blog.bioethics.net

Is there a suggestion that this case is analogous to the Schiavo case?
How, exactly, is it analogous?
Is it too much to ask for arguments? Or even the barest suggestion of the outline of an argument? Are you capable of even that much?
I doubt it.

- by Thomas on May 2, 2005 at 12:52 AM | link

I don't read any suggestion of a link to the Schiavo case in the post. It seems only that there have been cases in Texas before, similar to this one.
Reading before making snap judgments: is that too much to ask?

- by Sam I am on May 2, 2005 at 2:58 AM | link

Thomas, you are a moron if you don't see the connection.
The same politicians that intervened in the case of a brain-damaged woman on the grounds that all life, irrespective of quality is to be protected are not stepping to protect a child from being 'murdered' by default.
And in this case, there is no question conscerning the choice of the parent or child...

- by Carl on May 2, 2005 at 11:56 PM | link

There is an error in the 4-30 blog on the current futility case here in Houston at Memorial Hermann Hospital (primary affiliate of the University of Texas at Houston medical school). The Texas Advance Directives Act provides for a 10-day (not 8-day, as erroneously stated in the blog) period for the family to find another physician or facility after being notified that the hospital’s ethics or medical committee agrees with the attending physician that continuing life-sustaining treatment is inappropriate. Full text of TADA is at http://www.capitol.state.tx.us/cgi-bin/statutes/pdfframe.cmd?filepath=/statutes/docs/HS/content/pdf/hs.002.00.000166.00.pdf&title=HEALTH%20%26%20SAFETY%20CODE%20-%20CHAPTER%20166 . See section 166.046.

- by Larry McCullough by way of ema on May 3, 2005 at 2:55 AM | link

How much you wanna bet we won't hear a peep from the wingnuts on this one?

- by Wilson Kolb on May 3, 2005 at 11:01 PM | link

Carl--If the suggestion is that those who opposed starving Terri Schiavo to death always and in every case believe that further medical treatment is a moral necessity, then you've misunderstood their point, and I'm not sure where to begin. Perhaps if you--and whoever posted this bit to begin with--actually tried to understand the views of your opponents you'd be able to do more to make cheap and inaccurate comments.
Where one might expect to see some outrage is on the part of those who insist that they favor "choice" or patient autonomy or similar values. But obviously those are simply code words for a substantive preference for death in every possible case.
Is that a fair summary of the position? Fairer than that suggested in the original post!

- by Thomas on May 4, 2005 at 2:34 AM | link

Thomas - I agree that all sides of a debate should strive to understand the views of their opponents. So it might help to move the debate forward if you acknowledge that valuing "choice," in the sense of respect for autonomy, does not mean that a patient's or surrogate's desire for treatment must be satisfied irrespective of medical judgments about the propriety of the treatment in question. Patients are not "free" to choose (i.e., compel) interventions lacking a sound medical justification.

- by Bob Koepp on May 4, 2005 at 11:23 AM | link

Bob- I think that those of us who reject the notion that autonomy is the foremost value have an easier time of coming to that judgment than, say, the person who posted this bit. I don't have much problem with the idea as you set it out. I may have differences with you about what 'sound medical justification' means.
So, what's the connection to Schiavo? Is this an admission that most proponents of Ms. Schiavo's starvation weren't much concerned with what her wishes were, but simply believed that the provision of hydratiion to a woman in her condition lacked a 'sound medical justification'? I don't doubt that that's true, but I doubt most anyone will admit it.

- by Thomas on May 5, 2005 at 3:58 AM | link

Thomas - It's obvious that the Schiavo case turned on the question of autonomy rather than the presence or absence of medical justifications. What the courts looked at was evidence of Ms Schiavo's wishes -- evidence which you may or may not find persuasive. The choice at issue was the choice to refuse treatment -- a choice which "autonomists" believe should be respected regardless of whether the treatment could be medically justified.
In the present case, however, the dynamic is reversed. Family members desire treatment that providers believe is lacking in medical justification. The ethics of requests/demands for treatment are different from the ethics of treatment refusals, and a proper understanding of autonomy reflects those differences. Blurring all such distinctions under the rubric of "choice" does not help us to find our way.

- by Bob Koepp on May 5, 2005 at 11:00 AM | link

Bob--On the Schiavo case: I don't think that a fair assessment of the evidence, in light of the presumption in favor of life provided by Florida law, could possibly lead to the conclusion that the courts reached in that case; it seems quite clear that the courts were operating on the assumption that 'no one would make that choice' (a complete reversal of the presumption under Fla law), and that that's what did the work.
Your insistence that 'autonomy' should be respected in cases where it leads to the cessation of treatment but not where it leads to the continuation of treatment makes exactly my point: it isn't autonomy that's doing the work, but rather your substantive view that some lives aren't worth living, and that either the patient can choose that, or the provider, but someone must choose it. It's rhetoric, and nothing more.

- by Thomas on May 5, 2005 at 12:44 PM | link

Thomas - Your insistence on portraying a provider's refusal to go along with a patient's (or surrogate's) request/demand for treatment as somehow contrary to respect for patient autonomy "makes exactly my point." Respect for patient autonomy does require that we allow patients to refuse treatment -- or, if you prefer, compel others to not provide treatment. It does not require that we allow patients to compel others to provide (or continue) treatment. It's the difference between being empowered to say what others _will not_ do to one's own person and (not) being empowered to say what others _will_ do to one's own person. So, contrary to your assertion, it _is_ autonomy (properly understood, that is) that's doing the work. (BTW, your attribution to me of a particular substantive view is so wide of the mark as to be laughable, but for the fact that you apparently offer it in all seriousness.)
The fundamental misunderstanding of autonomy evidenced in your failure to address the substance of my comments is widespread, and might have something to do with disputants talking past each other. It might also explain why, instead of engaging my comments, you so easily dismiss my effort to respect an important distinction as "rhetoric, and nothing more." I'm afraid, however, that it is your easy dismissal that warrants the label "rhetoric."

- by Bob Koepp on May 5, 2005 at 1:48 PM | link

Bob--Certainly you're not suggesting that 'autonomy' can be understood as simply the ability to say 'no'--that's not the sum and substance of autonomy, is it? If that's your vision and view of autonomy, then, please, provide an argument for it, and don't assume that it is one that others will share.
And surely you're not suggesting that doctors, for example, don't owe any duties to their patients other than a duty to abide the patient's 'no'. I mean, surely a doctor has a duty to provide treatment--a duty that arises because of the relationship between doctor and patient. (That is, to make it more clear for you: sometimes a doctor must take particular actions, because of the relationship between doctor and patient. The doctor is compelled to act.)

- by Thomas on May 5, 2005 at 5:52 PM | link

Does a doctor have a duty to provide treatment that he or she, on the basis of his or her training, and in fairminded consultation with current knowledge and medical colleagues, believes will provide the patient with no real benefit?
Is your 'duty to treat' in this context just code for an insistance which is really a modern perversion of medicine, i.e. the insistance to preserve life at all costs, costs to the patient included?

- by geodude on May 5, 2005 at 7:36 PM | link

geodude, in my view it isn't the doctor's belief that matters in determing her duty, but the facts. I don't believe that 'duty to treat' is equivalent to an insistence on preserving life at all costs.
And I don't have an incoherent view of autonomy, unlike some people.

- by Thomas on May 6, 2005 at 3:26 AM | link

Thomas - I'm back... Your view of autonomy might be "coherent" (so is solipsistic idealism), but if it treats a refusal to assist another in the exercise of his/her liberties as an infringement of those liberties (i.e., as a violation of his/her autonomy), then it's at odds with the standard view of autonomy one finds in philosophy, politics and law. So feel free to enlighten the rest of us with your radical new theory. That would be a welcome change from cheap shots taken at strawmen, evasions and non sequiturs.

- by Bob Koepp on May 6, 2005 at 11:36 AM | link

But Thomas, you said before that the duty to treat does not arise out of the facts -- you said it arose out of the patient/physician relationship. That's not the same thing, because there are different conceptions of that relationship, all of which are normative, and from which different actions would be required from an ethical point of view.
So how does your conception of a duty to treat distinguish itself from an insistance on preserving life at all costs?

- by geodude on May 6, 2005 at 4:47 PM | link

Bob--I'm not sure there is a standard view of autonomy used in philosophy, politics and law.
It seems to me that all sorts of controversies in the news recently involve just the assertion you insist isn't made by the standard view. Example: Is it a violation of a woman's autonomy for a pharmacist to refuse to dispense particular prescribed medications? Is it a violation of a rape victim's autonomy for a Catholic hospital to refuse to provide emergency contraception in some cases? Perhaps you don't share the standard view, but the law and politics are pretty clearly on these cases (if not yet uniform).
Since you're back, do you mind answering the questions I posed? They weren't merely rhetorical.
geodude, I don't believe that autonomy is the highest value to be protected in the doctor/patient relationship. I also don't believe that every belief that a doctor has about the merits of a particular course of treatment is in fact the correct one. There are likely a great many circumstances where I'd disagree with the choices and reasoning used in reaching a conclusion that treatment is futile, because I don't think that the question in any case is whether a patient's life is of continuing benefit to him. So, I may disagree with outcomes and reasoning, but not the possibility of reaching the determination properly. Sometimes--often, even--further care is futile and may be withdrawn.

- by Thomas on May 7, 2005 at 5:28 AM | link

Thomas - OK. Autonomy should not be understood as "simply the ability to say 'no'." There's fairly widespread agreement that autonomy entails the ability to formulate and implement plans to more or less effectively pursue goals reflective of personal values. So there's no need for me to provide an argument for an absurd view which I never stated. And no, I'm not suggesting that doctors "don't owe any duties to their patients other than a duty to abide the patient's 'no'." Doctors' duty to respect the autonomy of their patients is only one among many duties -- but it is, nonetheless, a duty so long as the physician-patient relationship is understood as a relationship between _moral_ equals.
As for the controversies you mention, I believe that many supposedly liberal bioethicists have argued for a very illiberal view that is very disrespectful of the autonomy of pharmacists who have sincere moral objections to various forms of birth control. They _claim_ to be championing the autonomy of the women whom these pharmacists are refusing to assist. But in doing so, they are deviating from what I think is the standard view of autonomy one finds in philosophy, politics and law -- precisely because they treat a refusal to provide requested assistance as a violation of the autonomy of the person making the request.
Diagnosing the cause of this error is probably risky, but I think it has something to do with a failure to appreciate the significance of the agent/patient or active/passive distinction. Odd, that, since autonomy is about agency if it's about anything.

- by Bob Koepp on May 7, 2005 at 1:46 PM | link

Hi. Sorry, I've been away. Thomas, perhaps it would help if you explained what the distinction is between this case and that of Terry Shiavo, because, quite frankly, i'm not seeing it.
And please be specific. You have already acknowledged that preserving a broad definiton of 'life' is the only consideration when it comes to patient care. But you believe that the doctor has an obligation to the patient that goes beyond saying 'no', though you muddy things a bit by framing that argument in earlier posts as a being part of a doctor's service to a patients choice. So what, exactly are a doctor's obligations?
Be specific, please, I don't want to mischaracterize your most likely dumb arguments when I inevitably give them a good wacking. :)

- by Carl on May 14, 2005 at 8:31 PM | link

Or, to be more clear. You don't value life as paramount, so what do you value?

- by Carl on May 14, 2005 at 8:33 PM | link

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

- by ra on Nov 9, 2005 at 5:59 PM | link