As of now (0600 hours in Pittsburgh) the court of appeals in Atlanta has upheld the ruling of the previous courts in the Schiavo case. There will be no more feeding tube. This is probably the last appeal. It is highly unlikely the Supreme Court will hear the case.

I have only a few brief comments before we shift this discussion to Med-Events where it belongs now.

In my opinion, this is a terribly scary potential precedent because it has been made an all-or-nothing issue. As it shakes out, if a person does NOT have a living will or some other instrument declaring their wishes, it is ASSUMED that they desire to be kept alive by any means possible. That’s ridiculous and a false premise. NO ONE would want to be in a nursing home with a feeding tube drooling and gawking at nothing in particular. This family has bought into the pie in the sky bye and bye long shot cure. They told the court they thought she has “Rehab: potential. She doesn’t. Bill Frist, in his clinical wisdom looked at the distillation of hours of video tape and made the statement that she seemed to be reacting to her environment. Her reaction to her environment is always the same. What Sanjay Gupta calls “unaware wakefulness”.

So in my mind, had this issue been resolved in favor of the parents and the feeding tube replaced, no one in this country would ever die without the full application of “everything”. I believe the husband is correct. That she at some point in their relationship made noises like she wouldn’t want to live in PVS should it ever occur because NO RATIONAL PERSON WOULD DESIRE IT. She doesn’t have a living will or other such document because she was a healthy person in her 20s and very few such young persons feel the need to draw up such a document. I believe a husband knows his wife’s wishes infinitely better than parents. He has the right and the authority to speak for her and that’s the end of it.

I think that the inverse of this issue should be considered. That a person who lands in PVS for more than a year should be considered to NOT desire that state and should be removed from all extraordinary care unless they provide a prospective document stating they WOULD want to be maintained in an indolent state with no home of ever coming back. I defy ANYONE in this group to tell me they would sign such a document.

Emotions have clouded the reality of this issue and it has become a fight to see who can win, not what’s in the best interest of all those involved in this disaster. Not one of the politicians that got together for this circus has the slightest interest in Terry Schiavo. They all knew this would never fly in the appeals but it gave them all an opportunity to show how “humanistic” they are for their constituents. Lots of crocodile tears and “vote for me in November- I’m for human rights”. Cheap points.

One more thing- on the way back from NC yesterday I was looking for a National Public Radio station and happened upon some National religious evangelist speaking on this issue. He introduced so and so who he described as a “bioethicist”. The “bioethicist” quickly launched into a personal opinion diatribe following the hard line of one side of this issue. I would have loved to have called in and asked after the qualifications of this “bioethicist” with lots of personal opinions and nothing else to offer. The whole point of bioethics is to look at the frameworks of these issues and how decisions are made, not to simply give a heavily biased opinion, couching it in terms of academia. In that regard we are lucky to have the real thing on CCM-L.

If there are any true villains here, they are the politicians that forced this issue into the Federal courts after due process was had at the State Level. They knew it wouldn’t fly there and they also knew it was an excellent opportunity to jump on the “humanistic” bandwagon risk free. It’as always politically correct to come out on the side of “human rights” even though that isn’t what this case is about. If there was a chance the court might have found for the parents, all of them would have hedged to see which side was the probably winner and then came out on that side.

They came out with some of the dumbest statements I ever heard. Not one of them had a clue what they were talking about including Bill Frisk. One bemoaned the terrible pain and agony of “starving to death”. It’s totally painless and discomfort free in this situation. Some female weighed in as a “mother” decrying that Terry “had done nothing to deserve starvation”, relegating this to a criminal case. The opportunistic bastards each and every one only did this to get some cheap points with the public. They’re responsible for this not to have ended like it should have, after due process.

Leslie Whetstine says that there is nothing new here. There are several states (Florida among them) that require “clear and convincing” evidence that any maneuver to an incompetent person is in their best interest. Remember the Cruzan case was in Missouri, a state also requiring CCE. Pennsylvania and most other states require only a “preponderance” of evidence, a much easier standard to achieve. So in Pensylvania, it is enough that a husband knows the wishes of his wife without having to prove a written declaration. In Florida and Missouri it is not enough.

The law in Florida is clear but there was dissension among the family and a lot of special interests involved, so it went through the court system and in the end the issue was resolved legally. The finding by the state high court that the husband was authoritative essentially threw out the premise that a written declaration was required, a ludicrous proposition anyway. Young people don’t make out living wills because they think they’re going to live forever. Old people don’t make out living wills because they’re afraid of death. It is a VERY fallacious argument that because these people choose not to declare in written form that they NECESSARILY wish to be artificially kept alive in a blank state as long as humanly possible. That’s simply ludicrous on the face of it.

The Clear and Convincing evidence rule instantly revokes the Principle of Unintended Consequences and needs to be abolished in my opinion. This case might be the first step.

As I remarked in earlier sagas, I heard a pulpit pounding tele-evangelist make this issue very clear from the religious right. He said that if we start going around deciding which incompetent persons should not be kept alive on the basis of what we “think” their mental status is, we’ll eventually let someone die who is capable of potential rehabilitation. Therefore, it is necessary to keep EVERYONE alive as long as possible to insure a very few don’t fall through the cracks. He made no distinction at all between PVS patients and ICU patients on vents and life support. Further- Terry or anyone else in similar circumstances may have a right to be sustained in a state of “unaware wakefulness” if she so desires, and there is no convincing evidence at all that she does, or that anyone else does either. But it is not clear at all whether the taxpayers have the same obligation to fund it.

There it is. That’s where this is going. Those who desire to keep Terry alive indefinitely do so because they belive that, even after fifteen years, she will someday wake up and be normal. Says so in the National Inquirer every issue. They advocate keeping all such persons alive on the vanishingly slim change one or two may unexpectedly get better. And they expect the taxpayers to fund it.