Apples, Oranges, and Comas by Art Caplan
Wesley Smith has a new column out,
in which he inappropriately uses the case in Belgium of Rom Houben to argue that somehow Terri Schiavo should not have
been permitted to have her feeding tube removed.
Smith argues that a case of locked-in syndrome is somehow analogous to the chance of recovery for someone in a PVS state post anoxia. I would like to have him find three neurologists who agree with that claim.
Terri Schiavo suffered anoxia to her brain--twice! her brain damage was confirmed while she was alive by CAT scan and then at autopsy. She was BLIND despite the alleged tapes that were made showing her tracking objects. Her cortex had shriveled to to half its normal mass.
To equate the discovery of Houben's locked in state with the idea that this provides any reason to challenge Terri Schiavo's diagnosis and prognosis is not
consistent with the facts and does a disservice to those who grapple with the treatment of loved ones who are in PVS states due to anoxia.
The argument about Houben, or at least my argument, is not that he might be conscious and his locked-in state misdiagnosed for many years but rather with the technique of faciliated communication that is being used as the way to 'communicate' with him. FC has been found to be unreliable by many medical and scientific groups. Worse it has a history of being misused in legal cases involving allegations of child abuse that have led U.S. courts to reject it out of hand. Time and again the therapist has been shown to be the source of messages when FC is used. Does Smith credit this technique?
The Houben--Schiavo analogy is completely bogus--they are apples and oranges. It is time for more experts in neurology and the brain sciences
to speak up about the way
in which the Houben case is being misused by those who are still trying to vindicate their erroneous views on the Schiavo case.
As a final point, it is important to point out that not only was Terri Schiavo in a PVS state with 100% certainty, but her husband could have directed her care to be stopped in the State of Florida even if she had been in a minimally conscious state or, for that matter, a 23 year locked-in state. No one is bound to accept medical care if it violates their religious or personal views about what they want from medical interventions. The fact that Wesley is arguing that Houben proves there was hope for Terri Schiavo neglects the core issue of the case--can a spouse direct care be stopped on the grounds that it's provision violates the wishes and values of the patient.
Michael Schiavo insisted his wife would not want to be kept alive in a PVS state. Schiavo's parents and siblings disagreed. But ultimately in Florida the view of the spouse trumps that of the parents/siblings.
With the fifth anniversary of Schiavo's death approaching it is important to get the facts straight and not let ideology drive the ethical assessment of the propriety of
family and patient decisions about what they wish in terms of medical care whether at the end of life or at any other point in their lives.
Arthur Caplan, PhD
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With all due respect, you're chasing a red herring. Smith's article didn't make an analogy between Houben and Schiavo, it instead suggested that much of the blowback about Houben hasto do with our collective guilt about Schiavo. Nowhere in his article does he say, or even hint, that "Houben proves there was hope for Schiavo." It's wrong to misrepresent his ideas in this way. But he's right about the collective guilt--what happened to Schiavo is a horror we can't quite swallow. No amount of "civil" discussion about laws and spouses can change that fact.
- by Elizabeth K. on Dec 6, 2009 at 11:58 AM | link
Art: In your penultimate paragraph, you get the court ruling in Schiavo wrong. The trial court opinion reviewed the testimony of three people, not just her husband, about statements Ms. Schiavo made as an adult that were judged to show a consistent refusal of treatment in the circumstances created by a permanent vegetative state (which is addressed specifically in the Florida advance directive statute). The reports of statements from her parents were from when she was not an adult. This is why the judge did not accept these statements as authoritative substituted judgment. The judge emphatically did not base his opinion on the closeness of the source, i.e, husband vs. parents. Indeed, he was at pains to emphasize that there were sources other than her husband whose reports were reliable. Getting the facts straight is very important, including an accurate report on the trial court's opinion (which is a paradigm of disciplined jurisprudence).
Larry
- by Larry McCullough on Dec 7, 2009 at 8:27 AM | link
Technically, in the Schiavo case, the husband petitioned the court to make a determination about removing the feeding tube.
The court held a bench trial and ordered the removal (as guardian the husband was ordered to by the court)
- by Bill on Dec 7, 2009 at 10:07 PM | link
I love how Art completely dismisses the fact that Michael was living with another woman and had moved with his life. This in my opinion completely destroyed any credibility Michael had about Terri's wishes. Art also forgets to tell you that the witnesses were Michael's brother and sister in law; highly biased witnesses. These 2 persons suddenly "remembered" Terri's alleged wishes after 10 years and after the GAL had deemed Michael's claims uncredible. Finally, both persons testified they never told Michael about Terri's claims which given the timeline and sequence of events in Terri Saga make this a virtually impossibility. The Schindlers lost the 2000 trial because they bad lawyer and the the testimony went unchallenged. Judge Greer apparently accepted it as fact and it became law of the case.
If anyone is interested to know just how "Unclearing and UnConvincing" Terri's wishes really where, I advise you to read the following law review by O. Carter Sneed:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=886373
- by James on Dec 8, 2009 at 7:03 PM | link
Hey Art! You need to read this: http://www.christendomreview.com/Volume001Issue002/lydia_mcgrew_01.html
Most UnClear and UnConvincing!
- by James on Dec 8, 2009 at 7:30 PM | link
Despite the protests of some of the commenters here, Art's article is absolutely on point. Wesley Smith's article did inappropriately conflate Houben and Schiavo and should be called out for doing so. And Caplan rightly points out the established established (though imperfect) legal axis around which these cases necessarily turn: that "a spouse (can) direct care be stopped on the grounds that it's provision violates the wishes and values of the patient."
As to James' comment about Michael S's subsequent relationship and children, the original GAL's report specifically notes that the Schindlers themselves encouraged Michael (who they were still very close to at that stage) to date since Terri would never recover. All on the record, statements uncontested by the Schindlers. Facts are important.
As to Elizabeth K's comment about collective guilt, a decade of delayed justice and a dignified death certainly implies guilt... but only for those who decided to wage a cultural war (with misinformation) from a family's private tragedy.
- by Okakura on Jan 31, 2010 at 1:32 AM | link