| Dr. Linda Emanuel on "The Terri Schiavo Case" |
The husband of a brain-damaged woman has filed a complaint that
Florida governor Jeb Bush’s law to keep Terri Schiavo alive violated
the state constitution. Dr. Linda Emanuel, professor of medicine and
director
of the Buehler Center on Aging at Northwestern University, believes replacing
the feeding tube was a mistake.
Some of the things that are not widely discussed would involve, for example,
what were her general religious positions, as some of the discussion
and disagreement between the two sides of the family appear to be matters
of religious value. But the really salient point is that as best as we
can tell her values about her circumstances are consistent with not enforcing
medical intervention.
Emanuel says it is not unusual for families to have various opinions
about intervention.
It’s quite common that members of the family have different approaches
to the value of intervention and I would say the majority of cases--any
disagreements-- are resolved within the family. The next best move is
to try and facilitate agreement within the family. If that doesn’t
work then involving the ethics committee is an excellent next step. If
none of that works, then one goes to court and the legal system is in
many ways all about having a due process.
Emanuel says the patient’s prior wishes are considered
first in life-or-death cases.
What’s taken into account is the person’s preference provided
it’s within legal limits, then the proxy, and then general medical
standards. And general medical standards are much more complicated because
it has to do with weighing the value of residual health states and balancing
those against the value of or the burden of intervention. So those are
decisions which are very difficult, and that’s why we lodge them
in people to whom it matters most.
According to Emanuel, patients in vegetative states likely do not suffer
as a result of nutrition withdrawal.
Those who do come back and can describe to us their experience do not
describe suffering. If anything there may be a euphoric state induced
by chemical balances of a state of starvation. So it is a matter of projection
that we think that it is cruel. For many situations where someone is
terminally ill, putting nutrition and hydration into the body is far
more uncomfortable than allowing them to stay without hydration.
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