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April 1, 2005

Extreme measures
Posted by Teresa at 11:34 AM * 193 comments

Corndog, writing in The Daily Kos (via) quotes from the report on Theresa Schindler Schiavo written by Dr. Jay Wolfson, the Guardian Ad Litem whom Jeb Bush appointed to the case in 2003:

The Testimony provided by members of the Schindler family included very personal statements about their desire and intention to ensure that Theresa remain alive. Throughout the course of the litigation, deposition and trial testimony by members of the Schindler family voiced the disturbing belief that they would keep Theresa alive at any and all costs. Nearly gruesome examples were given, eliciting agreement by family members that in the event Theresa should contract diabetes and subsequent gangrene in each of her limbs, they would agree to amputate each limb, and would then, were she to be diagnosed with heart disease, perform open heart surgery. There was additional, difficult testimony that appeared to establish that despite the sad and undesirable condition of Theresa, the parents still derived joy from having her alive, even if Theresa might not be at all aware of her environment given the persistent vegetative state. Within the testimony, as part of the hypotheticals presented, Schindler family members stated that even if Theresa had told them of her intention to have artificial nutrition withdrawn, they would not do it. Throughout this painful and difficult trial, the family acknowledged that Theresa was in a diagnosed persistent vegetative state.
If no degree of physical or mental depersonalization, nor the express desires of the woman herself, could alter the Schindler family members’ resolve to keep the remains of Theresa Schiavo alive, then they were engaged in a transaction that had nothing to do with the person of Theresa Schiavo herself. One mindless denatured animate corpse is much like another. If the only point was that the Schindlers got to go on thinking that some animate corpse designated Theresa Schiavo was still alive, then any such corpse, or the idea of any such corpse, would do as well. The specific remains could be excused from further participation.

I don’t doubt that members of the Schindler family sincerely believe they loved her. But then, most domestic violence is committed by people who sincerely believe they love their victims. Most murderers who, in a fit of jealous or possessive rage, kill a departing spouse or SO (and sometimes their children as well), claim that they loved them. Perfectly warm, well-behaved, supportive families do the same. Who am I to say that any of them are right or wrong? I can’t see into their hearts. For all I know, what they feel is what they call love. The trick is what they do about it.

Comments on Extreme measures:
#1 ::: Elese ::: (view all by) ::: April 01, 2005, 03:16 PM:

In the past few years, I have re-evaluated my personal definition of love. I believe that love and desire are very different things, and that people often get the two confused. True love, real love, is selflessness, is concern about your loved one's happiness, and most importantly is, when need be, putting your loved one first, no matter how difficult that can be. Desire is about your own happiness. It is often selfish, and your personal feelings come before that of your 'loved one'.

I became seriously ill four years ago. I am still recovering and am often house-bound. When I became ill, the person I loved, and thought loved me, couldn't handle the situation and abandoned me. We are no longer in contact.

This is what led to my re-evaluation, and I truly believe that when your loved one's world falls apart, whether through illness or otherwise, that if you truly love them you will put them first even if it causes you pain.

I'm not saying it is easy, love never is. But it is different than desire, which is what I believe leads to crimes of passion, and domestic violence, which the perpetrator always seems to commit in the name of 'love'.

#2 ::: Chuck Nolan ::: (view all by) ::: April 01, 2005, 03:20 PM:

So, according to the Schindlers, their wishes as parents supercede the wishes of Terri, whatever they might be? Do they overrule the wishes of their other adult children in this way?

#3 ::: Mris ::: (view all by) ::: April 01, 2005, 03:27 PM:

Chuck, while I agree that that's one of the implications, I think what they would say is that one voice for "keep a body alive" trumps all other ideas. Because the primary thing here is "life," no matter what. So it wouldn't matter if you were talking about your adult children, your parents, your spouse, or your garage mechanic.

#4 ::: Anna Feruglio Dal Dan ::: (view all by) ::: April 01, 2005, 03:31 PM:

I am sorry, Elese. Something like that, on a minor scale, happened to me and it is horribly painful in the re-evalution that it forces you to do among other things.

I am not innocent of selfish love. But I do think that parents owe selfless love to their children, if nothing else.

#5 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 01, 2005, 03:34 PM:

I had a friend who went too long without oxygen. After a while, when it became evident that nothing was working north of her brainstem, they pulled the plug.

It was hard. It was a bad, bad day. Some of her friends were insisting right down to the end that she might recover. They wanted her to not be dead.

Well, so did I. But there was no use to it. All I could do was forgive her for stumbling into a bad combination of circumstances, and let her go.

I'd have done the same thing if I were the person holding power of attorney. Insisting against all evidence that she could be brought back would have been a power trip: all about me, not her. She was gone.

#6 ::: Meredith Tarr ::: (view all by) ::: April 01, 2005, 03:42 PM:

To those who wonder what definition of "love" the Schindlers were using, I submit this.

Makes you wonder, doesn't it?

(*waves* long time reader, first time commenter, blah blah blah :)

#7 ::: PiscusFiche ::: (view all by) ::: April 01, 2005, 03:47 PM:

Lee and I talked about it--we had a long time to do so, considering we just crossed the country by car--and each of us reiterated that while we'd like a good go of possible treatments, as soon as it became evident that we wouldn't come back from whereever we were, that we should be let go.

("Rule Number Three: I can't bring people back from the dead. It's not a pretty picture, and I don't like doing it. ")

I am slightly worried that if I were to get in such a state before getting married that my extremely Mormon family would insist on the same rigamarole that Schiavo's family went through. I wouldn't be interested in being a poster child for the Religious Right's so-called "Culture of Life".

Here in SF, I read that a lot of folks are worried about this superceding of the patient's wishes, particularly because gay partners often are overlooked in favour of parents, in terms of guardianship.

#8 ::: Charlotte ::: (view all by) ::: April 01, 2005, 03:50 PM:

What I don't get is the way they used the Church to defend their "right" to keep her body alive. If one truly believes what the Church teaches us, that we all return to the loving presence of God, then why would one seek to artificially deny a loved one that release? Watching the papal death watch today seems like a pretty stunning reminder of what the Church's actual position on death is, that it's nothing to be hastened, but that it's also something perfectly natural, and not to be feared.

#9 ::: Lucy Kemnitzer ::: (view all by) ::: April 01, 2005, 03:54 PM:

When my mother was dying, there were a few days when the doctor sincerely thought she could be bought a few month's comfortable remission. She had always said she didn't want heroic measures. But at that time of crisis, she wasn't entirely sure. So I didn't think I was violating her wishes giving her a little respirator. After a couple of days we could tell that remission wasn't going to happen, so --since it was a Catholic Hospital, we had to use the term "weaning her from the respirator." The doctors were entirely wondeful about the whole thing -- the figuring out period, the decision, the process.
I mean, my brother and I killed my mother much more surely than anybody killed Theresa Schiavo -- my mother was conscious and participated in the discussion in a way. But it was right.

Now. You know Mother Teresa? The one they're going to make a saint out of?

She never prolonged anybody's life, including people who had curable conditions. The whole point of her "hospitals" was to provide spiritual comfort to the dying, which in my mind is not a problem except for two things: many of her dying had conditions from which they could recover given any medical support at all, and the way her operation was presented in the media was that they were conventional hospitals.

But the point here -- if everybody thinks Mother Teresa was so great for just comforting people as they died and not trying to prolong their lives, why do they think Michael Schiavo is such a goon for caring for his wife's vegetative body for so long and then asking to turn it off?

It can't just be parental wishes: I bet a lot of Indian parents would have been quite happy to have their children come back to them healthy, from a real hospital.

It's not that religiousness has to mean this kind of crazy behavior: the wonderful cancer doctor who navigated the issues of my mother's dying so delicately had a fish thing on his desk.

#10 ::: Andrew Brown ::: (view all by) ::: April 01, 2005, 04:04 PM:

That Mother Teresa question is very good. It made me realise that I don't see how any Catholic can simultaneously maintain that MT was a saint and that Terri Schiavo should still be alive.

#11 ::: mayakda ::: (view all by) ::: April 01, 2005, 04:14 PM:

Ew, I didn't know that about Mother Teresa. Anyway, the whole vow of poverty thing strikes me as problematic as well.

Back to Schiavo. I remember one Sunday a couple weeks ago, the homily was about Lazarus. When Jesus came back to resurrect Lazarus, one of the women berated Jesus along the lines of "If you had not left, he wouldn't have died". Then it says Jesus wept. The priest asked the us to consider why Jesus wept when he was going to resurrect Lazarus anyway?
Possibilities:
- Wept for the pain caused the family
- Wept becaue Lazarus will die anyway after he is resurrected
- Wept for his own coming death
Who knows? Life is a temporary state.

Really, my take away from all this death these past weeks is that if I die tomorrow, it's enough that in this life I have loved and been loved. (Of course I would like to get to a healthy old age and be a doting grandma, but we never know).

#12 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 01, 2005, 04:29 PM:

Didn't I read that Mr. Schindler pulled the plug on his own mother? I DO doubt their sincerity. Especially after reading that they're selling their mailing list. Though I have to say I find the prospect of a whole lot of Schindlerites getting junk mail far from unpleasant!

I'm still working out the terms of my living will. Oddly, I've decided I WOULD want to be kept alive if I were conscious but unable to communicate. (Unable to perceive, no. No opportunity for learning.) And I'm going to leave decisions in ambiguous cases to my friend and Priestess Susan. She'll know what to do, and have the judgement (and Atropine dispatch) to call halt when the time comes.

#13 ::: Trapped in amber ::: (view all by) ::: April 01, 2005, 04:32 PM:

I found this blog really interesting, and it lets you read some of the court judgements:

http://abstractappeal.com/schiavo/infopage.html

He's been following this case before it came to international, or even national, attention.

Back to lurking:-)

#14 ::: Trapped in amber ::: (view all by) ::: April 01, 2005, 04:40 PM:

(smacks forehead)
The above link is also on The Daily Kos.

I really should have read the links before posting. Sorry.

#15 ::: Anna Feruglio Dal Dan ::: (view all by) ::: April 01, 2005, 05:06 PM:

Among the several hundred people that were interviewed here in the desperate need to fill hours and days of Papal vigil (almost all the channels are running non-stop special editions and have been since yesterday afternoon) was the, hum, er, the head friar of the Franciscans in Assisi.

The anchor presented him and he chimed in with a jolly and cheerful: "Hello!" He managed to curb his jollity and go on in a more neutral mode, but I was reminded that part of St. Francis's Canticle says, "Blessed be our sister, bodily death...". My friend Anna told me later that they have feasts in the convents when a nun dies, because she's going to Paradise.

Despite all this the Franciscans are not ghoulish, as a rule they are, well, cheerful souls. It would also seem a more natural attitude for people who belive in an afterlife than this gloomy celebration of pain and suffering we're seeing.

#16 ::: Laurie Mann ::: (view all by) ::: April 01, 2005, 05:10 PM:

T - Yup, everything you're said, you're 1,000% correct on this one.

Xopher - you might be thinking of the ever-popular Tom DeLay, whose father became badly brain-damaged in an accident (he seemed to recognize Tom's younger brother's voice but not much else) and they pulled the plug on him in 1988 without any governmental intervention.

One good thing about this situation is I think many families who wouldn't talk about these things have talked about them. My parents are both reasonably healthy and in their mid-70s. I was up visiting them last week, and both made a point of saying that they had living wills and they didn't want to be subjected to all the crap that Terri was. We'd never discussed this sort of thing at all before.

I've had a donor card/living will since 1978, since the Karen Ann Quinlain days. I never want to be anthrophomorphized after severe brain damage the way that Terri was. It was simply appalling.

#17 ::: Mac ::: (view all by) ::: April 01, 2005, 05:31 PM:

Laurie Mann posted:

One good thing about this situation is I think many families who wouldn't talk about these things have talked about them.

Oh yes. I've realized, to my utter horror, that my parents might well do precisely what the Schindlers did. Since I'm single, I don't think anyone could stop them without some fairly specific steps on my part to enforce my wishes.

After investigating my options, I just signed a medical power of attorney, giving the decision-making power to a dear friends of mine. She's a critical-care nurse, and an extremely practical person. She informs me that these things stand up in court VERY well.

#18 ::: Michael Dietsch ::: (view all by) ::: April 01, 2005, 05:53 PM:

I'm sorry if this is pedantic, but in your first paragraph following the quotation, I think you meant to say "...could alter the Schindler family members’ resolve..." and "...the Schindlers got to go on thinking...".

Thanks for sharing this report, though, for I hadn't seen it, and I agree with your conclusions here.

#19 ::: Meredith Tarr ::: (view all by) ::: April 01, 2005, 06:25 PM:

Watching the papal death watch today seems like a pretty stunning reminder of what the Church's actual position on death is, that it's nothing to be hastened, but that it's also something perfectly natural, and not to be feared.

Precisely. Which is why this article left me puzzled. If the Pope really did express a wish for life support to be maintained as long as possible, wouldn't that be defying the will of God?

There's preserving life, and then there's denying death. The line may be thin, but it does exist. The Catholics (the tradition in which I was raised) believe in the kingdom of Heaven -- why, then, would the Pope want to be kept away from there any longer than necessary?

#20 ::: Melissa Mead ::: (view all by) ::: April 01, 2005, 07:03 PM:

Someone on another board made a comment to the effect that "Most disabled people want her to live, and most able-bodied people would let her die."

As a disabled person who would NOT want to go through that, I was indignant and horrified. Anyone else have 2 cents on this?

I'm so sorry for what she and her loved ones went through, but grateful that it's gotten people talking about what they'd want.

#21 ::: Trapped in amber ::: (view all by) ::: April 01, 2005, 07:33 PM:

Melissa, I'm disabled and I was horrified by that over-simplification. I also believe I wouldn't want to have my life prolonged if I were unfortunate enough to be in a similar condition as Terry Schiavo was in.

I've just been reading the testimony given by Father Gerard Murphy, and he spoke about unhealthy grief, in relation to some of the extreme things the Schindler family said.

#22 ::: Mary Dell ::: (view all by) ::: April 01, 2005, 07:46 PM:

Teresa, your post refers to "the Schiavos" and "the Schiavo family" when I believe you mean "the Schindlers"...

As for the disability thing...I haven't asked my disabled sister about it, but I can guess her reaction. It would involve a lot of cussing. The argument I've seen disability advocates make is that Terri Schivo's life is being devalued because she's severely disabled. But it seems to me that what's being devalued is her self-determination. She stated a desire not to live like this, but because she's "severely disabled," there's no need to honor that?

wacky.

#23 ::: Jon H ::: (view all by) ::: April 01, 2005, 08:08 PM:

Teresa,

Apparently, a later page in the Wolfson report has a footnote stating that the Schindlers later retracted that stuff you mention. It's not clear to me how the retraction relates, time-wise, to the original statement, or what the context was.

I'm inclined to take the amputation stuff as valid, considering the Schindlers have shown themselves to be amenable to changing their story for best effect. (For example, going from 'she's drying up, her nose is bleeding' to 'she has rosy cheeks, she's fine' the other day, when they realized their negativity might lead the courts to dismiss their last filings because it was too late to help Terri.)

The Schindlers kinda remind me of cat-hoarders.

#24 ::: Melissa Mead ::: (view all by) ::: April 01, 2005, 08:27 PM:

"She stated a desire not to live like this, but because she's "severely disabled," there's no need to honor that?"

Yes! Exactly!

And entrusting a person's life to politicians who don't even know her...:shudder:

"Honoring life" also means respecting the fact that it's finite.

#25 ::: Lenore Jean Jones ::: (view all by) ::: April 01, 2005, 08:31 PM:

I was really mad that Jesse Jackson showed up, siding with Terri's parents. Why on Earth?

I totally disagree with the characterization of Terri as "severely disabled". She was *gone*.

Today a papal spokesman compared Terri's situation to the Pope's. Again, they're totally different. The Pope is still present in his body, and is in position to indicate what care he wants. Terri was not.

My grandmother died after her feeding tube was removed at her children's request. She was 99 years old, unconscious, and not going to get better. They had revived her before, but realized that it was for their own benefit and not hers. She was ready to go. This time they were able to let her go.

My cousin Katie was with her when she died, and said she had a beatific look on her face, and actually rose in the bed and extended her arms as though she was going to meet someone. Katie imagined her going to meet our grandfather. (I can't vouch for this story, of course. I wasn't there.)

#26 ::: Eric Sadoyama ::: (view all by) ::: April 01, 2005, 08:42 PM:

Regarding the pope's impending death, I was interested to learn of the traditional method to confirm that he's really dead: they ritually call out his name and hit him on the head with a silver hammer three times. (Presumably if he's not dead, he'd cry out "ow!".)

Is that where the Beatles got the idea for Maxwell's Silver Hammer?

#27 ::: Niall McAuley ::: (view all by) ::: April 01, 2005, 08:45 PM:

I'm stunned by the whole Schiavo furore, since I really can't imagine the State even thinking about pretending to believe that I'm not my wife's next of kin.

I don't mean that the State couldn't possibly do it, I mean that I can't imagine my reaction.

I salute her husband, since she has (by all accounts) been dead for fifteen years, and he could just have walked away and left her to the various vultures.

Bravo, sir.

#28 ::: Mary Dell ::: (view all by) ::: April 01, 2005, 09:10 PM:

I totally disagree with the characterization of Terri as "severely disabled". She was *gone*.

I agree with you. Those who advocated keeping her alive were calling her "severely disabled" and comparing her condition to, for instance, cerebral palsy. My point is that whether you call her condition a disability or a living death, her wishes should still be paramount. It seems strange to me that advocates for the disabled would champion the idea of government being appointed to decide the fates of those who can't speak for themselves - as opposed to their own carefully selected guardians and kin. But there it is.

The Karen Quinlan case is an interesting contrast - her parents fought for her right to die, and founded a hospice in her name.

#29 ::: Melissa Mead ::: (view all by) ::: April 01, 2005, 09:24 PM:

Oh for crying out loud.
I have cerebral palsy. People do, on occasion, underestimate my intelligence. It's NOT the same thing as having virtually no cortex.

The poor woman got used like a rope in a tug-of-war.

#30 ::: Jonathan Vos Post ::: (view all by) ::: April 01, 2005, 10:08 PM:

================
DIE OR NEVER DIE
================

"I would never die for my beliefs,
because I might be wrong"
-- Betrand Russell (1872-1970)

================

I would never die for my beliefs,
I might be wrong.
Fatal terrors turn into reliefs,
right all along.

I would never die for my beliefs,
the battle song
shows life is short, in its motifs,
but art is long.

================
Jonathan Vos Post
1730-1737
13 March 2005


#31 ::: Dan Hoey ::: (view all by) ::: April 01, 2005, 10:38 PM:

Melissa Mead: The poor woman got used like a rope in a tug-of-war.

The image I kept getting was of the crowd in Somalia using the airman's body as a puppet.

#32 ::: Graydon ::: (view all by) ::: April 01, 2005, 10:52 PM:

Cattle die; kinsemen die.
You yourself shall surely die.
Only word-fame dies not,
For one who well achieves it.

Dying for belief is one thing;
Surely this is knowledge.

#33 ::: Bruce Arthurs ::: (view all by) ::: April 01, 2005, 11:50 PM:

Jon H wrote:
"Apparently, a later page in the Wolfson report has a footnote stating that the Schindlers later retracted that stuff you mention."

Gee, what might that have been like?

"Hey, all that stuff about how we'd rather let our daughter rot than let her die? That was a joke! We were making a funny! Ha, ha! We Schindlers, we're a barrel of laughs. Just like that movie a few years ago. Laughed ourselves silly at that one."

#34 ::: Lydia Nickerson ::: (view all by) ::: April 02, 2005, 01:17 AM:

Anything that Randall Terry is for, I'm against. It's a useful rule of thumb.

Has anyone ever read _City of God_?
"Gomers never die." A gomer is someone, like Teri, who lives but has no brain.

#35 ::: Ayse ::: (view all by) ::: April 02, 2005, 02:10 AM:

I find it odd that disabled people feel they have something in common with a body sustained on life support. There's a huge, gaping distance between a disability and NOT HAVING A BRAIN.

OK, enough yelling.

Clearly, the Right to Life people wanted to use this case to get a precedent set by the Supreme Court, which was not buying it. I think it was the case of the parents wanting revenge, and the Right using that to try to advance their own agenda, trampling all over anybody in the vicinity in the process (as usual).

#36 ::: bryan ::: (view all by) ::: April 02, 2005, 02:44 AM:

given the limb-cutting off thing perhaps the schindlers could receive a roomfull of persistent vegetative people and use them to build a range of home furniture, a la clockwork orange. The one thing that would normally work against such a plan is all those ungainly limbs but if they're okay with cutting them off when neccessary? Anyway I think this would be the kind of hobby/home-redecorating project that could help them take their minds off their grief.

#37 ::: Jon H ::: (view all by) ::: April 02, 2005, 02:53 AM:

It would be pleasantly ironic if the Right-To-Life people push the issue, and end up getting euthanasia legalized.

A lot of people have been complaining about the dehydration/starvation, and the discomfort caused thereby. Of course, if Terri Schiavo had a witnessed, notarized living will approving removal of a feeding tube, she'd still have died in the same manner.

I think they may harp on the inhumanity of starving people to death in an effort to remove the advanced directive option of having feeding tubes removed.

I don't think that'll go over very well. I think way too many people, across the political spectrum, feel that termination is a necessary, ethical, and moral option even when the body can breathe on its own.

So, if the right-to-lifers set up a debate in which the nation agrees that removal of feeding tubes leads to a nasty end, but the nation believes a means of terminating life is necessary, it naturally leads to the conclusion that a more humane method is required, and that would only be provided by euthanasia.

Then the right-to-lifers will get to explain that people should be forced to die by starvation and/or dehydration, rather than something more humane.

Doh!

#38 ::: John M. Ford ::: (view all by) ::: April 02, 2005, 03:13 AM:

I find it odd that disabled people feel they have something in common with a body sustained on life support.

Were large numbers of them doing so? This argument seemed to be used most by people who were sound in body.

Though -- and here I'm no doubt going to be misunderstood -- while it may be odd, it is not an incomprehensible or meaningless notion. There have been regimes -- we all know them -- that have legalized doing away with damaged but functional human beings, though the argument has generally been that it's to "protect" the Gesundvolk. (When the dignity of the damaged comes up, no one ever asks them -- it's always "Would YOU want to live like this?" with the answer presumed.) One does not have to be very badly damaged at all to hear (or overhear) comments as to what a waste of resources and burden on one's alleged fellows one is. Sometimes this causes one to glance over one's shoulder.

But "the culture of life" is just another codeword for an issue that has nothing to do with disability or brain death; it is absolutely separate from capital punishment -- and, as we have been reminded, the former Governor of Texas had no problems whatever signing a bill that made it easier for hospitals to cease support to vegetative indigent patients, for the protection of the weal -- er, healthy citizens.

#39 ::: Lois Aleta Fundis ::: (view all by) ::: April 02, 2005, 03:18 AM:

A local radio station carried a report from CNN Radio that Congress was considering a ban on drinking while using the Internet. (They admitted at the end of the piece that it was an April Fool's joke.) I couldn't find a link to it from CNN's website, though.

#40 ::: Lois Aleta Fundis ::: (view all by) ::: April 02, 2005, 03:23 AM:

Aaugh! Somehow that got into the wrong thread. I'm not sure how. Sorry. (And no, I'm not drinking while using the Internet. Not now, at any rate. Sleepy, yes, high, no.)

#41 ::: Elese ::: (view all by) ::: April 02, 2005, 03:29 AM:

Jon H - I've been thinking about that too. I don't understand why they can't give someone in Terri's position a more humane release. If the decision has been made, why starve her to death so slowly?

I find the name right-to-life ironic. If you have the right to life, surely you should have the right to decide what to do with that life.

And I want to chime in: Having no cerebral cortex is NOT the same as being disabled. And being disabled does NOT mean that you are unable to decide for yourself and must rely on 'healthy' people to do your thinking for you. Aargh. I have had time to calm down and will not start cussing.

#42 ::: Dorothy Rothschild ::: (view all by) ::: April 02, 2005, 06:23 AM:

Re the Pope: yes, he gets called by his baptismal name three times. Trying to find where I read that....well, here's a reasonable site. And they can cover his face instead of whacking at him with a silver hammer.

#43 ::: SJ ::: (view all by) ::: April 02, 2005, 07:02 AM:

Thanks, John M. Ford, for your compassionate and thoughtful post. Some of the comments on this thread are too callous for words.

Have been a devoted follower of this blog for two years. ~waves~ Relurking, probably for good.

#44 ::: John Farrell ::: (view all by) ::: April 02, 2005, 07:45 AM:

One of the things that fascinates me about this whole case, is the sense that what motivates the pro-lifers outside the hospice resembles in a fashion what motivates the bible-types who want to promote creationism ("intelligent design") in public school science classes. A form of presumption,

Thus: if we just keep her alive, then eventually a miracle will happen, she'll get better. Because we want God to do it.

If we construct a theory of creation in which God must take an active part—at such and such a period in the X era, God zapped an ape and turned him into a man—then the theory will be accepted.

It's a form of presumption on God. And, if I recall my theology correctly, that presumption is a sin. (You shall not tempt the Lord thy God.)

Isn't it? Or am I drawing with too broad a brush here?

#45 ::: Graydon ::: (view all by) ::: April 02, 2005, 08:07 AM:

Too broad, yes, I think so.

It's -- so far as I can tell -- a whole lot simpler.

God does not allow bad things to good people. This is a good person. Therefor, the bad thing didn't happen and stuff that looks like a bad thing can only be the result of malign influences.

This is the theology they're using. I think there's a whole lot wrong with it, most especially in the degree to which is results in picking axiom over experience, but it is internally self consistent and tremendously flexible, since almost anything can be designated a malign influence.

#46 ::: Regina ::: (view all by) ::: April 02, 2005, 09:40 AM:

John Farrell--no you are quite right that the Intelligent Design folks are a part of what happened with the Schiavo case. The Discovery Institute is based in Seattle to my utter embarassment. This post from digby at hullabaloo connects all the dots:

http://digbysblog.blogspot.com/2005_03_27_digbysblog_archive.html#111202763462966966

#47 ::: Kizmet ::: (view all by) ::: April 02, 2005, 09:52 AM:

So, and perhaps I'm making inferences that were unintended...

My mentally retarded sister, who is over 40 physically but functions around the level of a 5 year old, who cannot make any truly important decision for herself, cannot care for herself without the reminders that the average kindergartner needs, who cannot work to earn enough to feed herself, much less provide clothing or shelter, whom you perceive contributes nothing to the culture or society and in fact is a drain because she collects social security and uses medical resources perhaps beyond the average use of any other 40 year old woman...

So, because her cognitive skills have peaked, and the extent of her brain function is that George Washington is president and she wants to know what's for dinner tonight...

You don't think she's worth keeping around? She's not getting better. She's only going to get worse - the co-incidence of Downs Syndrome and dementia is extremely high and she has heart trouble.

Shall you kill her now?

That's EXACTLY how I see the Shiavo case.

When you all have some time and knowledge of living with a mentally incapacitated person, then we'll talk. Until then, you have no idea what you're talking about, what the Schindlers have lived through for fifteen years and what I've lived my entire life with. Until then, you have no clue.

#48 ::: Mary Dell ::: (view all by) ::: April 02, 2005, 10:12 AM:

And being disabled does NOT mean that you are unable to decide for yourself and must rely on 'healthy' people to do your thinking for you

Well, some disabilities do mean that. Many brain injuries and developmental disabilities require that others do your communicating for you, if not your actual thinking. This is why we have legal guardians - to speak for us when needed. But guardianship can be challenged in court based on just about anything, whereas a living will can't be.

#49 ::: Melissa Mead ::: (view all by) ::: April 02, 2005, 10:33 AM:

Functioning at the level of a 5-year-old is different from having no consciousness. I've lived and worked with people with severe cognitive disabilities and would not for an instant advocate killing any of them.

What's disturbing about the Shiavo case is that we have someone maintaining that this is what she would have wanted, and the government stating that her wishes don't natter.

It's a tragedy all around.

#50 ::: Renatus ::: (view all by) ::: April 02, 2005, 10:37 AM:

Kizmet, the difference is that Terri Schiavo had a flatlined EEG and no cerbral cortex. There was no one home, and there wasn't even the physical structure to support it.

Your sister, on the other hand, is impaired, but obviously there. It seems you're reading comments on this thread as if they imply your sister would be a similar case to Schiavo, which confuses me. I'm not seeing it.

#51 ::: Elese ::: (view all by) ::: April 02, 2005, 10:58 AM:

Mary - I agree with you. I think my comment was not written clearly enough. I am disabled, and I was responding to the discussion about people who take disabled to mean that a more able-bodied person is better qualified to make judgements about there life.

I have encountered many people like this myself and find it very frustrating. The discussion further up had been talking about this kind of presumption that does exist.

Many people are more severely disabled than me, although I do require a full-time carer (many thanks to my Mum). And Kizmet, I do not think your sister is a similar case to Schiavo. Your sister is not brain-dead. I am in the same position as your sister, although her problems are much more severe than mine. I rely on social security. I cannot work or support myself. I rely on my Mum and Dad to take care of me, even though I am thirty. I am impaired. So is your sister. But that is very different from having no brain activity. Being disabled doesn't stop any person from having value and worth.

#52 ::: Mary Dell ::: (view all by) ::: April 02, 2005, 11:01 AM:

Melissa Mead: please don't get the idea that I personally believe Terri Schiavo is "disabled" or that a brain injury resulting in a persistent vegetative state is in the same category as developmental disabilities or other brain injuries. I don't. But I'm not disabled, so I don't want to make bold statements about what counts as a disability and what doesn't.

I'm just baffled by the logic employed by the harvard guy with CP (linked in my post up yonder, who expresses the fear that by ending Terri Schiavo's life we're moving toward establishing a nazi-like regime in which the disabled will be exterminated. But it seems to me that the first step in creating such a regime is taking life-and-death decisions away from individuals and their carefully selected guardians, and handing it to the government.

#53 ::: Graydon ::: (view all by) ::: April 02, 2005, 11:11 AM:

Kizmet --

You seem to be missing the important distinction between 'killing someone' and 'not keeping them alive'.

Lots of street people starve to death or succumb to exposure; no one is, or could be, tried for murder or manslaughter over this.

Lots of people in hospitals are dying, and have decided that they don't want anybody contesting this point. Lots of people not in hospitals are doing the same thing. (The present pontiff comes to mind.)

Those people are certainly going to die; the fundamental point is that they're allowed to, for whatever reason. You can refuse medical treatment. (And a good thing, too.)

In a case like that of Terri Schiavo, the person isn't able to have wishes; in other cases, they may well have them but not be able to communicate them.

In which case there's a lot of mechanisms for figuring out what that persons wishes might be. In this particular case, pretty much the entire available mechanism got used. Three courts and something like nine different judges all agreed that Terri Schiavo, so far as was possible to tell, would not have wanted the medical treatment that was keeping her alive, given her condition and prospects.

I'm somewhat at a loss as to how that much effort and care to act in accordance to her wishes is equivalent to 'not wanting to keep her around'.


A door opens, and a door closes; we are all guests in the hall of life. It is not mete that we should, of our own fear or desire or need, refuse to another guest that they should depart.

#54 ::: RiceVermicelli ::: (view all by) ::: April 02, 2005, 11:14 AM:

Kizmet, one of my uncles, who died of heart failure some years ago, when he was around forty-five, had severe Downs Syndrome. I've done my time. I've earned my clue.

And I still don't see what Terry Schiavo, whose cerebral cortex was utterly destroyed, who had been in a persistent vegetative state for fifteen years and was not at all concious for any of that time has in common with a person with Down's Syndrome. My uncle was perfectly capable of stating his wishes, even when he was suffering from severe dementia. His wishes might have been impossible to fulfill, or totally irrational, but he stated them, often, and at high volume. There was no need to run tests to determine whether he might be concious at some level, because you could just follow him around for a while and watch him respond to stimuli (incidently, I am quite certain that a persistently vegetative patient is easier to keep tabs on than one suffering from dementia).

Terry Schiavo was not killed because she was a drain on society (although law in Texas does allow indigent patients to be removed from life support at the hospital's discretion, and I don't understand why that fact hasn't received more attention and outrage). Terry Schiavo was removed from life support because the courts in Florida, after extensive investigation, found the testimony stating that she would not have wished to be on such support to be credible, and found opposing testimony not to be so.

#55 ::: Elese ::: (view all by) ::: April 02, 2005, 11:29 AM:

I just realised that what I said above could also be mis-interpreted:

"But that is very different from having no brain activity. Being disabled doesn't stop any person from having value and worth."

I apologise, I shouldn't have put those sentences side-by-side, it makes it sound like I'm saying Terry Schiavo had no worth. What I mean is, every person has worth and value, whether disabled or no.

But, as Graydon and RiceVermicelli have said much more eloquently than me, disabled is different than having no cerebral cortex, and if a person would not wish to be kept alive under such circumstances, no matter how difficult it is I think their wishes are important to honour.

#56 ::: Mary Dell ::: (view all by) ::: April 02, 2005, 11:32 AM:

Kismet, if you read the legal brief Teresa links to at the top, you'll see that the "improvement" they're specifically talking about in the Schiavo case is in her ability to swallow. If Terri Schiavo was able to swallow, there would be no artificial means necessary to keep her alive. The issue wasn't whether she should be kept alive through natural means (feeding, bathing, turning to prevent bedsores), but through artificial means (stomach tube, breathing aid, etc).

Although I know it can feel like this has implications for disabled folks like your sister, it's not the same thing at all, because the issue is specific to the use of artificial means, and the discussions about "improvement" are also specific to that.

#57 ::: Melissa Mead ::: (view all by) ::: April 02, 2005, 11:49 AM:

Mary Dell, I agree with you completely. Giving life-and-death power over individuals to the government is exactly what I find disturbing.

#58 ::: Kizmet ::: (view all by) ::: April 02, 2005, 11:50 AM:

Renatus: I already see developmentally disabled people being killed. There have been and are Downs infants who are starved to death _after birth_. Not permitted to be adopted, not permitted to be fed. Allowed to die of starvation. Newborns. Based on someone else's determination of what quality of life should be considered to be minimal.

So you may not see the connection. I see it.

Graydon: "You seem to be missing the important distinction between 'killing someone' and 'not keeping them alive'."

This case crossed that line. Terri wasn't "not kept alive," she was starved to death. She was killed in a horrific manner while people say "it's what she wanted." Who wants to be starved to death? Honestly. Answer the question. Who wants to _starve to death_? Who wants to _die of thirst_? Go read "Final Exit" and its description of this sort of death.

A door did indeed open. But to what? No longer is the standard of death brain death, now we have adjusted the standard to flatline EEG. And what's behind door number 2, Graydon? Do you really not see that there is a fundemental difference in how we've redefined death here?

RiceVermicelli: You have indeed walked the walk. Do you ever wonder when the decision is going to be made not to let people like your uncle and my sister have the choice? When the line will be redrawn again and they'll fail to pass the brainwave test?

#59 ::: pericat ::: (view all by) ::: April 02, 2005, 11:59 AM:

(although law in Texas does allow indigent patients to be removed from life support at the hospital's discretion, and I don't understand why that fact hasn't received more attention and outrage)

I keep seeing this, but cannot find a cite of any actual law that references ability to pay. The law Bush signed is this one, the Health and Safety Code, Chapter 166*, and the relevant section is 166.046 through 166.052.

Regarding Sun Hudson, the short form from the news stories I've seen is that his condition was incurable, it got worse as his body grew (his lungs weren't growing), and he was considered to be suffering. IOW, the longer he was on support, the worse he hurt.

Nothing having to do with ability to pay, or making room for other patients, or suggestions that if his family was wealthy the hospital would have continued life support regardless of how much suffering it caused the patient.

--
* that's according to this guy, who says he helped write it.

#60 ::: Renatus ::: (view all by) ::: April 02, 2005, 12:05 PM:

Where would this be, Kizmet? Any links or sources or something I could look at?

#61 ::: pericat ::: (view all by) ::: April 02, 2005, 12:15 PM:

No longer is the standard of death brain death, now we have adjusted the standard to flatline EEG.

I'm missing something. I thought a sustained flatline EEG was the indicator of brain death.

#62 ::: Laurie Mann ::: (view all by) ::: April 02, 2005, 12:29 PM:

Kizmet - I guess you didn't read Time magazine this week.

Terri Schiavo had no clue whatsoever what happened to her for the last 15 years. It did not honor life to keep her breathing.

In the case of your sister (and my own fairly incapacitated sister, too) she knows what's going on around her. It's a completely different situation. Being disabled and being in a persistent vegetative state are two completely different things. Whenever members of the disabled community try to connect them, it's very unfortunate.

The same people who keep raving about "erring on the side of life" are sending our soldiers off to die around the world and killing tens of thousands of civilians who may not have been involved with any insurgency. They're allowing guns to proliferate throughout our society so that a teenaged boy shot a teeneaged girl merely because she didn't want to kiss him. The Republicans are trying to hoodwink people who see Terri Schiavo as a "symbol of life." They don't believe in "erring on the side of life," they merely believe in extending their control over personal issues.

#63 ::: Michael Weholt ::: (view all by) ::: April 02, 2005, 12:48 PM:

Has anyone ever read _City of God_?
"Gomers never die." A gomer is someone, like Teri, who lives but has no brain.

Lydia, I always thought "gomer" was used by hospital staff to refer to barely ill patients who were taking up space in their emergency rooms ("Get Out of My Emergency Room") so I went exploring. That link suggests the book you are thinking of may be House of God rather than "City".

#64 ::: worddude ::: (view all by) ::: April 02, 2005, 01:12 PM:

There was a doctor interviewed on the news last night who stated he was entering the hospital room soon after she was admitted and overheard the Schindler family asking the husband how much of his share of the money he planned to give them from the lawsuit over her condition (and yes, I do believe that is the world's longest run on sentence). He said he never agreed to give them any of his money from the lawsuit. Then the war began. Other points to consider:

The husband gets the remainder of the lawsuit money now that it is not going towards her care. I don't know how much that is. Maybe it's all gone.

Dying of thirst seems like a hell of a way to go. Have you ever seen survivors of shipwrecks or plain crashes describe almost dying of thirst? The doctors said it would put her in a near-sedated state. And how do they know this, and how near and how painful? If an animal is unable to eat or drink we put it out of its misery, so why can't we do so for humans?

What if she was aware on some level and didn't want to die? What if her last days were spent not only in physical pain from thirst and hunger but in emotional pain because she could not understand why the people she loved and trusted were no longer caring for her? What if, even with lessened capacity to think, she was happy. She always smiled and looked towards family members when they entered the room.

#65 ::: Georgiana ::: (view all by) ::: April 02, 2005, 01:19 PM:

Kizmet - It's hard to listen when you're very angry and you feel threatened. Maybe it would help if you waited a couple of weeks and came back and reread this thread. I don’t mean this in any kind of negative way to you, I'm just sayin' from my own experience when we're worried about those who we perceive as unable to defend themselves we are already so revved up that we don't always read things the same way we would when we are calm and feeling safe.

There are some really excellent posts in this thread that may help you late. John M. Ford and Graydon's posts are examples. If you asked me, and I know you didn't, I would suggest you read those carefully when things have settled down.

As for starving and thirsting someone to death it does sound horrid at first thought. But when I think about ritual fasting and purification that has gone for thousands of years to help people attain enlightenment it starts to sound different.

This particular essay was very helpful to me. (I think I got the link here, if so thanks to whoever posted it.) I especially found solace in this part:

In talking with my friend, I strongly urged against putting in what we call a peg tube, a subcutaneous feeding tube. About a month or so later, she called me and said she was so grateful. Her mother died, she said, an ecstatic death. She had this wonderful kind of peaceful, serene vision that accompanied her dying days. And it occurred to me that that's what we have been depriving modern patients of, that possibility, by insisting on replenishing their food and fluids.

I hope you find some peace soon.

#66 ::: Regina ::: (view all by) ::: April 02, 2005, 02:01 PM:

The Schindlers, had they been given guardianship of Terri Schiavo, planned to turn over her care to one of their other kids. They weren't going to do more than they already did: visit her occasionally. If you read the court documents, it's clear that the laboring oar in terms of constant care, was born by her huband.

And Kismet, I do not think that we stand on the slippery slope here. This is one very extreme case. To allow your own feelings to overwhelm you robs you of the ability to truly view this case.

Think about how overuse of emotion would affect the quality of medical and legal care that we have come to expect. Do you want ER docs to get all bent out of shape when a horribly injured victim is admitted to the ER room? Or do you want someone who can suspend their emotions and deliver good medical care? Do you wnat judges who take their prejudices w/ them into the court room or do you want impartial arbiters who will apply the law fairly? If Judge Greer could have brought his religious convictions into his deliberations, I think that as a Republican Baptist, he might have ruled in a far different way than he did as a Judge sworn to uphold the laws and constitution of the State of Florida and the United States. What he did was appropriate, and took far greater courage than it would have to rule the other way. I doubt if he had ruled to keep the feeding tube in that there would be any calling for his impeachment or worse, his death.

#67 ::: abi ::: (view all by) ::: April 02, 2005, 03:17 PM:

Speaking of the deaths of Catholics, the Pope just died (9:37 pm Roman time; 7:37 GMT)

As a Catholic, I can't say I'm too sad - if we believe what we believe, death is not a horror, but a transition. I worry about the future of the church, and who will be next elected, but excessive grief is not appropriate.

Requiescant in pace, both of them.

#68 ::: Jonathan Vos Post ::: (view all by) ::: April 02, 2005, 03:52 PM:

So Pope John Paul II strides to the gates of heaven, with the resurrected body of the mountain-climbing young man he once had been. He kneels and kisses the ring of Saint Peter -- what a change, he thinks, after so many people kissing my ring -- and is waved right in.

The first person he encounters in heaven itself is a young lady with a slightly less than angelic smile.

"What's the deal?" asks Terri Schiavo. "I had to wait just outside those gates for 15 years, and you got to go straight through!"

#69 ::: Marilee ::: (view all by) ::: April 02, 2005, 04:20 PM:

Kizmet, Terri Schiavo died years ago. That was her husk letting go the other day. She didn't have enough brain to feel pain or other stimuli. Your sister has a brain, she responds to stimuli. I can take on a bit of this because some of my disability involves brain damage and I am not worried that anybody wants me to die. Okay, maybe my crazy neighbor, but I think she'd want me to die even if I wasn't disabled.

#70 ::: Kizmet ::: (view all by) ::: April 02, 2005, 04:33 PM:

Georgiana:

1. My emotion is hardly new and my life experience says that I'm not going to change my mind about this issue. From the beginning of this I've found those "enlightening posts" to be... less so.

2. But when I think about ritual fasting and purification that has gone for thousands of years to help people attain enlightenment it starts to sound different.

Georgiana, I'm in the middle of a seven-week long religious fast. What Terri Schiavo went through was NOT anything like what I've been going through, what religious fasters have practiced over the ages, and did not lead to Terri's enlightenment, unless you mean her death. Your comment is insensitive, insulting and offensive.

#71 ::: bellatrys ::: (view all by) ::: April 02, 2005, 04:53 PM:

So how do you feel about the war with its "collateral damage" and the death penalty, Kizmet? Let alone the fact of all the people who die every hour here and abroad from hunger and deprivation due to exploitation, often by pious godfearing types who talk nonstop about the "culture of life," like Thomas Monaghan, but then fire pregnant women who "sinned" (unless they're too well connected for it to be safe.)

Got loopholes in your conscience for those?

--It really doesn't take too much logical thought to realize that the instances of complex, relatively rare situations like this, and the decisions made in it, in no way create the mythical "slippery slope" by which, say, using condoms will make couples have abortions, another beloved theocratic argument, or than my refusing a medical procedure ten years ago on the grounds that the possible side effects were worse than the greatest potential benefits, has prevented a single other person in my city from making the opposite choice as me, and having that surgery.

I do know why the establishment has pushed so hard this "slippery slope" talk and equations with the Nazis, though. They don't want people like you stopping to notice the very real differences between the principles as well as the practices of eugenics in the Reich - any more than they want you thinking about the mainstream churches and corporations who supported that family-values party.

#72 ::: Georgiana ::: (view all by) ::: April 02, 2005, 05:25 PM:

Kizmet - Thank you for the invitation to argue but I must respectfully decline. Best of luck finding someone else to fulfill your needs.

#73 ::: Anna Feruglio Dal Dan ::: (view all by) ::: April 02, 2005, 06:02 PM:

Mary Dell, I agree with you completely. Giving life-and-death power over individuals to the government is exactly what I find disturbing.

You already have that. Every time I step off the plane in the US I know that I can be legally killed by the governament. I keep track of this kind of things. New York: here they can kill me. Massachussets: don't think so. Vermont: No. Texas: why YES. And so on.

#74 ::: Ayse ::: (view all by) ::: April 02, 2005, 06:17 PM:

I find it odd that disabled people feel they have something in common with a body sustained on life support.

Were large numbers of them doing so? This argument seemed to be used most by people who were sound in body.

There were several disabled people protesting outside the hospice.

As to whether dehydration is a brutal, painful death, my grandmother chose to starve/dehydrate herself to death. She died peacefully and calmly, happy in her decision. It was not at all painful; in her last days she slipped into a dream state. It's not how I would choose to go, but it was how she chose to go, and I honour that.

#75 ::: Graydon ::: (view all by) ::: April 02, 2005, 06:23 PM:

Kismet --

Used to be, really bad burn cases came in, hospitals -- some of them, some of the time -- would give those people enough morphine to make sure they died relatively quickly.

It was either that, or having them die relatively slowly, blind with pain.

This is exactly the place you are sure you don't want to go -- treatment options that involve actively killing the patient.

The great majority of doctors don't want to go there, either.

As for Terri Schiavo, she couldn't eat. Couldn't swallow food if it was placed in her mouth. Disconnecting her from life support -- which is exactly what happened -- meant she died when she was dehydrated enough to stop breathing.

The other two options are -- actively hasten her death, or ignore the best available understanding of her wishes in that situation.

People get to pick hard deaths, too, if the life they have will leave them without being held to them by medical intervention, and adding the choice of a quick death is precisely what you -- with good reason -- do not want.

#76 ::: Joy ::: (view all by) ::: April 02, 2005, 06:52 PM:

Anna Feruglio Dal Dan ::: said:.

You already have that. Every time I step off the plane in the US I know that I can be legally killed by the governament. I keep track of this kind of things. New York: here they can kill me. Massachussets: don't think so. Vermont: No. Texas: why YES. And so on.

And so on...

Sheesh.

Back to the Schiavo case, the lesson I've learned from it is the importance of an explicit living will.

#77 ::: Vicki ::: (view all by) ::: April 02, 2005, 06:56 PM:

Anna--

New York State does not have the death penalty: the state Court of Appeals [the highest state court] has found the state's death penalty law unconstitutional, and (to my pleased surprise) the legislature hasn't passed a new one. (The court ruling was straightforward enough that it more or less said "here's the constitutional problem with the law, you can fix it by passing a new law without this piece.")

Yes, anywhere in the US you could be subject to a federal death penalty--but if you're sorting by state, New York is as safe as anywhere.

#78 ::: Dave Bell ::: (view all by) ::: April 02, 2005, 07:07 PM:

A part of the problem we have is that medical technology now makes it possible for severely injured people to be kept alive.

You can see it in all sorts of ways. Terri Schiavo was living with no brain. The most recent VC went to a soldier who had an RPG go off next to his head, and needed major brain surgery.

Look up "triage". We're lucky to live in a world with enough resources, quantity and quality, that Doctors don't need to let patients die. They don't have to choose. Though you might have to wait a long time for treatment for minor injuries in an ER.

#79 ::: Mary Dell ::: (view all by) ::: April 02, 2005, 09:02 PM:

Kismet - many terminal cancer patients choose to starve rather than suffer any more with the cancer. As I understand it, death will often come by morphine overdose or by pneumonia before starvation, but there's no guarantee of that.

The way it works at the hospice my friend died in, nothing is done to prolong life, but nor is anything done to induce death. So her nutrition tube was removed (although she could have popsicles when she asked for them - she couldn't digest actual food any more, because of her surgeries) and no antibiotics were given to fight pneumonia, and she was given as much morphine as she needed to take away her pain, but not any more than that.

Morphine somewhat paralyzes the lungs, and taking it combined with lying in bed gives nearly everyone pneumonia if it goes on for long enough. In her case she went into a coma about a week after her nutrition was stopped, and died a day after that. She was lucid up until the day before she died, and while she was extremely thin, and clearly anxious because the fluid in her lungs was making it very hard to breathe, she wasn't in pain, for the first time in months. Starvation wasn't the cause of death in her case but the weakness it caused helped the process along.

So it's not actually that unusual for people to choose to starve to death. There are many deaths that are harder and less dignified.

Worddude - if you read the GAL's brief on the case, you'll see that in fact she did not really respond to family members.

#80 ::: kizmet ::: (view all by) ::: April 02, 2005, 09:02 PM:

Pericat:

As my anatomy class was decades ago, I did some reading. It turns out that there's a lot more to determining "brain death" than simply a flatline EEG.

According to How Stuff Works By definition, "brain death" is "when the entire brain, including the brain stem, has irreversibly lost all function."

Terri Schiavo still had brainstem function, which is how she continued to breathe without a respirator. According to MedicineNet "According to experts, her condition has always fallen into a kind of gray zone between brain death and physical life."

So she wasn't brain dead. She may have had a flatline EEG but her brainstem is still functioning.

The standard of death used to be not breathing, no heart function. It then moved to "brain dead" with its concomitant test results (see the HowStuffWorks link for the additional tests - why don't they ever mention those on the tv medical shows?) and now the standard is moving again, to PVS with a functioning brainstem.

#81 ::: kizmet ::: (view all by) ::: April 02, 2005, 10:31 PM:

Bellatrys: no loopholes, thanks for asking. I've been a pacifist my entire life, but I will confess to trying to figure out what my response is to the question "Do I stand aside while the innocent are killed, or do I fight to protect them?" As of now, I'm still conflicted.

I'm kind of confused by your last paragraph.

Graydon: I'm convinced, if nothing else, that for the most part, there are people of good conscience on all sides of this issue. Unfortunately, this issue failed in compassion in every direction and will likely become the legal precedent for the next case.

But euthanasia is itself the slippery slope: take a look at what's happening in the Netherlands where doctors are making life and death decisions without the consent of their patients. I have a friend outside Amsterdam who knows many older people who are terrified to go to the hospital for any care, minor or major, for fear of a doctor's decision that will lead to their death.

I do not accept this philosophical duality that the mind is separate from the body, and if the mind no longer functions at some level, then it is useless for the body to continue to live. If it were true, we'd have already thrown Terri's breathing body into a tomb. We know better; we know that there's life. I want to preserve it, not because she's going to get better, but because she's alive and there is value in her to me, whether or not she ever speaks another word or she has another thought. Her physical body - not a husk or a shell or whatever other euphemism has been (occasionally disrepectfully) used on this site - has worth. If we only value someone because of their ability to think, is this simply the inverse of only appreciating value of a body?

Renatus: I've found two links that are perhaps less suspicious to you, as they aren't blatantly pro-life agenda. It's somewhat difficult to find non-prolife references to the Baby Doe case of 1982 on the net, as Al Gore hadn't invented it yet, but I've found these:
A civil libertarian's POV on Baby Doe and this about the Baby Doe case. There are others on pro-life websites, if you care to google for them.

#82 ::: Clark E Myers ::: (view all by) ::: April 02, 2005, 10:44 PM:

Mike the Headless Chicken pretty obviously had brainstem function but higher functions were not recoverable. Some say his original head was catfood and a substitute brain in a jar toured with him. Quite possibly brainstem function need not imply other functions can be recovered in other species.

Any 2 cases can always be distinguished on the facts - to use the fact of distinction to deny a slippery slope then proves too much by proving that a slippery slope never exists.

We're lucky to live in a world with enough resources, quantity and quality, that Doctors don't need to let patients die. They don't have to choose. Well yes for some values of patients perhaps not for other values of patients or perhaps not for other values of world.

I doubt anybody chooses domicile based on choice of law in this area - voting with the feet, or even choice of hospital or hospice - but it does seem to me a reasonable area for Federalism.

#83 ::: Jon H ::: (view all by) ::: April 02, 2005, 10:55 PM:

kizmet writes:"So she wasn't brain dead. She may have had a flatline EEG but her brainstem is still functioning."

But the parts that make someone human were gone.

Her heart and lungs were merely working to support the function of her stomach and intestines. Call me crazy, but being human is more than just the ability to make poop.

If someone hooked a digestive tract up to a heart/lung machine and a dialysis machine, you'd pretty much have the same thing. I doubt anyone would worry about shutting it off, though.

#84 ::: Jon H ::: (view all by) ::: April 02, 2005, 10:58 PM:

kizmet writes: " I want to preserve it, not because she's going to get better, but because she's alive and there is value in her to me"

She's not your toy.

Buy a teddy bear if you want something to make you feel warm inside.

#85 ::: Mary Dell ::: (view all by) ::: April 02, 2005, 11:05 PM:

Kismet writes:

but because she's alive and there is value in her to me,

this is the heart of the concept - her life still had value to you, to her parents, and to many, many other people. But all that should matter is what value her life had to HER.

As for the changing definition of "dead," you make a good point, but this is the price we pay for technological advancement. The standard of death used to be not breathing...because there wasn't a way to artifically make you breathe. Larry Niven's law #9: Ethics change with Technology.

#86 ::: Graydon ::: (view all by) ::: April 02, 2005, 11:33 PM:

Kismet --

I'm personally sympathetic to the idea of letting severely ill people die when they want to; that necessarily involves some interaction with doctors. There is no compassion in a situation where people are required to endure as much pain as possible in the absence of hope.

The actual Dutch law doesn't even create a right to die; it makes assisted suicide non-criminal if a list of criteria are met. Two of those criteria are the lucidity of the patient and a durable specific request by the patient.

(Could this be abused? Certainly. But that's true of any system with people in it; look up the stats on mis-perscription sometime.)

And you know, I really meant --

It is not mete that we should, of our own fear or desire or need, refuse to another guest that they should depart.

People are themselves, and fundamentally ought to make choices out of their own desires, not the desires of the people around them.

#87 ::: moe ::: (view all by) ::: April 03, 2005, 12:25 AM:

Kizmet, Let's say you were in the midst of a 6 week lenten fast that you performed every year for your religion because of a deeply held conviction that this was something that you HAD to do. And someone in your immediate family decided that you were endangering your health by doing this because of your general condition, and went and got a court order forcing you to eat and drink.

Can you see the least bit of analogy there? If someone does not want to be kept alive by extraordinary measures, then the wishes of those around him/her do not control.

The Judge, after hearing all the evidence, the testimony of Michael Schiavo, his brother and sister in law, and the Schindlers and a friend of Ms. Schiavo's--after being present and observing their demeanor as they testified, ruled that there was clear and convincing evidence that Terri Schiavo had not wanted to be kept alive if she was in a vegetative state. Why can you not let it go? The fact finder had much more information before him than we will ever have. Sometimes, you just have to let go and let g*d as they say.

Let go.

#88 ::: Bruce Arthurs ::: (view all by) ::: April 03, 2005, 12:30 AM:

kizmet said her sister had the intelligence of a 5-year old. That's intelligent enough that, if you pinched her arm, she could say "That hurts! Stop it!" I don't see any possible comparison to Terri Schiavo's condition.

And while Jon H's "teddy bear" remark was blunt, I think it was also very on-point.

Back in 2000, when my wife Hilde's crumbling cervical spine had to be taken apart and put back together with bolts and cables and chunks of hipbone, we were told before the surgery that besides a 1-in-7 chance of dying on the operating table, there was also a strong chance, if the surgery encountered any problems, that she might come out of surgery as a brain-damaged quadriplegic.

In such a case, she made it clear (verbally and in a living will) that she would not want her life sustained by any extraordinary measures. She's been dealing with increasing physical disabilities since her early 20's (severe degenerative rheumatoid arthritis), but the thought of losing her mental facilities as well was too much to accept.

And in such a case, OF COURSE I would have honored her wishes. OF COURSE I would have allowed her to pass on. How could I possibly have NOT honored her wish, and still called myself a loving husband? Even if losing her would have plunged me into a despair that would have been simply... unspeakable.

#89 ::: Clark E Myers ::: (view all by) ::: April 03, 2005, 03:06 AM:

For many of us I suspect such questions were first raised in print long before they became real:

"Kana swallowed, his mouth dry. For an instant he was back again in the chapel on Terra, half the Galaxy away from this Fronnian wood. He had been drilled in the Ritual, he knew what had to be done. But somehow, in spite of all the solemn instructions, he had never really expected to be called upon to give the Last Grace—"

“If it has to be done, a man — a real man — shoots his own dog himself; he doesn’t hire a proxy who may bungle it.”

There’s a nice gimmick story of a man trying to scratch his wife’s eyes out - with no organs left for harvest the machines may be turned off...

Poul Anderson has a story in which the others – the aliens – demand a painful death as a ritual. Perhaps based on “the North American natives of the Great Lakes ….demand that captives should play a co-operative role in the ritual torture that led to their deaths.” John Keegan, who then quotes “The torture continued throughout the night, the victim being revived when he fainted and given food and shown kindness”

Lots of thoughts through the ages and like the mothers throwing their children under the Juggernaut ( substitute Melek or Moloch if you prefer to think such things never happened in India) each likely thought it the logical thing to do at the time.

I have no faith that our society has the last word so I would not embody incomplete thoughts in national law.

I know what I prefer for myself.

When it has to be done I'll not rush with a shotgun myself nor choose to send an agent to stop a man from shooting his own dog.

#90 ::: abi ::: (view all by) ::: April 03, 2005, 04:57 AM:

Kizmet,

What if the case had gone the other way? What if the judges had ruled that, despite Terri's wishes, despite the decision of her guardian, the government's "culture of life" took precedence?

Fast-forward a few years to a time we hope will never happen, when your sister falls gravely ill. Suppose, furthermore, that the government in power has different priorities. Maybe they're deeply linked to the business community, and obsessed with cost above all else.

You and your family make some care decisions about your sister - deciding, perhaps, to get her some expensive heart surgery - which do not fit in with the government's beliefs. Would they look at the Schiavo case and say, "That's not a precedent...that was about life?"

No. They'd look at it as a precedent that the government can interfere in the private decisions of the family when those decisions are inconsistent with whichever values they espouse.

Given the choice, I'm glad that the courts upheld her guardian's right to follow her expressed wishes, even if those private decisions did not agree with the government's dogma.

It's an issue of freedom (a word we've heard a lot less of lately).

#91 ::: kizmet ::: (view all by) ::: April 03, 2005, 07:38 AM:

Moe,

I am in the middle of the Lenten fast, so your point got my attention.

However, there is nothing at all similar in the cases. A fast for religious purposes does not compare in any way to someone being starved to death. A fast should not end in death: in the Orthodox Christian practice of faith (which I am) a fast that would lead to death or severally compromising the health is forbidden (diabetics or pregnant/nursing women, for examples.)

Terri was not fasting, she was starved to death.

#92 ::: Michelle ::: (view all by) ::: April 03, 2005, 09:27 AM:

There are a couple of points that I have not seen mentioned. First, is that anorexia (as a bioloical process) occurs naturally in many terminally ill patients.

In such a situation there in typically neither hunger or thirst, and so to say that a terminally ill patients "starves to death" is misleading at best. In fact food and water, frequently taken by patients not due to appetite but to apease family members, can cause patients pain.

(If I remember correctly from my readings, it is because the body is shutting down, and one of the first processes to shut down is the digestive system.)

The second thing is that Graydon and someone else mentioned giving a patient enough morphine at the end of life to deaden the pain. Legally and ethically, a patient who is in unremitting pain at the end of life can be sedated into unconsciousness to relieve that pain, even if doing so hastens death. The practice is called terminal sedation and has been accepted by the Supreme Court (See: Vacco v. Quill) and the Catholic church.


The actual Dutch law doesn't even create a right to die; it makes assisted suicide non-criminal if a list of criteria are met. Two of those criteria are the lucidity of the patient and a durable specific request by the patient.

Unfortunately the Dutch law has had major problems in application. Both assisted suicide AND euthanasia are allowed. And the guidelines set up for the practice are not being enforced, and involuntary euthanasia (killing a patient against their wishes) is being practiced by some doctors, and doctors are not making sure that patients are not being coerced by their families.

Anyone looking at the Netherlands for guidance on end-of-life care might come to agree with me that neither euthanasia nor physician assisted suicide can be morally applied. However neither was the case with Terri Schiavo. Her case involved the removal of unwanted medical treatment, which has been a legal right going back to English common law, (unwanted medical treatment is a battery).

#93 ::: Lisa ::: (view all by) ::: April 03, 2005, 09:31 AM:

As a teacher, I've worked with some students who had generally healthy bodies, but very diminished cognitive function. These little children could not imitate gestures or vocalize sounds, and they had only reached the developmental milestones of 18 months when they were approaching 5 years old.

No one, however, would EVER mistake them for being in a vegetative state. They were clearly engaged with life. Despite the fact that they had not achieved reliable communication skills, they clearly had needs and desires that their caregivers could respond to. All of them had some ability to learn, sometimes in surprising ways. One completely nonverbal child suddenly began to babble when he was in my class, after years of speech therapy in which he never made a sound. I heard that, the following year, he said his first words.

My beliefs have changed as a result of working with these children and their families. I believe that people are highly adaptible and can live with hardship that they never imagined that they could bear, IF they are able to perceive the situation in a realistic light. All caregivers hope for dramatic improvements in those they care for, but sometimes the improvement is not dramatic, or does not come at all. And what happens to the child then?

Do we love our children because of who we hope they might be? Or might have been? Do we refuse to accept them as they are, hoping they will change to fit our ideas of how they should be? Are we ever really able to separate the reality of the human being in front of us from the hopes, dreams, fears and desires that we have for that human being?

I do see why some disabled folks might see the Schiavo case as ominous. However, I think this may be because society as a whole has not achieved an accurate understanding of what it means to be disabled -- i.e. that those lives could BE worth living. There is a fear among many people that they could not bear a life with a disability, especially a cognitive disability. That issue, though, at least for me, is separate from the issue of a vegetative state. Perhaps the issue of disability has entered the public eye as a result of this case, however tenuous the link may be, and so people respond based on that.

#94 ::: moe ::: (view all by) ::: April 03, 2005, 11:30 AM:

Kizmet, you do not understand my point. sigh.

In someone else's view you are harming yourself by your fast--they are looking at it only through their perceptions, not yours. For them, it's their views that govern, that's why they go to court to stop you. Same w/ Ms. Schiavo. Her parents wanted their perceptions, not their daughter's beliefs to govern. That is wrong and it is dangerous to let the government in to enforce someone else's beliefs when they contradict those of the person in Q as established by a court of law where both sides have been able to present their evidence.

I somehow anticipate that you won't get this either but....

#95 ::: Graydon ::: (view all by) ::: April 03, 2005, 11:34 AM:

It is well to consider that the decision wasn't "should support be withdrawn if she is in a persistent vegetative state?", it was "would she want to have been kept alive in a persistent vegetative state?"

Those are mightily different questions.

As for the Dutch law, I'd want to see the raw data for the studies about its results, since a little Googling shows two very different pictures, each obviously using very different definitions and interpretation criteria.

All of those thing you've cited as problems go on everywhere; the question is counting them accurately. This problem, already bad, gets a lot worse where there isn't agreement on the meaning of the terms. (the drafters of that law and the people who refer to the Schiavo case as an instance of euthenasia aren't going to be counting the same things, frex.)

#96 ::: Michelle K ::: (view all by) ::: April 03, 2005, 12:16 PM:

Graydon,

I'm referring to the medical and legal definitions of the terms--both of which are in close agreement. (I'm getting my definitions from medical literature or congressional/court documents.) And in a medical case, I think that medical definitions would be the preferred definitions.

And you are right about the question being one of choice. If the patient's wishes are not clearly known, then society should err on the side of caution and preserving life. But if the patient's wishes are known, and have been clearly stated in the past, then there should be no argument. Forcing medical treatment upon an individual is immoral, unethical, and illegal.


Regarding the Netherlands, see the following sources on the topic:
Boehnlein JK. The case against physician assisted suicide. Community Ment Health J. Feb 1999;35(1):5-14.
Hendin H. Summary for Congressional Subcommittee on the Constitution Suicide, Assisted Suicide and Euthanasia: Lessons From the Dutch Experience. House Judiciary Committee. April 29. Available at: http://www.house.gov/judiciary/2169.htm. Accessed November 22, 2004.
Gittelman DK. Euthanasia and physician-assisted suicide. South Med J. Apr 1999;92(4):369-374.
van der Maas PJ, van der Wal G, Haverkate I, et al. Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995. N Engl J Med. Nov 28 1996;335(22):1699-1705.
Hendin H, Rutenfrans C, Zylicz Z. Physician-Assisted Suicide and Euthanasia in the Netherlands. JAMA. June 4 1997;277(21):1720-1722.

I apologize that only one source is web based, but JAMA and the NEJM you should be able to find at any university library. (The articles are available on-line, but NOT for free.)

#97 ::: kizmet ::: (view all by) ::: April 03, 2005, 12:41 PM:

Moe,

No, I understood your point. I think your choice of example clouds the issue instead of clarifies it.

Let's look at a different example.

Let's say that I have a method of childrearing that is not mainstream or currently approved of by society at large, is frequently misunderstood and taken out of context, may be construed as harmful to a child.

Should my preference rule? Or should a social worker have the right to come in (without warrant, proof, opportunity to face my accusers, or conviction in a court that I'm guilty of a crime) and take my children, hold them in a foster home or other system, until I conform to an approved by the court method of parenting?

#98 ::: Heatherly ::: (view all by) ::: April 03, 2005, 01:46 PM:

Speaking as a social worker, with numerous caveats that laws very from state to state, and policies from agency to agency, etc, etc...

In a situation where there is a question of harm to a child, as a social worker, I would be able to go and *interview* the child, speak with him or her, and determine whether he or she was truly being harmed, regardless of what mainstream society thought of the method of childrearing.

There was no possible way to *interview* and discuss options and choices with Terri. And because there was no way to communicate with her, the last known available information of her beliefs should have been the basis of decision-making. Not her parents perceptions, as Moe stated.

IMVHO.

#99 ::: pericat ::: (view all by) ::: April 03, 2005, 02:53 PM:

kizmet, the Schindlers, not being Terri's guardians, had no warrant and their "proofs" concerning her wishes as expressed when she was in good health did not stand up in any of the courts in which they were presented, yet you seem to be arguing they should have had the right to enforce their notions on her in spite of this.

Comparing Terri's situation to that of a child or a condition that's been present since childhood obscures what I think is an essential point: Terri, when a fully-aware, fully-competent adult, expressed a clear desire to forego life-sustaining medical treatment under such conditions as she has suffered the last fifteen years.

As a society, we are bound by our own ethical strictures to respect those wishes.

#100 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 03:06 PM:

Kizmet, this may be old-fashioned religion, but are you familiar with the concept if the inevitability of death? Theresa Schiavo died long ago, in any real sense of the word. What spiritual good was accomplished by her family's years-long denial of it?

Re-read that quote from the GAL's report. The family consistently acknowledged that she was in a persistent vegetative state. She'd been in one for years. Her cerebral cortex was gone. Knowing this, they nevertheless claimed to derive joy from having her mindless corpse still be technically "alive."

You tell me: where was the spiritual good in that? What value was being defended?

While you're explaining, please leave out the part about the slippery slope, because it's rubbish. Slippery slope arguments are rightly classed as a variety of fallacy, an extrapolative error. Such arguments say that any step in a direction which the speaker doesn't favor must inevitably continue to slide, leading to a catastrophic fall. What they leave out is the part that supports the assertion that the floor is slippery, that it slants in the direction they claim, and that it must result in a fall. If you don't demonstrate inevitability, it's the argument that takes the fall.

Regarding that non-inevitability, I'm offended by the implicit assertion that the general public doesn't possess the moral discrimination necessary to see the difference between letting Theresa Schiavo's remains die their natural death, and actively killing off people whose lives we find inconvenient. Frankly, I think it's a wholly unjustified piece of holier-than-thou attitudinizing, because I don't know anyone who can't see that difference.

If it coarsens the moral fiber of our society to hold cheap an individual life, why aren't these same people out protesting against the death penalty, or the killing of Iraqi civilians, or funding cuts in social programs that help provide prenatal and infant health care?

But let's go back to the Schindler family, and their awareness that Theresa Schiavo was in a persistent vegetative state. They were willing to have her kept on a feeding tube even if she developed diabetes, and the consequent gangrene (diabetes and immobility are a bad combination) necessitated the amputation of all her limbs. They were willing to have open-heart surgery performed on her.

Are these the same people who wept on-camera at the prospect of her remains succumbing quietly to dehydration? Do you not find it disturbing that they were willing to subject her to future medical horrors, when they knew she didn't want to be maintained in a permanent vegetative state in the first place?

If they truly believed Theresa Schiavo's consciousness was still present in any degree, they should have quailed at the prospect of putting her through that. That level of suffering is bad enough when the patient has the consolation of consciousness. (Even so, if someone doesn't want to go through it, we won't force it on them.) But I'll tell you now: near-mindless suffering is worse. Along with the pain, you have terror and confusion. You're stuck in that moment, and that moment is terrible.

Theresa Schiavo's remains were mindless, and thank God for that, because the legal case might have turned out differently. Let us be grateful that she won't be maintained in a helpless state and tortured for the emotional satisfaction of her family.

#101 ::: Mary Dell ::: (view all by) ::: April 03, 2005, 03:16 PM:

Teresa - not to be a pest but - you keep saying "the Schiavo family" when you mean "the Schindler family." The Schiavo family -including Michael Schiavo's brother and sister-in-law - have gone through hell in order to respect Terri's wishes.

#102 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 03:21 PM:

Cripes, you're right. What an awful error. Let me fix that. Thank you.

#103 ::: James D. Macdonald ::: (view all by) ::: April 03, 2005, 04:10 PM:

At one time (and in certain places) the standard for proving death was physical corruption.

#104 ::: Trapped in amber ::: (view all by) ::: April 03, 2005, 04:25 PM:

"At one time (and in certain places) the standard for proving death was physical corruption."

I wasn't aware of that. So what would happen when a body didn't corrupt? I know that this was sometimes viewed as miraculous.

I do think that the boundaries between death and life have been blurred by medical advancement. The priest who gave testimony in the Schiavo case was afraid that people would begin to support euthanasia, precisely because of the possibility that they would have their lives prolonged in a way that they did not wish, or their suffering might be prolonged.

#105 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 05:16 PM:

Yes. And one of the early attractions of embalming was that it guaranteed you wouldn't be buried alive.

#106 ::: Stephan Zielinski ::: (view all by) ::: April 03, 2005, 05:52 PM:

From Wade Davis' Passage of Darkness (University of North Carolina Press 1988, ISBN 0-8078-4210-9, pp 88-89:)

On the continent, prizes were offered for the discovery of a conclusive sign of death. In France in 1890, a certain Dr. Maze was awarded the prestigious Prix Dusgate and twenty-five hundred francs simply for asserting that the only reliable sign of death was putrefaction. (Mant 1968).

The reference is to Mant, A. K. 1968. "The Medical Definition of Death." In Man's Concern with Death, edited by A. Toynbee, pp 13-24. London: Hodder and Stoughton. (A later reference to Mant in the book indicates there still isn't a more foolproof method.)

Although there is one circumstance under which even a mere EMT-Basic is allowed to assume that the patient is dead, and there's no point in attempting any medical treatment at all: decapitation.

#107 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 05:56 PM:

I thought putrefaction and dependent lividity also qualified as DNattemptR conditions, as did any other bisection of essential body parts.

#108 ::: enjay ::: (view all by) ::: April 03, 2005, 05:57 PM:

Kizmet:

I want to preserve it, not because she's going to get better, but because she's alive and there is value in her to me, whether or not she ever speaks another word or she has another thought. Her physical body - not a husk or a shell or whatever other euphemism has been (occasionally disrepectfully) used on this site - has worth. If we only value someone because of their ability to think, is this simply the inverse of only appreciating value of a body?

Your position with regard to the worth of the physical body means that physical life must be maintained even if that means extraordinary suffering for the individual whose life it is, and if the continuation of that life is against their wishes.

In practice this means that the physical life of the body has primacy over the existence of any presence or life other than the purely physical. In effect you are saying that the physical body—its mere existance—trumps what I would call the soul.

Let's say that I have a method of childrearing that is not mainstream or currently approved of by society at large, is frequently misunderstood and taken out of context, may be construed as harmful to a child.

Should my preference rule? Or should a social worker have the right to come in (without warrant, proof, opportunity to face my accusers, or conviction in a court that I'm guilty of a crime) and take my children, hold them in a foster home or other system, until I conform to an approved by the court method of parenting?

You are describing a power struggle between two external agencies holding responsibility for the welfare of an individual who is not considered practically or legally competent to make all decisions for themselves before they reach their majority. This is not equivalent to the situation of a legally competent individual who has made her wishes known.

When decision-making power is taken away from a legally competent individual, it is very easy to shift its location from an agency you approve of to one you don't, because it normalizes the transfer of power from the individual to any external agency. If Terri Schaivo's wishes had been ignored in this situation it would have made it much more likely that yours would be ignored in some other situtation in the future.

#109 ::: Larry Brennan ::: (view all by) ::: April 03, 2005, 06:49 PM:

Stephan Z: Although there is one circumstance under which even a mere EMT-Basic is allowed to assume that the patient is dead, and there's no point in attempting any medical treatment at all: decapitation.

I have a couple of friends who are/were EMTs in NYC, and they all related with some bemusement the brief training given in how to pick up a severed head with some semblance of dignity. Not that any of them ever had to.

#110 ::: Miriam ::: (view all by) ::: April 03, 2005, 07:23 PM:

Kizmet's priest would have the authority to tell him to modify or curtail his fast. Fasting for an Orthodox Christian is a matter of obedience, not self-expression.

#111 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 07:47 PM:

Whoah, Enjay. High muzzle velocity, heavy projectile, dead accurate. Thank you for posting that.

#112 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 07:49 PM:

Larry, all I can imagine is "not by the ears." Is there more to it?

#113 ::: Stephan Zielinski ::: (view all by) ::: April 03, 2005, 07:50 PM:

"DNattemptR" is a different question. Obviously, if an EMT-Basic encounters someone with spears impaled through every single organ listed in Gray's Anatomy, odds are the patient is quite dead. Still, err on the side of caution-- bring the patient to a doctor, and let HIM be the one to say, "Oh yeah, that's a corpse, all right."

The idea is to avoid having non-doctors making calls they're not 100% qualified to make. Hypothermia cases are the classic example where you REALLY want a doctor making the call. There, the patient can be cold to the touch, not breathing, have no perceptible heartbeat, and yet still be revivable.

Poking around on the web, I did find at least one case of an EMS worker attempting resuscitation on someone with dependent lividity-- but he knew perfectly well he was doing it to make the family feel that Everything Possible Was Being Done. Besides, there's the question of HOW MUCH putrefaction / dependent lividity / critical organ bisection there is; maybe the patient just has terrible circulation, a really bad skin rash, and wasn't using that side of their brain for much. There's little point in trying to come up with a hard and fast rule and then carving it into stone; it's easier to go case-by-case.

Similarly, "Time of death" boils down to when the seniorest doctor standing around says, "Okay, that's it; I give up. That guy's dead." This could occur hours after a non-doctor like me would say, "Look, he's got a YIELD sign impaled through his skull, and no more blood in him than a cinder block. He's dead." The flip side is a doctor may well pronounce someone dead even though a non-doctor would say, "For God's sake, he's still moving." Cellular death is not instantaneous; if the fellow in question just got the YIELD sign through his skull, his fingers may still twitch every now and then for quite a while after there's no hope left.

These are not just ghoulish musings. The best design I've seen suggested for Schiavo's tombstone reads: "Terri Schiavo B. 1963 D. 1991-2005." Death is not an unambiguous instantaneous event. As far as I'm concerned, Schiavo died years ago; that extreme measures kept her heart beating for years afterwards is a mere testimony to just how far medical technology has advanced.

(On a slightly more chilling note, recall that the rules change in the event of a mass casualty-- such as a building collapse, or a major hazmat spill. There, EMS workers are expected to walk away from people who don't start breathing after a manual airway clear if they can't find a pulse-- even though under ordinary conditions, they wouldn't give up nearly so soon. Dave Bell's argument above that "triage" is an obsolete concept turns out not to be valid; not only is the term still in use, triage still takes place.)

#114 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 08:03 PM:

Heck yes, triage still takes place; I have a tear-off triage tag on my bulletin board.

#115 ::: Mary Root ::: (view all by) ::: April 03, 2005, 08:09 PM:

One thing that is missing from the arguments of Kismet and the keep alive crowd is the sense of ambiguity. There are two kinds of people - good ones who keep a person beyond hope and reason alive, and bad ones who don't. But these decisions are far more complicated than that.

Take my grandfather's case. He had Alzheimer's, and took a quick turn for the worse after an operation. He was fine during the day, but the dementia ruled at night. Because his days were good, we faught and worked hard to keep him in his home and working his garden for one last summer. I moved in with him (I had just gotten laid off.) and followed him around the house all night, telling him who the people in the pictures on the walls were, trying to calm him.

He eventually had to go into a nursing home, and he really hung in there. But after a few years, when he was confined to bed and couldn't recognize anyone, he caught pneumonia. There was a DNR in place, and machines weren't brought in.

So which category is my family in? Fight heroically or pull the plug? I think the decision depends on the circumstances, even with the same patient, same disease, same family.

I think that is why the handling of the Schiavo case rang so many alarm bells for people. This sort of thing has been going on for a while, with families making hard decisions for what is best for their members. The Christian Right was acting like this had never happened before and they were the only ones morally equiped to handle it.

Sorry guys. We've been there.

#116 ::: Larry Brennan ::: (view all by) ::: April 03, 2005, 08:12 PM:

Well, I don't recall the details, but it largely had to do with placing something under the head to catch whatever might leak out and placing/carrying it horizontally and face up. After, of course, the police had done their thing, or if it had to be moved to avoid (further) damage to the head.

#117 ::: Stephan Zielinski ::: (view all by) ::: April 03, 2005, 08:17 PM:

Well, that's boring. Teresa's first thought was "Not by the ears"; my first thought was "Not like a bowling ball." (Particularly if the donor card in the wallet says corneal transplantation is okay.)

#118 ::: Teresa Nielsen Hayden ::: (view all by) ::: April 03, 2005, 08:36 PM:

Thank you for that image, Stephan. I'll have to get out the mental floss now.

Mary Root, a lot of us have been there more than once. The one that comes to mind just now is a conversation with my elderly friend Ferdy about our elderly mutual friend Bonzo, who'd been having strokes. I knew Bonzo--who had been brilliant--no longer had all his marbles. I asked Ferdy what I considered the pertinent question: was Bonzo happy?

Ferdy said he'd been happy enough after the first and second strokes, though of course considerably impaired. The third one, though, had left him unhappy and confused and intractable.

The first two strokes weren't the bad news. The third one was. I was sad but relieved when he finally passed on.

#119 ::: Stephan Zielinski ::: (view all by) ::: April 03, 2005, 08:47 PM:

(Psst, Patrick... I'll mail you twenty bucks if you wait until she's about ready to fall asleep tonight, and then lean over and whisper "Gutter ball" into her ear.)

#120 ::: Georgiana ::: (view all by) ::: April 03, 2005, 09:43 PM:

During my first responder training my teachers had a bit of a disagreement over death criteria. Like the basic EMT we were taught to treat the patient until we were essentially in the same condition as the patient when we arrived on the scene or we were told to stand down by someone with more training.

One teacher said if the patient was obviously dead then we could skip CPR but the only way to tell they were obviously dead was decomposition or decapitation. Then the other said that sometimes a body looks like it is decomposing when it isn't, for instance large blisters and bad smell caused by some sort of gas, so they settled on perform CPR unless the head is at a distance from the body.

Thankfully I have never been the most one with the most medical training at a scene where there was anything like that going on.

The most frightening time I ever had when I was the first responder was working the archery range at MD Renn Fest when a non-custodial father decided his son who was having a seizure was doing it to embarrass him and tried shaking the boy in an effort to get him to stop seizing.

After trying to get him to unhand the boy I pulled myself up to my full 5'6" and, using all my acting training to project as much as possible, declared, "By the power the State of Maryland has vested in me I demand you put that child down now!" I knew as I said it that it was a ridiculous thing to say but it felt really satisfying and superheroish. It worked and he gave me the boy.

I got his airway open and he took this wonderful breath of air and stopped turning blue. A few minutes later my older sons came running back with the EMTs from up the hill who relieved me and I sort of collapsed with nerves.

#121 ::: Jon H ::: (view all by) ::: April 03, 2005, 09:58 PM:

TNH writes: "Yes. And one of the early attractions of embalming was that it guaranteed you wouldn't be buried alive"

Apparently, one of the things that spurred commercial embalming was a Scottish woman's will. Her will stipulated that her husband would get the use of her fortune only as long as her body remained above ground...

#122 ::: CHip ::: (view all by) ::: April 03, 2005, 10:12 PM:

Kizmet: wrt your child analogy: yes, there are difficult cases in child custody -- because people of all faiths and political persuasions see children as both vulnerable and capable of increased capacity. Child services (whatever it's called in your state) has got to be one of the most thankless jobs in the world; let one badly-hurt child be found, or a single child be removed from a less-than-catastrophic household, and the brickbats come from everybody that wins when the noise level goes up and many who ought to know better. But what was left of Theresa Schiavo was not a child, and was \never/ legally in the custody of her parents; her potential was over 15 years ago, and her husband was the one most authorized to make a decision -- to recast your analogy with facts, it was her parents who were snatching her from her home.

BTW, wrt facts -- lines like "... on the net, as Al Gore hadn't invented it yet" tend to make me (at least) question any facts you present (e.g., the report that Down-syndrome infants are being allowed to die without the parents' being involved); that's a right-wing smear that was disproved long ago. I'd also be surprised if it was difficult; in 1982 I'd already spent two years on a project to provide a common interface for disparate net-accessible databases going back several years. (I'd expect LexisNexis to have indexed much further back because the complete history of a precedent is valuable in a legal argument, but it's not an area I know.)

#123 ::: Stephan Zielinski ::: (view all by) ::: April 03, 2005, 10:34 PM:

Jon H wrote: Apparently, one of the things that spurred commercial embalming was a Scottish woman's will. Her will stipulated that her husband would get the use of her fortune only as long as her body remained above ground...

Even as a joke, that ain't much of one. Embalming only stalls putrefaction for days at the most, and plenty of crypts are above ground. Shoot, even a garden variety columbarium is above ground.

#124 ::: pericat ::: (view all by) ::: April 03, 2005, 10:48 PM:

in 1982 I'd already spent two years on a project to provide a common interface for disparate net-accessible databases going back several years. (I'd expect LexisNexis to have indexed much further back because the complete history of a precedent is valuable in a legal argument, but it's not an area I know.)

The only case I could find that looked like what kizmet referenced had to do with a DS newborn in Indiana in 1982 who also had a throat (?) problem that might have been resolvable with surgery. Left unstated in the account was the risk of surgery in that situation and whatever other problems the baby had that might have complicated treatment or longterm prognosis. The doctor apparently counselled against surgery, the parents agreed with him, and the baby was allowed to die.

I don't know who made a federal case of it afterward, but someone did and Congress got involved with legislation and Reagan shot his mouth off. Seems the popular notion was that "the parents didn't want a DS child so they refused to feed it."

#125 ::: Scott Lynch ::: (view all by) ::: April 03, 2005, 11:25 PM:

Teresa wrote:

Larry, all I can imagine is "not by the ears." Is there more to it?

When we covered what my instructor called "catastrophic casualties" in firefighting class, he gave us three basic pointers for this sort of thing:

A. Look around to see who might be watching (victim's family... chief of police... mayor of the city...) before you do anything.

B. Have a bag or a board or something that will enable you to transport the, um, object in question without undue haste (your adherence to Body Substance Isolation procedures, use of gloves, etc. is already presumed).

C. Whenever possible, especially when there are cameras on the scene, arrange to have another emergency responder "inconveniently" interpose themselves, standing nearby to block a general view of a sight like the lifting and bagging of a severed head. Stretchers and other equipment can also serve this purpose, especially with blankets draped over them.

The stories our instructor gave us by way of example were illuminating. They were also extreme threats to contented eating.

#126 ::: kizmet ::: (view all by) ::: April 04, 2005, 12:15 AM:

Enjay: you were the one who most nearly understood my point. In situations such as I used for an example, it becomes a battle of the titans and the child becomes a sort of MacGuffin in the power struggle. The child as a minor has no voice in the process and becomes a trophy of sorts. Moe was trying to use an example where family intervenes in a matter of religious choice made by an adult. My example was to study what the Schiavo case had become: a battle of titans with a trophy.

You said When decision-making power is taken away from a legally competent individual, it is very easy to shift its location from an agency you approve of to one you don't, because it normalizes the transfer of power from the individual to any external agency. If Terri Schaivo's wishes had been ignored in this situation it would have made it much more likely that yours would be ignored in some other situtation in the future. Is this not the same slippery slope fallacy? Or does legal precedent not fall into logical fallacy arguments? It seems to me, and all my legal training was on LA Law, that legal precedent is a kind of continuum where case law builds on case law. Perhaps not. What do you think?

Teresa: You said: Regarding that non-inevitability, I'm offended by the implicit assertion that the general public doesn't possess the moral discrimination necessary to see the difference between letting Theresa Schiavo's remains die their natural death, and actively killing off people whose lives we find inconvenient. Frankly, I think it's a wholly unjustified piece of holier-than-thou attitudinizing, because I don't know anyone who can't see that difference.

I wish to God that I didn't know them, but I do. When my sister lay in ICU with pneumonia, we had that exact attitude of "she's inconvenient, let her go" given to us. I don't wish to be seen as holier-than-thou. It's my experience speaking.

Chip: it was a joke. Sorry that it offended. I was seeking free access sites that were not pro-life sites to give the story of Baby Doe, and most of the contemporary reports are archived and require money to access because the event took place more than 20 years ago. One of the sites I linked was to a report about then Surgeon General C. Everett Koop, who did address the survival and success rate of the surgery required by the baby. I felt that the other site's rhetoric might be offensive to many of the readers here and sought to find something that would present the facts of the case.

My original post was this: Cases such as the Baby Doe case, and others we hear through the family of DS people, make it very clear that there is a much higher tolerance of refusing to give care to Downs Syndrome (DS) patients because they are a)not having a quality of life deemed by someone else that's good enough, b)take up too much care/resources/time, c)socially unacceptable in a culture that demands perfect children or d)all of the above. Again, I speak from my family's experience. If you don't know people like this, count yourself blessed. I'm related to some of them.

So, without the slippery slope fallacy, I still present these questions in all honesty.

We have changed the definition twice in my lifetime (not quite 50 years) of what is death. We now allow statements/living wills to enforce our will when incapacitated that include contingencies which we presume are unbearable while living "normal life".

At what point do we as a society say "No. Your life has value to us, despite what you said you wanted at one point."?* Or are the wishes of the person always preeminent?

What happens when the lines for quality of life and death are redrawn? When instead of no breath, no heartbeat, then flatline EEG/negative tests, then PVS (the Schiavo case and others), what happens if the line is redrawn to "minimum mental capacity"?

I've spent my life thinking about the answers to these questions. I've heard the pro-life side. Now tell me your perspective.


*I will defer to Teresa on the proper punctuation of that sentence.

#127 ::: Lenora Rose ::: (view all by) ::: April 04, 2005, 01:37 AM:

If my life has value to you, then my values have value to you.

If I say, "I want to die now, please, don't put me through another surgery." I hope you will value me enough not to put me through the surgery.

If I say, "If I someday end up in a persistant vegetative state and can't live without medical intervention, please don't try and keep me alive." I damn well hope you will still value me enough.

If not, well, someone made a point about teddy bears above.

If I'm cognitive enough to express my wishes (And someone with the mind of a five-year-old is), then I hope you value me enough to listen to my opinions expressed at the time, if they should differ from what I said when I was hale.

(You in this case used in a generic plural sense).

#128 ::: Lenora Rose ::: (view all by) ::: April 04, 2005, 01:38 AM:

This:

If I say, "If I someday end up in a persistant vegetative state and can't live without medical intervention, please don't try and keep me alive." I damn well hope you will still value me enough.

Was supposed to read as this:

If I say, "If I someday end up in a persistant vegetative state and can't live without medical intervention, please don't try and keep me alive." I damn well hope that once I end up in that state you will still value me enough to do as I asked.

I read the preview screen. honest!

#129 ::: Trian ::: (view all by) ::: April 04, 2005, 02:33 AM:

What happens when the lines for quality of life and death are redrawn? When instead of no breath, no heartbeat, then flatline EEG/negative tests, then PVS (the Schiavo case and others), what happens if the line is redrawn to "minimum mental capacity"?

Perhaps you would like to define a state of "minimum mental capacity" that would somehow qualify as death? Despite changing definitions, there's still quite a leap between "never going to recover, lost all mental capacity, will be in that state no matter how long we force the body to sustain" and "mentally alive, but disabled".

There are still going to be grey areas simply because we don't fully understand what can and can't be recovered from.. but there are points where it can be reasonably determined that, barring direct divine intervention, the person in question is "dead" despite the autonomous processes allowing the body to function.

Perhaps you're also ignoring that the line of what is "dead" has also been moving towards even more hopeless situations, rather than away? You mention no breath/heartbeat as no longer being the line, but ignore that it is now more possible to bring people back from that state in some circumstances. Is it your opinion that we should go back to that indicator, and throw out the medical advances that made brain function a better indicator of death than those physical functions? If doctors learn how to keep a body "alive" eternally, should they do so after all other possibility of conscious life has left?

#130 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: April 04, 2005, 03:18 AM:

I think it's possible that Kizmet has a valid point to make. However, Kizmet appears to be ignoring all evidence that the point in question doesn't actually apply to the case of Terry Schiavo.

I mean, Terry was essentially a human version of Mike the Headless Chicken. While it was cute for the farm to keep Mike around as a high-maintenance celebrity pet, I can't imagine Terry would have wanted her remains to end up in a similar situation. To the poster who said "if that's what you want, get a teddy bear," I tip my hat.

I simply can't see any non-fallacious slippery slope that slides from "the cerebral cortex is gone; this is a breathing corpse" to "disabled person is too much trouble to keep alive." Not unless Kizmet claims that the status of breathing corpse is just a very extreme form of disability. In which case, such broad application renders the term "disabled" practically useless.

#131 ::: Nicole J. LeBoeuf-Little ::: (view all by) ::: April 04, 2005, 03:20 AM:

Terri, I meant. Not Terry.

/me smacks self

#132 ::: Stephan Zielinski ::: (view all by) ::: April 04, 2005, 03:37 AM:

Further, it might be easier to wait until someone is actually proposing gassing the severely mentally disabled before spending much time worrying about it.

Today, right now, the USA is occupying a state in the Middle East full of people that don't want us there. People are getting their brains blown out right now. Detainees are being disappeared right now. If you're worried about basic respect for human life, that's the thing that needs fixing right now. Left, right, atheist, religious, Big-Endian, Little-Endian-- it doesn't matter.

#133 ::: Mary Dell ::: (view all by) ::: April 04, 2005, 08:22 AM:

Kismet, the old standard of determining death would mean that anyone who had a disability requiring a ventilator (famous example: Christopher Reeve) would be dead. Anyone requiring a heart or lung transplant, in the absence of a heart-lung machine, would die instead. In previous centuries, anyone with anorexia brought on by illness would starve to death no matter how much they wanted to live.

Medical technology now makes it possible to survive all kinds of lethal conditions, including traumatic brain injury or being born with a hole in your heart. That requires choices in cases where formerly no choice could be made.

Personally I don't think it's appropriate to characterize Terri Schavio's state over the past decade + as "already dead," but as "dying." Despite intensive therapy, she never regained the ability to swallow and because of her PVS she was not going to regain the ability to swallow. Continuing to feed her via tube artificially prevented her from dying. In cases where the patient wants to go on living, this is appropriate; in cases where the patient wants to go on dying, it's not.

What's being fought for is the right of a patient to forgo treatment, not the right to take away treatment from someone who wants it. The rhetoric on both sides makes it seem otherwise. Arguments about her actual quality of life are irrelevant; her husband's action to remove her feeding tube was based on her expressed wishes.

I understand how you could see this as having implications for people with mental disabilities - but it's not the Schiavo case that makes quality of life a deciding issue. The new technologies are responsible for that. When someone has a broken neck, and needs to be artificially ventilated in order to survive, a decision has to be made about quality of life. When someone too weak to get out of bed has their 6th heart attack, and can be revived by extreme measures, again it's a quality of life decision. Some people will still want to live, some will want to die; the introduction of artificial measures is the point at which the decision must be made, because euthanasia is against the law. And refusing measures in the first place is, as we've all seen, much simpler than discontinuing them later.

The tough thing with children and with adults with lifelong diminished mental capacity is that someone else has to make these decisions for them, without really knowing what they would want. Adults with sufficient mental ability can decide for themselves what makes life worth living, and can communicate that in advance of a debilitating injury, so that others can carry out their wishes. Terri Schiavo did that.

#134 ::: kizmet ::: (view all by) ::: April 04, 2005, 08:44 AM:

Mary Dell: Personally I don't think it's appropriate to characterize Terri Schavio's state over the past decade + as "already dead," but as "dying." Thank you, you have elegantly said what I think.

#135 ::: Tina ::: (view all by) ::: April 04, 2005, 08:49 AM:

I don't really have anything to say here that hasn't been said above, except that I'd like to note that Kizmet has ducked answering Teresa's religious/spiritual points. Also enjay's.

As this is one of the most important issues from my perspective, it sort of stood out to me. Personally, if I were held up from whatever appointments I have waiting for me post-death, I'd be kinda pissed off.

#136 ::: kizmet ::: (view all by) ::: April 04, 2005, 09:49 AM:

Tina: to what end?

Religious discussions on the internet never produce anything but anathemas and misunderstandings.

But you asked.

Teresa asked You tell me: where was the spiritual good in that? What value was being defended?

My response: Jesus' strongest words of judgment are for those who say "go and be at peace" to the helpless, starving, imprisoned and naked but do nothing. As I see spiritual good in serving these people not only for themselves but because whatever I do to the least of these, I do to Christ God Himself, I see spiritual good in this situation.

Now, I have no idea what Teresa's religious views are, and an impersonal forum is no place to try to convey mine. If I've offended (and knowing only that Teresa was raised in the Mormon Church and elected as an adult to leave) or confused her by my failure to communicate well, what do I do?

Enjay said physical body—its mere existance—trumps what I would call the soul.

My response: I disagree that the body trumps the soul or the soul (care to define soul?) trumps the body. Both together make the human, neither alone are human. Every human being is made in the image and likeness of God. God has dwelt in this body. Desecrating a temple where God has dwelt is beyond my capacity.

Now, what do we have? I don't know what Enjay's definition of soul is, I don't know if he agrees with my belief that the body has intrinsic worth because of God's image. He might very well say that my desire to maintain the body in such a fashion is desecrating that temple. We come to a point where neither is going to change the other's spiritual understanding.

So my avoidance of spiritual issues is mostly a desire not to beat the dead horse again.

#137 ::: James D. Macdonald ::: (view all by) ::: April 04, 2005, 10:05 AM:

Those who are interested in Teresa's religious views can find them here.

#138 ::: Richard Brandt ::: (view all by) ::: April 04, 2005, 11:00 AM:

All you need to know about the Schindlers: They once sued, unsuccessfully, to have a judge grant Terry a divorce so she could be buried under the Schiavo family name.

#139 ::: Jill Smith ::: (view all by) ::: April 04, 2005, 11:06 AM:

Richard - don't you mean "Schindler family name"?

#140 ::: Trey ::: (view all by) ::: April 04, 2005, 01:10 PM:

So, Kizmet - you ever going to back up your argument that disabled infants are being starved to death with evidence or not?

Now, recently you said:

Enjay said physical body—its mere existance—trumps what I would call the soul.

My response: I disagree that the body trumps the soul or the soul (care to define soul?) trumps the body. Both together make the human, neither alone are human. Every human being is made in the image and likeness of God. God has dwelt in this body. Desecrating a temple where God has dwelt is beyond my capacity.

So, would you repair a cleft palate? Or worse birth defects with gross surgery or not? After all, this is something God has made and we're tampering with it.

And in all of this, you seem to be dodging again, the right of self determination. Last I checked, God gave us free will - and we can do with it as we please - turn toward Him or away. You seem rather intent on denying the others that divine gift, even if they exercised it before they couldn't communicate.

#141 ::: kizmet ::: (view all by) ::: April 04, 2005, 01:30 PM:

I posted links to the story of Baby Doe above in a message, I repost the links here:

A Civil Libertarian's Take on Baby Doe

And

The C. Everett Koop Papers on Baby Doe which include information regarding the surgerical procedure that Dr. Koop himself had performed with an extremely high success rate.

Are you seriously asking me if I don't differentiate between repairing a cleft palate and killing some one? Come on.

Self-determination. Let me ask you this: why do we intervene when someone attempts suicide?

#142 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 04, 2005, 02:45 PM:

kizmet, there are those who believe we should NOT intervene when someone attempts suicide. Having been repeatedly in the grip of severe depression myself, I have to say I would have a strong rebuttable presumption that the would-be suicide is not in hir right mind, and therefore not competent to make the decision to die.

But when a person who is of sound mind makes a statement about what kind of conditions s/he would consider a meaningful life, and when "letting them die" means withdrawing a surgically-implanted feeding tube rather than not talking them down off the ledge, the situations are not comparable.

Terminally-ill people of sound mind, but in great pain? I think we should NOT prevent them from committing suicide if they so choose, though I'd certainly favor mandatory psychological examinations to ensure that it's a clear-minded choice, rather than depression...and of course, that's another can of worms.

#143 ::: Laura Roberts ::: (view all by) ::: April 04, 2005, 03:30 PM:

Kizmet: in your opinion, are there any conditions under which it is acceptable to let people die, and if so, what are they?

I mean, you do understand that everybody has to die, right?

(this is not directed at Kizmet personally, but I've often wondered thoughout this Schiavo case if these people want to make death illegal. Except for the death penalty. And poor people. And non-American citizens, whom I understand have no rights at all now.)

#144 ::: pericat ::: (view all by) ::: April 04, 2005, 03:31 PM:

Further, wanting to be free of intrusive medical intervention is not the same thing as wanting to die, (which is itself not the same thing as "wanting to commit suicide").

#145 ::: Tayefeth ::: (view all by) ::: April 04, 2005, 03:59 PM:

Apparently kizmet doesn't distinguish between not forcing gruel into someone's stomach with a tube and keeping food and water out of reach of someone who can chew and swallow, either.

Just because the Schindlers were Terry Schiavo's parents doesn't mean they were acting with noble intent. Unlike kizmet's sister, Terry Schiavo could never throw a temper tantrum, never express an opinion her parents didn't approve of, never try to run away from home. Her parents weren't the ones changing her diapers, turning her body to prevent bedsores, or bathing her.

They were, IMO, exactly analogous to an agency that takes a child away from a family without evidence or a 'well-meaning' family member who tries to force someone fasting for religious reasons to eat and drink. They wanted to be praised for being wonderful people without taking on any of the burdens that might be associated with their daughter.

The irony of claiming that Terry was cruelly starved to death, of course, is that Terry's heart attack was triggered by her own efforts to starve herself.

#146 ::: MichelleDB ::: (view all by) ::: April 04, 2005, 04:04 PM:

Kizmet said: At what point do we as a society say "No. Your life has value to us, despite what you said you wanted at one point."?* Or are the wishes of the person always preeminent?

(emphasis added)
Yes. As a patient, my wishes are always preeminent. Always. Over my doctors' wishes, over my family's, and certainly over Congress's or some judge's.

#147 ::: Heatherly ::: (view all by) ::: April 04, 2005, 04:15 PM:

Xopher said everything I wanted to say re: suicide. I would add one thing, and that is that 'we', for the most part, are operating under an American or Western cultural perspective, and that our attitudes toward death do not reflect the attitudes of all other cultures in the world. Kubler-Ross said the US was a death-fearing culture, and after reading that Wolfson report, I think that's more accurate than pro-life.

(I say this very vaguely, because the computer that contains all my more specific references on cross-cultural comparisions on death is currently. Err. Dead, or at least, lacking a working power supply. And my thantology texts are packed up. Somewhere.)

#148 ::: Laura Roberts ::: (view all by) ::: April 04, 2005, 04:18 PM:

What MichelleDB said.

Kizmet goes back and forth between being afraid that society will "change the definition of what death is," thereby condemning people to death even though their lives are still valuable, and apparently saying that we should not respect the wishes of the individual.

"Your life has value to us, despite what you said you wanted at some point"

That's kind of a scary attitude to have.

#149 ::: Jon H ::: (view all by) ::: April 04, 2005, 05:22 PM:

"Your life has value to us, despite what you said you wanted at some point"


Next thing, the government will be saying "your reproductive capacity has value to us, despite what you said you wanted at some point" and women will be used as brood mares in service of natalism. Gotta keep pumping out them affluent white babies!

#150 ::: Marilee ::: (view all by) ::: April 04, 2005, 07:19 PM:

Last week, DC fired an EMT because she pronounced a woman dead and left the scene. About 10 minutes later, a police officer saw the "dead" woman move and called EMTs back.

Mary Root, the night dementia is called Sundowner's, and there are meds for it, although they don't work on everyone.

Kizmet: At what point do we as a society say "No. Your life has value to us, despite what you said you wanted at one point."?* Or are the wishes of the person always preeminent?

Dear Ghu, yes. It's my body, my life, I make the decisions. I think all adults have the right to kill themselves, although I hope they make an honest attempt at medical/therapeutic intervention first. If I think someone wants to kill themself, I'll try to get them to go to a doctor, but in the end, it's their right to end their life.

#151 ::: Melissa Mead ::: (view all by) ::: April 04, 2005, 07:53 PM:

"If I think someone wants to kill themself, I'll try to get them to go to a doctor, but in the end, it's their right to end their life."

Except for one thing-it's cruel to the people they leave behind. I'd make an exeption in the case of end-stage illness, though.

#152 ::: Mary Dell ::: (view all by) ::: April 04, 2005, 08:11 PM:

Melissa Mead said: Except for one thing-it's cruel to the people they leave behind

Well, if we're going to outlaw cruelty, human life as we know it will cease.

Heatherly said: my computer...is currently. Err. Dead, or at least, lacking a working power supply.

As an information technology professional, I have clear authority to state that lack of a power supply does not constitute death. And this kind of thinking will ultimately lead you to throw away your perfectly good television.

#153 ::: Heatherly ::: (view all by) ::: April 04, 2005, 08:41 PM:

Mary Dell: Very true. :) However, the power supply was just the most recent in a long line of indications that that particular computer was ready to be recycled onto newer and braver things.

And I'm calmly and peacefully letting it go. :)

#154 ::: Melissa Mead ::: (view all by) ::: April 04, 2005, 09:08 PM:

Mary Dell said: Well, if we're going to outlaw cruelty, human life as we know it will cease.

But just think of what we might wind up with instead! ;)

#155 ::: Rivka ::: (view all by) ::: April 04, 2005, 09:25 PM:

"If I think someone wants to kill themself, I'll try to get them to go to a doctor, but in the end, it's their right to end their life."

I operate under the assumption that people who genuinely and unambivalently want to kill themselves do not signal their intentions in advance. Especially not to someone who, like me, is a psychologist. Especially not to someone who is their psychologist. So if I find out about it, I assume that I have been notified by the part of the suicidal person which does not actually want to die.

So, although I acknowledge that if someone really wants to kill themselves, I'm not going to be able to stop them, I nevertheless take whatever steps are necessary to stop people from attempting suicide if I discover that they're thinking about it - including involuntary hospitalization.

I have never had someone come back and tell me that I should have let them die.

#156 ::: enjay ::: (view all by) ::: April 04, 2005, 10:33 PM:

Teresa: thank you.

Kizmet:

To answer your question about slippery slopes: a slippery slope analogy is considered a fallacy because it asserts that one event must inevitably follow from another, but does not provide any credible evidence to support that belief. You can assert that event B will follow event A, and you might be right or you might be wrong. But if you don't offer clear evidence that one event must follow as a consequence of the other, your assertion is a logical fallacy.

Every society must develop codes by which to live, in order to protect itself. They provide a structure by which individuals within the society can live reasonably safely and securely because the rules are known, predictable, and generally adhered to. Morality is one of the manifestations of these social codes.

When slippery slope arguments are attached to arguments about morality, often part of the argument is that if Event A happens, there will be a movement of the moral line we use to differentiate between good and evil. It is suggested that with that loss of moral stability our society will lose its moral compass altogether, with a consequent breakdown of all moral behaviour. This position sees the movement of moral standards as being the cause of the breakdown of social structure. This seems to me to be the argument you are making when you suggest that accepting someone's wishes regarding being allowed to die under very specifically delineated circumstances is likely to lead to euthanasising the disabled.

The problem with this argument is that it ignores the actual evidence, which is that over centuries moral lines do move as societies change, within the larger social structure. Although individuals and groups at any given time may or may not approve of where those lines end up, the overall social structure remains and there are still rules. For example, there have been groups historically whose morality insisted that allowing mixed race marriage would lead to the breakdown of all social standards and lead to perversions such as incest, but somehow incest is still illegal; moral codes and their expression through law managed to survive. Societies may become more liberal or more conservative, but the structure of morality and laws remains. Although there may be individual circumstances occasionally in which changing one law results in another which is not directly related to it changing as well, there is no evidence to support the assertion that the consequence is guaranteed or even likely.

WRT my suggestion that ignoring Terri Schaivo's wishes in this situation would make it more likely that your wishes would be ignored at some time in the future: I was talking about the results of shifts in power, not shifts in morality. The point I was trying to emphasize was that this would have represented a transfer of power from the individual to an external agency, with consequent reduction of individual power. When power shifts from one agency to another, all relationships change because the ability to make choices or do things changes. These shifts are very complex and usually lead to unexpected, unpredictable and sometimes unfortunate results. Because there is plenty of evidence to demonstrate that this is a common occurance (an obvious example is what happens when a change in political parties leads to changes in law), I don't believe that it constitutes a logical fallacy.

WRT to legal precedent,I don't know enough about how it works to have much of an opinion. I think there is a continuum, but legal precedent can't be absolutely rigid in its consequences, or we wouldn't have mixed race marriages, to go back to the earlier example.

I don't know what Enjay's definition of soul is,

The part that engages with life, on whatever level and to whatever degree is possible. I do not include the mechanistic function of the body. To me the body is a shell, not a temple; it deserves respect but not worship.

I don't know if he

She, actually.

One other thing I noticed—Teresa asked what was the spiritual good, what values were being defended in the Schindlers' finding joy in keeping their vegetative daughter's body "alive". You said:

Jesus' strongest words of judgment are for those who say "go and be at peace" to the helpless, starving, imprisoned and naked but do nothing. As I see spiritual good in serving these people not only for themselves but because whatever I do to the least of these, I do to Christ God Himself, I see spiritual good in this situation.

This includes an inherent assumption that there is good being done. In practice the effects of intervention must be evaluated on the merits of the specific case. You (I use the term generically) aren't doing good if you aren't meeting the actual needs of the suffering person. If you allow an individual no agency, you are respecting neither their wishes nor their value as a human, and you might actually be doing them great harm. If that happens the supposed "good" is only a performance of religious work (as opposed to the actuality) which makes you feel good about yourself.

At what point do we as a society say "No. Your life has value to us, despite what you said you wanted at one point."?* Or are the wishes of the person always preeminent?

The wishes of the individual should always be preeminent so long as they are competent. Choosing to end one's life should not necessarily be easy, but it should be possible under certain limited circumstances.

And I would suggest that everyone involved in the discussion go out and rent the movie Johnny Got His Gun (or read the book by Dalton Trumbo).

#157 ::: Trapped in amber ::: (view all by) ::: April 04, 2005, 10:51 PM:

"And I would suggest that everyone involved in the discussion go out and rent the movie Johnny Got His Gun (or read the book by Dalton Trumbo)."

I'll try and get the book. It reminds me of a folk song, 'Johnny I hardly knew you'. The lyrics are in the link below. That song gave me nightmares for a long time.

http://www.makem.com/discography/recordings/lyricpage/johnnyihardlyknewye.html

#158 ::: julia ::: (view all by) ::: April 04, 2005, 10:58 PM:

Kizmet, this has no doubt been covered better above, but the point that I don't think you're seeing as a distinction here is that Theresa Marie Schiavo, a fully-cognizant grown woman, made the decision that she did not wish to be kept alive if everything she recognized as life was gone.

That's not a decision you only get to make if no-one disagrees with it.

Her parents were quite straightforward in acknowledging that they had no interest in what their daughter wanted or had decided - that their interest was in investing the vegetated body of their daughter in the hopes and beliefs and wishes that they would have preferred her to have.

Do you not see this as a bad, bad precedent for people like your sister? Because if a parent decided that her wish to live was less important than their projecting a will to an end on her, it would be authorized by a precedent set by putting the Schindlers' wishes above their daughter's.

#159 ::: Georgiana ::: (view all by) ::: April 04, 2005, 11:17 PM:

I second enjay's suggestion re Johnny Got His Gun. I read the book in seventh grade and it has always stayed with me. I don't think I'm brave enough to see it as a film. I get the shivers just thinking about it.

Of course my brainy side is wondering exactly how to translate all that internal stuff into visuals...

#160 ::: Jon H ::: (view all by) ::: April 05, 2005, 02:57 AM:

enjay writes: "This includes an inherent assumption that there is good being done. In practice the effects of intervention must be evaluated on the merits of the specific case."

In a more obvious example, consider a broke heroin addict in withdrawal, with no money to score.

You could help the person out, by giving them some money. But you're not really helping them at all, you're just enabling and prolonging their suffering. Real charity would be to help them get into a rehab program.

There's a Buddhist concept I've read of, called 'idiot compassion'. The addict scenario is an example. I think keeping a person alive in a PVS, when they've expressed a desire to not live like that, is another example of idiot compassion.

#161 ::: Laura Roberts ::: (view all by) ::: April 05, 2005, 10:13 AM:

I recently read that "pity" is considered to be a sin in Buddhism. Not sure how true that is, but maybe it's "idiot pity" that was referred to.

#162 ::: Lucy Kemnitzer ::: (view all by) ::: April 05, 2005, 11:48 AM:

Jon -- I despise the attitude that because a guy's a wino or a junkie the best thing we can do is to withhold money because they'll just spend it on their destructive habit. It's a form of paternalism that excuses people from actually exerting the care that paternalism pretends to imply. It's smug, it's mean-spirited, unfriendly, and unhelpful.

If you don't want to give the guy a dollar, don't, but don't pretend you're doing it for his own good.

Personally, I'm pissed off when I go downtown without some extra dollars in my pocket to hand out to the first panhandlers I see, as long as the extra money holds out. It offends me not to be able to share a little.

And if the guy spends it on junk or booze, that's too bad, but I'm willing to risk it, because a dollar will also buy a a banana -- and junkies and winos need lots of potassium -- and four of them will buy a sandwich.

And, you know, a living junkie or wino is that much more likely to, you know, kick the habit, than a dead one.

I know I've gone on too long already but it just occured to me that you just compared a person with a habit to a corpse, and you just advocated starving street people because it's more kindly than giving them a dollar here and there. I can't express how offensive these things are.

#163 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 05, 2005, 12:16 PM:

Lucy, you're making a false dichotomy between "starving street people" and "giving them money." Giving to a charity that helps the homeless and indigent is another alternative.

I used to give money to street people occasionally, until a friend who worked with the homeless told me that it doesn't help them. Even if they don't spend it on their next bottle of Night Train, people with wise spending habits don't tend to end up on the street. Find out where your local soup kitchen or shelter or whatever is, and tell them to go there instead of giving them money.

If you're truly concerned about them being hungry, give them FOOD. I bought one very hungry-looking guy a sandwich once; he was amazed but delighted and grateful, which made me think his "I'm hungry" sign was genuine.

That's another reason not to give money on the street, by the way. You can't tell which ones are really hungry and which ones are professional mendicants. One woman that I saw looked like she was about to drop from hunger; she said "Please help me I'm hungry" in a loud, squeaky, desperate voice that sounded truly genuine. The first time. After a solid year it was much less convincing.

The more people give money on the street, the more people (real and not) will beg there. This is a huge social problem, and giving cash to beggars makes it worse, not better.

#164 ::: Heatherly ::: (view all by) ::: April 05, 2005, 12:41 PM:

Another option for helping homeless is buying gift certificates to local grocery stores, resturaunts, etc. (Do check with the store first to make sure they are willing to serve the homeless first though. Some business are not homeless-friendly.)

There are often programs in many large cities specifically geared towards this--homeless shelters, libraries or mental health agencies will have 'street packets' or something similar one can give to a needy person that contains not only gift certificates, or public transportation tokens, but also lists of homeless shelters and other services for anyone living on the street.

enjay: I went to bed last night and dreamed about Johnny Got His Gun, and was wishing I could remember what it was called. I'm so glad you mentioned it. It's an extraordinary and powerful film.

#165 ::: enjay ::: (view all by) ::: April 05, 2005, 12:41 PM:

Even if they don't spend it on their next bottle of Night Train, people with wise spending habits don't tend to end up on the street.

People who have no savings (and many who are "working poor" do not earn enough money to have savings) and lose their jobs end up on the street. People whose life savings are ripped off by corporate malfeasance end up on the streets. Families and single mothers with kids end up on the streets. Abused kids end up on the streets. You and yours could very easily end up on the streets if things don't go well for you, and it would have nothing to do with your spending habits.

#166 ::: mayakda ::: (view all by) ::: April 05, 2005, 12:44 PM:

If you're truly concerned about them being hungry, give them FOOD. I bought one very hungry-looking guy a sandwich once; he was amazed but delighted and grateful, which made me think his "I'm hungry" sign was genuine.
We've done this. One time my SIL was visiting and we were doing the tourist stuff in DC. We had a wonderful lunch in a Chinese place with a lot of leftovers. We wrapped the leftovers and gave them to a person who looked like he could use it. He seemed to appreciate it.
I also give money though. It's a habit, from growing up where there's a lot of poor people and not a lot of social services. But not always -- it depends on my mood, unfortunately.

#167 ::: Mris ::: (view all by) ::: April 05, 2005, 01:08 PM:

I'm hypoglycemic, so I tend to carry things like granola bars and fruit leather in my purse. When I used to go into downtown Berkeley when we lived in the Bay Area, I'd give them to homeless people and say something like, "If you don't want it, give it to someone who needs it." It was pretty easy because they were self-contained, sealed items, very light to carry, and easy for someone else to stash in their pocket until later if they wanted/needed to. Also they'll keep longer in your bag than a sandwich or fresh fruit, so you can just throw them in and give them away or eat them when it seems like the right thing to do, and you don't have to make a ritual of cleaning out and packing your bag every day.

It doesn't negate sharing money either directly or through shelters, food shelves, soup kitchens, etc. But it's fairly easy and safe for both the giver and the recipient.

#168 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 05, 2005, 01:22 PM:

enjay, you're right. But it doesn't change my point, which was that direct donation is less helpful than getting them to seek help from an experienced organization.

#169 ::: enjay ::: (view all by) ::: April 05, 2005, 02:27 PM:

enjay, you're right. But it doesn't change my point, which was that direct donation is less helpful than getting them to seek help from an experienced organization.

Xopher, what I take issue with is the implication that giving to an experienced organization is the best/only solution. I think it's important to understand that the population on the street is not a single monolithic entity; there are different components that have different needs, and the services for them may or may not be adequate or even exist. For this reason there is no simple solution to the problem as a whole, or even to the individual question of whether or not to give a panhandler money.

I live in the downtown part of a medium-sized city. Twenty years ago there were hardly any street people; I could walk all over the downtown and it was actually fairly unusual to see a panhandler. Now it's hard to walk a block without being accosted. The estimates in 2004 were that there were up to 1200 people living on the street, and the numbers had doubled in 2-3 years.

A comprehensive survey done by the city in 2001 found that "Symptoms of mental illness appeared from time to time in at least one third of [the street people] found." One of the reasons for this is that there was a decision made in the 1980s to close the big mental institutions. The idea was that community-based support would be a much better solution, and so it would—but the community support never materialized in any kind of meaningful way. These people are not on the street because they are careless with money, and their needs in terms of services are different from those who are unemployed and down on their luck or suffering from addictions. (Although one of the sad consequences of closing the institutions is that many who are mentally ill now also are addicted, because they are very vulnerable to being preyed on by the dealers.)

Also found in the report: "About one-half of those woken said they could not find housing because they have no income. They mentioned that they no longer qualify for social assistance or they have given up because the application process can take weeks or months. Others reported that in the past they qualified for Employment Insurance or student loans, but are no longer eligible. Most rely, at least in part, on recycling things they find in dumpsters and collecting bottles as a source of income."

Those who are simply down on their luck are caught in a catch-22 situation: you can't get social assistance unless you have a fixed address, and you can't get a fixed address unless you have money for a down payment. There are supposed to be mechanisms to solve this problem, but in practice they don't always work and people fall through the cracks.

The same study also found that 2/3 of the population suffered from severe addictions (and I would point out that means that 1/3 don't). This number included those who were unable to access services, some of whom made serious attempts to detox themselves. It takes a long time to get into a detox program (there are very few spaces), and you only get one month of treatment. If you can't kick your habit and set up viable support networks to help you afterwards during that time, you're out of luck.

All of these groups have very different needs (though they may overlap), and the services for them are very limited. The experienced organizations you cite can help with some problems, but not all. There aren't enough shelter beds in the city for all the street people, for example. So yes, I agree that it is important to give to those organizations, and do everything to support them, but that doesn't change the fact that some of the people out there are genuinely hungry. I think it's very important to recognize that, and not simply blow them off with an assumption that their needs can and will be automatically taken care of by charitable and public organizations.

So when it comes to the question of whether to give to panhandlers, there is no simple answer. Giving money to the organizations that help street people is a good thing to do, but what they can do is limited in scope, so it is not a complete solution. It also doesn't help someone who needs food or a roof over their head right now if they have been unable to access the support those organizations give. Giving food or buying someone a coffee is a good thing to do. There is no reason anyone must give money to a panhandler. But I can't always reliably differentiate between those who are going to spend the money on crack and those who are going to buy lunch or pay for a cheap hotel room, so sometimes I do give money to them, and I will continue to do so.

#170 ::: Jon H ::: (view all by) ::: April 05, 2005, 02:44 PM:

Lucy,

Sorry, I wasn't clear in my writing. I meant that the money would be given explicitly to fund the drug use, to get the person out of withdrawal.

It'd be helping the person, in a the sense of relieving the withdrawal symptoms, but not helping the person in a more longterm, meaningful way.

I wasn't getting on the more general "don't give money they'll just spend it on booze" thing.

#171 ::: Lucy Kemnitzer ::: (view all by) ::: April 05, 2005, 04:14 PM:

The more people give money on the street, the more people (real and not) will beg there. This is a huge social problem, and giving cash to beggars makes it worse, not better.

Xopher, I usually agree with you on things, but this is simply bullshit.

Some background here: My dad is spending his retirement working in the St. Martin de Porres soup kitchen (it's a Catholic Worker thing -- anarchist, you know, that Dorothy Day stuff). I helped out on a city council task force looking at the homeless problem in my town, and volunteered at the Census homeless count. Here's some things I figured out from these exposures:

Panhandlers aren't always, or even possibility mostly, doing it for drug or drink money. Mostly they're doing it as a job. Like any other job, they work out their strategies for advancement, their wardrobe, their commute plans, their hours. Their job is rather analogous to the job of entertainer: they're selling something intangible -- their story, their gratitude, something else I haven't thought of. You're free to buy it or not, as you are free to buy or not to buy movie about somebody down on their luck.

Panhandling as a job may repel you. But while for any individual person there may always be better choices, sheer statistics and demographics indicate that for thousands of people at a time, there is no better alternative. There are massive holes in the availability of jobs. There is a massive degradation of conditions in the workplace, and relative degradation of income across the entire lower level, at the same time as there is a steep rise in housing costs and a relative drop in the availability of cheap housing -- the traditional cheapest housing, the residence hotel, has practically ceased to exist in many communities.

This leaves a lot of people who can't think of anything better at the moment than panhandling.

If you watch a particular street for a long time, you'll see a gradual turnover of panhandlers. This is not because the panhandlers all die, go to jail, or get run out of town. Some -- and extrapolating from local figures on homelessness (which overlaps with panhandlerness, but isn't identical, so I have to extrapolate), maybe most -- quit the scene because they get jobs that can sustain them.

Give them a dollar or don't, but don't pretend that witholding the dollar is somehow going to create "programs" that will magically solve the problems of a whole class of people displaced by modern economics.

#172 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 05, 2005, 05:39 PM:

I don't think that withholding the dollar will magically create programs. I think that begging on the streets is increased when it's seen to be effective: i.e., no one would beg on the streets if no one ever gave money to beggars, and the more people do give money, the more people will beg. Thus: it makes the social problem of begging on the street worse when you give money to beggars on the street.

I certainly agree that people begging on the streets need better alternatives - some of them. Some of them have taken it on as a career and actually enjoy it (yes, I know they're the exception rather than the rule).

I repeat: people who work closely with the homeless (and related individuals - there are people in my own community who are employed full-time and still can't afford housing) have told me that giving money to the ones that beg does not help them. Does not help the individuals you give money to.

If I give money instead to programs that do exist - the shelter in town, the food pantry, even the church's mission in the poorest section - I know what that money is going for; in fact I can make in-kind contributions (mostly canned food) that really can't be misused. AND I don't contribute to the social problem of street begging.

Why do I think street begging is such a problem? Well, for one thing, some beggars cross the line into verbal abuse or even physical intimidation -- and they're more likely to do that in areas where there are lots of other beggars, even if all the others are the usual benign sort. (Yes, this has happened to me.) Second, it raises the resentment level of the targets toward the poor. I don't like being importuned by beggars, but I don't want them cleared away by the police, either, or seen as convenient targets by people out looking for someone to beat up -- that one's all too familiar.

So I'm not saying "withhold the dollar." I'm saying "give the dollar where it will do more good." You know what? From now on every time someone asks me for my spare change on the street, as soon as I get home I'm going to empty the change in my pocket into a jar, which I'll put into the Shelter box at church.

#173 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 05, 2005, 05:41 PM:

And: sometimes the turnover you see in a given street is due to them moving to another location, having used up the charity, or the effectiveness of a given story, or whatever. The "please help me I'm hungry" lady I first saw in Penn Station, and then she vanished; when I changed jobs I saw her again in the World Trade Center.

#174 ::: Melissa Mead ::: (view all by) ::: April 05, 2005, 05:54 PM:

I'm in favor of the "give food, not money" response-mostly because I've run into too many people like the guy who accosted me on my first day on the job and said he was hungry.
I told him I hadn't been paid yet, so I had no money, (true) but he could have my lunch.
He looked at it, wrinkled his nose, and said "I'm not gonna eat that!"

Heck, *I* was going to!

To top it off, he claimed he needed the money because he was from out of state and stranded, and needed to tide himself over 1 or 2 days until someone could bring him home.

A week later he ran out into the street in front of my car. I nearly hit him. He acted like he knew the area VERY well.

#175 ::: Mary Dell ::: (view all by) ::: April 06, 2005, 12:02 AM:

I give cash to homeless people. I don't care what they spend it on; I'm not their mother. If they spend it on booze or drugs, that's fine, because if they're addicts, they have an immediate, painful need for booze or drugs. Making it harder for them to get it isn't going to drive them to rehab; it'll drive them to something worse than begging. If you don't believe me, try taking all the booze away from your alcoholic parent/kid/friend/roomate and observe how they fail to have a life changing epiphany, and how quickly they learn to steal and lie to get and keep a new stash.

I don't give money because I think money fixes the problem; I give money because it might, in a tiny way, alleviate pain, of the body or the spirit. At the very least I can show someone that the universe hasn't entirely forgotten them, and maybe that will make a difference to them.

#176 ::: Andy Perrin ::: (view all by) ::: April 06, 2005, 01:49 AM:

I came to Philly eight years ago for college, having never met a homeless person before that time. At first I gave the street people money when I saw them. It was my parent's money, but from my food budget.

There was one woman who tended to loiter on the street outside my dorm; I saw her every night on my runs to the convenience store for coffee. (She gave me some useful advice once— when you walk outside at night in an area with few cars, walk in the middle of the street. You can see around the corner that way.)

I had been giving her a dollar now and then, or spare change, but one night she needed five dollars. I don't remember the story now, but I gave her the money. The next night she had a better, longer story, and the price was ten dollars. I could see where this was going, so I was unsurprised when she showed up the next morning on my way to class. This time, she need a lot of money because she had a brain tumor. I'm may be slow, but I do catch on eventually. I said no. She persisted. She followed me all the way to the engineering building. She followed me inside the engineering building all the way to my lab (it was early and there weren't many people in the building) before she gave up. This was several years ago, but I still see her around, so apparently the tumor isn't inconveniencing her.

After this affair, I stopped giving money directly to people altogether for several years, reasoning along the same lines as Xopher has above. (In the mean time, I graduated, and I'm now spending my own money.) I started giving again during the first big snowfall this year. A guy came up to me in the storm and begged me for money to pay for a prescription. I gave him what I had on me, reasoning that whatever the truth was, in the middle of a snowstorm it's probably an emergency. Since then, I've given money semi-randomly to people who sound like they're not trying to scam me in a big way. I don't believe in gifts with strings attached, so I don't worry what they do with the money.

#177 ::: Jonathan Vos Post ::: (view all by) ::: April 06, 2005, 06:23 AM:

I read the statistics. I grew up in New York City. I've seen people literally step over someone (nonvagrant, clean suit) passed out on the sidewalk, too indifferent to even walk around them, while I phone for medical help. You've got to try.

Sad to say, I've had too many acquaintances become homeless. The video and microwave autodidact who once co-wrote with Bill Tuning, wife left, job gone, sister threw him out of her garage. The grandmother who'd run a business newsletter for a decade during the years when the Internet was all control lines, son in jail again, ex-husband bankrupt, house-sitting gig over. Too many more like that. Nice people, creative people, with not a mean bone in their bodies, none of them on booze or drugs, just hitting a long rough patch, and fair-weather friends long since fled.

I took them shopping, took them to conventions, let them shower at my place, shared fast food at the places they preferred, lent them books, lent them money I never expected to get back, and slowly realized that I'd done the best I could for each of them, for many years running, and had to selfishly let the contact fade, my family unwilling to be interrupted by so many beseeching phonecalls at inconvenient times, sometimes several a day. I'm in debt myself, until I can land another Professorship, or sell a novel, but I've lent many thousands of dollars, to try to help people back on their feet. I'd have lent more if I'd had more. I'm not sure I solved any problems, as I have no solution to life. I do always carry a dollar bill or two in my shirt pocket, to hand to someone in obvious need, without having to take out my wallet and pretend it's empty. Or bills in the hat of any street musician. Have to give something. Whether it makes a long term difference or not. Scrooge not, lest ye be scrooged. Pay it forward.

#178 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 06, 2005, 11:31 AM:

I do not lack generosity, of wallet or spirit. I look at them and talk to them, which is more than a lot of people who DO give money do.

#179 ::: Andy Perrin ::: (view all by) ::: April 06, 2005, 12:21 PM:

Xopher: I do not lack generosity, of wallet or spirit.

(Not sure if that was directed at me, but:) I'm not accusing you of lacking either. I've just ended up on a different middle ground than you have. There's no good solution to the problem, so different people will do different things. I didn't think I made any value judgments in my post. I was just trying to describe my thinking on the subject at different times.

#180 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 06, 2005, 12:41 PM:

Andy, of all the people who have said they give money on the street you are the one to whom it was LEAST directed! I had in mind comments like At the very least I can show someone that the universe hasn't entirely forgotten them, and maybe that will make a difference to them and Scrooge not, lest ye be scrooged, which may not have been meant as accusations either, come to think of it, but which felt like it to me.

#181 ::: Jonathan Vos Post ::: (view all by) ::: April 06, 2005, 03:33 PM:

Nonaccusatory, honest. I was digging down in a maze of thoughts and feelings from my own past, and not consciously comparing my confusion with anyone else's actions. The confusion deepends when I think about it on a global scale. I know, as a techno-optimist, that we could eliminate involuntary homelessless completely within a decade or less. Rapidly manufacturing a deploying housing with lowered costs from economy of scale in the neighborhood of US$100 Billion to US$1 Trillion would fix that. Cheaper than that to get fresh water to the 1 billion who don't have current access. Absent miraculous loaves and fishes, or nanotechnology, it is somewhat harder to feed an expanding population with countries slipping into fractal tyranny, blocking the roads and starving demographic segements for political reasons, but hunger can be drastically reduced. The question is, is that equivalent to giving a dollar to a beggar, reinforcing the tragic circumstances instead of fundamentally changing them?

It is easier for Science Fiction to cover Mars Base construction that Habitat for Humanity. Easier to be eaten by aliens than make sure that some third world child has a tilapia salad sandwich. I found myself agreeing with Newt Gingrich when he proposed giving away laptop computers in inner city slums, and the new Negraponte (not the "what death squad?" monster, the MIT one) about giving away US$100 laptops to impovershed children. Does the "Green Revolution" make things better, or lock in an insane status quo? I get more confused the more I ponder.

Is giving a dollar to someone on the street where you work a way to hide yourself from the Big Picture, and thus a cheap escapist guilt-reduction mechanism, or is it what Jesus or Mohammed or Buddha would do? Or both?

#182 ::: Lucy Kemnitzer ::: (view all by) ::: April 06, 2005, 04:12 PM:

I for one have been explicitly saying that nobody need feel that they must give to all or even any particular panhandler. That's not your job, any more than it is your job to go to all or even any particular movie, play, concert, or stand-up act. Your generosity is not my concern (I don't think I am particularly generous, personally, in the scale of things, from my observations of people who give so much of their time and resources to others).

What I'm after is a certain understanding of what's going on, at the level of the street. Panhandling is not a pathology: it's a job. The fact that it is the job of choice for so many people is a demographic issue, and not merely the individual bad choices of all those people. All of us of a certain age can remember when the panhandler existed more in the tales of old farts than on the street. There are real economic, political, and social reasons why this has changed so drastically.

The other understanding I want to share is that for most of these people it is not a career choice but a temporary job. And I do also mean the scammers -- the ones who walk around with a gas can for weeks claiming they're on their way to Lodi, the ones with the long sob stories scrawled on cardboard. Those props, by the way, are not entirely dishonest -- they are attempts to do a job thoroughly and to give the customer good value for the money. Considering that the price for participating is whatever lint you have in your pocket, it's not a bad deal - consider it flash fiction as opposed to the Sierra Club's generation saga.

And the last understanding I want to share is that whether you choose to participate in the transaction or not, the underlying problem will not go away. If you keep your dollar in your pocket with the intention of buying one of those funky charity papers at the grocery store or something, you haven't made there magically be better alternatives for the panhandler. If you give the panhandler a dollar, you haven't, usually, saved his life and given him the impulse to magically go straight and get a decent=[aying job and an affordable apartment.

No, either way, what you've done is buy the story for a dollar. And -- everybody wants your dollar. The clerk in the bookstore wants your dollar: the reporter in the newsroom wants your dollar: the school library wants your dollar. And everybody else. The owner of the company that makes the shocking blue marshmallow breakfast cereal. The ex-hippie surfer guy who runs a sweatshop on the border churning out groovy keychains. The manufacturer of insulin.

To the extent that you can, you choose where your dollar goes. It's not a matter of big deal morals and politics and ethics, it's just a dollar. -- no, I don't mean that the dollar is never a matter of etc., only that the panhandler's dollar isn't.

#183 ::: Mary Dell ::: (view all by) ::: April 06, 2005, 04:17 PM:

Xopher, I absolutely didn't mean I can show someone that the universe hasn't entirely forgotten them as an accusation. I think that talking to people and taking a genuine interest in them is kinder and more generous than what I do. I'm merely explaining my reasoning and saying, "this is what I am able to give of myself."

Now, I'm sure you're right in saying it doesn't help most people, in the grand scheme of things. Which is why I make genuine, big donations to the Chicago Food Depository. But I also give dollars here and there to people who seem to be suffering (as distinct from obvious grifters*). There have been many times in my life where a tiny kindness made the difference between hope and despair for me, so I'm trying to do the same.

I see these guys who will stand on an overpass all through rush hour, in a howling winter storm, holding a sign. And I just think, "thank God I don't have that guy's job." 500 cars will pull up at the light with nobody giving him anything. And I figure after the 200th car he's gotta start to feel like he's invisible, like he's completely fallen through the cracks of life.

So that's what I meant by the "universe" comment.

* popular Indiana grift: "I'm almost out of gas and I lost my wallet, can you help me to get a couple of gallons of gas? $5? why thank you, that's very generous...you know, actually I need to get to Memphis tonight to pick up my daughter-in-law, who's..."

#184 ::: Christie Johnson ::: (view all by) ::: April 06, 2005, 04:35 PM:

>>Theresa Schiavo's remains were mindless, and thank God for that, because the legal case might have turned out differently. Let us be grateful that she won't be maintained in a helpless state and tortured for the emotional satisfaction of her family.

I'm a little late to this party, but thank you, Teresa. This is exactly what I was thinking while I followed the case.

My mother had a degenerative disease which over time robbed her of everything that makes a human life worth living. For the last three years of her life she was unable to eat, speak, or move (except for the involuntary and constant tremors.) She was bed-ridden and catheterized for several years, fed through a tube in her stomach just like Ms. Schiavo, and due to her inability to swallow had to have her airways frequently cleared out with a suction device when phlegm caused her to choke.

The worst part was that *she was conscious.* I hope - fervently - that she was at least insane, and not fully aware of her condition.

When I was 12 she was still able to talk, but the tube was already in place because of a choking incident the year before. She told me then that she wished she had killed herself when she had still been able to. Over the next year she lost the ability to speak. I was 15 when she finally died - nobody was around to get the suction gadget to her in time. I was happy for her - in the opinion of some friends and family members, inappropriately so.

Until the Schiavo case came up I had no idea that there was even a possibility that someone could have spared my mother those last years.

I've thought a lot about what it must have been like to be locked in that body, in that moment - that nightmare, with no hope of waking up for years and years to come. The past few weeks I have wished that I could turn back the clock, and plead her case to someone. I wish that I had been old enough then. I could have fought my grandparents on her behalf (who were of much the same mind as the Schindlers.)

But ultimately, it's like Teresa said - if brain function were the deciding factor for my mother, the courts would surely have elected to torture her for years to come. It was damaged by placques and lesions, but it still worked, and they would have kept her alive.

#185 ::: Patrick Nielsen Hayden ::: (view all by) ::: April 06, 2005, 04:48 PM:

Xopher is indeed a generous human being; I have been a benficiary of this. However, I'm with Lucy Kemnitzer in this argument.

Once again I'm reminded of Jon Carroll's holiday column The Untied Way, which he writes differently every year. This is from 1996's version:

It may be that some of the people to whom you give money will spend it unwisely. They will not use it to update their resumes; they might not even put it toward the purchase of a better pair of shoes.
Some of the people experiencing need and want are also suffering from confusion. This confusion is often chemical. Sometimes the chemicals are ingested; sometimes they are produced naturally by the brain. Naturally, it would be better if they sought help. It would be better if you sought help sometimes, too, and you have not always done so.
Within the context of need and want, we owe people the dignity of their own confusion. We are not performing triage here, nor are we sitting on a golden throne. We are doing what we can. We are aware that it is not enough, and still we are doing it. That's the Untied Way.
Gratitude may not be apparent at all, or it may be embarrassing and overly effusive. It would be unwise to have an opinion about that. When a person is in a doorway, the concept of "appropriate" may be a little fuzzy.
You can be sure the money has gone to someone who needs it. You can be sure that your client will spend 100 percent of the donation on self-identified need areas. You can use the experience to meditate on the nature of charity, or the fragility of personal narrative, or anything else--it's a little koan-in-a-box, just for this holiday season.
Of course, I'm a hypocrite; I don't deal well with panhandlers, not because I object to giving them money, but because I'm squirrely about talking to strangers, particularly perhaps-crazy strangers. But I seriously sympathize with Carroll's observation that most of us wouldn't do all that well under the sort of moral scrutiny we're regularly called upon to apply to mendicants.

#186 ::: Lucy Kemnitzer ::: (view all by) ::: April 06, 2005, 05:08 PM:

Jon Carroll is just one of the world's finest people and that's all there is to it.

#187 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 06, 2005, 05:10 PM:

Well, let me just say that while I haven't completely changed my mind about this, I'm less certain of my position than I was. And I will think further on the topic.

If reading here never changed my thinking about anything, I probably wouldn't keep coming back.

Patrick, I don't think that makes you a hypocrite. If I did, I'd have to say that I'm a hypocrite because I didn't go to the WTC site for almost three years after the event (I believe in dealing with ghosts rather than fearing them or ignoring them). Well, maybe we both are...which supports your argument in your final sentence.

#188 ::: Lenora Rose ::: (view all by) ::: April 06, 2005, 06:15 PM:

Sadly, in Winnipeg, there IS a segment of "Bored kids from River Heights" that do come down to one particular panhandling area. There are "cool" shops just far enough off that they might not be seen going into them when they've got enough money, and in the summer, it's kind of a fun place to hang out and walk around outdoors. (This is what draws real panhandlers there, too).

There's a famous story of someone spotting a kid in "Ratty" clothes and a bit unshaven getting out of his BMW in the parking lot and wandering off to sit down with his friends. (Someone proceeded to play a trick on him a couple of hours later by saying loudly, "I can't believe what those vandals did to that Beemer!" as he walked past. NOBODY can run that fast on an ordinary day. My fiance was one of the people with the person who said it -- this isn't urban legend though it is second hand.)

I live in the middle of this area.

I give to the kids I see in midwinter in terrible weather. The people I've seen for a few years. The people I can tell cannot possibly be from "River Heights". I try not to wonder if they're going to spend it inappropriately. That's less important to me than that I know they really could use it.

I have nothing but disgust for the kids who pretend, not only for their own lie, but because they've led several people I know to stop giving to anyone in that vicinity, because "you can never tell if it's for real".

#189 ::: Lenny Bailes ::: (view all by) ::: April 06, 2005, 10:36 PM:

After living with panhandlers in San Francisco for twenty years or so (having been a street person, myself, for a few years), I operate on subjectively-developed principles. When I'm moved to engage with a panhandler, I generally buy food (if money for food is requested, and the panhandler assents to the offer). I also carry a list of phone numbers and addresses for places that offer free food, places to stay, and medical assistance. I offer to share this information if the panhandler is receptive or requests it. I'm willing to discuss what I know about strategies for getting San Francisco General Assistance and food stamps -- establishing a mailing address, and so on -- including my own stories of frustration with the system, when I needed it and tried to use it. I'm also occasionally willing to just stand there, absorb hard luck stories, and offer sympathy.

Lucy's "professional-temp" panhandlers just walk away from this, of course. It's not quite in the spirit of the "Untied Way," (which stresses that panhandlers are people just like us, who deserve an occasional bit of unqualified good luck and freedom from poverty). I agree with Jon Carroll that unqualified giving, once in awhile, is good for the soul of both donor and recipient.

But for day-to-day being hit on, I've drifted into the "goody two-shoes" approach described above, because a) I don't enjoy seeing people in trouble use panhandled money to buy hard dope or remain in a permanent state of drunkenness. I've seen enough of this in my neighborhood to know that it's a pattern that a certain percentage of panhandlers follow.

The b) part is that I don't like the idea of encouraging panhandling as a regular "job" for people who fall through the cracks. I see being a storyteller (or street performer) as a slightly different thing from having to be a panhandler. I've been there, with no food and no roof. I remember the mental and emotional ambiance that goes with various attempted solutions.

Possibly naively, I buy into the Wharf Rats paradigm (I'm willing to put out the dime as well as the time). I know that the majority of panhandlers aren't necessarily driven to it by substance abuse issues. But I believe that monetary assistance to panhandlers should generally cover emergencies and build escape routes from panhandling.

I'm not arguing that Everyone Must Always Find Gainful Employment to eat and pay for basic necessities of life. But my perception is that panhandling as a day-to-day lifestyle kind of sucks. I'd like to spend money to encourage alternative solutions.

#190 ::: Xopher (Christopher Hatton) ::: (view all by) ::: April 07, 2005, 12:25 PM:

Thank you, Lenny Bailes. I was flailing around trying to come up with that sort of thing, but couldn't. Also, I don't have your experience. Your DTD solution sounds like good strategy to me; the implementation will require some thought, though.

#191 ::: CHip ::: (view all by) ::: April 07, 2005, 06:52 PM:

Lenny has spelled out what occurred to me in summary after closing up last night; I call it a preference for teaching people to fish rather than giving them fish. He's done much more real intervention than I ever have, but I think the agencies that I give to have greater competence there than I do.

#192 ::: Lucy Kemnitzer ::: (view all by) ::: April 07, 2005, 08:15 PM:

But . . . giving the guy a dollar isn't giving him a fish. It's giving the guy a dollar. It's half a cup of coffee or a fourth of a sandwich. It's just a friendly interaction on the street, not an intervention.

I give chunks o money to outfits that do real work when I am not too squirrely to find the checkbook and stamps, but that's not the same thing as giving the guy a dollar. I don't claim great effects for giving the guy a dollar. What I'm saying is that not giving the guy a dollar doesn't have any positive effect either. And is, to my mind, less fun than giving the guy a dollar -- the guy has less fun, and I have less fun. The conversation doesn't happen.

#193 ::: Adrian Bedford ::: (view all by) ::: April 08, 2005, 03:46 AM:

I live in the suburbs of Perth, Western Australia. I don't get into the city core all that much. Last year my wife and I went on this epic trip across Canada, and then to New York and Boston for Noreascon 4.

One night, after a book signing/reading thing in Calgary, there was a group of us standing outside the bookshop, chatting. A guy comes along, asking for money. I asked him how much he needed. He said a few dollars, so I gave him what I had in my pocket. He said thank you, and left.

The other folks in the group, all locals, told me that while I was very nice to have done that, I was also foolish, and that this guy was now almost certainly off to the liquor store/etc, to feed his probable habits. This was pretty disturbing--not the encounter with the guy, but the agreement that I was wrong to give the guy money.

Background: I have a mental illness. While right now I'm happily married and live in a beautiful home and have the privilege of writing full-time, my life wasn't always like this. Years ago I had every expectation that I would end up homeless like a great many other mentally ill people I've known over time. I still fear that I could wind up homeless and unable to pay for the medication I need to keep my head straight enough that I can write.

This guy in Calgary wasn't the only guy we encountered during our trip who asked us for money. I tried to give money to every one I encountered--because I can only too easily imagine myself in their situation one day, and I would hope that someone would help me, rather than assume I just want to feed some habit.

(Of course, there are panhandlers etc in the city of Perth: I just don't see them much because I hardly ever go into the city.)

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