Terri Schiavo, Life and Death
[Updated on April 3, 2006]
All over the world, as the Terri Schiavo case unfolded, people asked themselves, "what would I do if this were my loved one?" or "what would I want done if this were me?"
Mrs. Schiavo is dead now. Fifteen years earlier, worried about her weight, she became bulimic. The bulimia upset her body's chemistry, which caused her heart to stop, which deprived her brain of oxygen, which plunged her into a coma. She never revived. She could breathe on her own and she had reflexes. This lled some people to believe that she was aware at times, but she remained vegetative. She couldn't take water or nourishment easily, so surgeons inserted a feeding tube - a PEG tube, percutaneous endoscopic gastrostomy — into her stomach. This technique was developed 26 years ago (in 1979). It is now used more than 250,000 times a year in the United States alone. Liquid formula and water is fed through the tube.
Mrs. Schiavo's husband has been demonized by the media, but the record shows that, for the first four years after his wife became comatose, Michael Schiavo did everything he could, working with therapists and other experts, nurses and her family, to revive her. He gave up hope, apparently, only after her neurologists told him that there was no hope. Her heart stoppage had caused irreversible brain damage. They showed him that her cerebral cortex, which controls the brain's higher functions, was liquifying, literally, and that she would never again become conscious.
Mrs. Schiavo continued to receive visitors frequently, as well as a remarkably high level of care. In 15 years, all parties agreed, she never had a single bedsore. Nurses would get her out of bed daily, clean her, and sit her in a chair. Family members, including her husband (who, after the first four years, started another family, without divorcing Terri), massaged her, brushed her hair, and tried to exercise her muscles for her. She was loved, at least by her blood relatives, but even love couldn't revive her. She remained comatose.
Examining this matter in the light of God's teachings: every human life, including the life of one who is terminally ill or comatose, is sacred. God created man not just for the pursuit of animal pleasure and the avoidance of animal discomfort. Ultimately, He created us to serve Him. We serve Him by living life until the last moment until He takes it. Our lives are not whole otherwise; no one has a right to diminish a human life by encroaching on His prerogatives.
Human beings may take animal life, but our dominion doesn't extend to our fellow men. Only God may take an innocent human life. To die in God's time and at His command brings man blessing — that is, atonement. Still, one need not be conscious in order to die, and our Maker absolutely does not prevent us from administering drugs, or other appropriate therapies, to relieve pain and suffering.
We don't serve God with our pain but with our lives. Nothing may be done to shorten them. A "hopeless" person is never to be regarded as a dead person. However, God doesn't necessarily require us to pursue heroic measures to prolong the last moments, days or years.
One must try to supply even a medically hopeless patient with life's ordinary necessities, such as food, water, air, warmth, and (by transfusion) blood, because the obligation to save or preserve human life is always paramount. Furthermore, the patient has an obligation to accept such necessities. No one has the right to commit suicide by willfully starving or refusing liquids until death comes. No legal arrangement or written instrument, calling for the withholding of life's ordinary necessities while one is still alive, is moral.
When the time to die has in fact arrived, the patient, or the patient's representatives, may refuse, and the physician may withhold, treatment by means of surgery, drugs, artificial stimulation, or other extraordinary intervening measures. There are times when one simply doesn't try to shock a heart back into beating, for instance, or administer powerful drugs. But Mrs. Schiavo wasn't anywhere near the edge of death. [Allow me - Michael D. -to highlight this section, which has troubled me since we first posted it: Neither was there any question here of taking her off a medical device that was doing her body's work for her — a respirator, say, doing the work of her lungs, or a heart machine, pumping her blood, or a kidney dialysis device, or the like. She simply needed food and water and loving care, as she had been receiving.] She was like a baby, in many ways — helpless, unable to communicate, unable to feed herself, needing others' help.
Terri Schiavo, after a long drawn-out battle in the courts between her husband and the rest of her family, was finally killed by dehydration. Her PEG tube remained in her stomach but, pursuant to court order and after numerous appeals, the people attending her stopped putting anything through it. So, after almost two weeks without water, she died, still in her coma.
Among attorneys, judges and legislators, one frequently hears the expression, "hard cases make bad law." Unusually unhappy or difficult factual circumstances can easily lead to bad legal decisions. Terri Schiavo's case exemplifies that principle.
In the last few years, much of the worldwide medical establishment has been advocating death by dehydration — by cutting off all water — to "hopeless" patients. One should consider that if this approach to human life were valid, the cause of mercy would be far better served by simply slitting the patient's throat, by a bullet to the brain, or by injecting him or her with poison. Nonetheless, American jurisprudence seems to be heading in this direction — especially after Terri Schiavo.
Some interpreters of Torah - Torah is the Guidance, the Teaching, that God revealed at Sinai - argue that a PEG tube is a medical device. In other words, it's like a respirator or an artificial heart or kidney, as opposed to a feeding device. As a medical device, they say, it can be removed, even though removing it will certainly kill the patient. (Giving a comatose patient food and water orally, or by means of a tube down the nose into the throat and stomach, is no solution. It shouldn't be done over a period of more than a few days lest it cause gagging and choking, along with physical irritation and infection.)
This is not the position of most Torah-decisors. So long as the means exist to simply, safely provide a patient with the plain necessities of food and water, through a PEG tube or otherwise, food and water must be provided. In a hospital setting, they say, the Law would permit a DNR — a "do not resuscitate" order — meaning a patient should not be subjected to "heroic" or extraordinary life-saving measures. But God would never countenance a DNT — a "do not treat" order — if it meant witholding life's ordinary necessities.
These authorities view the PEG tube as a relatively simple feeding device. And this is a uniform rule governing all humanity, they say: when the means exist to deliver food and water to one who needs them, food and water must be provided.
Let this be the end of the matter. It has nothing to do with one's personal prejudices — the writer's own prejudices would not incline him to persecute Michael Schiavo — and everything to do with the kind of world we want to live in. Whether one's loved ones or doctors regard one as being "hopeless" or not, people have the inalienable right not to be killed, or be pressed to kill themselves, or be quietly hustled off in any way before their time. [Emphasis added, see below.] The question here isn't really "what would I do if this were my loved one?" or "what would I want done if this were me?" Rather, we need to recognize that our obligation as human beings is to bring holiness to earth, to protect civilization and improve it. It isn't for mortal men to assess the comparative current value of any human life. Human beings are not like the lesser animals, to be "put down" whenever life becomes difficult or inconvenient. Even when there is very little life left in a person, that life still matters.
3 April 2006
One tries to get things right all the time but I have been troubled by this essay since we first put it up.
Speaking of God's seven universal touchstone principles of higher consciousness, it clarifies for us the things that everyone ought to know are wrong, the obvious things, like stealing, or a man engaging in sex with a boy, or killing someone in order to steal something, etc. It certainly forbids murder. The question here is, was Terry Schiavo "quietly hustled off in any way before [her] time?"
I can't say that she was - certainly, not with the certainty required to advise others to criminalize the actions described above, that were taken regarding Mrs. Schiavo.
Some Torah authorities regard a PEG tube as a medical device - and it certainly is a medical device, a terrifically sophisticated invention, wonderfully and skillfully made. It functions simply enough - it's like a straw that delivers liquids - but it is nonetheless a tool or device that physicians attach to their patients in order to help them.
After further deliberation, I realized that I couldn't say that Mrs. Schiavo's life came to a premature end by the withdrawal of PEG tube-feeding. It seems to me that her caregivers were, on the whole, remarkably attentive to Mrs. Shiavo's needs. It seems to me that they acted towards her in a manner indicating that they were fully conscious of their responsibilities to Mrs. Schiavo as a unique human being of infinite worth, created in God's Own holy image. I certainly don't think that they acted like criminals.
Even though I'm writing this on our foundation's website I'm speaking only for myself in this. I did want to put this up as soon as possible, so as not to mislead anyone. Anyone who feels that I've missed the mark in this matter may contact me directly.