The Flog Me Document
Anxious to keep the Schiavo case alive, fundamentalists have begun to beat a new drum: the evils of living wills. You see, a living will is "inherently biased against a pro-life Christian understanding of values." Now, I am not sure what that could possibly mean. But I am quite sure that this anti-living will nonsense is going toHere's a sample from the Florida Baptist Witness:
'I direct my health care provider(s) and health care surrogate(s) to make health care decisions consistent with my general desire for the use of medical treatment that would preserve my life, as well as for the use of medical treatment that can cure, improve, or reduce or prevent deterioration in any physical or mental condition.
'Food and water are not medical treatment, but basic
necessities. I direct my health care provider(s) and health care
agent to provide me with food and fluids orally, intravenously,
by tube, or by other means to the full extent necessary both to
preserve my life and to assure me the optimal health possible.'I direct that medication to alleviate my pain be provided, as long as the medication is not used in order to cause my death.
'I direct that the following be provided:
* the administration of medication;
* cardiopulmonary resuscitation (CPR); and
* the performance of all other medical procedures, techniques,
and technologies, including surgery %u2013 all to the full extent
necessary to correct, reverse, or alleviate life-threatening or
health-impairing conditions, or complications arising from those
conditions.'I also direct that I be provided basic nursing care and
procedures to provide comfort care.'I reject, however, any treatments that use an unborn or
newborn child, or any tissue or organ of an unborn or newborn
child, who has been subject to an induced abortion. This
rejection does not apply to the use of tissues or organs obtained
in the course of the removal of an ectopic pregnancy.'I also reject any treatments that use an organ or tissue
of another person obtained in a manner that causes, contributes
to, or hastens that person's death.'The instructions in this document are intended to be
followed even if suicide is alleged to be attempted at some point
after it is signed.'I request and direct that medical treatment and care be
provided to me to preserve my life without discrimination based
on my age or physical or mental disability or the 'quality' of my
life. I reject any action or omission that is intended to cause
or hasten death.'I direct my health care provider(s) and health care
agent to follow the above policy, even if I am judged to be
incompetent.%u201D"
The truly scary thing is that there is so much conservative money flowing into bioethics right now that this document and many more like it will no doubt be much more widely adopted than 'traditional' living wills. So, maybe we should say, God help the poor clinicians who have to try to figure out how to explain to family members that a feeding tube is in fact medicine and that it is not appropriate to use one in Mr. Jones' case.
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Isn't there more to this living will? "If I should die and one request of this will is shown not to have been followed, I order my lawyer to initiate a law suit against the party involved." That should add a bit more stress to those "poor clinicians". ..Maurice.
- by Maurice Bernstein, M.D. on Apr 23, 2005 at 4:37 AM | link
They should also add: "Because I deeply respect life, feel free to use the most expensive medical means to keep me alive, even if it drives my loved ones into personal bankrupcy."
- by geodude on Apr 23, 2005 at 11:56 AM | link
These silly fundamentalists--they believe that "living wills" are about the patient's wishes, and not just an excuse for terminating treatment.
Without doubt, this post will confirm their worst fears.
- by Thomas on Apr 24, 2005 at 3:11 AM | link
...it will be interesting to see if hospitals with religious affiliations that entail the kind of commitments outlined in the "Will to Life" are going to allocate resources to fulfill these obligations on a large scale.
It is conceivable that hospitals/doctors who believe that what a patient/surrogate is asking for in terms of life-sustaining treatment is beyond what they are willing to provide, and may require that the patient be transferred to a facility and to another physician willing to carry out the patient's/surrogate's wishes. In short, some religiously affiliated hospitals might find themselves becoming referral centers for the long-term care of patients with profound neurologic deficits (PVS, advanced alzheimer's dz) in whom the family wants "everything" done.
And, why would that be a bad outcome? It would seem to satisfy most sides of the debate. The patients and families would get the care they are asking for, and the respective institutions and professionals are permitted to act according to their (different) moral commitments. Since there are hardly a shortage of either doctors or hospitals with religious commitments compatible with the "Will to Life," it is unlikely that any single institution or group of doctors will become overburdened with the exclusive care of these patients.
This is not relativism....just a practical solution that doesn't involve more egregious interventions by the State.
- by Actually... on Apr 24, 2005 at 10:01 AM | link
Thomas,
The worst fears of fundamentalists (per definition) can be raised by pretty much anything.
My point was that there is an economic aspect of the debate that cannot be ignored. I would agree with fundamentalists who say it should not play a dominant role in the debate, but (as Actually ... interestingly shows) it has to enter in somewhere, somehow. I shouldn't have to point out, in the year 2005, that health care happens on the planet earth, where we pay for things with money.
Those who believe in the 'life at all costs' approach are entitled to it, but they not entitled to make those who think otherwise foot the bill for their world view. This is not some crass economic argument; it is about fairness.
Maybe the proposal of Actually ... is worth considering, though I fear that only the rich will be able to really pursue the 'life at all costs' lifestyle.
- by geodude on Apr 24, 2005 at 1:36 PM | link
Hey, since my worldview is different from yours, does that mean that I can stop subsidizing you? Does that work across all areas, or just for this particular case?
- by Thomas on Apr 25, 2005 at 3:21 AM | link
Well, I've made a note on my Advanced Directive to note that I don't mean that I would refuse natural means of nutrition and hydration. I even suggest that they try a little chocolate syrup.
It had never occured to me that anyone would forbid natural means, at the threat of arrest for anyone who offered me ice chips until Greer did just that.
- by Beverly on Apr 25, 2005 at 5:09 AM | link
...geodude, my proposal is predicated on the assumption that religiously-affiliated hospitals understand part of their mission as providing care for those who cannot afford it. The economic power of those who support the "Will to Life" and similar proposals might make up the rest.
As the public polls in response to the Schiavo case demonstrated, most Americans did not look favorably upon the attempted interventions of the Congress and the executive. I offer this point not to inflame Thomas or Beverly, but simply to suggest that implementing a "Will to Life" or something like it will only be a challenge for a relatively small number of people. Around many coffee-tables in this country, conversations are being had with regard to the end-of-life wishes of family members and loved-ones. Many, in light of the Schiavo case, may actually write their wishes down. That can only be a good thing.
However, geodude's concern about the economic impact of sustaining a cadre of neurologically devestated patients for decades is not unwarranted. My suggestion: ask the moral communities which insist that it is a moral obligation to sustain these persons to kick in the resources to do so.
Why shouldn't they want to do so? Subsidizing this kind of care in the absence of secular support offers a sterling, public example a willingness to put private resources behind a "Culture of Life" agenda, with tangible, practical results. Say what you want about the obligation of the (secular) government to provide resources for this care; on a practical, political level of publicly acting on a moral commitment, it makes sense for religious institutions to do this.
As to Thomas, I cringe at the thought that his tax dollars might be involuntarily subsidizing me, or geodude for that matter. Really! Though in all fairness, this should wait until a fully libertarian society comes to fruition, I'm willing to go ahead and refund my share of Thomas' lifetime tax expenditures to him now.
However, I'm not sure that PayPal takes nickels.
That, after all, is what the aftermath of the Schiavo case ought to be about: (a) Encouraging all Americans to make their wishes known to their loved ones; (b) establishing a power of attorney for health care; (c) ensuring that the wishes of patients, insofar as it is possible, are met. In short, it ought to be less about the details of the Schiavo case, and more about the principles of individual autonomy, about prospectively controlling substituted judgment on your behalf, and about federalism.
- by Actually... on Apr 25, 2005 at 10:32 AM | link