More Schiavo

More Schiavo

: See Mark Kleiman on the irony of other cases involving the Texas Futile Care Law signed by Gov. George W. Bush himself.

: Matthew Yglesias sends us to a good post by Rivka on the medical claims in the case; see another on the ethical issues. And Rivka recommends a post by Hilzoy, which includes a picture of a scan of Terri Schiavo’s brain.

: Barbara O’Brien says (relevant to the economic points I made below):

We need a list of politicians and commentators, including bloggers, who have been calling for cuts in Medicaid but who now have joined in the “save Terri Schiavo” cult. These people need to be challenged to take her off Medicaid and pay for her maintenance themselves.

[via Kevin Drum]

: My views today here.

: Below, I said that the connection would not be made between this case and the death penalty. But right now on MSNBC’s Connected, Sister Helen Prejean talks about the Catholic church coming out strongly against the death penalty.

  • Jon

    John Stuart Mill’s concepts of self-regarding vs other-regarding acts as the standard for government interference is a helpful starting point in the Schiavo discussion:
    “All that makes existence valuable to any one depends on the enforcement of restraints upon the actions of other peopleÖThe reason for not interfering, unless for the sake of others, with a personís voluntary acts, is consideration for his liberty.”
    For an extension of Mill to a “Culture of Living” that respects personal autonomy, see:
    “Schiavo, Mill and the Culture of Living”

  • this case is buzzing through my mind on so many different levels. jeff, i agree with much of what you wrote in your posts.
    but in my gut, my deepest thoughts are these: if i were to end up in a similar situation as terry, and if my spouse at the time moved on to have a new love and new kids and has obviously moved on with life, i WOULD NOT want that person to be my legal guardian in charge of making my life and death decisions. i have already told my family that this is the case so i think i’m covered.
    how that man continues to be the legal guardian of terry schiavo while her immediate family is forced to sit on the sideline based on the decisions of the Florida courts is really beyond me. from the outside looking in, it is an absolute travesty. but that may be a matter which should rest solely on the heads of those Florida judges.

  • gunther

    Michael Schiavo is her immediate family.

  • hmmm

    is she being kept alive through medicaid or damages from a lawsuit? i thought is was the latter.

  • plunge

    “how that man continues to be the legal guardian of terry schiavo while her immediate family is forced to sit on the sideline based on the decisions of the Florida courts is really beyond me.”
    While Michael remains her legal guardian, he isn’t the one that made the decision. A court made the ultimate decision.
    And if you want to get married, you have to accept what being married means: that your spouse is now your closest legal guardian unless you take steps to make it otherwise. This is exactly why, for instance, gay people want to marry: so that a lifelong partner can have more say than an estranged family.

  • Mike

    Minus a living will, no one should be able to just say this is what she would have wanted. It is ridiculous to think that Michael, given his current situation (new family, life, etc.), speaks for the best interests of Terri. He is speaking to the best interests of Michael.
    I read somewhere that he claims Terri mentioned she would not want to be kept alive while watching an episode of Melrose Place, now come on, does that sound like someone who has put a lot of thought into something as meaningful as a living will?

  • Dawn

    This is a very sad case which I don’t think was handled very well. Of course people have a variety of opinions, and I certainly don’t claim to have the definitive answer. However, I do take issue with the medicaid analysis. Ms. O’Brien states that the the hospice is picking up part of the cost, Medicaid pays the rest, and yet $350,000 of the malpractice award has been spent for care that comes to $80,000 a year. That $350,000 would pay for over 4 years of hospice care. Furthermore, Mr. Schiavo was awarded well over $1,000,000 in those three court cases. Why is she on medicaid? Not at the request of her family or any “cult”. Only Mr. Schiavo, her legal guardian, could have filled out the paper work and made the request for medicaid. Therefore, this was not a decision made by her parents or people who do not believe the feeding tube should be removed. Also, her parents have volunteered to accept complete responsibility for her health care, including the cost.

  • alcibiades

    As to your original point, Jeff, this is from The Corner:

    In August 1996 the Journal of the American Medical Association published an article describing procedures then in effect in Houston hospitals. Under these procedures, if a doctor wished to deny a patient lifesaving medical treatment and the patient or the patient’s surrogate instead steadfastly expressed a desire for life, the doctor would submit the case to the hospital ethics committee. The patient or surrogate would be given 72 hours notice of the committee meeting would be allowed to plead for the patient’s life at it. During that short 72 hour period, the patient or surrogate, while preparing to argue for life, could also try to find another health care provider willing to give the lifesaving treatment, food or fluids.
    If the ethics committee decided for death, under these procedures there was no appeal. There was no provision that the food, fluids, or lifesaving treatment be provided after the decision while the patient or family tried to find another hospital willing to keep the patient alive.
    So under these procedures, the hospitals in Houston were denying life-saving treatment, food and fluids against the wishes of patients and their families, when the hospital ethics committees said their quality of life was too poor. Patients and families were being given only 72 hours after being notified of the proposed denial to find another health care provider.
    In 1997 there was an advance directives bill going through the Texas legislature that would have given specific legal sanction to such involuntary denial of life-saving treatment. An effort in the Texas legislature to amend the bill to require treatment pending transfer to a health care provider willing to provide the life-saving treatment had been defeated. When that bill reached Governor George Bushís desk, he vetoed it, and said he was vetoing it precisely because it authorized hospitals to deny lifesaving medical treatment, food, and fluids against the will of the patients.
    But even without that bill, these procedures were still going on. So there was an effort in the next sitting of the legislature, in 1999, to pass protective legislation. Unfortunately, the votes just werenít there to require lifesaving treatment, food, or fluids be provided by unwilling hospitals. So there were negotiations that resulted in a bill that gave partial protection. That 1999 bill:
    first, formalized more protections for in-hospital review
    second, gave patients 10 days of treatment while seeking transfer, and
    third, authorized court proceedings to extend the 10 days for reasonable additional periods to accomplish transfer.
    Now this was not what patient advocates wanted and it wasnít what Governor Bush wanted. However, it was an important advance over the existing situation of no legal requirement of treatment pending transfer, for any period of time. The votes were not there in the Texas legislature to accomplish a more protective bill. So Governor Bush signed it because it was an improvement over the existing law.

    The upshot is that GWB by no means signed a perfect bill, but he signed a bill that improved the existent law and was the best that he could do, in a compromise vote, in the circumstances.
    Sometimes, historical context actually effects the meaning of an act. You ought to look at it before you decide a man’s guilt or his level of hypocrisy.

  • Randy Daitch

    Jeff – Are you aware that Judge Greer’s order not only mandated the removal of Terri’s feeding tube, but EXPLICITLY FORBIDS her to be given food or water by mouth, despite the fact that there is an affadavit already filed by one of her former nurses, Heidi Law, which states that she was able to swallow ice water and jello when they were given to her by the staff. She also stated that the staff was terrified of Michael Schiavo would only give Terri sustenance by mouth when they were sure her husband wouldn’t catch him.
    You talk about putting her to death painlessly with drugs – but how can you justify this without knowing if death is what she wants?
    How can you trust the word of a husband who, after winning a lawsuit for her medical care, used the money to buy the legal right to starve her? How can you trust the word of a man who claims to be acting in his wife’s interests but abandoned her ten years ago to raise a family with another woman?

  • There are serious differences between the two Texas cases cited by Mark Kleiman and the Schiavo case.
    Here is a newspaper story; here is a Health Law Prof blogger; and here is my own ill-tempered takedown.
    Briefly – in the case of the infant, there is NO evidence presented that financial considerations played any part in the decision; in the case of the adult, we have speculation that other hospitals may be declining to accept the patient for financial reasons, but no evidence is presented that the current hospital was motivated by anything other than medical ethics.
    Secondly, the infant was terminal, *possibly* in pain, on a respirator, and had no hope of recovery – Terri Schiavo does not meet three of those criteria, and the fourth (possible recovery) is highly unlikely, but in dispute.
    My point – linking these cases is an absurd analogy. But the left seems to love it…

  • franky

    Reading over these comments, it seems it sums up exactly what is wrong with politics today. Look at the endless personalising of this case, focusing on the personality of the husband or the motivations of the family (I’m leaving out criticism of politicians, because to a greater and lesser extent all of them have demonstrated their absence of morality and spines). This is now the politics of personal slime, smear your opponent and hope to win the argument. This is politics for the dumb, politics for people who can’t think larger than a soap opera plot. Worryingly it is also the politics of extremism – when your opponent is evil, any tool you use to defeat him is legitimate. Now I guess it’s standard to see it in fighting between politicians of the left and right, but to see this applied to a family of citizens is simply disgusting.

  • -asx-

    See Mark Kleiman on the irony of other cases involving the Texas Futile Care Law signed by Gov. George W. Bush himself.
    I appreciate your bringing attention to this, but I would not call it “irony.” I would call it “rank hypocrisy,” and “solid proof that Republicans are using Terri Schivo’s body as a political football.”
    I would also assert that the cable nets have made no or very little mention of this rank hypocrisy, and therefore reveals themselves as nothing more than enablers of the radical right wing agenda.
    Here’s another good post.

  • plunge

    “Also, her parents have volunteered to accept complete responsibility for her health care, including the cost.”
    This is irrelevant. Should anyone who wishes otherwise (sorry, arguments to the contrary, this was the finding of the court) be kept alive simply because someone else wants to keep them alive to play with?

  • Catherine

    As for the notion that because Michael Schiavo has moved on with his life after FIFTEEN YEARS he doesn’t speak for Terri’s best interests, what could he possibly gain by staging this fight? If all he really cares about is moving on with his life, why didn’t he get a divorce a long time ago and leave the family with the burden of caring for Terri? There’s nothing he can’t do now that would be made possible if Terri’s tube were removed. So doesn’t it stand to reason that he’s actually ONLY doing this to stand up for what he thought Terri would want?

  • Jim S

    Randy, the claims that these affadavits actually mean something are only put forth by people who want to keep Terri Schiavo’s body going at all costs. The idea that there is one evil liberal judge responsible for taking Michael Schiavo’s side is so bogus it’s not even funny. There have been nineteen different judges involved in this over the years and every one of them has concluded that there is no factual basis to these claims. None. But that doesn’t stop the ideologues. They know that they can’t be wrong. The scans of Terri Schiavo’s brain can’t be right no matter how many people find them to be conclusive. Facts never get in the way of ideology.

  • “The scans of Terri Schiavo’s brain can’t be right no matter how many people find them to be conclusive.”
    Standard protocol by a neurologist is to take an MRI, which gives more detail than a CAT scan. Michael refused to allow it. Many neurologists have NOT found the image conclusive.