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March 18, 2005

Calling All Liberal Bloggers!

Okay, there's a lot of animosity between liberals and conservatives in the blogosphere. But occasionally we do find common cause -- Trent Lott, for example.

I think we can find common cause again. And achieve results. And maybe save a life.

I think many liberals don't much care about the Terri Schiavo matter not because they don't value life, but because they value even more highly an individual's autonomy.

And that's understandable.

And I think further that many liberals assume that Terri Schiavo is just one of many right-to-die cases in which a person's autonomy is being challenged and thwarted by religious righties with an agenda. I think liberals are not really very well acquainted with the case; I think they are, understandably enough, simply putting in into the individual vs the state template, or the individual vs meddling religious righties template, and basing a decision on those templates.

But those templates do not apply here. This is not the typical right-to-die case. Terri Schiavo is not on videotape, as Dr. Kervorkian's clients were, stating clearly her desire and intent to take her own life. She signed no Living Will specifiying that in certain dire medical circumstances she would prefer to be left to die rather than kept alive.

She expressed to no one, even verbally, her general preference to die in dire medical circumstances.

Well-- that last point is actually the whole subject of debate in this case.

Her husband, Michael Schiavo, claims that she did in fact raise the issue at one point and state that in some situations, she'd like him to see to it she had an easy and quick death, rather than being allowed to persist in a bad state.

One person claims she says this.

A man who has been involved with another woman for years and has sired children by that woman.

A man who was awarded $1.2 million in a malpractice case, and will no longer have to pay any expenses for Terri, other than funeral costs, once she passes.

The husband is not what you normally would call a disinterested party. Not generally the sort of witness whose testimony you'd take as the gold standard.


Even if you believe in the general proposition that one has a right to die, shouldn't we have minimal evidentiary safeguards as regards a person's declaration of such intent, such as signed Living Will specifying the circumstances under which he'd rather be allowed to expire?

Or at least multiple witnesses to an oral declaration?

Or at least one disinterested witness who will not reap potential monetary benefits upon the patient's death?

This is not the typical right-to-die case.

This is a case where a husband, finding his wife brain-damaged (but not brain dead!) and yet perfectly capable of living without medical assistance (except that she must be fed through a tube), has, understandably enough, found another life with another woman. And began a new family. And there's nothing really blameworthy about that; it would take a saint to remain faithful to Terri Schiavo.

However, given the fact that Michael Schiavo is now clearly Terri's husband in name only, does it make sense to treat him as if he were the normal sort of husband, devoted to his wife, concerned only with her best interests and with seeing her true wishes carried out?

Or does it make more sense to treat his claims with a bit more skepticism?

Terri's parents have been fighting for years to take guardianship of her. They want to take care of her. They want to disburden the husband of the expense and obligation of caring for Terri.

Michael, for some reason, is fighting them tooth and nail.

Isn't that... rather odd?

Why is he fighting so hard? Is it credible that he's just passionately committed to honoring his abandoned wife's vague wishes?

Does one typically spend years in court to vindicate the vague wishes of a spouse one has abandoned?

Or is it more likely he has a somewhat more tangible interest in her death?

One might object, "But what reason do we have to supect his motives?"

Well, apart from the obvious, classic ones -- money, new family with a new girlfriend -- we have evidence which tends to cast doubt on his concerns about his wife's welfare:

Many people believe that Terri Schiavo has had “the best of care,” and that everything has been tried by way of rehabilitation. This belief is false. In fact, Terri has had no attempts at therapy or rehabilitation since 1992, and very little had been done up to that point. Terri has not even had the physical therapy most doctors would regard as normative for someone in her condition. The result is that Terri suffers from severe muscle contractures, which have caused her body to become contorted. Physical therapy could remedy this, but husband Michael has refused to provide it.

Terri has also suffered from what many professionals would regard as neglect. She had to have several teeth extracted last year because of severe decay. This decay was caused by a lack of basic dental hygiene, such as tooth-brushing. She also developed decubitus (skin) ulcers on her buttocks and thighs. These ulcers can be prevented by a simple regimen of regular turning: a basic nursing task that any certified nurse’s aide can perform. The presence of these easily preventable ulcers is a classic sign of neglect. Bob and Mary Schindler have repeatedly complained of Terri’s neglect, and have sought to remove Michael as guardian on that basis. Judge Greer was unmoved by those complaints as well.

And, quite apart from the question of Terri’s therapy and care, it is entirely likely that Terri has never been properly diagnosed. Terri is usually described as being in a Persistent Vegetative State (PVS), and indeed Judge Greer ruled as a finding of fact that she is PVS; but this diagnosis and finding were arrived at in a way that has many neurologists expressing surprise and dismay.

I have spent the past ten days recruiting and interviewing neurologists who are willing to come forward and offer affidavits or declarations concerning new testing and examinations for Terri. In addition to the 15 neurologists’ affidavits Gibbs had in time to present in court, I have commitments from over 30 others who are willing to testify that Terri should have new and additional testing, and new examinations by unbiased neurologists. Almost 50 neurologists all say the same thing: Terri should be reevaluated, Terri should be reexamined, and there are grave doubts as to the accuracy of Terri’s diagnosis of PVS. All of these neurologists are board-certified; a number of them are fellows of the prestigious American Academy of Neurology; several are professors of neurology at major medical schools.

...

Terri’s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging). MRI is widely used today, even for ailments as simple as knee injuries — but Terri has never had one. Michael has repeatedly refused to consent to one. The neurologists I have spoken to have reacted with shock upon learning this fact. One such neurologist is Dr. Peter Morin. He is a researcher specializing in degenerative brain diseases, and has both an M.D. and a Ph.D. in biochemistry from Boston University.

In the course of my conversation with Dr. Morin, he made reference to the standard use of MRI and PET (Positron Emission Tomography) scans to diagnose the extent of brain injuries. He seemed to assume that these had been done for Terri. I stopped him and told him that these tests have never been done for her; that Michael had refused them.

There was a moment of dead silence.

“That’s criminal,” he said, and then asked, in a tone of utter incredulity: “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?” He drew a reasonable conclusion: “These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information.”

...

So why hasn’t an MRI been done for Terri? That question has never been satisfactorily answered. George Felos has argued that an MRI can’t be done because of thalamic implants that were placed in Terri’s skull during the last attempt at therapy, dating back to 1992. But Felos’s contention ignores the fact that these implants could be removed. Indeed, the doctor who put them in instructed Michael to have them removed. Michael has never done so.

I hope the Rev. Johanson and NRO (yes, conservatives and reverends are of course involved in this) will not mind the extended quotation.

This is not a standard left-right issue. This is not about the substance of the right-to-die debate.

This is about something less red-meat, and something less sexy, and something much less ideological.

It's about process. And evidentiary standards. And basic judicial safeguards for determining a stricken patient's true desires.

But it is also about preserving the life of a woman whose true wishes we simply cannot know with any real certainty.

Would you feel comfortable allowing spouse who has abandoned you and begun a family with a new partner to, upon his or her say-so and his or say-so alone, determine your fate, against the wishes of your parents, and despite his or her glaring conflicts-of-interest?

If you wouldn't feel comfortable with such an arrangement, please blog about this case, and let other liberals know it's reasonable, right, and, well, safe and sane to argue on behalf of perserving Terri Schiavo's life.

Thusfar mostly conservatives have taken any issue in this case at all, and I think that's a shame, because I think many liberals -- feminists in particular -- would be pretty shocked if they new the real facts of the matter.

Even if we have a right to die, which, for now, let's assume we do, obviously the taking of the life is a serious matter, and we should require some minimum level of evidence as regards someone's wish to be allowed to die.

The hearsay testimony of a single party -- and not a disinterested one -- should never be enough. You need a written contract for any lease of land that lasts more than one year; it seems very odd to me indeed that the taking of a human life requires only one hearsay statement from one interested party.

We all may arguably have a right to die as we wish.

But certainly a husband doesn't have the right to so easily dispose of an inconvenient and no longer sexually useful wife.

Nixon Goes to China Update: The self-described ardent liberal who inspired me to stop bashing liberals about this and actually try to reach out to them wrote her own post on the matter here.

Bonus Points! Only Republicans Need Be Embarassed By This! No Democratic votes need to be moved on this. In the Florida Senate, nine *Republicans* voted against a bill that would preserve Terri's life (I assume by raising the evidentiary threshhold to determine if somone truly wishes to be painfully starved to death for two weeks, but I'm not sure about that).

Most likely they're moderates, in moderate districts, who fear being associated with the religious right on this matter.

If enough liberals of good will made it clear that they also don't consider Michael Schiavo's testimony to enough to starve a woman to death, those Republicans could be whipsawed into changing their votes.

And of course they would be exposed as craven and cynical bastards for doing so.

So, you know-- it's win-win!

(Though, admittedly, those of us on the right wouldn't mind seeing them embarassed, either.)

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posted by Ace at 03:17 AM

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