition.

For me, having faced these issues in my personal life, I prefer to err on the side of prolonging life, especially life with consciousness and without suffering; to not begin a life without taking responsibility for it; to advance medical research in reasonable areas to sustain life; and to help those who are going to die to accept death with dignity and not prolong their suffering.

Wouldn't it be wonderful if Congress and the President would pay as much attention to the needs of millions of people who are unable to afford medical assistance, go without, and suffer and die, as they are paying to Schiavo?

- Scott

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