Well said and well reasoned. I will post on the matter tomorrow, addressing some of the issues you raise.

The reference to Kim's grandfather is moving. The fact of the matter remains that thankfully, his wishes were clear- which is not the case here.

While I cannot cogently discuss the merits of the case, I am moved by Hentoff's beliefs and points. There remains too much ambiguity and obscurity- and that in itself merits a review. To patraphrase Churchill, 'Err on the side of life'- certainly until all the facts are clearly understood.

SC&A

Aldon,
I always enjoy all your posts; you are a fine man.

I too share very similar personal feelings about my own fate. I too do not want extreme measures taken. I have not gone to the extreme of the tattoo yet. I have been in the position of supporting a dearly loved relative's decision not to introduce an IV or feeding tube at the end of her life. She had made the decision, talked to me personally about what she did and did not want, and had documented the decision in her Living Will. It still turned out to be somewhat controversial.

However, I must object on rational grounds to your conflation of the Sun Hudson case and the Schiavo case. In the Schiavo case, it was her husband who went to court and demanded that she not be fed by mouth. The "life support" that was removed was therefore a feeding tube, and there are affidavits on file from nurses who say they fed her before the order and doctors who say she probably could swallow. In addition, the judge in the case ruled that after the feeding tube was removed no attempt to feed Terri by mouth would be permitted.

In the Sun Hudson case, ventilation (machine breathing) was removed. If we define "life support" to be spoon feeding, then you may make justly make a comparison of the two cases. But I am not willing to cross that line. I would not endorse that definition if I were threatened with death for failing to endorse it. To accept that definition exposes millions of infants, children, mature adults and senior citizens who are disabled to the risk of an excruciating, unchosen death.

In reality, thousands and thousands of cases occur in which people are removed from ventilation without ever having made their decision in advance every year in the US. I realize that we cannot pay for extreme medical care for everyone, yet these decisions trouble me when, as you say, they are made by government. They also trouble me when they are made by bioethics committees at the hospitals who are stuck paying for the care of the very people whose fates they are deciding. Medicare's and Medicaid's reimbursement rates simply are not sufficient to pay for the medical costs of keeping such people alive.

I have not gone through all the states, but at least 1/3rd of them have some sort of legal apparatus by which people who have been ruled incompetent may be refused food and water while in a medical institution by someone else. If a person choses this, I don't have a complaint. But when a person has not chosen it, I don't feel that it is right to let someone die from thirst and hunger.

Forget about Social Security for now - it is Medicare and Medicaid that is the huge budgetary problem. Clearly we will be rationing medical care. My interest is seeing that we do so on some sort of equitable basis. If not, we will see more poor people starved to death, and I am using "poor" in the economic sense. In part my horror at this case stems from reading a nurse's account of one such incident in Florida, at the same place where Terri has been. It is comment #72 at Polipundit, and since I notice those who are comfortable with the proceedings in Terri's case tend not to click my links, I will take the liberty of posting it again here:
"I’m an RN who’s worked in the facility where Terry is. I’ve been working in Long Term Care for 20 years and have unfortunately seem quite a few Terry Schiavo’s. The latest patient I’ve had the pleasure to work with was a 76 year old woman with progressive swallowing problems.
"It got to the point after extensive testing, that she was unable to take food by mouth without the risk of choking. She was aware of her surroundings but occasionally confused so her out of state family had power of attorney to make her medical/legal decisions. They denied doctors the right to place a feeding tube, saying she was “old, sick and tired.” We had instructions from the legal team to not give her food or water for fear of her choking. So we had a sweet little 76 y/o senior citizen that we were literally starving to death!! It was pathetic and pitiful. This poor soul would beg for food and water only to be told no. It was heartbreaking. Long story short, we nurses took the chance of her choking and gave her food and water when we could. The family knew something was up and came to move her from our facility to one near them. Found out she died 2 weeks later of dehydration. Her family threatened to sue all of us for not following their instructions. Hasn’t happened yet, we’ll see. It’s so sad to see someone pass away that way. It’s the rules of threes. Three minutes without air, three days without water and three weeks without food. The patient really ends up suffering greatly."

The bums, the homeless, the poor without family, those with callous families - those are the people who will meet their end in this way. I cannot support it. I support withholding or withdrawing water and food for those who have made the decision in writing. I would never support withholding food and water from a baby such as Sun Hudson, no matter how ardently it was portrayed as "futile care".

Oh, sorry. That excruciatingly long comment was by MaxedOutMama.

Aldon,
you and I have nad many discussions both political and non. It was Kim's grandfather who has helped me figure out what I would do with my life. The few moments I spent with him aided me in deciding to make healthcare my life's mission. As you know I take care of the infirmed aged. I have watched the passing of many of my residents, and I pray that I have made their last days comfortable and easy.

Terri's case is a hard one. The decisions involved fall into numerous catagories, the rights of the husband/wife vs their extended family, with the congressional action occurring the constitutionality of the government to interfer in personal matters, which also brings in states rights vs federal rights. A perpetual vegetative state is costly emotionally, physically for the care giver, financially to the funding party be it family or government. Her husband claims that she expressed to him that should would never want to live in such burdensome state of being. I have expressed those very wishes myself. Who is to determine our right to a dignified life and death?

What is a persistent vegetative state? A persistent vegetative state (commonly, but incorrectly, referred to as "brain-death") sometimes follows a coma. Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.

The person that Terri was is no longer there. Why would anyone force her to continue this non-existence, especially if she has expressed to her husband her feelings regarding not living is such a state of being. I feel the republican congress is trying to make the democrats look bad because of the unethical behavior of their leaders.

We should give the husband/wife decision the privacy, peace and dignity it deserves, and butt out of their business.

Your friend always,

JT

Aldon, I'm afraid you've picked the wrong side of this debate.

First, there is a big difference between extreme measures to extend life like a machine that artificially causes a body to continue breathing and provision of basic nutrition. While the former may be considered beneath human dignity, the latter is a necessity for all, healthy or ill. If someone is unable to take nutrition without assistance, this disability makes them no less dignified than any other human being in need.

Also, in any matter of life or death like this where are legitimate doubts about the patient's desires or prognosis, we should err, if we err, on the side of life, because the alternative is utterly irreversible. If there is life, impaired or not, there will be suffering for both the patient and his loved ones, but there will also be the chance of touching or of being touched by others, and that is the most human quality of life.

You wrote that the government is deciding whether Terri Schiavo lives or dies, but that is not the case. The effect of the bill passed by Congress today will be to postpone the execution of Michael Schiavo's decision to remove Terri's feeding tube to allow time to ensure that Terri's human rights are being given their due protection. I don't think there is anything in the new law that presupposes any particular outcome for this case or any other.

In this case, there are two questions that need to be answered definitively: 1) Is Michael Schiavo fit to be Terri's guardian? Questions of motive aside, it is fact that Michael has failed to provide Terri prescribed therapy that stands a good chance of helping her to recover to the point where she may no longer require a feeding tube. He has also failed to obtain basic tests that most neurologists now agree are necessary for a valid diagnosis of PVS, even though he is using the diagnosis of PVS arrived at without such tests as the basis for his decision to end Terri's life.

2) If Michael's guardianship is to continue, should his decision to remove Terri's feeding tube be ratified? There is ample reason to doubt the diagnosis of PVS on which his decision was based: Inadequate testing and evaluation, an expert witness who is an outspoken activist for the euthanasia movement, and the chance of therapy, denied for years, to significantly improve Terri's condition.

I am grateful Congress and the President have given the courts one more chance to do justice for Terri Schiavo. I pray that Michael may have a change of heart, or that in any case Terri be given the chance to live out her natural life in the care of those who love her.

--
David Meyer
Takarazuka, Japan
papa@jtan.com