The story of Terri Schiavo is probably known to most Americans. A 39-year-old Floridian, she has been sustained by a tube supplying artificial nutrition and hydration since she suffered, 13 years ago, brain damage brought on by a heart attack. The brain damage has reduced her to a condition called P.V.S., a persistent vegetative state. Although she never made out a living will, her husband, claiming that she never wanted to live like this, won a court battle against Terri’s parents and had his wife disconnected from the feeding tube. The Florida legislature, however, last month passed a law allowing Gov. Jeb Bush to trump the court decision and reinsert the feeding tube.
There it is. Simple as that. And yet almost every sentence of the above paragraph is hotly contested. There are charges and countercharges. There is controversy over the actual cause of the brain damage, disagreement over the diagnosis of Persistent Vegetative State, counterassertions over Terri’s actual desires and her husband’s moral fitness to speak on her behalf and angry accusations concerning a million-dollar settlement supposedly meant to provide therapy.
It is not, however, the dark complexities of human motivation or compromising circumstances that will be resolved in our search for the stern truth of this conflict. Those things will not be settled, even by the most bitter or best-financed legal challenges. They will be resolved only before the judgment of God. What is on this earth most challenging to the litigants and to each of us is our frightening vulnerability and our willingness to embrace it.
Some assertions made about Terri Schiavo’s actual condition seem to be irresponsible. If, as some claim, she is able to respond positively or negatively to questions, then there should be no problemas there indeed isin determining her own will with respect to treatment. Inability to respond, on the other hand, is no proof that she has lost all higher cognitive function. The most that can be said is that she is not displaying such activities.
Similarly irresponsible are absolute predictions and prognoses. If, as has been reported in The New York Times, a neurologist claimed, She’s vegetative, she’s flat-out vegetative, there’s never been a shred of doubt that she’s vegetative, and nothing’s going to change that, the good doctor might want to rein in his hubris. If it is true, as reported in other sources, that this very physician saw Terri Schiavo for a mere 45 minutes while another physician, after more than 25 hours with her, judged her not to be vegetative, then the first doctor needs not only humility but also more training.
But what of the act itself, the removal of the tube? Without waging a war over ideology, covert motivation and questionable circumstances, I offer two simple principles. One, I do not have to do everything in my power to keep myself or others alive. Two, I must not intentionally kill myself or another person. (Both of these principles require argument and defense, but I hold them based upon philosophical and Catholic theological grounds.)
Removing nutrition and hydration is a decision not to do everything to keep me alive. In itself, it is not an intent to kill.
To be sure, there may be motives and circumstances that make the decision morally tainted. I may secretly want to terminate the life in question. There might also be some very desirable circumstantial outcomes that are my covert goals.
But removing the artificial life support is not necessarily a will to kill someone. Many patients not given antibiotics conquer the infection, many removed from respirators continue to breathe on their own, many removed from artificial nutrition survive. Their caregivers, moreover, continue to care for them.
And this is the first key required to unlock the Schiavo quandary. Wean her from the artificial appliances, but try to feed her by mouth.
I am open to correction, but after extended discussions with a French neurologist who cares for P.V.S. patients and with a swallowing expert at the Mayo clinic, I believe that most patients on tube or peg feeding can, with care, swallow. The problem with this, it seems to me, is that such careful feeding is too labor intensive. It costs more. It takes longer. It may cause a reflux of the material and cause choking or other complications (so also may tube feeding).
In the Terri Schiavo case, there are many people willing to feed her protein-enhanced Jell-O, medication and refreshing water. Yet a court saw fit that she not even receive Communion and a state legislature saw fit to reconnect her to a tube. They all miss the point.
What is human nourishment about? Surely it is not the same as filling up a car’s gas tank. When humans eat, it is as much about companionship as it is about refueling. It is about taste and savor, memory and refreshment. As for pegs and tubes, they are best used as emergency solutions to short-range problems. Unfortunately they have become standards for nourishment, sometimes only prolonging the process of dying and often serving as a cost-saving way to provide nourishment without companionship.
Let Terri Schiavo be weaned from that tube. Volunteers are willing to give her swallowing therapy and spend the time to help her taste the sweet and cool. Let her feel the touch of a hand to her neck and chin. Let her imbibe companionship, not a labor-saving technological fix. If she refuses or it seems clear that her body cannot take the food, it is because that is the way a body dies. To force more on her is only to prolong her dying.
Why must our society confront this issue over and over and over? Despite previous debates about Karen Ann Quinlan, Nancy Crouzon, Hugh Finn and now Mrs. Schiavo, we continue to argue over the lengths to which medical and social science must go to maintain life. And it seems that each of these discussions becomes more fractious, difficult and painful for all parties involved. In the most recent debate, a grieving, suffering husband is even being accused of ulterior motives when he merely tries to honor his wife’s final wishes.
It seems to me there are two basic issues involved in these discussions.
First, with recent advances in medical care, miraculous things are possible and almost commonplace. Septuplets who could have never survived in an earlier age, now do. Heart and lung transplants are commonplace. We remove half the brain of children with uncontrollable seizures and they develop normally. Over half of all Americans with cancer are cured of their disease, and we even replace people’s livers destroyed by alcohol. So one could fairly ask, why can’t we cure Karen and Nancy and Terri?
Second, the Right to Life movement has had a tremendous impact on our society, and more and more Americans are rightfully asking if abortion for any reason, at any time is acceptable or justifiable. As Americans, we increasingly accept the need to protect the lives of the unborn, the retarded, the innocent and those incapable of speaking for themselves.
As a result of these advances, it has become more difficult to determine when any medical intervention is excessive or extraordinary. However, just as we are called to respect life; so too, are we called to respect death. The two are a continuum and cannot be separated.