Schiavo Means?
Living Wills May Not Work, but I'm Getting One - There couldn't be a more salient test of the question as to what it might mean if I do not write down "I prefer not to be held hostage by fears about a feeding tube for more than a decade, please." I've argued in several papers that living wills are a mistake and are unlikely to work, and others have found enough empirical evidence to cast doubt on the idea that advance directives make much difference in the care that patients receive. But tell that to Michael Schiavo. Today it is awfully clear that no matter what I and other critics of living wills might have believed about how well they work, they do at least make it easier to avoid the Schiavo level of confusion and wrangling. I have opined over and over again that living wills are too litigious. Um, ok, I was wrong. All around the country people will now begin thinking very seriously about writing down their wishes about feeding tubes and respirators. It is as John Danforth said when he pushed for the Patient Self-determination Act in the first place: young people "should get a Miranda warning" about what can happen if they do not talk to others about health care preferences.
In the Future, it Will Be Tough to Get a Majority of Legislators to Agree to Support Choices by Individuals About Health Care - The scene on the House floor as the debate persisted about Schiavo is staggering. Those who fought for the sanctity of marriage now fight against the importance of a husband's choice. Those who fought for the importance of the 10th amendment and states rights more generally are suddenly desperately fighting against a state's rule of law. The body that made it possible for Cruzan's case to become the Patient Self Determination Act is now deciding that expressed views about dying just don't matter. Why? Because Democrats do not want to run for office against campaign commercials that feature Terri Schiavo dying.
Systemic End of Life Care Is Now Officially Less Important than Jack Kevorkian and Terri Schiavo and Tom DeLay's Own Ethics Problems - Ask yourself when was the last time that President Bush and the Congress undertook anything like a midnight effort - including a flight to get the President from Texas to D.C. during a vacation - on behalf of healthcare. Give up? Never. Just think what could happen if Congress worked this hard or spent this much of our tax money to discuss and vote quickly on reform of managed care. It could never happen - but why? Because the battle over Terri Schiavo is illuminated by a single, vulnerable woman. If Democrats could manage to make a symbol out of a young woman dying of a curable chronic disease because she has no insurance, we might have 40 million fewer uninsured people in the nation today. And the lesson doesn't end there: this case is sucking the life out of the end of life care debate. Just as Kevorkian turned the nation's attention away from the problems that made his services seem desirable, the Schiavo case turns our attention away from dozens of critical questions about the funding of hospice and a dozen other issues.
Compassion for the Dying Schiavo and Her Family Ought Not Be Lost - There is no question in my mind that the Schiavo case illustrates wanton, callous political maneuvering on the part of some. It is equally clear to me that Congress has no business working on this case in this way - interfering in the lives of those who are touched by such tragedy as they make private decisions. But it should not be lost that many who have begun to fight in this matter as it has been quickly escalated have deep compassion for the Schiavos, and that such compassion comes from a vital sense that death and suffering must be understood and respected - and that love for life is important and beautiful. Somewhere in the middle is the opportunity to take this case and use it to move quickly to reform of national policies. I hope that happens. That will of course come as no comfort to the mother of baby Sun in Houston.
People Struggle Most Against the Worst Odds - There is no question about Terri Schiavo's condition. She is never ever going to awaken, no, to be more blunt, her brain is utterly destroyed and there is nothing of what was Terri Schiavo remaining in her but the simple functioning stem that causes her other organs to continue to function at the most basic level. That much is clear. All that remains of Terri Schiavo is her dignity and the symbolic meaning of her body. So why does anyone fight to keep her in this condition rather than discontinuing a treatment that everyone agrees is not therapeutic? What does it mean to fight against the impossible in this case? Republicans fighting against this measure have tried desperately to avoid discussion of what might re-grow Ms. Schiavo's brain, because God forbid they say what the man who offered Mr. Schiavo $1 million to keep Terri Schiavo said: stem cells. No, there is nothing here for them to point to but miracle. And it should be noted that pushing for a miracle against impossible scientific odds is a critical part of the American culture in an era in which physicians often feel that they must offer treatments that they do not believe are therapeutic. The idea that patients and others have a right to request things whether or not they work is being reinforced right now.
- Glenn McGee
