More on the Terri Schiavo Case
Posted on Friday, December 16 @ 14:29:17 PST by John |
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mick submitted: "In the November 15 issue of Annals of Internal Medicine (www.annals.org), Dr’s Perry (JD), Churchill (PhD) and Kirshner (MD) discuss the legal, ethical, and medical issues surrounding Terri Schiavo. As I posted a previous article on planetpreterist with my opinions I thought I would let others know what the American College of Physicians has permitted to be published in their peer-reviewed journal, as this is the body that certifies specialists in adult medicine.
In the first section they explain the meaning and the diagnosis of the persistent vegetative state. They report the findings of the Multi-Society Task Force which was set up to “establish criteria for diagnosing the persistent vegetative state.” The Task
Force estimates10 000 to 25 000 adults and 6000 to 10 000 children in the United States are in the persistent vegetative state.” They go on to point out that the criteria for this diagnosis must be met at least 1 year after traumatic brain injury in young patients and at least 3 months after nontraumatic illnesses. In a review of 434 adults and 106 children with traumatic brain injury and 169 adults and 45 children with nontraumatic injuries, mostly due to hypoxia, the Task Force found that of those in a persistent vegetative state for more than 3 months after traumatic injuries, the probability of moderate disability or good recovery was 1%(a). They continued, for patients still in the persistent vegetative state at the 6 month point after injury or illness was 0% and no patient has been reported to recover after a full year of being in the persistent vegetative state.(b)
The article points out that in all cases the persistent vegetative state is a diagnosis based on observation over time. They also point out that CT, MRI and PET scans can support the diagnosis of persistent vegetative state but none adds to the diagnostic specificity(c)with certainty. I think this point is well made and answers the critics who complained that these tests were not done or should be done before any decision should be made regarding Terri Schaivo.
Finally, this article gives practice guidelines for the management of patients in a persistent vegetative state. If anyone would like to see these guidelines and they are unable to get them from the article, I can email them. The guidelines are vague and clinical and may not mean much too non-clinical people.
The second section detailed the legal history and provided. I am not qualified to address this section, but for those interested it chronicles the legal context of Terri Schaivo’s case and seems to be well written.
The final section addresses the two “competing ethical frameworks.” The authors frame their argument as autonomy verses the sanctity of life. They site columnist David Brooks who defined the differences as a battle between “social conservatives” who believe in the “intrinsic value” of all life(d) and “social liberals” who emphasize “quality.” The authors ask the question whose notion of “sanctity” and “quality” counts(e). So the authors conclude that the autonomy and liberty of the patient needs to be the central question. This position allows the courts to “preserve the prerogative of the individuals to decide according to their own values.(f) ”
On the issue of discontinuing treatment and the concern that it would initiate a subsequent disregard for disabled persons or others that are felt to have a poor quality of life, the authors conclude that the appeal to autonomy and liberty are the brakes on this slippery slope rather than the potential energy behind the fall. To quote the authors, “The wisdom of deciding this case within the moral framework of individual autonomy and liberty interests is that it portends nothing as a general policy for what should be done to and for other persons in the persistent vegetative state. In fact, stressing liberty as the fundamental issue means precisely that individuals will be able to choose for themselves and that a variety of differing living wills and legitimate proxy decisions can be honored.”
As I have read and re-read the article and tried to compare my understanding of the scriptures with the arguments presented by these three learned men, I have come to several conclusions of my own.
First, we as Christians and preterists, in particular, need to be engaged in this debate. Why preterists? I believe we see the enormity of God’s love for humanity and the consequences of rejection of God’s Messiah, as God works through history, more clearly than other Christians. Also as preterists we understand the need to engage society for the betterment of humanity, since we do not see the rejection of the value of life as the next sign of a degenerate society that will soon bring about the return of Christ. I believe that the part of the message of salivation through Jesus Christ is a message that we have been set free from the contemporary religious and cultural answers. We have been freed to seek the answers that God would offer without the pragmatisms, experiences and wisdoms that would be thought of a correct without question. We as preterists understand this process. That is how many of us became preterists by rejecting the orthodoxy of the day and seeking God through his word.
Second we need to be students of American History of the same caliber that were have become of the Bible. We understand the value of a Berean attitude. We need to be able to correct historical arguments that are flawed. Does our Constitution or any other founding document support the view that autonomy and liberty are the “super rights?” Are life and other rights minor in comparison to these super rights? Was the vision of the founding fathers of our nation to have a group of rights that would be interpreted in light of the God who granted them? I am neither a scholar of history nor law that would be able to answer these questions.
Third, we need to be pointing out through the scriptures that to be human is much more than physical life. Humanity is to be made in the image of God. Maybe my desired soul-o-meter(g) lies in that aspect of humanity. My soul-o-meter would ask the question, “Does this individual have the potential to demonstrate the image of God now or in the future? If medical intervention continues will that increase the likelihood that the individual will be able to demonstrate the image of God?” Maybe if the answer to both of these questions is no, then attempts to continues to use human knowledge to improve the condition of the patient should stop. All efforts then would be used to keep the patient as comfortable as possible as long as possible. I think this position preserves the right to life of the unborn and yet recognizes the limits of human knowledge that can say to a terminal cancer patient, “We have done all we can do.”
Finally, I think Terri Schiavo’s case is a modern version parable of the Good Samaritan. We have the opportunity to be the Samaritan that tries to help when the legal and medical communities will not. There is a point where that parallel breaks down though. Terri Schavio had apparently reached a point where intervention was futile. At that point, comfort should be provided and treatment that would not improve her condition should not be started.
I fear I have asked more questions than I have answered in this article. I perceive that the answers that our current culture offers are the wrong ones. I welcome your comments. “I don’t know. Can you can help?”
(a)For those PP readers who are statisticians the 99% confidence interval was 1%-4%
(b)No 99% CI given.
(c)Specificity is a statistical term used to determine if a test helps make a diagnosis
(d)While I believe in the value of all life, I believe human life has intrinsically the greatest value.
(e)I would argue that God’s definition of these terms would answer the question.
(f)The problem with this position is that God warns there is way that seems right to a man and in the end leads to death.
(g)See my comments to others who responded to my previous article about Terri Schiavo"
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