Tuesday, March 22, 2005

Reactions to The Terri Schiavo Case

There's been a variety of responses to the Terri Schiavo case since the bill was passed giving federal courts jurisdiction. In California, the California Medical Association voted, with agreement by all but one of the 450 members, to "express its outrage at Congress' interference with medical decisions."

Congress is planning to have a hearing next week to decide if further national legislation is needed. Some do not believe this is a good idea:
"We don't really have a problem that requires federal action," said William J. Winslade, a bioethicist and law professor at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. "The state laws have already covered these situations relatively well."
There has been speculation that Harry Reid made a deal with the Senate Republicans to allow them to pass the measure without requiring a quorum (and without debate) in order to prevent such a move. Reportedly the compromise was to have such a law which only affects Terri Schiavo rather than more general legislation. If the Republicans are now going to go ahead and do this, the Democrats played dead in the Senate for nothing.

As a physician who is sometimes involved in end of life decisions which may result in cessation of life support, I am glad that they (so far) have prevented the current Congress from getting involved in more widespread legislation. I fear that the result of such legislation, considering the degree to which the Republicans are pandering to the religious right, could wind up unnecessarily inhibiting cessation of life support. The Schiavo case got messy due to differences of agreement in the family, followed by politicians butting in where they shouldn't. Most of the time these matters go remarkably well, but it is best having a somewhat free hand to do what makes sense at the time, while trying to follow the wishes of the family and those which may have been expressed by the patient. I fear what a mess the Republicans will make out of this.

An example of the bad judgement we can see from Republican legislators comes out of Michigan where a state legislator wants to prohibit spouses who have been involved in adulterous affairs from making decisions involving cessation of life support. (I initially heard this on radio reports over the local NPR stations, and it is also reported here.) Should these matters be taken to the courts, the court should certainly consider the presence of adultery in deciding whether a spouse is acting in the patient's best interests, but I feel it is overstepping the bounds of the legislature to make a blanket rule that adulterous spouses can no longer represent the interests of their spouse.

Howard Brody, a professor at Michigan State University's Center for Ethics and Humanities in the Life Sciences, took a similar position to mine:
Brody said the current judicial process to consider such issues is a good one.

"Who would be the person to best know Terri's wishes and who could best report to us what Terri wanted? That person might well be the person who lived with Terri day in and day out," said Brody, who added that a court has not stopped Michael Schiavo from being his wife's legal guardian.

"Who are we to say that they're wrong?"


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