The Terri Schiavo Case

[Rosie]

Quote:

---

This misunderstanding is exactly why the parents, and many christian activists, are behaving the way they are.

---

What misunderstanding?

You sound like you know all the facts of this case and are prepared to tell everyone to just shut off their humanity till this is all over.

Do you think another possibility that "parents and christian activists" might be reacting as they are is because this is a brutal way, (in fact THE most brutal way) to end someone's life? Do you think it might bother some of us to picture what's going on right now in this hospital room?

That we might feel some empathy for this "shell" and for anyone who loves her?

Someone just posted this on another board:

From page 11 of the appeal--Terri's skin is cracking, her nose is bleeding, she is vomiting and has hunger pangs.

Sound like "Terri's already dead" to you?

[Bravus]

Chrys - I accept your points and they're well made, but what does it practically mean to 'leave the decision to God'? Does the tube stay in or come out? In terms of being able to survive on her own, God has already made the decision: if this had happened in Biblical times she'd have already been dead for 15 years.

I'm not attacking your point of view, I'm trying to understand it.

[Rosie]

Quote:

---

In terms of being able to survive on her own, God has already made the decision:

---

How do you know this? How do you know the decision God has made?

In all the videos and pictures I've seen she's not drooling, and is supposedly able to swallow her saliva, why not water?

Quote:

---

if this had happened in Biblical times she'd have already been dead for 15 years.

---

That's no justification. This is NOT Biblical times. If that logic held any weight, we could close the hospitals and let nature take it's course for any sick or hurt person.

[Bravus]

I wasn't actually stating a position, Rosie, just trying to understand what Chrys meant. Maybe I was unclear and sounded like I was stating what I thought, but that wasn't my aim.

Really, literally, I'd be delighted if either you or Chrys would explain to me what God's will is in this case and how we'd know.

[Gregory Matthews]

Re: "No major painkillers are involved in the exit protocal, but for a person who supposedly has no brain left, why would they be needed? Or is the morphine suggested to speed the process along?"

1) No one says that she has no brain left. That is a total misunderstanding of the process. She clearly has some parts of her Central Nerveous System that is functioning on some level. In a PVS it is the higher centers that are non-functional.

2) On the level of brain function that a person in a PVS has, pain may be felt. It is quite helpful to give such a person a pain-killer to allow the death process to take place free of pain.

3) No, morphine sulphate is NOT given to speed the process in the U.S. [Nocomment on thesituation in Oregon, and what may or may not be happening there.]

4) Morphine sulphate is used to provide relief to a dying person for more, and often much more than relief from pain. If you understood the pharmachology you would know that in such cases in provides for a comfortable death in other ways.

[there buster]

Just to make things clear. My mother died on Christmas day 2003 after almost nine years with a feeding tube. When she was lucid, she would try to disconnect the IV's and other things she was attached to. She wanted to die that whole time. Her husband (my father died when I was 24 and already married, she then married someone else) had the feeding tube put in without consulting either my sister or myself. Mother had clearly indicated to us, and we were agreed, that she did not want "heroic measures" to save her. But he had buried one wife, and couldn't face the death of another.

So I'm not automatically opposed to letting nature take its course, depending upon the circumstances. That, however, is precisely where this statement falls short:

Quote:

---

In terms of being able to survive on her own, God has already made the decision

---

She cannot survive on her own. This would also be true of someone we happened upon in the desert, a newborn babe, a whole host of people cannot survive on their own. So what? Do we just let them die?

As far as this case goes, I really don't understand the eagerness some display to see her die. Just don't get it.

Looks to me like she'd have been better of brutally murdering a number of people. Then she could have attracted lots of activists trying to keep her alive. The very same people who now want her dead. Instead, she committed the crime of being inconvenient, and unable to speak for herself. In newspeak society, that's the only remaining capital crime, I guess.

[bevin]

Quote:

---

As far as this case goes, I really don't understand the eagerness some display to see her die. Just don't get it.1

---

There are both sides to this question.

I don't understand why you think a 15 year process shows eagerness.

I don't understand why some Christians, who of all people should fear death the least, are so adamantly in favor of wasteing vast amounts of money in keeping a vegetable's heart beating.

We are talking about $80,000+ per year on one person. When that same money, spent sensibly, could dramatically improve the lot of hundreds of intelligent human beings.

/Bevin

[Pockey]

I think that the beast wins regardless of the outcome of the court decisions. If the decision is stayed to have the tube out, then the beast will gain the moral support of the people who viewed that they were trying to do the "right" thing. If the decision is reversed to reinsert her tube, then they've gained more power.

[there buster]

Quote:

---

wasteing vast amounts of money in keeping a vegetable's heart beating.

---

[cricket]

Quote:

---

if this had happened in Biblical times she'd have already been dead for 15 years.

---

Tell that to Mary and Martha.

In Biblical times, people relied on God a lot more than they do now. As I said, none of us knows for sure, only God.

Perhaps we just need the faith of Mary and Martha; perhaps we just need Jesus.

You asked, Bravus, how we can know God's will? The answer is through prayer and listening. We don't pray enough. We don't walk with God as we should.

Maybe I'm being a bit too bold to presume that none of us here on Club Adventist walk as closely with God as we should. If there is any here that feels that he/she walks as closely with God as He desires, let them speak.

Otherwise, we don't have the answers. We shouldn't presume to know the will of God. We should err (if indeed it be error) on the side of hope, I think, and not on the side of lost faith.

Where is the faith in God? Where is the hope in miracles?

Do we not believe in Him? Do we not believe He can still work miracles?

_____________

Bob Sands,

I will not respond to your comments in Free For All. I will respond here.

My words are not a "cop out". They are a call to faith in God.

When I spoke about time with my father, I spoke directly from my heart. I praise God that He gave us the time to share with my father. In that precious, precious time I do believe my father gave his heart to the Lord.

[:"blue"] Romans 8:28 And we know that all things work together for good to them that love God, to them who are the called according to his purpose.[/]

I encourage you, Bob to continue this discussion here in Town Hall, where my posts may be taken in context.

Chrys

[Dr. Shane]

Not only that Sister Wall, but Sister White clarified that when babies die that is not God's will. Many use to believe that when a miscarrage happened or an infant died that it was God's will. Sister White rejected that. Death is a consequence of sin and is outside of God's will. If it were not for many childhood vacinations many of us here would have been dead before we were 2 years old.

[Planey]

Quote:

---

many of us here would have been dead before we were 2 years old.

---

And in some cases (mine in particular) this would have been a benefit to them and to many other people around them as well.

Graeme

[Bravus]

I absolutely agree, Shane - death is a scourge upon this universe, and God does not will it or want it. I definitely don't want Terri Schiavo (or anyone, ever) to die. But, absent a miracle (and Chrys, I'll keep on praying for one - wouldn't *that* be an awesome end to this story!), I believe she has *already* died in every way that counts.

And Chrys, what if we earnestly seek God's will with prayer and fasting and discover that His will is that the tube be removed? There are sincere, God-fearing and God-seeking people on both sides of this issue and in the middle too (i.e. don't know what to think).

[Rosie]

One would think that if it were His will that Terri die, she would have died on her own long ago. She was once able to swallow, now due to refusal ( could even say forbidding) of her "guardian" of any type of physical therapy or rehabilitation, she has lost that ability, and is totally dependant (as are thousands of adults and children) upon a feeding tube.

Which of course has been taken from her for 5 days, lawfully.

"Open your mouth for the speechless, In the cause of all who are appointed to die."

Proverbs 31:8

May God have mercy on us all.

[bevin]

Quote:

---

what if we earnestly seek God's will with prayer and fasting

---

The trouble with this approach, and it is a real and huge problem, is there are many sincere christians who can not distinquish between God's answer and intense feelings.

So we end up with these intense but ignorant people standing in front of buildings yelling in support of a bad course of action, dropping to their knees when the news goes either way, fingering rosaries, etc.

Yet these same people vote for liars like GWB to loot the country's coffers while killing and injuring hundreds of thousands of Iraqi's

It has been like this throughout history. Sincere christians seeking God's will but not thinking led the Crusades, burned witches, used the Iron Maiden on heretics, and persecuted Quakers when they themselves had fled persecution.

Don't mistake pious feelings for reasonable beliefs.

"Come let us REASON together"

/Bevin

[Gregory Matthews]

Re: "I don't understand why some Christians, who of all people should fear death the least, are so adamantly in favor of wasteing vast amounts of money in keeping a vegetable's heart beating.

We are talking about $80,000+ per year on one person. When that same money, spent sensibly, could dramatically improve the lot of hundreds of intelligent human beings."

The question that Bevin raise here is a valid question, whether one agrees with its premise, or not. i.e. It is one that needs to be considered.

However, allow me to comment on it from the perspective of one who sits on an ethics committee that has to deal with literally life and death issues.

a) We do NOT EVER relate to that people that we are discussing from the perspectie that they are a vegetable. We consider them from the perspective of a valued human.

We do not make our recommendations on the basis of financial costs. We have discussed this issue. We have decided that we will make our recomendations on the basis of other considerations. Those considerations may result in recommendations, may result in our spending scarce resources that some might say take medical care from others.

c) Some of our considerations, and there are others, include the following:

1) What does the patient want?

2) Does the patient understand the consequences, and is the pt. competent to decide.

3) Is the treatment likely to be effective?

4) Is the treatment likely to either increase the quality, or the quantity of the pts life.

5) Is the treatment one that the provider feels ethicly able to provide? NOTE: If the clinical provider raises an ethical objection to providing the treatment, we may state that the provider should withdraw from the case, and facilitate the trasfer to a provider who is ethicly able to provide that treatment. e.g. We will never demand that a surgeon operate when the surgeon beleives that the proceedure will kill the patient.

6) What is the best treatment for the pt? e.g. We may decide that our hospital can not provide the level of care that the pt. needs, and we then may transfer the pt. to a specialized spinal-cord, or rehab., hospital.

Folks, I hope that this provides some insight into how we work. Money is not the deciding factor.

[bevin]

My EMT-Paramedic textbook has an interesting and useful chapter on ethics. It uses the following four fundamental principles or values for deciding whether an action is

• Beneficence - do good to the patient and others
• Nonmaleficence - do no harm to the patient and others
• Justice - treat all patients equally
• Autonomy - a mentally-okay adult is allowed to decide what they want done to themselves

Now let us apply these to stopping life-support for Terri.

(1) There is nothing we can do to improve Terri's situation. Her parent's are in major denial, and someone should have helped them over this phase a decade ago - they are being exploited.

(2) Stopping feeding her will kill her, but she has already irretrievably lost all her higher level functions. This is a small change.

(3) Justice - can we afford to spend $80,000 / year on everyone that needs it? No. So why should we treat Terri differently? It is not just to single out one individual for preferential treatment.

(4) Autonomy - it has been settled in the Law Courts that several people, including some not connected to her husband, heard Terri express the wish to not have such life-support.

Every hospital has a committee that chooses what equipment, staff, and procedures the hospital will have based on their finances. Hospitals decline patients based on having inadequate resources to deal with them. Hospitals without the resources find themselves with patients that they do not have the resources to treat - and with nowhere to send them. Such patients die for financial reasons.

In the field, as an EMT, the situation is the same but sometimes clearer. We are trained in triage. To quote from my local protocols

"Mass Casualty Incident: Do not attempt resuscitation of near-arrest or full-arrest patients if EMS personel are required to care for the Category Red/immediate patients"

So we are always making decisions based on available resources. We just don't like it.

/Bevin

[Gregory Matthews]

Bevin, I understand what you have posted. In our ethics discussions, those four issues regularly come up, as well as others. I do not deny that in any way.

I, who was once an Army enlisted medic, one who presently works in a hospital, and has some training in mass casualty issues, understand triage issues.

Having said this, there is always the application of the theory, and sometimes the application may seem to ignore, or ru[n counter to the theory. From this aspect I will tell you that money does not determine our recommendations. Let me spell it out in two hypothetical examples, drawn from reall life, but not from any specific case. By clairfication of a point, the funding of these examples is not a question. The money is available from a pool of money that is of a specific amount that is available to us, and not dependent upon the ability of the pt. to pay.

a) Jim Jones come in with cancer. It has spread throughout his body to his brain, bones, lungs, and liver. He and the family demand that we remove the cancer in his brain. We determine that doing so will not increase his life span, it will not and it will not increase his quality of life. He will likely die in 3 - 6 months regardless of what we do. In addition, the surgery is risky, may decrease his quality of life, and decrease the time that he lives. The surgery, and follow-up care, under the best of circumstances will likely cost $250,000 and if it worsens his condition could reach $500,00 to $1,000,000. [NOTE: I have a ex-relative who recieved $1,000,000 worth of medical care last year in the system in which I work.]

The ethics committee considers this case. It frankly does not spend any time with the financial issues. But, it recommends that the cancer not be removed from his brain because: 1) it will likely be ineffective. 2) it will likely not increase his life. 3) it will likely not increase the quality of his life. 4) it may decrease both the quality and the quantity of his life.

case #2: Jim Jones comes in. He has had over 30 years of high-tech medical care. The costs to the system have been millions of dollars. Again he faces a life endangering situation. We can cure it, but at a price, and then will just have to wait until it happens again, and again and again. We give him the care because we can both increase the quality of his life, and the quantity of his life. He can easily live, independentlly anothre 20 - 30 years.

[Gregory Matthews]

Let me give you another case:

In 1982, a 17 YO realitive of mine drove an automobile, at a high rate of speed, into a solid object, while under the influence of illegal substances. He was in a coma for over 30 days. He spent the next decade in an institution, and udnergoing rehab. Finaly he was considered able to live independently, with continued medical/rehab care. But, he was in a wheel-chair, and unable to work. After years of this he was able to accept a job at Wal-Mart, one that they give to disabled people. So, he wheeled himself around the store in his wheel-chair.

Today, he is out of a wheel-chair, off crutches, in his third year of college, owner of a home, in a stable relationship, and you would never know of his past medical history.

As a member of a hospital ethics committee, I can tell you why he recieved all the care that he recieved: Because the clinical providers believd that they could increase the quality of his life, and the quanitity of his life if he recieved that care. His care was not shut off because it was costly.

By the way, he is doing well in college.

[Bravus]

I think this is the point that many have missed. When I said she's not able to maintain life on her own, Ed pointed out that that's true of a newborn, or a person lost in a desert, or people in a whole range of situations. The point is, in all those situations we rescue the people *so that they'll get better*. When there's no realistic prospect of Mrs Schiavo *ever* getting better, all those analogies cease to apply.

One more point: I said in Biblical times she'd have died 15 years ago. How about, in 90% of the world in 2005 she'd have died 15 years ago?

[Gregory Matthews]

Money, what is the cost, and what is care worth?

I have seen several thousand dollars spent on a person who died a few days later because we knew that spending such would increase the quality of their life.

Bevin is correct that financial issues may determine some aspects of medical care, and that such are valid questions. But, the application can be different from the theory, do not misunderstand the actual situation.

[cricket]

Bravus,

I think that too many of us are in the middle. Many of us are earnest Christians, but so very few of us are walking with God so closely as did Noah, Enoch and Elijah. Truly, I believe I've encountered only one such man in my life.

And so, if we're not listening, how can we know the will of God? I don't think any of us here knows His will in this case. Someone, somewhere, may; but no one here at CA.

If His will is that her feeding tubes be removed: Praise the Lord!

If His will is that her feeding tubes stay: Praise the Lord!

If His will is that she die: Praise the Lord!

If His will is that she live: Praise the Lord!

I do realize that this is a decision that the family must make. In my own life, I, too, had to make the decision to allow the doctors to remove the feeding tube for my father.

You can bet I prayed for a miracle! I loved him very much. Despite all the difficulties we'd had with one another, I loved him very, very much.

In the meantime, I had some really good talks with God; and, I had a lot of really good, possibly one-sided, talks with my father. In faith, I believe my dad heard every word I said. In faith, I believe he found God before his time came to pass away.

In faith, I believe that we had chosen God's will for my father. He died a peaceful, pain-free death. And, my last memory of him was him turning his head and eyes toward me, and smiling.

Curse the doctors and their medical terms describing this as an involuntary action!

God was there.

Praise the Lord!

Chrys

[Gregory Matthews]

Not directed to Christine:

We on ethics committies struggle with issues. The recommendations that we make are often not easy to make. Ususally we come to unity in our recommendation. But, at times, we disagree among ourselves.

Speaking personally:

I believe that God often calls me to take action/make a decision in an imperfect world. In that world, I sometimes face actions/decisions in which I feel that all posibilities are outside of the what God wants for us. But, I feel that I am called to make a choice. In those cases I may decide on what is the lessor evil.

I will say this, that I do not beleive that we are "killing a patient" when we allow the natural process of death to take place. When I think that death is going to happen, regardless of what we do,, and can not be stopped, I begin to look to other choices such as death with comfort, with dignity, and among family (as appropriate).

[there buster]

Quote:

---

in all those situations we rescue the people *so that they'll get better*. When there's no realistic prospect of Mrs Schiavo *ever* getting better, all those analogies cease to apply.

---

Two points.

1)We don't rescue people "so that they'll get better," but because they're people, and we can. And we care for them because we don't know the end from the beginning. At least I hope we do.

2)There's at least one Nobel laureate, whose Nobel prize was for helping people like Mrs. Schiavo, and who has examined her for more than ten hourse, who believes she can get better.

As for me, I have no doubt that when history comes to an end, all of us who watched this episode will hang our heads in shame. The God who will not "quench the smoking flax" would surely not extinguish this helpless woman.

As far as dying 15 years ago. That's true. In Germany 60 years ago, she'd have been exterminated, along with other "feeble minded" persons, Poles, Gypsies, and Jews. None of that is to the point.

She's here, she has been living, and as a society, through the courts, we have decided to end her existence. Good or bad, we all share that responsibility.

[bevin]

Quote:

---

I believe that God often calls me to take action/make a decision in an imperfect world.

---

This is where the rubber hits the road - people like you and I who are prepared to do more than talk - who actually make and execute a decision, and have to live with the results.

It ain't easy - but it is necessary.

/Bevin