I’ve had many thoughts on this case, but have been too busy to organize my thoughts and write something sensible. I haven’t even had a chance to read all of the articles that Nomad has linked to. I just read the NRO interview with bioethicist Robert P. George and the Krauthammer article. We’ve also started way too many threads on one issue, which will fragment the conversation.

First the George NRO interview. What George proposes is a radical pro-life rewriting of current medical ethics. That he is not called on it is to NRO’s shame. Here are some proof-texts.

From a moral vantage point, it can be, though it will not always be, permissible to decline treatment — even potentially life-saving treatment — when one's reason for declining the treatment is something other than the belief that one's life, or the life of the person for whom one is making a decision, lacks sufficient value to be worth living.

George is now laying the groundwork for delineating what are moral and immoral reasons for refusing life-saving treatment. But such a distinction is absent in current medical ethics. An informed patient who understands his decision may refuse life-saving medical care for any reason. Making some reasons unacceptable puts the gov’t in the position of forcing medical care even if a fully alert and oriented person is articulating his refusal. Is that what George wants?

Even if we were to credit Michael Schiavo's account of his conversation with Terri before her injury — which I am not inclined to do — it is a mistake to assume that people can make decisions in advance about whether to have themselves starved to death if they eventually find themselves disabled. That's why living wills have proven to be so often unreliable. One does not know how one will actually feel, or how one will feel about one's life and the prospect of death, or whether one will retain a desire to live despite a mental or physical disability, when one is not actually in that condition and when one is envisaging it from the perspective of more or less robust health.
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In any event, it is clear that the only reason for Michael Schiavo's decision is that he considers Terri's quality of life to be so poor that he wants her to be dead. He claims that she would want that too, which I don't grant, but even if he's right about that, we should treat her like anyone else who wants to commit suicide. We rescue, we care. We affirm the inherent value of the life of every human being. Our governing principle should be always to care, never to kill.

This is outrageously far from accepted medical ethics. What he is saying is that lots of people change their minds when they get sick or disabled and decide they would prefer to live in conditions that previously they thought were worse than death. This is true. But then he extends that to assert that because of this all previously stated desires for refusal of care should be disregarded. “Living wills have proven to be so often unreliable”? When? There may be a few cases in which they have been contested, but the vast majority of the time they take precedence over what the family thinks the patient would want. The only thing that trumps a living will is an informed patient that can communicate his current wishes. Nomad, you have to realize that what he is saying is that if I make a videotape of myself saying that if I am to be on a mechanical ventilator for longer than 30 days, I want it withdrawn (these aren’t my wishes, just an example) and I add lots of statements that make it clear that I understand that this might kill me and I understand that my condition may improve with a few more days on the ventilator, that these clearly stated wishes are to be ignored and that I am to be kept on the ventilator indefinitely since it is conceivable that I may have changed my mind in the interim.

Can we all agree that George is suggesting something that is a radical right-to-life position and that none of us want?

Now to Krauthammer’s article. I read it with great hesitation because I have been let down on this issue by all the conservative columnists I usually admire. (See my comments about Noonan’s article.) Thank goodness, he is a voice of reason. The conservative movement has, in my opinion, acted terribly on this case, coming to the issue too late, with too little information, and with passion about human life clouding their duty for personal liberty and limited gov’t, values they should also be zealously defending. Two short quotes:

For Congress and the president to then step in and try to override that by shifting the venue to a federal court was a legal travesty, a flagrant violation of federalism and the separation of powers. The federal judge who refused to reverse the Florida court was certainly true to the law.

Yes! Bush (whom regular readers know I strongly support on many issues) and the Republican led Congress were wrong to step into this. Tom Delay acted particularly poorly when he criticized Mr. Schiavo in an interview and repeated allegations of neglect and abuse – charges that have never been legally brought against the husband. Even if true, I think this was behavior below what we should expect from Senators and I believe Delay owes Schiavo an apology.

There is no good outcome to this case. Except perhaps if Florida and the other states were to amend their laws and resolve conflicts among loved ones differently -- by granting authority not necessarily to the spouse but to whatever first-degree relative (even if in the minority) chooses life and is committed to support it. Call it Terri's law. It would help prevent our having to choose in the future between travesty and tragedy.

In the absence of previously stated wishes that might be a good idea. But we should take a long sober look at that before we change the current system. Think what would happen. There are specific situations in which I would want care withdrawn. I have communicated those cases clearly to ball-and-chain, and I think we may even have filled out Durable Power of Attorney For Healthcare documents which state that I want her making decisions for me if I can’t make decisions for myself. So what would Terri’s law do? Would it make it that my mom, who I’m certain would be happy to keep me alive on a ventilator for decades, would be allowed to override my previously stated wishes? Or would Terri’s law only apply when there is no documentation of the previously stated wishes?

Here is a blog by a Florida attorney that has dispassionately followed Schiavo’s case. He has assembled a timeline of the case and has dissected the legal issues without (as far as I can tell) an agenda. Take a look at the timeline as well as the answers to FAQs immediately below. At least the following facts emerge:

• Terri has been examined multiple times and by multiple physicians, some of them court appointed, and some hired by her parents. No serious objection to the diagnosis of PVS has been raised by any physician who has examined her.

Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.

• Mr. Schiavo could simply have divorced Terri and proceeded with his life and then married the mother of his two kids. He has been accused of many bad things in the media, but never in a court of law. It is at least possible that the reason he hasn’t walked away from this case is that he wants to see Terri’s wishes carried out. He has also turned down large monetary offers to walk away from the case.

• The Florida courts heard both sides in great detail, as did the appellate court.

The lawyer who maintains the blog concludes “I continue to hope that when this saga ends it will be the ending that Terri would have wanted.” I agree.
 

A couple things:

1) Would an MRI and PET Scan help to resolve the remaining debate on how much tissue is left? If so, shouldn't it be done before she's sent to her grave?

2) Appelate courts don't overturn issues of fact. If the physician(s) made diagnoses based on insufficient data in Greer's court, it doesn't matter to the appelates. The appelates simply rule on whether or not the law was applied correctly. So, the whole thing really rests on the original diagnosis by a man who has an established pro-euthanasia agenda, and by the subsequent examination of a panel of 5 physicians, 2 of whom disagreed that she was in a permanent vegetative state.

I believe I am correct to say that an MRI would give a clearer indication of the state of her brain tissue, and that a PET scan would give an indication as to the functionality of whatever tissue remains.

Can you give me good medical reasons for NOT performing these non-invasive tests prior to sending a person to their grave absent their known wishes?

***adding: Mr. Shiavo's original decision to deny treatment came on the heals of a million dollar malpractice suit award, in 1994 (when he refused her treatment for a urinary tract infection). 700K of that award was designated for Terri's continued treatment. Coincidentally, he suddently remembered her wishes right about the time he stood to profit 700K from doing so. Whether or not he truly is acting on her behalf or his own, there is an obvious conflict of interest here that seems to have been swept under the rug.

He stood to profit from her death at the point he decided to seek that death. That's a conflict of interest. Not wishing to up the rhetorical ante, but in a trial court, they'd call it motive.
 

For the sake of defragmenting the conversation about the Schiavo case, please make all further comments on this thread. Thank you.

Move along. Nothing to see here.