Caplan on MSNBC on Schiavo

Writes Art Caplan on MSNBC.com:

We have now reached the endgame in the case of Terri Schiavo. Her husband, Michael, remains unwavering in his view that she would not want to live in the state she is in. Despite the fact that he has been made the target of an incredible organized campaign of vilification, slander and just plain nastiness, he remains unmoved. Even a pathetic effort to bribe him into changing his mind with the offer of $1 million did not budge him.

He says he loves his wife and will do whatever it takes to end an existence that he believes she would not want to endure. He thinks that she would want her feeding tube stopped and that she would wish to die rather than remain bed-bound in a nursing home in a permanent vegetative state for the rest of her days

The Schindler parents and their other children remain equally convinced that Michael is wrong.  They say that Terri would want to live, that she is not as brain-damaged as Michael contends, and that there is still hope for her recovery despite the fact that she has failed to show any real improvement in 16 years. They argue that there are still more treatments to be tried and that as a Catholic Terri would want to honor recent Papal teachings that feeding tubes should not be removed from those in permanent vegetative states.

Congress, or at least the pro-life constituency in the House and Senate, are doing their best to halt Schiavo's death. Last-minute bills invoking habeas corpus, a legal doctrine that has historically only been used for those held in federal custody, along with incredibly zany and inappropriate subpoenas to doctors and nurses requiring that Terri Schiavo be brought to Washington, show a level of grandstanding that is normally reserved for issues such as the use of steroids by major-league baseball players. 

So now that this miserable case is moving toward a resolution, what can be said about who is right and who is wrong? And what is the likely legacy of the battle over the fate of Terri Schiavo?

Ever since the New Jersey Supreme Court allowed a respirator to be removed from Karen Ann Quinlan and the U.S. Supreme Court declared that feeding tubes are medical treatments just like respirators, heart-lung machines, dialysis and antibiotics, it has been crystal clear in U.S. law and medical ethics that those who cannot speak can have their feeding tubes stopped.  The authority to make that decision has fallen to those closest to the person who cannot make their own views known. First come husbands or wives, then adult children, then parents and other relatives.

That is why Michael Schiavo, despite all the hatred that is now directed against him, has the right to decide his wife’s fate. The decision about Terri’s life does not belong to the U.S. Congress, President Bush, Rep. Tom Delay of Texas, Florida Governor Jeb Bush, the Florida Legislature, clerics in Rome, self-proclaimed disability activists, Operation Rescue founder Randall Terry, conservative commentators, bioethicists or Terri’s parents. The decision is Michael’s and Michael’s alone.

Remember the recent debate about gay marriage and the sanctity of the bond between husband and wife? Nearly all of those now trying to push their views forward about what should be done with Terri Schiavo told us that marriage is a sacred trust between a man and a woman. Well, if that is what marriage means then it is very clear who should be making the medical decisions for Terri — her husband.

But, isn’t it true that tough questions have been raised about whether he has her best interests at heart? They have. But, these charges against Michael Schiavo have been heard in court again and again and again. And no court has found them persuasive.

Has there really been careful review of this case? Is Terri really unable to think or feel or sense? Will she never recover? The flurry of activity in Washington and Tallahassee might make you think there has not. But that is not so.

There have been at least 11 applications to the Florida Court of Appeal in this case resulting in four published decisions; four applications to the Florida Supreme Court with one published decision (Bush v. Schiavo); three lawsuits in federal district court; three applications to the U.S. Supreme Court and nearly untold motions in the trial court. This has got to be the most extensively litigated "right-to-die" case in U.S. history. No one looking at what has gone on in the courts in this case could possibly deny that all parties have had ample opportunity for objective and independent review by earnest and prudent judges of the facts and trial court orders.

The time has come So, it is clear that the time has come to let Terri die. Not because everyone who is brain damaged should be allowed to die. Not because her quality of life is too poor for anyone to think it meaningful to go on. Not even because she costs a lot of money to continue to care for. Simply because her husband who loves her and has stuck by her for more than 15 years says she would not want to live the way she is living. If Terri is allowed to starve to death what next? Undoubtedly there will be efforts to pass laws to prohibit feeding tubes from being taken away from others like Terri in the future. And there may even be efforts made to push right-to-die cases out of state courts and into federal courts. These are bad ideas. We have had a consensus in this country that you have a right to refuse any and all medical care that you might not want. Christian Scientists do not have to accept medical care nor do Jehovah’s Witnesses need to accept blood transfusions or fundamentalist Protestants who would rather pray than get chemotherapy. Those who are disabled and cannot communicate have the exact same rights. Their closest family members have the power to speak for them. The state courts of this country have the power to review termination of treatment cases and have done so with compassion, skill and wisdom for many years. Those who would change a system that has worked — and worked well for the millions of Americans who face the most difficult of medical decisions — should think very hard about whether Sen. Bill Frist, DeLay, Sen. Hillary Clinton, Bush, Sen. John Kerry or the governor of your state needs to be consulted before you and your doctor can decide that it is time to stop life-prolonging medical care.