MaxedOutMama
Friday, March 25, 2005
Full Circle
You think the case of Terri Schiavo is about personal choice, but it is not. The least interested person who testified about Terri's wishes was her friend, and Judge Greer dismissed her evidence as not credible. But the friend did not stand to get any money; the friend could not have had the emotional entanglements of Terri's parents; the friend testified that they had had a highly relevant conversation while watching a movie about Karen Ann Quinlan in college. Judge Greer's reasoning for refuting the evidence as stated in his written opinion has been refuted, but of course that is of no significance to Judge Greer.
To make sense of what is happening to Terri Schiavo you must read this article, which has nothing to do with Terri Schiavo's case. I would recommend that you save it down and reread it several times. This was published in 2002. The abstract:
This is what is being wrought in the name of choice, and this is the implicit standard under which the execution of Terri Schiavo has been implemented. The judgements of all the practicing physicians and nurses have been ignored, and the judgements of people like Dr. Cranford have been elevated. Go back and really look at the records, and you will see I'm right.
This is the future unless individuals decide to prohibit it by law. I can assure you that Dr. Cranford is making a very nice living, as is Singer, and the insurance companies will not be advocating for your interests. The only thing really standing in the way of "improving the dying process" are those pesky doctors and those advance directives, especially the lunatic ones that specify that the patient does want to be fed and watered. Within ten years your advance directives will not be legal. There you have it - do what you will with it.
I will close with this excerpt from the same article:
To make sense of what is happening to Terri Schiavo you must read this article, which has nothing to do with Terri Schiavo's case. I would recommend that you save it down and reread it several times. This was published in 2002. The abstract:
After passage of the Patient Self-Determination Act and the Cruzan decision by the Supreme Court, honoring individual patient choice has become the primary means by which we have sought to improve the quality of life of the dying patient. However, the decision-making capacity of the dying patient is usually compromised, and advance directives have not consistently improved the dying process. We respect patient autonomy in order to respect the patient as a person; patient autonomy should be respected to the degree that it is intact. When autonomy is significantly diminished, as it usually is in dying patients, respecting autonomy reconstructed from documents or proxies may not be the best way to respect the dying person. We rather need to seek social consensus about when patients are dying, the nature of a "good death," and when it is preferable to a longer life.Note the phrase "when patients are dying". Note it well, for it is crucial to understanding what is being suggested here, which is basically that doctors and society should decide when a person is dying and when to make sure they are. No kidding. I will whet your whistle with a few enlightened excerpts:
Choice has become a part of the process of modern dying. Decisions to limit or withhold care occur in the clear majority of deaths today, particularly among elderly patients; 90% of patients who die in intensive-care units have life-sustaining treatments withdrawn, a dramatic increase in the past decade.So what's the problem? The author goes on to explain that the average age at death continues to increase and that roughly 30% of patients die in nursing homes, where the risk of cognitive impairment is high. And what's the problem? Allowing advance care directives or the decisions of proxies to stand:
In the Cruzan decision, the U.S. Supreme Court allowed Missouri to demand that there be "clear and convincing" evidence that Nancy Cruzan did not want life-sustaining care in her condition in order for that care to be discontinued. That is, Nancy Cruzan's parents could discontinue her care only if she had previously made such an explicit choice. I will argue that this produces problems by introducing the false gold standard for end-of-life care of "what the patient would choose if he or she were now autonomous."The author continues:
I will conclude by briefly arguing that quality-of-life assessment and quality-of-care policies offer a better way to improve human dying than bolstering individual patient choice.A "better way to improve human dying." Goebbels couldn't have said it better. In other words, you are not going to be allowed to make the choice for your loved one, because you are certainly not going to be allowed to make that quality-of-life assessment. This psychiatrist wants society to make the decision. Not you, not your advanced directive, and not your chosen surrogate. And why? Because you aren't smart enough and don't really have the right to make that choice anyway:
Integrity does not simply involve adherence to a life's plan. It involves relationships of honor and respect by others. Individuals do not invent for themselves what constitutes dignity. Family and community do this. Dying patients place a high priority on both relieving burden to loved ones and strengthening relationships with them. They achieve this by involving loved ones in decisions about end-of-life treatment.So in the name of preserving dignity we will strip you of choice, including your decision as to when you are dying:
Explorations of the context within which advance directives function has shed some light on their failure to direct end-of-life care. In-depth interviews with patients, physicians, and the nurses responsible for the intervention revealed that physicians were not unilaterally disregarding advance directives. Rather, physicians and family came very late to seeing these critically ill patients as "absolutely, hopelessly ill," and therefore came to implement the advance directives very late. The criteria for when a patient is "dying" thus appear to be a critical element in end-of-life care. It is important to note that this must be a matter of consensus among all the parties involved, not just the individual choice of the patient.Uh huh. We aren't talking about dementia patients here. We are talking about people who can make a choice but have some hope and choose to continue treatment. Earlier the author has argued for substituting a "best interests" judgment in place of an advance directive. Now if physicians aren't sure if you are critically ill, just whose judgement is going to be used to decide that you are dying? Bioethicists will decide. People like Peter Singer will decide. You and your family will not decide when it is your time to die.
This is what is being wrought in the name of choice, and this is the implicit standard under which the execution of Terri Schiavo has been implemented. The judgements of all the practicing physicians and nurses have been ignored, and the judgements of people like Dr. Cranford have been elevated. Go back and really look at the records, and you will see I'm right.
This is the future unless individuals decide to prohibit it by law. I can assure you that Dr. Cranford is making a very nice living, as is Singer, and the insurance companies will not be advocating for your interests. The only thing really standing in the way of "improving the dying process" are those pesky doctors and those advance directives, especially the lunatic ones that specify that the patient does want to be fed and watered. Within ten years your advance directives will not be legal. There you have it - do what you will with it.
I will close with this excerpt from the same article:
Pain, fatigue, and dysphoria are common and burdensome symptoms in dying patients. It seems that we know enough about dying well without asking individual patients to know that these are not good quality-of-life outcomes. Yet, we shy away from clearly defining a good death and defer to individual preference.How on earth can you die without being fatigued and being dispirited? There is only one way, and that's currently known as "lethal injection". This, dummies, is a proposal for euthanasia, administered without the patient's, the doctor's, or the family's consent. This is also what Dr. Cranford believes in. It is not what I believe in. This is a proposal for mass murder by yet another "ethicist".
