Monday, March 21, 2005

I have finally put my finger on what's been bugging me about the Terry Schiavo case. Maybe someone can clear it up for me.

I don't get what animates the people who think Schiavo's feeding tube should be removed. I understand their position that Schiavo is not really alive. I even think they might be right. I certainly understand and sympathize with Michael Schiavo: I think it must be horrible to be emotionally tethered to someone you consider a corpse. I get why he has fought passionately and tenaciously to bury his wife so he can move on. But I do not understand why people who do not know Terry Schiavo and who do not have an intense personal interest are so vehement that her life should be ended. I do not understand what principal is at stake here.

I really do understand why people would vehemently argue that Schiavo should be kept alive. I don't know that they're right, but I understand why they care so deeply. I understand why many disabled people feel threatened by the argument that some people are so impaired that they are actually not alive and that therefore it's ok to kill them. I don't think it's crazy to think that once that precedent is set, we could see considerable movement in the line that distinguishes a disabled person from the living dead. I understand why some folks don't buy the concept of living death and don't like differentiating between people who it's ok to kill and people who it's not. As a dyed-in-the-wool death penalty opponent, that argument makes sense to me.

But in other instances I'm willing to put those considerations aside because there are compelling arguments for the other side. I believe in organ donation, even though I'm not convinced that "brain death" actually exists. I'm not a pacifist, either: I believe that there are occasionally times when it's necessary to kill in self-defense, although they're few and far between. But I don't understand the compelling arguments here. What do we lose if we allow Terry Schiavo to continue her current existence?

If Schiavo had made it clear that she wished to die if she were in this sort of situation, I would understand the principal at stake. People have a right to make their own choices about their medical treatment, and they have a right to die on their own terms when it comes to that. But she didn't make her wishes known, so I don't see how that right is threatened here. Is it about protecting the centrality of marriage in our culture and legal practice? We've got rid of the ugly aspects of coverture, in which at marriage possession of a woman was transferred from her natal family to her husband, but we still assume that the marriage bond trumps all other relationships. I'm not sure, though, that's a concept that I, as a feminist, want to fight to protect. Is it Michael Schiavo's very real suffering, and if so, why does that trump the suffering of Schiavo's parents? Is it that it's expensive to keep someone alive on life support?

Assuming that Schiavo really is dead, it doesn't matter to her what happens to her. She isn't in pain, and she can't mind that her body is being kept alive after her mind is gone. So what do we lose if she continues to be fed and kept as alive as she currently is? Why would that be such a terrible thing?

OK, I'm also in favor of continuing to feed Terri, so it may not be my place to speculate, but here are some of my thoughts:

Our political system has gotten so extremely polarized that each side feels like they can't give an inch to the other. That's why the right wing proposes anti-abortion laws that don't have an exception to save the life of the mother (I'm pro-life, but I think legislation like that is horrible). They think that if they make any concession about abortion being OK in some circumstances, it will be a victory for the other side. You'll hear them say sometimes that if they include a health exception, women will just lie and cheat and claim their lives are in danger all the time in order to have abortions on demand.

Similarly, there are some on the other side who feel that if pro-lifers are given an inch on anything, they'll take a mile. For example, if they're allowed to ban late-term abortions, they'll figure out how to interpret those laws so that all abortions will be banned, then they'll outlaw all forms of contraception and then weaken the sexual assault laws so as to force women to become baby factories, producing offspring at the whim of men.

I've talked with a lot of pro-choicers who are heavily invested in the idea that life/personhood really begins when a person has a functioning cerebral cortex, regardless of what other bodily functions are already in action before that. I don't know if Terri Schiavo's cerebral cortex is really gone, but if it is determined that she should be kept alive, some people feel it could impact the abortion debate.
I am in favor of carrying out the court order to remove Terri's feeding tube. I am in favor of this because I have read the court decisions, and I think it is clear that she expressed, several times in her adult life, a disinclination to have medical treatment that would keep her alive and vegetative. The feeding tube qualifies as "medical treatment", and for me the issue is simple: who controls my body?

I have a Living Will that specifies that if I am ever in a vegetative state with my cerebral cortex turned to liquid, I want the tube pulled. I am disabled, and I know very well the difference between disability and brain death, and for me, the gap between then is so large that I don't want to linger on after I am (in my view) dead.

I think that forcing Terri to accept this medical treatment in the face of her expressed wishes to the contrary is a horrible thing. (And if you read the court documents, you will learn that it is not just her husband to whom she made these statements, but other adults, as well.)

I've had to sit by the bed of someone dying horribly of cancer, who declined a last-ditch chemo treatment. This treatment had about a 5% chance of making a difference, and he'd been through chemo twice already, and he chose not to accept the proffered "last ditch" treatment. If that treatment had been forced on him, then it would have been (in my view) assault.

If we can force someone who said she did not want to have her life prolonged to accept treatment that prolongs her life, then I am afraid that my Living Will won't matter.

For me, what is at issue is the right of adults to make their own decisions about medical treatment, and to have those decisions honored. For anyone who wants to be fed by tube in a circumstance like Terri's, I think they should be fed. For someone who said she did not want to be, I think we should respect that, too.
Actually, I don't think that anyone is claiming that she's brain dead. PVS is, as I understand it, different from brain death.

I guess I think that a living will is just really different from things said in casual conversation. For one thing, I know I say all sorts of stuff in conversation that I haven't thought through very well. I've probably said that I'd rather be dead than have all sorts of stuff happen to me, but I'm not sure I'd want anyone to take me up on it. A living will is a document that is explicitly meant to direct treatment, and you can assume that people mean it in a way that you can't with day-to-day chit-chat. But also, your living will clearly spells out your wishes in writing, in a way that's hopefully not susceptible to distortion. People don't necessarily remember five-year-old conversations correctly.

So yeah, I'd be really disturbed if I thought this was going to interfere with people's living wills. But I'm not sure I think it will. I think wills and similar documents have always been given more weight in court than things said in conversation.
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