Dr. Andy

Reflections on medicine and biology among other things

Saturday, March 19, 2005

The Schiavo Case

I've avoided discussng this case because I didn't have much to add. I'm not sure I do now but here goes.

This is a very difficult case. It is not black and white. Terry Schiavo has suffered massive brain injury and is in what is called, unfortunately, a persistent vegetative state (PVS) which is not to be confused with brain death which is the irreversible cessation of all brain activity. It is very unlikely, but probably not impossible that she will improve substantially.

If it were me, I'd want the feeding tube out and my loved ones to go on with their lives without me, but I don't think it is impossible that someone else might want to be kept alive for the 1 in a million (maybe) chance of improvement.

Of course nobody knows what Terry Schiavo wants and her husband, who is her legal guardian, and her parents differ. Mr. Schiavo thinks whe would want support removed, but her parents want her kept alive. That is what makes the case so difficult. If everyone agreed, whichever way, we'd probably never hear about the case.

I guess in the end, someone needs to decide for people who can't decide for themselves, and in this case the three people who can best decide, are irrevocably split. I do think that the Florida legislature and Congress getting involved is rididculous. This is one tragic case, not a national crisis

(Ed still don't have much to add, huh? no, no I don't). I would advise people to make sure they have a living will, so they decide what happens to them in cases like this.

UPDATE: these kinds of decisions are surprisingly common


At 6:05 PM, Anonymous jb said...

Amazing who is on which side in this case. This is a situation where the legal next of kin (spouse) states that the patient would not want to be maintained on the tube feeding indefinitely. He takes appropriate steps to follow her expressed wishes, and all hell breaks loose, including literally an Act of Congress, to prevent her from having her expressed wishes carried out. Imagine: you are sick and can't speak for yourself. You take comfort in the fact that you have left specific instructions with a loved one how you wish to be treated. Now, all the do-gooders, well-meaning but guilt-ridden relatives, and publicity hungry politicians decide that, whatever you have told your spouse you want, they collectively have a better idea, and they will stop at nothing in their efforts to "save" you from your previously expressed desires.

People, laws are passed to cover situations in general. Just because a particular application of a law is considered unwise, undesireable, or unfortunate does not invalidate the law, or give veto power over the law to other interested parties, no matter how well intentioned they are. The law says that no one can be forced to have any treatment that she does not want. It further says that the spouse speaks for the patient if the patient cannot speak. Change the law to cover the next case if you want, but that means that your medical treatment will be decided by family members that you may not like, the governor of your state, a judge who may be runnning for re-election nest year, or, if you are completely SOL, the United States Congress. Is this what we really want?

At 10:58 AM, Blogger Dr. Andy said...

I agree with most of this. You have to come up with a way to resolve these issues and stick to it.

It is not entirely clear to me that spouses should always be the one's to make these decisions. They may have reason to want support withdrawn (like remarrying) that conflict with what the patient might want. I know that has been alleged in this case, but I have no reason to think the husband is acting less than honorably

At 9:21 PM, Anonymous jb said...

Spouses are not always the best substitute decision makers, and every person is free to appoint any individual she trusts to be health care power of attorney. In this case, the default person is the spouse, as no other person was specified by Terri. It makes sense for the spouse to be the default POA, as spouses are, at least theoretically, freely chosen and can be "unchosen," unlike parents, siblings, children, or Federal judges.

At 7:21 PM, Blogger Dr. Andy said...

This argument strikes me as overly legalistic. Just because the law has set up the situation so that Mr. Schiavo gets to make the decison, doesn't mean it's right.


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