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COMMENTARY:
CASE POINTS UP URGENCY OF WILL TO LIVE
By Burke J. Balch, J.D., director of NRLC Dep't of Medical
Ethics
It is evident from e-mails and other
communications coming in to NRLC's Department of Medical
Ethics that many grass-roots pro-lifers are shocked and
appalled by the denial of food and fluids to Terri
Schindler-Schiavo. Apparently, they cannot believe this is
happening in America.
It is appropriate to be appalled, but
no one should be shocked.
Denial of food and fluids to people
who cannot speak for themselves has been going on for
fifteen years in this country. It is routine practice in
hospitals and nursing homes across the country. And for over
a decade, the law on this, established by numerous court
decisions and statutes, has been largely settled. If someone
who is now incompetent to make health care decisions has not
left clear instructions in a legal document (variously
called an "advance directive," "durable power
of attorney for health care," "living will,"
or the like), then a surrogate decision-maker can legally
decide to cut off the person's food and fluids.
The surrogate decision-maker is
normally whomever is classed by the particular state as the
closest relative, but if no relatives are available may be a
guardian or even the person's doctor. Such surrogates are
daily authorizing the cutoff of food and fluids to patients
who are unable to speak for themselves and never gave any
indication that they might want to be starved.
Only in the comparatively rare cases
when there is some dispute among relatives, such as in the
Wendland case in California, the earlier Hugh Finn case in
Virginia, and the Schindler-Schiavo case now in Florida, do
these cases reach public attention, normally in the context
of lawsuits.
It should come as no surprise that,
with important exceptions, the prevailing view in the
judiciary, as in the medical profession, is receptive to the
quality of life ethic. Judges are often dismissive of our
position that all human beings possess dignity and the right
to live, regardless of their age or degree of disability.
When the relative or other individual designated by state
law to make health care decisions for an incompetent person
who has left no clear advance directive chooses to cut off
food and fluids, courts are rarely willing to agree with
other relatives who seek to overturn that decision.
Indeed, the current battleground is
over efforts by health care personnel to cut off food, fluid
and life-saving treatments from patients they think have a
poor quality of life AGAINST THE WISHES of the patient and
family. A large body of medical and ethical opinion holds
that even when there is no doubt that a patient wants to
live, or when family members are united in saying the
patient should get life-saving treatment, doctors and
hospitals should be able to say no.
We may hope and pray that recent
developments in the Schindler-Schiavo case, drawing into
question the accuracy of key testimony by her husband, lead
the judicial system to order that she continue to receive
assisted feeding. Whatever the final outcome, however, the
publicity surrounding this case should sound a warning
siren.
It is CRITICALLY IMPORTANT that we
ensure our friends and family members fill out a "Will
to Live." The Will to Live is a legal document, varying
in its form from state to state, that makes clear a person's
wishes concerning treatment if no longer able to make health
care decisions. It provides for designation of who the
person wants to speak on his or her behalf in such
circumstances.
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