Terri Schiavo and our Moral Confusion

In thinking about the meaning of the tragedy of Terri Schiavo's life and the decisions it has generated, I spent much of Good Friday reading a number of articles by bioethicists, theologians, and various columnists. The entire time, I was haunted by the title of an essay by Stanley Hauerwas, who has written a lot about the moral nature of our care for the severely mentally retarded and more generally of those whose lives are incomprehensible and (thus?) burdensome to us. In "Must a Patient Be a Person To Be a Patient? Or, My Uncle Charlie Is Not Much of a Person But He Is Still My Uncle Charlie," Hauerwas challenged the conventional framework that guides many debates in bioethics: the definition of what constitutes personhood. According to this framework, to be alive and to be human is not sufficient to make a moral claim for care and protection. One must also be a "person," a status (in both beginning-of-life and end-of-life settings) that is usually defined in terms of capacities for reason and volition. Leon Kass, in Life, Liberty and the Defense of Dignity: The Challenge for Bioethics (Encounter, 2002), observes that the Western tradition of conferring dignity and respect on persons, on "rational beings" capable of "genuine moral agency," has preserved the unique value of human life by distinguishing it from beasts and machines. But, as we are painfully discovering on many issues addressed by bioethicists, it is an inadequate framework, appropriate perhaps for the Hellenistic view of human nature, but not rich enough for the account preserved by Jews and Christians in the account of Creation, and extended by Christians in reflection on the reality of the Incarnation. As Kass notes, "Precisely because it dualistically sets up the concept of 'personhood' in opposition to nature and the body, [this view of human dignity] fails to do justice to the concrete reality of our embodied lives—lives of begetting and belonging no less than of willing and thinking. . . . Precisely because 'personhood' is distinct from our lives as embodied, rooted, connected and aspiring beings, the dignity of rational choice pays no respect at all to the dignity we have through our loves and longings—central aspects of human life understood as a grown togetherness of body and soul. Not all of human dignity consists in reason or freedom." [page 17] Reason and freedom are valued in the Biblical account of human nature. But in the modern, Enlightenment account that has shaped our political institutions and much of our thinking about the contours of caring for one another, reason and freedom are pretty much all there is to a person rightly so called. The modern picture of the human cannot account for our nature as embodied spirits created for and constituted by relationships of love. In his book Bioethics: A Primer for Christians (Eerdmans, 2nd edition 2005), Gilbert Meilaender reflects on how Christian thinking should challenge the common assumptions of our culture about "personhood": "[O]ur personal histories—precisely as histories of embodied spirits—do not require the presence of 'personal' capacities throughout. Our personal histories begin in dependence—first within our mother's womb and then as newborns. Often our life ends in the dependence of old age and the loss of capacities we once had. Personhood is not something we 'have' at some point in this history. Rather, as embodied spirits or inspirited bodies, we are persons throughout the whole of that life. One whom we might baptize, one for whom we might still pray, one for whom the Spirit of Christ may still intercede 'with sighs too deep for words' (Rom. 8:26)—such a one cannot be for us less than a person. Dependence is part of the story of a person's life." [2nd edition, page 6] Meilaender concludes this section of his book with an observation that applies to Terri Schiavo's situation most particularly: "Those human beings who permanently lack certain empowering cognitive capacities—as well as all human beings in stages of life where those powers are absent—are simply the weakest and most needy members of our community. We can care for them and about them only by acknowledging the living bodily presence that they have among us—seeking to discern in their faces the hidden spirit, the call to community that their bodily presence constitutes, and the face of Christ." [ibid.] In an article written for The Weekly Standard and posted online on Good Friday, Eric Cohen, the editor of The New Atlantis, also reflects on moral framework questions. "For all the attention we have paid to the Schiavo case," Cohen insists, "we have asked many of the wrong questions, living as we do on the playing field of modern liberalism." Like Kass and Meilaender, Cohen is unhappy with the liberal idea that volition is the defining characteristic of the human: "[T]he real lesson of the Schiavo case is not that we all need living wills; it is that our dignity does not reside in our will alone, and that it is foolish to believe that the competent person I am now can establish, in advance, how I should be cared for if I become incapacitated and incompetent. The real lesson is that we are not mere creatures of the will: We still possess dignity and rights even when our capacity to make free choices is gone; and we do not possess the right to demand that others treat us as less worthy of care than we really are." Cohen observes that liberalism's celebration of liberty as autonomy, as independence, distorts the meaning of the human and establishes "a set of assumptions about what makes life worth living and thus worth protecting" according to which we regard "incompetence itself as reasonable grounds for assuming that life is not worth living." Cohen thinks that medical ethics organized around the single theme of autonomy is flawed. "[T]he autonomy regime, at its best, prevents the worst abuses—like involuntary euthanasia, where doctors or public officials decide whose life is worth living. But the autonomy regime, even at its best, is deeply inadequate. It is based on a failure to recognize that the human condition involves both giving and needing care, and not always being morally free to decide our own fate." The article is posted online here. In watching and reading the news coverage of Terri Schiavo's case, I can't remember hearing the word "euthanasia" once. And yet it should be clear that by withdrawing food and water from her, she is euthanized, not simply being "allowed to die." I doubt that a parent who withheld food and water from their children, or a warden who withheld food and water from a prisoner, could be excused from culpability on the grounds that they were simply allowing someone to die. In none of these cases, including Terri Schiavo's, is there a dying person, just a dependent one. Two articles from First Things help sort through the issues involved in distinguishing killing from allowing to die. The first, "Always to Care, Never to Kill: A Declaration on Euthanasia," was produced by the Ramsey Colloquium, a group of Jewish and Christian theologians, ethicists, philosophers, and scholars that met periodically to consider questions of ethics, religion, and public life. The statement was prepared at a time when many states were considering laws liberalizing the practice of euthanasia and physician-assisted suicide, and its principal theme was declared quite concisely: "In relating to the sick, the suffering, the incompetent, the disabled, and the dying, we must learn again the wisdom that teaches us always to care, never to kill. Although it may sometimes appear to be an act of compassion, killing is never a means of caring." Later in the declaration, a warning that has relevance to Terri Schiavo's case was offered: "Once we cross the boundary between killing and allowing to die, there will be no turning back. Current proposals would legalize euthanasia only for the terminally ill. But the logic of the argument—and its practical consequences—will inevitably push us further. Arguments for euthanasia usually appeal to our supposed right of self-determination and to the desirability of relieving suffering. If a right to euthanasia is grounded in self-determination, it cannot reasonably be limited to the terminally ill. If people have a right to die, why must they wait until they are actually dying before they are permitted to exercise that right? Similarly, if the warrant for euthanasia is to relieve suffering, why should we be able to relieve the suffering only of those who are self-determining and competent to give their consent? Why not euthanasia for the suffering who can no longer speak for themselves? To ask such questions is to expose the logical incoherence and the fragile arbitrariness of suggested 'limits' in proposals for legalized euthanasia." The article is available online here. Finally, the August/September 2004 issue of First Things featured an exchange between Robert D. Orr (director of Ethics for Fletcher Allen Health Care and Professor of Family Medicine at the University of Vermont College of Medicine) and Gilbert Meilaender. The exchange dealt explicitly with the question of the use of feeding tubes for patients in a "permanent vegetative state." Orr and Meilaender both agree that such patients (like Terri Schiavo) are not dying. Given that fact, Meilaender discusses this question: "Under what circumstances may we rightly refuse a life-prolonging treatment without supposing that, in making this decision, we are doing the forbidden deed of choosing or aiming at death?" "The answer of our medical-moral tradition has been the following: we may refuse treatments that are either useless or excessively burdensome. In doing so, we choose not death, but one among several possible lives open to us. We do not choose to die, but, rather, how to live, even if while dying, even if a shorter life than some other lives that are still available for our choosing. What we take aim at then, what we refuse, is not life but treatment—treatment that is either useless for a particular patient or excessively burdensome for that patient. Especially for patients who are irretrievably into the dying process, almost all treatments will have become useless. In refusing them, one is not choosing death but choosing life without a now useless form of treatment. But even for patients who are not near death, who might live for a considerably longer time, excessively burdensome treatments may also be refused. Here again, one takes aim at the burdensome treatment, not at life. One person may choose a life that is longer but carries with it considerable burden of treatment. Another may choose a life that is shorter but carries with it less burden of treatment. Each, however, chooses life. Neither aims at death. "It is essential to emphasize that these criteria refer to treatments, not to lives. We may rightly reject a treatment that is useless. But if I decide not to treat because I think a person's life is useless, then I am taking aim not at the treatment but at the life. Rather than asking, 'What if anything can I do that will benefit the life this patient has?' I am asking, 'Is it a benefit to have such a life?' If the latter is my question, and if I decide not to treat, it should be clear that it is the life at which I take aim. Likewise, we may reject a treatment on grounds of excessive burden. But if I decide not to treat because it seems a burden just to have the life this person has, then I am taking aim not at the burdensome treatment but at the life. Hence, in deciding whether it is appropriate and permissible to withhold or withdraw treatment—whether, even if life is thereby shortened, we are aiming only at the treatment and not at the life—we have to ask ourselves whether the treatment under consideration is, for this patient, either useless or excessively burdensome. "Is the treatment useless? Not, let us be clear, is the life a useless one to have, but is the treatment useless? As Dr. Orr notes—quite rightly, I think—patients 'can live in this permanent vegetative state for many years.' So feeding may preserve for years the life of this living human being. Are we certain we want to call that useless? We are, of course, tempted to say that, in deciding not to feed, we are simply withdrawing treatment and letting these patients die. Yet, as Dr. Orr also notes, these patients 'are not clearly dying.' And, despite the sloppy way we sometimes talk about these matters, you cannot 'let die' a person who is not dying. It is hard, therefore, to make the case for treatment withdrawal in these cases on the ground of uselessness. We may use those words, but it is more likely that our target is a (supposed) useless life and not a useless treatment. And if that is our aim, we had better rethink it promptly."

"On what basis would you suggest that it be invalidated?"

That'll cost you 30%.

I'm no lawyer. I'd guess a case could be made that a) it was done in haste, b) not a clear mind (why would a wealthy man write on a scrap of paper?), c) he has some obligation to his family (he's brain dead and they're in poverty).

Hell, lawyers have broken iron-clad wills.

Sure, they could be lying.

In other words, their testimony is not clear and compelling evidence.

Why? Why would they lie? What's to be gained by their lying?

Plausible scenario: Michael offered them $100,000 each if they'd help him get rid of his wife.

And if there were the remotest possibility that they were conspiring with Michael, why was this not brought up during the January, 2000 hearing -- a perfect time to do it?

Maybe because the Schindler's legal help has been less than stellar?

If someone is going to be put to death (whether in a criminal or civil case) the evidence should be so strong that there is no plausible scenario in which such action would not be justified. In a few cases, hearsay may manage to reach this standard of proof. Generally, though, it does not.

"If you thought your friend was serious about his wishes, you should get some paper and ask him to write them down."

Now that's just plain silly. And you were doing so good there for a time.

If your friend isn't serious enough about his wishes to write them down, why should you (or anyone) think him really serious about them?

"In other words, their testimony is not clear and compelling evidence."

Correct. If the judge thought they were lying, their testimony would not be "clear and compelling" evidence.

Obviously, the judge believed them.

"Plausible scenario: Michael offered them $100,000 each if they'd help him get rid of his wife."

I'm speechless.

"Maybe because the Schindler's legal help has been less than stellar?"

I remain speechless.

I had to re-check the post. I thought it was another poster making these unsupported, tin-foil conspiracy statements.

"why should you (or anyone) think him really serious about them?"

Because if a person says to me, "I wouldn't (would) want to live like that", I believe them to be telling me the truth and that they're serious.

They could have remained silent, but they didn't. They spoke out, and expressed themselves quite clearly (as to their state of mind).

I would be happy to pass those comments on to a judge, then let the judge apply them to my friend's specific situation. They may not apply. Who knows?

Correct. If the judge thought they were lying, their testimony would not be "clear and compelling" evidence.

Even if a judge has reason to think they might be lying, their evidence is no longer 'clear and compelling'

"Plausible scenario: Michael offered them $100,000 each if they'd help him get rid of his wife."

I'm speechless.

You wouldn't consider such a thing as being plausible? Why not? Many people would be willing to lie under oath for $100,000, and had Michael been able to kill off Terri he would have netted about $500,000 so giving $100,000 each to his helpers would not seem unreasonable.

"Maybe because the Schindler's legal help has been less than stellar?"

I remain speechless.

Are you implying that their legal help wasn't less than stellar (to put it very mildly)?

I had to re-check the post. I thought it was another poster making these unsupported, tin-foil conspiracy statements.

I'm not claiming that the above scenarios are true--merely that they are plausible. The proper standard for putting someone to death, absent exigent circumstances, is that there is no plausible scenario in which such action would be unjustified.

I'm not suggesting you should believe that the Schiavos are lying, but there is a very clear and plausible motive for them to do so. Stating that the possibility exists hardly makes me a tinfoil-hat conspiracy theorist.

"why should you (or anyone) think him really serious about them?"

Because if a person says to me, "I wouldn't (would) want to live like that", I believe them to be telling me the truth and that they're serious.

In society, there are accepted actions for people to indicate that they are serious about various things. Failure to perform such actions is a sign of not being serious.

In business, if a customer keeps expressing interest in a product but never actually buys anything, the business owner is apt to conclude after awhile that the customer isn't really serious no matter what he says. In real estate, if a prospective home buyer claims interest, but never signs any purchase papers nor puts down a deposit, the seller should eventually conclude the buyer isn't really serious.

Why should advance directives be any different? If you're serious, write them down. If you fail to do so without a good reason, you're not really serious.

They could have remained silent, but they didn't. They spoke out, and expressed themselves quite clearly (as to their state of mind).

In the other scenarios I described, the person in question could have remained silent, but expressed verbal interest. Their failure to act beyond tht proved that they weren't really serious.

"Even if a judge has reason to think they might be lying, their evidence is no longer 'clear and compelling'"

Correct again.

"You wouldn't consider such a thing as being plausible?"

Plausible? No. Not without some evidence.

"Are you implying that their legal help wasn't less than stellar (to put it very mildly)?"

How "less than stellar" were they to not even bring up the "plausible" conspiracy of these three people. Now, maybe they weren't stellar enough to get their testimony thrown out, but they couldn't even bring it up?

"You wouldn't consider such a thing as being plausible?"

Plausible? No. Not without some evidence.

Establishing plausibility generally doesn't require much evidence at all--in many cases, it requires none. Someone claims they had a $10 bill stolen from them. I have a $10 bill in my wallet. Do I need to produce any evidence to suggest that I got my $10 bill quite legitimately? No, I don't, because absent any evidence to the contrary it is entirely plausible that I could have gotten my $10 bill from any of countless thousands of places, quite plausibly without any recollection of where it actually came from.

In the case of the possibility of the Schiavos lying, I would cite as evidence the fact that they would have expected to gain, collectively, $500,000 if they lied and were believed, and the fact that many people have perjured themselves for a lot less than that.

"Are you implying that their legal help wasn't less than stellar (to put it very mildly)?"

I haven't read the court transcripts from that hearing, so I don't really know what was brought up. Can you offer me a source? I'd be interested to see it.

As to how the Schindler's attourney should have brought up the notion of the Schiavos inventing a story from scratch, I don't quite know. It would seem like it should be obvious to any judge that any witness might lie, especially if they'd have a motive to do so; telling judges things that are blindingly too obvious is not a way to make friends. I'd have to see the actual transcript to know what should have been argued differently.

"Unfortunately, Terri did not have a Living Will. Unfortunately, Terri's parents wanted her to live.
Unfortunately, as a result, the extreme right wing right-to-life groups went into full propaganda mode and called it euthanasia and murder."

Or put another way (and reading between the lines):

"Unfortunately, Terri did not have a Living Will."

Therefore, she must die!

"Unfortunately, Terri's parents wanted her to live."

Therefore, she must die!

"Unfortunately, as a result, the extreme right wing right-to-life groups went into full propaganda mode and called it euthanasia and murder."

Therefore, she must die!

And how to do you feel about partial-birth abortion?

In a nutshell: I'm pro choice. PBAs are rarely performed. Abortion isn't in issue I really care about. I believe abortion ought to remain legal but that compromises can be made.

People who think like you truly scare me.

As we should. My beliefs seem to parallel those of mainstream America. When the fanatical religious right takes over the Republican party and turns it into a theocracy, believe me, I and many millions of formerly Republican voters will flee. I wil do what I can to prevent this from happening.

I hope you have no ambitions to become a judge.

Rest easy. A career in law looks unlikely.

"My beliefs seem to parallel those of mainstream America."

Are you gloating? Mainstream America is a blob in the center, largely without direction, waiting on someone to lead them, either from one side or the other.

"When the fanatical religious right takes over the Republican party and turns it into a theocracy, believe me, I and many millions of formerly Republican voters will flee. I wil do what I can to prevent this from happening"

Flee where? To the left? So what? Many millions will probably flee to the right too. For instance, this issue has galvanized me toward the right, and I'm not "fanatical". H@ll, I'm not even "religious". I just follow my heart on what is right and what is wrong; or in this case, what are clear instructions on how one wants to die and what is state-sanctioned murder. It is the issue that is of importance to me, not who on a particular side espouses it. I suspect there will ultimately be more traffic heading to the right on this issue than to the left, as the left has been largely without moral compass.

And where do you think the Republican party would be without the "fanatical religious right" as you can them? If you think Christians are looking for a theocracy, you don't really understand Christians. But that's okay - we don't look for understanding from Republicans like you. George Bush is president, a Christian, and as you can see, he has yet to establish a theocracy. But, if you really are a Republican, you should be thankful the religious right even bothers to vote or we'd be speaking of President Kerry.

Hi,

I believe we've butted heads once or twice on this topic already, but I'd like to make an observation regarding your stance vis-a-vis the Schindler-Schiavo duels. Your command of the proceedings of the case is fairly impressive, but it presupposes reasonableness on part of the court and, more specifically, judge Greer.

While there is a lot of wild accusations flying around, many (perhaps even most) of which don't pass the smell test, insisting that this case is cut-and-dried because of the conclusions of the judge is akin to insisting the Bush National Guard memos were true and accurate because CBS said they were. Some of the allegations being made impeach the competence of the judge. To cite his statements as proof of correctness, therefore, does not address the key component of the allegation.

For instance, I personally have a VERY hard time accepting Michael Schiavo's statements regarding Terri's wishes regarding "artificial life support". His brother's and sister-in-law's corroboration adds little believability, in my mind. The simple fact that Schiavo's testimony changed radically almost immediately after he won the large settlement for her "care" makes the 7 year delay in his memory suspect.

Further, there have been numerous allegations in the real world that Michael consistently refused to allow Terri to be treated with any form of medical care, including the therapy that the $800,000.00 was supposed to cover. This is incongruous with his stated intent (I am unsure if he 'swore' to it) to care for her 'for the rest of [his] life'.

In short, you are trying to use the conclusions of the judge to justify trusting the conclusions of the judge.

Just my $.02

"Some of the allegations being made impeach the competence of the judge."

Yes. Some didn't like the judges decision -- so they attacked the integrity of the judge. A common tactic of those who have nothing to offer as a serious rebuttal to his conclusions.

And I'm not going to waste my time reading (or signing a petition of) phony, trumped-up charges -- to those I say, "Bring charges or STFU".

"I personally have a VERY hard time accepting Michael Schiavo's statements regarding Terri's wishes regarding "artificial life support". His brother's and sister-in-law's corroboration adds little believability, in my mind."

Why? I bet if they said she would want to live you'd believe them. Right?

You need to reexamine your your motives for disbelieving them. Judge Greer, in his court order, found Scott and Joan's testimony to be extremely credible, more so than Michael's.

"The simple fact that Schiavo's testimony changed radically almost immediately after he won the large settlement for her "care" makes the 7 year delay in his memory suspect."

Michael received the settlement three years after the incident. During those three years, Terri's condition did not imrove. Michael discontinued thereapy after discussing it with her doctor. There was no hope back then of recovery.

That $800K went into a trust for Terri, not for Michael. Michael continued caring for Terri for another four years. A CAT scan showed that her cerebral cortex was gone. Then, he brought the issue to Judge Greer.

If he wouldn't have waited that long, you'd be screaming that Michael was rushing to kill her. That he should wait. That maybe she'd improve. Wouldn't you?

She did not want to live that way.

And that really pi$$ed off the extreme right-to-life fanatics who believed she had no right to make that decision for herself.

THEY decide who should die (no one). THEY know better. THEY hold the moral high ground. THEY are a group of very scary people.

Now, when we ask voters to vote conservative because we're pro-life, THEY are the people who come to mind.

Not really helping our cause, now is it?

Plausible means apparently true. In your $10 scenario, $10 is missing, you have $10 -- it's plausible.

But your scenario of, "Michael offered them $100,000 each if they'd help him get rid of his wife." is nothing more than wild-a$$ed speculation. It's not apparent at all.

Is it possible? Sure. Anything is.

But what leads you to believe the above scenario? What is so apparent to you? Did Scott and Joan suddenly start buying things? Did they say something to friends? Did their attitude towards Michael change?

I mean, give me something here that would convince me it's plausible.

"I haven't read the court transcripts from that hearing, so I don't really know what was brought up."

Given the hunger for conspiracy on these Terri threads, don't you think that if the Schindler's attorney brought up a "plausible" Michael-Scott-Joan collusion it wouldn't be front page news? C'mon. You say you haven't read the transcripts -- you wouldn't have to.

Look. If you have some evidence, present it. I'll seriously examine it. But this other stuff ... you're starting to sound like some of the others. Don't do that.

You've been making some excellent, well thought out points (a rarity on a Terri thread). Keep it up. I love a good, honest debate. That's why we're both here.

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