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Tuesday, March 29, 2005

Is No Fate Worse Than Death?

The only reason I mentioned my mother in “Death is Rarely Easy” was to demonstrate that death by dehydration is not unique to Terri Schiavo but is, in fact, a common end to many wasting diseases such as cancer, Parkinson’s, Alzheimer’s, MS and AIDS, etc. The end result from removing a feeding tube, after all, is the same as from refusing to insert such a tube in the first place.

Geriatric specialists June Lunney and Joanne Lynn, writing in The Washington Post, March 27, noted that Terri Schiavo’s plight is “not unique” but “a common situation.” We don’t know precisely how common, because the cause of death is recorded according to the underlying disease rather than by the refusal to use life support technologies.

I have had living wills in five states which always left the decisions to my spouse rather than my parents (I would have never upset my parents by confiding my views about their own end of life, much less mine).

My latest Advanced Medical Directive empowers my wife to refuse on my behalf “the use of mechanical or other procedures that affect any bodily function, including, but not limited to, artificial respiration, artificially administered nutrition and hydration, and cardiopulmonary resuscitation. This authorization specifically includes the power to consent to the administration of dosages of pain relieving medication in excess of standard dosages . . . even if such medication . . . inadvertently hastens my death.” The last provision is perfectly legal in Virginia.

Hunter Baker singled out euthanasia law in the Netherlands as symptomatic of collective sin, but he did observe such a slippery slope among the citizens of Virginia, Oregon or Switzerland (where assisted death has been legal since 1937).

I am not arguing that the laws of 44 states against lethal injection are right or wrong. I leave that to the states. I am merely making the factual point that such laws leave many dying persons with no choice but to die slowly though not necessarily painfully (anesthetics are generally effective against pain, as shown during surgery).

My previous entry was about living wills, not euthanasia. I speculated that the reason so many people have been motivated by the Schiavo case to fill out living wills is not because they wish to insist on being kept alive by any means possible under any conceivable circumstance. Nobody has yet questioned that premise, so what does it imply about “what the patient would have wanted for herself” in Terry Schiavo’s case? If Mrs. Schiavo had filled out a living will, what are the odds that her medical directives would have been the exact opposite of most other living wills?

Many people gratuitously accuse her husband (and the Florida courts) of lying about what Terri Schiavo would have wanted, even though many of these same people are openly horrified by the prospect of spending countless decades bedridden, immobile and unable to communicate. In the March 23 The Washington Times Charles Krauthammer wrote that “If I were in Terry Schiavo’s condition I would not want a feeding tube.” On March 26, Tom Sowell wrote in the same paper that he would not “want to be kept alive in Terri’s condition.” He added that he would also not “want to be killed so slowly and painfully.” Yet in all but six U.S. states, however, only the first choice could be part of his living will. In most states anyone who does not want a permanent feeding tube, such as Mr. Sowell and Mr. Krauthammer, has no choice left but to die slowly from dehydration. Those who support laws against physician-assisted death cannot have it both ways – first arguing for criminalizing a “humane way to end life” yet subsequently feigning indignation whenever life does not end humanely.

Also in The Washington Times March 27, William Goldcamp speaks of Mrs. Schiavo’s “ignominious death, one worse than would be permitted a death-row prisoner or a dog.” Yet such ignominy is entirely because most state laws prohibit physicians from making death entirely painless, except for death-row prisoners or dogs. That is, most states hold physicians criminally and civilly liable for the administration of dosages of pain relieving medication in excess of standard dosages even if such medication inadvertently hastens death.

Feeding tubes are not inserted by divine intervention. “Letting nature take its course” does not mean letting physicians do whatever they want. Anyone’s “appointed time” depends on human decisions to resuscitate, to use mechanical methods of assisting breathing or circulation, and/or to rely on a feeding tube.

A “slippery slope” toward widespread euthanasia could be an unintended consequence of one faction’s gross exaggeration of the notion that the absence of a feeding tube toward the end of life is either unusual or terribly cruel. Even for people who are not brain-damaged (Alzheimer’s being a much milder form of brain damage than Mrs. Schiavo's), the inability to eat or drink is not typically agonizing (the body and consciousness just shut down) and medication would be available if it were. If many people actually come to believe the recent hyperbole about the alleged horrors of ending life without a feeding tube, then they are far more likely to demand their living wills permit potentially fatal dosages of pain relieving medication. If their state does not allow that, they may well be prompted to agitate for more permissive laws. Indeed, they may reasonably conclude from Congressional meddling in the Schiavo case that voters have now been encouraged to do such agitating at the federal level.

Although I get there by a very different route, I end up agreeing completely with Sam Karnick’s conclusion: “A broad federal law—or worse yet, an overarching Supreme Court decision based on emanations from the penumbra of the Constitution—would surely be a classic illustration of the adage that hard cases make bad law.”


Tlaloc said...

Hrrm, you keep posting well thought out and reasonable pieces on the subject rather than the factually challenged emotional appeals karnak and baker have been reduced to.

I have to doff my cap to you on the topic.

Hunter Baker said...

Tlaloc, I'm sure Alan is thrilled to be your special friend.

Tlaloc said...

Don't worry, Hunter, if you keep at it you may not always be stuck at NRO and the spectator. I have some hope you can learn to see past the dogmatic blinders you've voluntarily put on.