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Thursday, November 21, 2019

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Deathwatch

Even for those of us who cast a cold eye on the passing media, Easter 2005 turned into a grotesque Deathwatch. Not only was there the usual commemoration of the crucifixion and alleged resurrection of a Christian divinity. There was also a dying Pope, an ailing prince of Monaco, and strangest of all, the case of a severely brain-damaged woman in Florida.

Terri Schiavo, 41, as almost everyone who glances at a TV tube or newspaper now knows, has been in a persistent vegetative state for 15 years and, more recently, has become the bitter object of a grim family feud about whether or not to remove her feeding tube, thereby killing her. The debate spread far beyond the usual courtroom boundaries where these disagreements are aired once they become irreconcilable, and promptly turned into the latest skirmish in a running American cultural war between rabid Christian fundamentalists and their more liberal opponents. The issue made it, with a little help from its devout friends, all the way to the Oval Office, where the American president offered some reassuring optics to the faithful when he signed a questionable law aimed at prolonging Schiavo’s twilight existence.

So much real and digital ink has been spilled on the Schiavo case, that there’s a temptation to let the horsemen of life, death and the media pass by. What decided me otherwise was reading two articles by the usually sensible and astute Toronto Star civic columnist Rosie DiManno.

Under an alarmist headline proclaiming that it is Schiavo’s embattled husband, Michael, “who has blood on his hands,” DiManno starts out with a bit of ad hominem hatchet-jobbing about the husband’s dubious motives in all this. Since none of the characters in this drama — parents, siblings, spouses and the rest of the cast — is especially loveable, and since there’s a pot of malpractice money involved, to say nothing of a bat’s belfry worth of theo-ideological commitments, casting aspersions is the easy part.

DiManno then turns to the medical issue, and reports that “numerous neurologists have given conflicting evidence, not just on the chances for even minimal improvement in the woman’s condition, but in trying to explain what, if anything, [Schiavo] can feel or sense or cogitate.”

DiManno concedes that it’s been agreed that Schiavo is in a persistent vegetative state, and has been for some 15 years, ever since a heart attack severely damaged her brain through oxygen deprivation. But “persistent vegetative state” isn’t good enough for DiManno. “That is an imprecise medical designation because nobody on this Earth can state categorically what is happening inside the brain of a person thus inflicted, or to what extent they are aware of their surroundings.”

On the politics of all this, DiManno washes her hands in the best Easter tradition. “It is immensely disturbing that political agendas are unquestionably fomenting the public debate. There is a constituency that’s hell-bent on exploiting a private tragedy to score electoral points in the cesspool of Florida politics.” But, says DiManno, “exploitation cuts both ways, and the ‘right to die’ lobby . . . has been just as crafty in promoting a death culture that terrifies the handicapped, the vulnerable and many of us who reject the expendability of human lives.”

In conclusion, DiManno offers her bona fides: she’s no “social conservative” and she’s lost “any religious faith I once had.” Nonetheless, bottom line: “Terri Schiavo isn’t dying. She’s being killed. And where there’s any doubt about her wishes, or even the shred of a chance for minimal recovery, that is unforgivable.”

In a subsequent column, DiManno reprises her “culture of death” idea. “What has struck and alarmed me most about the intense public debate,” says DiManno, “is the death culture grip that has emerged in our society. How quick to extinguish life so many have become, if that life is perceived as purposeless, a grotesquerie in its diminishment… I fear our right-to-die culture is steadily moving towards no-right-to-live.” Gee, good thing DiManno isn’t a social conservative.

Well, let’s see if we can unpack some of this. For starters, skip the motives of mere mortals, not-so-loving spouses, obsessed parents, and the packs of jackals who attend such disputes.

1. True, there is an issue about who gets to decide these life-and-death cases, and how the decisions are jurisdictionally divvied up (particularly in the U.S.’s peculiar “states’ rights” system). I doubt we’ll get much further on this one in the near future. But I’m not sure we have to get much further.

The basic power to decide resides with the individual affected. And that’s the case here, except, as often happens, the facts are in dispute. In the Schiavo case, the husband, who is the legal guardian, says that his wife said she didn’t want artificial prolongation of her life; the parents contest this claim. Yes, it would have been handy if Terri Schiavo had left a clearcut “living will,” but she didn’t. So, we’ll never know her wishes for sure, but I’m not sure that’s the issue that matters most here.

Though spouses have the legal power to pull the plug in these cases, in reality, a variety of dissenting parties can challenge the decision, and the case is actually decided in a public forum, in this instance, the courts. The courts then publicly examine claims about the wishes of the individual involved, diagnoses of her condition, and related best interest factors. That such cases are in effect removed from the hands of over-interested blood-related kin is basically a good idea. Putting such decisions, at least partially, into the hands of a group of contemplative, relatively cool-headed experts, a.k.a. judges, is a step forward in taking public responsibility for these issues.

And, in fact, some 20 or so judges have examined the case and just about all of them ruled, for a variety of reasons (some narrow, some broad), that causing the death of Terri Schiavo by means of removing her feeding tube is a reasonable thing to do. So, I don’t think the husband and his good or bad intentions are the issue here. Whether DiManno counts those generally conservative judges as part of her “death culture,” I’ve no idea. But her idea that we settle this by locating the bad guy is a bad idea.

2. The issue is: what should we do with a person in a persistent vegetative state (PVS) with minimal prospects of even minimal recovery? Here, we need some facts about doctors’ opinions and PVSs. DiManno very casually claims that “numerous neurologists have given conflicting evidence,” suggesting that the whole medical issue is up for grabs.

Not so. “Most neurologists agree on Schiavo’s diagnosis,” reports The New York Times’ Benedict Carey and John Schwartz (Mar. 27, 2005). “An overwhelming majority say there is little room for disagreement. Patients who have suffered brain damage from oxygen deprivation almost never recover if they have remained in a vegetative state for more than 3 months. Most neurologists who have examined Schiavo say she has been in a vegetative state for about 15 years,” says the Times.

According to the Times’ article, Ronald Cranford, the neurologist who examined Schiavo as part of a 2002 court case, reported that a CT scan of her brain showed very little but scar tissue and spinal fluid. To put it brutally, there isn’t much brain there, and there isn’t going to be any more there at any time in the future. An EEC measuring electrical activity in the thinking areas of her brain showed no evidence of continued function, said Dr. Cranford. “It’s totally flat — nothing, and this is very unusual,” Cranford said. “The vast majority of people in a persistent vegetative state show about 5 per cent of normal brain activity.”

The rest of the Times’ story is allotted to various neurologists backing up Cranford’s examination diagnosis. DiManno has all this gruesome info as much at her fingertips as I do. To imply that there’s a genuine degree of doubt about Schiavo’s condition is simply misleading.

3. For the sake of argument, let’s agree that the doctors agree on the diagnosis. What does it mean? DiManno dramatically declares that “nobody on this Earth can state categorically what is happening inside the brain of a person thus inflicted.”

Well, maybe not. But most of us who study the literature and philosophize about brains and consciousness tend to say — not “categorically,” of course — that what’s happening inside the brain of a person thus afflicted is, simply, not very much. The reason we say this is because we have evidence from other people with brain damage (though not as severe as Schiavo’s), and we therefore have some idea of how damaged brains do and don’t perform different functions. Various non-conscious functions, such as breathing, continue. As for the rest, as far as most of us know, nothing is happening: the person is not thinking about anything, is not aware of her surroundings, is not processing visual information even though her eyes are open, is not suffering or in pain, is incapable of responding to other people or events, and has no idea of who she is, or if she is. Philosophically, there’s a real question about whether there’s a person there at all. I’d be inclined to say that there’s not. But since there’s not “categorical” knowledge about what’s happening, I suppose you can grasp at alleged shreds of consciousness. I don’t think you should.

Understandably, people feel uncomfortable when they hear doctors and philosophers say that there’s a living human body present and breathing, but no person there, no conscious brain function, and the absence is permanent. I think we’d be better off accepting that claim, if for no other reason than to reduce our sense of denial about ultimate issues.

By the way, the consciousness question also addresses the subsidiary question of method of death. It would make more sense to give Schiavo an injection that would immediately cause her death, rather than to remove her feeding tube and produce a lingering death by dehydration, but that’s not socially acceptable in the U.S. at present. Not even the 60 to 70 per cent of the population who favour the ending of Schiavo’s life would presently agree to “active” euthanasia in her case. In any case, if we’re right about the consciousness question, and I think we have good reason to think we are right, none of this matters to Terri Schiavo, who is not experiencing the method being used to end her life any more than she’s experiencing the debate about her death.

4. Does any of the above solve the ethical question of what to do? Oddly enough, not necessarily. It’s perfectly conceivable for a society to say, Even though Schiavo’s in a permanent vegetative state and will never again experience consciousness, will never again be a person, and will never have a meaningful or purposeful life, we wish to preserve her existence for various symbolic reasons. That is, if for some reason the society (through its courts, say) decided to turn Schiavo over to the care of her parents, I wouldn’t think it a wise decision, but I wouldn’t think it immoral. It’s a decision within the bounds of possible ethical outcomes.

It’s not a decision I favour. Now, what normally follows here, but which I’ll skip, is a lengthy philosophical ground-staking in which one lays out one’s views about the value of human life, notions of meaning and purpose, and the conditions under which human life can be reasonably ended. In general, I take the standard secular humanist view, much of which is already enacted in law, which puts the focus on the individual affected having the right to make the decision about his or her life and death. The argument that leads to deciding what to do is an interesting one, and if you’re a secular humanist (someone who doesn’t think there’s a god who’s already ruled on the issue) you think that making such arguments and decisions is a human responsibility that each of us has a moral obligation to contribute to.

5. The area I find most puzzling about DiManno’s position is her distress about a so-called “death culture,” compared to her relative willingness to let the so-called “right-to-life” culture off the hook (except when they’re engaged in slimy politics). If anything, you’d think her criticisms would go the other way around. When DiManno refers to people in the grip of a death culture, does she mean the 60 to 70 per cent of the public who favour the decision to end Schiavo’s life, notwithstanding weeks of being pummeled by the arguments of the Religious Right?

People who argue for euthanasia don’t appear to have ulterior motives. That is, they’re arguing for an extension of secular individual rights, in this instance, in terms of controlling the end of one’s life, and their concrete proposals are usually hedged with an array of safeguards to prevent “slippery slope” dangers. It seems to me sheer hyperbole to describe such views as a “death culture.” I can’t think why DiManno would want to engage in this sort of distorted rhetoric.

Whereas, people arguing against euthanasia, against abortion, and against various forms of research involving embryos and stem cells — the very people who have been most prominent in revving up this issue — usually (and in this particular case) base their position on particular theological views, and they insist that other people who don’t share their ideas about God nonetheless must obey the God they claim exists. Surely, DiManno is as aware as I am of which way the theological wind’s been blowing of late. If anyone’s intent on imposing a way of life in the Culture War, it’s the folks who claim to be in possession of Revelation.

“How quick to extinguish life so many have become,” laments DiManno. How quick? Schiavo’s been laying there for 15 years. Every institutional level in the United States and significant numbers of their personnel — doctors, judges, legislators, commentators — have been engaged in the task of coming to a decision about Schiavo’s fate. All of that doesn’t look like a rush to judgment to me. It only looks like an unacceptable judgment in the eyes of people who think they know what’s in store on Judgment Day.

 

Berlin, Mon., Mar. 28, 2005

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Stan Persky

Stan Persky

Stan Persky taught philosophy at Capilano University in N. Vancouver, B.C. He received the 2010 B.C. Lieutenant-Governor's Award for Literary Excellence. His most recent books are Reading the 21st Century: Books of the Decade, 2000-2009 (McGill-Queen's, 2011), Post-Communist Stories: About Cities, Politics, Desires (Cormorant, 2014), and Letter from Berlin: Essays 2015-2016 (Dooney's, 2017).

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