Schiavo case: Professional Standards of Practice Leading to Judgment and Diagnosis
I wrote the following comment in Galen’s Log where Galen pointed out really the main issue in the Schiavo case.
Galen wrote: "The question is only if Michael is a credible witness in relaying his wife's wishes in absence of such legal documentation." Though I am not a lawyer, I suspect that making a legal "diagnosis" of this question is based on careful evaluation of all the facts with as much documentation as possible and in the end a conclusion is reached and acted upon. If this is done in good faith and according to the standards of judicial practice that is all one can expect. Of course there will be occasional errors. Is this the case with Mr. Schiavo's declaration of his wife's wishes? Who knows.. but the evidence and the decision is that it is not. Notice, how similar this is to the medical decision that the patient is in a permanent vegetative state. This is a clinical diagnosis without much help from outside documentation (EEG, MRI etc.). The diagnosis must be reached by careful examination of the history, the physical exam and the patient's course. Finally, a diagnosis is reached. There will be occasional errors. Is this the case with Terri Schiavo? Maybe, but she has apparently had a consensus by a number of neurologists, examining Terri, who were responsible for clarifying a diagnosis who agreed with a PVS diagnosis and which diagnosis was accepted by the court. That should be sufficient in both questions to settle the issue for this one tragic medical condition.
I feel that many in our Congress and perhaps the President himself and, indeed, the public itself either out of political bias or emotion or lack of knowledge, haven’t taken into consideration the standards of practice requirements that are part of the judicial and medical systems and how they played out in the Schiavo case. Decisions must be made in either discipline, sometimes swiftly. But everyone should know that if the established standards are followed faithfully, the decisions can and should be accepted. I think it would be rational and realistic at this time we accept them for the Schiavo case and go on to other issues with the goal to make life for the living better. Don’t you? ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:15:00 PM
5 comments
5 Comments:
I can totally agree on the medical/legal community saying "there is nothing else we can do, let her go". But I dont understand why the court or the husband refuses to allow the parents to give her some water/food etc. What ever the situation is, Is it humane/justfied to deny food and water to a person alive or almost dead.
The reason why Terri was on PEG tube feedings was because apparently she could not swallow. If food and fluid were poured down into her stomach from her mouth, it is likely she would likely aspirate the substances into her trachea and lungs and sufficate within minutes. Any person, even conscious, who has food or fluid poured into the throat beyond the persons control to swallow it may experience the same fatal condition. From what I understand, Terri wanted termination of life support and she would die from the from the consequences of her underlying illness and not an act which directly cause her death. Again, in the first case, the intent is to follow the patient's request and terminate tube feedings but not with the intention of killing her. In the second case, the intent of the provider would be to kill her by suffication, a request Terri did not make. I am sure that the nurses at the hospice, are keeping her lips and mouth moist during this period with moist and glycerine swabs though I doubt she even recognizes that comfort care. ..Maurice.
My understanding is that, although the husband forbid feedings several years ago, at least two nurses defied that order. One gave her a wash cloth with ice chips, which she claimed was enjoyed, then tried orange juice... also enjoyed. The other actually spoon-fed Jello, and which she claimed was "immensely enjoyed".
I don't know if it matters that she enjoyed it. I will give Michael enough credit that he based the decision not to allow food or drink by mouth on the advice of Terri's doctors. Just because she may have enjoyed it (in reality or in the perception of her caregivers), does not mean it would have been safe for her due to the aspiration risk.
On decisions: A Christian view
From a recent discussion with a professor, I've decided to include edited selections of my argument to contribute to your blog. I'd like to remind all readers that I am generally ignorant in this field and am still developing opinions.
"[...]everyone should know that if the established standards [of practice requirements that are part of the judicial and medical systems] are followed faithfully, the decisions can and should be accepted."
As a Christian, I believe in sanctity of life, and that as a result of separation from God, the choices we make define how close we are to Him. I think that the decision should be hers, and hers alone to carry out. If Mrs. Schiavo decides to take her own life, it will be her own sin. If she asks others to take her life for her, she would be laying the burden of "legal murder," or in spiritual terms, murder, on others' shoulders. For example, let's say I am unable to walk, so I ask you to assassinate the President for me, and you agree with me that it would be for the best. What happens on Judgement Day when you're blamed for a crime I thought up? Will you tell God, "Hey, it was her idea!"?
If Mrs. Schiavo is separated from the ability to take her own life, or to decide to, others should not put words in her mouth and take action. The husband may be right about what she indicated years ago about being in this situation, but she wasn't under the present circumstances. In the face of death, were she to be communicative and indicate that she was mentally present (or healed, and looking back on these days), her opinion may be changed. In my belief, everything that happens is the will of God.
What physicians and politicians would do with authority is all part of our punishment. I have been studying Genesis in the past year and decided that the Fall of Adam and Eve resulted from their decision to excercise their God-given free will to disobey God, and that the world they entered - this one, in the physical realm - is full of strife, misery and in this case, hard decisions that apply directly to the spiritual realm. I also decided that it is in the nature of man to want to fit in to this world by doing things to help himself physically. There is also a calling from the Garden, as if we feel we "ought" to go back there, to correct ourselves by filling or replacing elements in human life that cause agony with supernatural life full of bliss. These conflicting forces - dependancy on the physical and spiritual realms - are what drive our decisions, I think. This punishment includes circumstances for women such as Mrs. Schiavo, and I'm going to be very ugly in saying that we should all live up to the punishment of living in this world and enduring these pains. Although Mrs. Schiavo may be personally innocent of any crimes in this realm, we are all guilty for what Adam and Eve decided to do. If a family member passes away, I don't get angry at God, I sit there and realize that any agony in this world is a result of the Fall, and I move on. I believe that God chooses people and cases like this one to test us. Under these circumstances, any "rational and realistic" acceptance of legal murder and persuit of improved health will not be fruitful.
Stephanie
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