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March 19, 2005

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Am I the only one who was sideswiped by this Terri Schiavo thing and is now gobsmacked and just saddened by it all?

Nope. I'm planning to write something tonight. It's revolting.

Also baffling, since it's not as though there's anything about Terri Schiavo's case that's new, except of course for all the grandstanding.

Sorry, to be clear: the case itself is just sad whichever way you look at it. It's what's being made of it that's revolting.

I'm having to excuse myself from engaging in any extended discussion on it. I am not capable of being restrained in expressing the depths of my virulent contempt for the people who are making a spectacle of what should've been between a husband, a wife, and their doctor--all in order to advance their political agenda.

I've been wanting to ask this for some time, now. Why is the link to Google over on the "Reference" list (right hand side of ObWi) labeled "Fear the Pigeons"?

ral: no idea whatsoever.

Music for a quiet Saturday night. (Link will come down within 24 hours or so.)

"Am I the only one who was sideswiped by this Terri Schiavo thing and is now gobsmacked and just saddened by it all?"

It is absolutely horrifying. Seriously, I find the rendition stuff easy to deal with compared to this.

I've had two grandparents, one step-grandparent, and one grandparent-in-law die within the past year. Removing a tube or declining to insert one is an incredibly common issue for families to deal with. It's come up much more often than not for my family; perhaps that's atypical--aspiration pneumonia often seems to be the cause of death though. It is really quite an experience to hear people say what happened at Abu Ghraib was not torture, and that what would happen to Terry Schiavo if her feeding tube was removed & the medical decision that the immediate family members made for at least three of my grandparents is torture.

The media tends to talk as if science and facts are on one side of a debate and religion and morality are on the other, and they are often opposed. I think this is exactly wrong. Refusing to acknowledge science and to more generally engage with the facts leads to gross, appalling immorality.

Katherine: on my music link is a song that sums up my entire political mood just now. I think of it as the 'they can't pass HR 952, but they can subpoena Terri Schiavo' song. (It's 'Withered and Died'.)

Why is the link to Google over on the "Reference" list (right hand side of ObWi) labeled "Fear the Pigeons"?

You didn't know that Google technology is based on pigeons?

Ignorant fool that I am, I had tried googling for "fear the pigeons". Instead, the search "google pigeons" turns that up as the first hit.

Thanks, Jes.

Thanks for the music link, Hilzoy. I've heard of Richard Thompson but never heard him. Turns out that one of my faves, Robyn Hitchcock, covered two of the songs on your page!

Unfortunately I don't have one of them nifty music pages. Is that through iTunes?

I think what Vanderleun says about the Schiavo case is interesting.

Vanderleun writes: "it is not possible to know her will"

Well, the courts have already done so. Repeatedly, based on a very high standard. It's important to keep this in mind.

On the Schiavo case...it just seems contradictory the way some people oppose the death penalty because of the possibility for an uncorrectable error yet don't see the same possibility for error in a case like this.

Unless we are 100% certain, with no possibility of error, that the woman would have wanted to be killed if she was ever put in the circumstances she is in, we should oppose killing her. I am not intimately familiar with the details of the case, but I doubt that we are 100% sure of what the woman's wishes would be. If there is any doubt whatsoever, she should be kept alive.

That is the same principle that should apply with respect to the death penalty. There is no margin for error. If she had made out a living will expressing what her wishes would be, and if we were completely sure that will in fact was authentic, I would have no problem with what is being done. But I don't believe that is the case. Please correct me if I am wrong. 99% sure is not good enough when it comes to killing another human.

If there are flaws in my analogy, I'm sure you all will let me know, but that's my perspective on it.

Thanks hilzoy, it's always nice to know that the important issues will be dealt with by one of your posts... i.e. usually excellently.
[/flattery]
But seriously, "gobsmacked" scarcely described my own reaction to the disgusting circus that the professional Outraged Morals gang, and their stooges on Capitol Hill have made of this whole tragic situation: it would be nice to think that the blogosphere would or could add something productive to the discussion: hopefully you can help.
I doubt it, though, given the tediously predictable responses from the usual suspects... good luck!

It's through .mac. I just figured out how to make it. It will only be around for a day or so, since the idea is just to get me over that frustrating feeling of wanting to tell people: you must listen to this! And then you should buy the album!, not to encourage piracy.

Felixrayman: I'll try to address your argument in my post. I don't agree with it. But that's what I ought to be writing about now ;)

I have things to say about the Schiavo tragedy, but it's Saturday and I'm in a good mood.

Later, when someone here posts on it.

I can't get through to Billmon to make a link, but there's a post there about the Schiavo thing that just boils my blood.

And via Respectful of Otters I see that the poor woman has no c. cortex left. What a horrible death-in-life.

"99% sure is not good enough when it comes to killing another human."

This is a good argument, but I'd counter that Mrs. Schiavo is not alive. She's gone. What's left is to my mind a might-as-well-be Satanic mockery of what a human being is.

Unless we are 100% certain, with no possibility of error, that the woman would have wanted to be killed if she was ever put in the circumstances she is in, we should oppose killing her.

Felixrayman: I'll try to scoop hilzoy here. There's a legal standard, and it has been met:
-------------------------
Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate such as Michael can petition a court, asking the court to act as the ward's surrogate and determine what the ward would decide to do. Michael did this, and based on statements Terri made to him and others, he took the position that Terri would not wish to continue life-prolonging measures. The Schindlers took the position that Terri would continue life-prolonging measures. Under this procedure, the trial court becomes the surrogate decision-maker, and that is what happened in this case.

The trial court in this case held a trial on the dispute. Both sides were given opportunities to present their views and the evidence supporting those views. Afterwards, the trial court determined that, even applying the "clear and convincing evidence" standard -- the highest burden of proof used in civil cases -- the evidence showed that Terri would not wish to continue life-prolonging measures.
---------------------------
Now, if you think the burden of proof should be higher, you should lobby for the standard to be changed. As for "killing," she's not being killed. Her artificial life support is being taken away.

praktike, if her higher brain functions continued but she was paralyzed, and she indicated she wished to live, to remove the feeding tube would be to kill her, no?

True, artificial life support is not enough -- if that's the point you're trying to make here.

There's a legal standard, and it has been met

Oh, I don't disagree with that, I'm not a lawyer. I am not making legalistic arguments, I am arguing from the perspective of imagining I was in her place. If I was in her place I would want the life support to stay on as long as there was a heartbeat. My standard to remove life support is "100% sure". I don't think that has been met with regards to whether her wishes are being taken into consideration, and I don't think that it has been met with regards to whether there is any possibility of her regaining "consciousness", whatever we may define that to be. Doctors will tell you they have seen stranger things. If you are really 100% sure on either one of those issues, that's fine, I can understand the decision given that as an assumption, but I am not 100% sure on either of those issues.

100% is a hard standard to meet, but with regards to capital punishment, it is the standard om which I insist. Why should this be different?

Well, I think that, again, she expressed that she wouldn't want to be kept on a tube, and I also think she's not "alive" in a meaningful sense nor will she ever get better, so your conditions have been met.

rilkefan:
The question you ask goes right to the heart of the Terri Schiavo case, but at the same time renders the issue moot. By all (medical, not moral or poitical-opinion) indications, Terri Schiavo doesn't HAVE any higher brain functions, inasmuch as she doesn't have much higher brain left TO function. Check out the Respectful of Otters link, Rivka (who IS a doctor, and should know) points out that the Schindler family's submissions to the Florida court as to Terri's condition, prospects for "rehabilitation", and "responsiveness" are, to be charitable, excercises in wishful thinking.
In the example you cite, yes, removing a feeding tube would be "killing": Terri Schiavo's situation, though, doesn't fit the circumstances.

...and, in another case, a hospital in Houston (Tom DeLay's hometown, BTW) disconnected a 5-month old infant from life support against the wishes of her mother. The hospital had the law on its side - a law which was first enacted in 1999, with the support of the National Right to Life Committee, Texas Right to Life, and the Hemlock Society.  The bill passed both houses, unanimously, both years, and the 1999 law was signed by then Governor George W. Bush.

I'm not saying Sun Hudson shouldn't have been disconnected. Her case seems to have been as hopeless as Terri Schaivo's. But the same people who are now supporting the Schindlers approved of the law disconnecting life support in Texas. And the same mainstream media which is breathlessly covering every new development in the Schiavo case has pretty much ignored the Hudson case.

There are important differences between the two cases, of course. Sun Hudson and her mother are both poor and black.

so your conditions have been met

And you are 100% sure of that? Or if not, you would be willing to use the same level of certainty for capital punishment?

"Think" and "know for sure" are two different things to me. That's why the certainty argument with regards to capital punishment has merit as far as I'm concerned.

A great list for those in love....I really feel for Mr. Schiavo.

Nat King Cole & George Shearing: Fly Me To The Moon
Sarah Vaughan: I Won't Say I Will, But I Won't Say I Won't
Shirley Horn: I Wanna Be Loved
Billie Holiday: It Had To Be You
Blossom Dearie: Manhattan
Monica Zetterlund: Some Other Time
Shirley Horn: Ten Cents A Dance
Sarah Vaughan: Someone To Watch Over Me
Dinah Washington: Since I Fell For You
Shirley Horn: Only The Lonely
Anita O'Day: Early Autumn
Ella Fitzgerald: Spring Can Really Hang You Up The Most
Blossom Dearie: Some Other Time
Sarah Vaughan: Embraceable You
Dinah Washington: My Old Flame
Ella Fitzgerald: Mood Indigo
Billie Holiday: I Gotta Right To Sing The Blues
Pearl Bailey: Tired
Dinah Washington: Ev'ry Time We Say Goodbye

If I was in her place I would want the life support to stay on as long as there was a heartbeat.

...but this isn't about you. I know that sounds flippant, but it's not. What you want, what I want, what "any sane person" would want - none of those are the issue. Legally and morally, the issue is what Terri Schiavo wants (or would have wanted before she became incapable of wanting). The evidence provided by those who knew her best overwhelmingly indicates that she would not have wanted life support to continue at this point. It's no different than if she had decided to commit suicide. We who survive might be saddened or angered by such a choice but, if we believe in the right of people to make their own decisions, we must support their right to make this one. To do otherwise is to say that society (which doesn't even have a compelling interest in this case) knows better than the individual.

It's fine that you would make a different decision. By all means, put that in your living will. Just don't think that your choice should apply to everyone.

Correct, Platypus. Felix, you should get a living will done stating that you want to be kept breathing in such a situation. I, like Terri, do not. So I will make that clear myself when I get the opportunity.

Life interrupted me, and since we're all talking about this anyways, I'll just scoop myself: felixrayman's view makes sense, I think, only on the assumption that letting Terri Schiavo die harms her, but keeping her alive does not. If you think that going against someone's wishes about something as fundamental as this harms her, that isn't true. Personally, I think Terri Schiavo is being harmed even as we speak, by all the ghoulishness.

but this isn't about you. I know that sounds flippant, but it's not. What you want, what I want, what "any sane person" would want - none of those are the issue. Legally and morally, the issue is what Terri Schiavo wants

And I don't believe the evidence is 100% certain on the issue of what she would want. Again, I do not know all the details of the case. But my standard on putting someone to death against their wishes is much stricter than my standard for keeping someone alive against their wishes. Those are my values.

Felix, you should get a living will done stating that you want to be kept breathing in such a situation

I should do a lot of things, but I am lazy. Yes, if she had a living will we would not be having this discussion. But, given that, were I to become incapacitated, what standard would you apply before you would allow me to be killed? I would hope it would be pretty high - higher than circumstantial evidence or the testimony of a relative, at the least.

felixrayman's view makes sense, I think, only on the assumption that letting Terri Schiavo die harms her, but keeping her alive does not

That's close, but I would add that letting her die harms her in an irreparable way, as does imposing a death sentence on someone convicted wrongly of a capital crime. Sure, my argument rests on the assumption that killing someone when they wish to live is worse than forcing someone to live when they wish to die. In my moral universe, this is true - I would like to be treated in the future as though this was true.

One of my arguments - not my only argument, to be sure - against capital punishment is that death is different. When it comes to killing, our standard of proof must be higher. I do not like the grandstanding of Congress on the issue. I am not arguing from a religious point of view. But after careful consideration, I think what is being done is wrong.

It is not killing. It is removing artificial life support. It would be still be utterly unethical if it were done against the patient's wishes, but this is a distinction our law makes and a distinction our law needs to make.

Your argument would lead to many needless deaths, because people's relatives would be afraid to allow them to be rescusitated in the case of a sudden heart failure or be put on a ventilator in the case of a sudden loss of lung function, because they risked being forced to keep their relative alive, either unconscious forever or in pain, hooked up to machines that fed and breathed for them, in a way that the relative never, ever, ever wanted.

People would also be forced to die in hospitals and not at home, contrary to their wishes.

This would cost a great deal of money. Our society cannot claim that "money is no object when death is on the line," at a time when a lack of health coverage causes many preventable deaths and untreated illnesses every single year.

Living wills are good things, but it is simply impossible to write a living will to deal with all foreseeable medical conditions. I know of few cases where the relatives don't have to make a judgment call. A living will helps guide them in those judgments, but it cannot answer every question and remove all doubt.

I have personal knowledge of this. I was not the decisionmaker or a participant in the decisions in any case, fortunately, but people I'm very close to did make these decisions. In general, many of the people discussing this case seem to have no familiarity at all with end-of-life medical decisions. This is strange to me; all families go through this. I guess mine has gone through it a lot recently, and I do have a big family.

Life is not an on-off toggle switch--not at the beginning and not at the end. The beginning takes a little over nine months--a slow sunrise rather than the turning on of a lamp in a single moment, but at least it is predictable and steady. The end is neither of these things. There will almost always be room for doubt--usually much, much, much more doubt than there is in this case.

The death penalty is a totally different situation. There is no doubt that we are killing a person; the question is whether it's an innocent person or a guilty one. We are not forced to choose between killing people and artificially prolonging their lives in agony or unconsciousness against their will; the alternative is life imprisonment. And, in fact, we do not require "no doubt." We require "guilty beyond a reasonable doubt" at trial, and if reasonable doubt arises afterwards, too bad for them, and if they had a sleeping lawyer, too bad for them. If they can show it is less likely than not that they committed the crime--it is still sometimes too bad for them. (I am sure you strongly oppose all this but the people who are most vocally calling for us to "resolve all doubts in favor of innocent life" in Schiavo's case do not. In fact a remarkable number of them are directly implicated in the capital punishment system's failure to resolve doubts in favor of innocent life.)

I can't understand how people who believe in God and Heaven want to keep Terri from making the last leg of her journey to eternity. I know the argument is that the removal of the tube is against God's will, but it seems to me that the presence of the tube constitutes an interference with the death process, not a continuation of life.
I also question the sincerity of the legislators who voted against Medicaid funding and in favor of the bankruptcy bill, but now claim to respect life. They seem completely hypocritical to me.
Since there is no hope that she will recover, I hope Terri can complete her death soon. If I was a praying kind of person, I would pray for her release.

Katherine
And, in fact, we do not require "no doubt."

I would argue against capital punishment on that basis. I would aruge against removing life support without a clear indication of desire from the patient on that basis.

I am sure you strongly oppose all this but the people who are most vocally calling for us to "resolve all doubts in favor of innocent life" in Schiavo's case do not

I do oppose all that and am trying to work out what would be consistent with my beliefs about capital punishment. If the woman is truly already dead and beyond consciousness, how does it harm her to leave her on life support? It does not.

lily
I can't understand how people who believe in God and Heaven want to keep Terri from making the last leg of her journey to eternity

I believe in neither. If we are going to make medical decisions for those unable to make them, and for those who have not expressed a clear and undeniable preference, I believe we should be very conservative. If you think the chance of the person in question ever regaining consciousness is precisely 0%, than I have no problem with your argument. But in my experience certainty is a very rare thing, and I advocate caution when doing something that can't be undone.

I don't see the compelling need for immediate action. If the woman is not alive, she feels no pain, and we need not hurry. If she is alive, we risk killing her against her wishes. In the final analysis, death is different.

"I would aruge against removing life support without a clear indication of desire from the patient on that basis."

Not to repeat myself, but ...

The trial court in this case held a trial on the dispute. Both sides were given opportunities to present their views and the evidence supporting those views. Afterwards, the trial court determined that, even applying the "clear and convincing evidence" standard -- the highest burden of proof used in civil cases -- the evidence showed that Terri would not wish to continue life-prolonging measures.

If I was in her place I would want the life support to stay on as long as there was a heartbeat.

What is the sound of no brain-cells clapping?

What is left when the mind is gone forever?

Not to repeat myself, but ...

OK, if you didn't understand that the criteria I was using was 100% certainty, well there it is. If you are 100% certain of what the person in question wanted, then I have no argument with you. Personally, I have only been 100% certain of anything once, and as it turned out, I was wrong.

What is left when the mind is gone forever?

No pain and no suffering among other things. And if there is no pain and no suffering it would seem that there should be no big hurry to yank the cord out of the wall.

The sanctity of marriage, indeed.

felixrayman
I appreciate your comments even though I disagree. But I would like to ask what would induce you to change your mind in this case? You seem to be employing a form of Descarte's bargain, that given that the alternative could be infintely worse, we should avoid it. But the danger in demanding that all doubts be erased is that it would seem to make us unable to make distinctions. Also, I wonder (not intended to be snarky, genuinely curious) what you've read and what strikes you as unfair/demagogic.

Googling about for stories and statistics and these two were interesting. This is a pdf of a powerpoint presentation about estimating the number of children who are brain dead (who would not have a living will)

This was also interesting, the story of a California inmate who was shot in a prison and declared brain-dead, and regulations demanded that 2 guards be kept by his prison hospital bed.

"OK, if you didn't understand that the criteria I was using was 100% certainty, well there it is."

Sorry, I thought you had switched to "clear."

"And if there is no pain and no suffering it would seem that there should be no big hurry to yank the cord out of the wall."

I'm going to be rigorously pedantic here ... it's a feeding tube.

This is not just a legal problem that can be debated. It is not just a scientific or tech problem about the definition of death in a time where it is possible to maintain the mechanics of a person's body going after they have lost consciousness.

Terri is or was a wife to her husband and a child to her parents. Not so many years ago, it was commonplace for children to precede their parents in death, and for a wife to die in childbirth. If my wife dies, and I married another woman and had children, well, life goes on, and how long must I be expected to grieve?

Nowadays, we have different expectations. I would gladly give my life in exchange for my children's lives. The loss of a child would be devastating. Every parent expects and wants to die before their children. It is also expected that women will survive longer than their husbands. I've got most of the life insurance policies.

Whose grief is greater? Terri's parents who fight for the life of their child? Or her husband who wants to salvage something of a normal life.

This is a tragedy. It is not an ordinary end-of-life, old age situation. It cannot be fixed. Debate and blame are ultimately futile.

And if there is no pain and no suffering it would seem that there should be no big hurry to yank the cord out of the wall.

It's been 15 years since she succumbed; is that little enough of a hurry?

But I would like to ask what would induce you to change your mind in this case?

Other than a living will or something similar, I don't know what would. I would want the same level of certainty that I would want before someone was executed, and that would be a very high level of certainty indeed.

For those of you 100% sure that the person in question would have wanted life support removed, I have no argument with you. But I am not 100% sure.

And it is true that all my arguments here rest on the assumption that it is worse to kill someone who wishes to remain alive than it is to keep someone alive who wishes to die. But that is an assumption I am working from and I am not going to give it up.

If anyone has an argument that takes both of those factors into account and comes to a different conclusion than I have, I would love to hear it. Until then, I just think what is being done is wrong, and I have explained exactly why I feel the way I do and that's it.

"If the woman is truly already dead and beyond consciousness, how does it harm her to leave her on life support? It does not."

It subjects her medical treatment to which she never consented to and never would have consented to. Depending on her religious beliefs, she may have thought that being in such a state denied her the possibility of heaven or of rest for decades. She may have even been right; we have know way of knowing.

We obviously do not consider it all right to desecrate a corpse, or to disrespect the deceased's wishes about how his or her remains should be treated. Whatever motivates us in that case, ought to motivate us much much more when there is a living body.

There is quite literally no outrage that could be committed upon my dead body that fills me with as much horror as existing in Terry Schiavo's state for decades. None. Not even close.

You rule would also be equally applicable in cases where a patient was past the point where he could express any competent wish about whether kept alive, but could still feel a great deal of pain.

It also subjects her relatives to one of the worst forms of psychological anguish that I can possibly imagine. Voluntarily in her parents' case, and if they were her guardians that would settle it. But involuntarily in her husband's case, and if your suggestion became law, it might apply even when all the relatives wished for the person to be allowed to die.

I cannot tell you, without going into details that are much too personal to reveal here, what sort of destruction and pain your supposedly compassionate rule would have inflicted upon my family in the past year if it was written into law.

Just to explore a little further, this would mean that brain dead infants would also require the same level of certainity? I understand the intellectual idea behind your opinion, but I wonder how it runs into other situations where resources dictate that it isn't practical.

"And it is true that all my arguments here rest on the assumption that it is worse to kill someone who wishes to remain alive than it is to keep someone alive who wishes to die."

I would guess that every single one of us is working from that assumption and Florida law does too--hence "clear and convincing evidence." But when you raise it from "clear and convincing evidence" to "absolute certainty", you guarantee keeping alive many, many people who wish to be allowed to die, and whose families wish them to be allowed to die. You cause needless pain. You will ironically also cause needless premature deaths, because people will tend to refuse medical care earlier on, when they still have the option of doing so, rather than risk being kept alive against their will when their brain has been destroyed or they are experiencing agonizing pain, and rather than risk the suffering and expense this will cause their relatives. You will cause even more premature deaths by driving up health care costs and health care premiums in a way that causes even more poor and lower medical class people to be denied access to health.

It subjects her medical treatment to which she never consented to and never would have consented to. Depending on her religious beliefs, she may have thought that being in such a state denied her the possibility of heaven or of rest for decades. She may have even been right; we have know way of knowing.

This all comes back to the same point. I think it is worse (by orders of magnitude) to kill someone who wishes to remain alive than it is to keep someone alive who wishes to die. I don't know 100% for sure what the woman's wishes were, and I don't know 100% for sure that she would never be conscious again. Maybe you know one or both of those things with certainty. I don't. Given that uncertainty, I think removing life support is wrong. If there is a 0.00001% chance that she would have wished to remain on life support, and if there is a 0.00001% chance that she will ever regain consciousness, I can not support removing life support.

Similarly, if there is a 0.00001% chance of sending an innocent person to the electric chair, I can't support the death penalty. And there are certainly other reasons I oppose the death penalty, but that one is relevant here.

Death is different. I will be the most conservative of conservatives as far as taking another human's life goes.

felixrayman -

According to your standard, there is no way to prove a braindead person will recover. How could you do it? If there is some part of the brain functioning, and you can get some mystic/crank/doctor to say a miracle may happen, when do we die? We would spend millions on keeping the elderly alive way beyond what is feasible, warranted, and ethical.

Her life as she knew 15 years ago it is over. Any semblance of a uniquely human mind is gone. The law has a very high burden of proof for this. There have been several hearings on this very case. How many more experts need to battle it out in court to convince people?

Furthermore, given the above, it shows a simplistic view of life to say Terri must be kept alive. Katherine puts it much more eloquently, as usual. Life is a continuum. Even more importantly, a definition of life should (and maybe this is the sticking point) include liberty. Her wishes were discerned as best they could by those who were closest to her. Several times. She wouldn't want this. Period.

Is it life to have your husk treated as a political football?

The Billmon link noted above. CaseyL's subsequent post refers to the same case.

You will never, ever, ever know with 100% certainty what someone's wishes were, because people don't write living wills that specifically, because we do not get advance notice of the circumstances of our life threatening illnesses, accidents, and our final illnesses and deaths.

The relative I'm talking about had a living will. A pretty carefully written living will, I assume; she'd been a caregiver for terminally ill people herself, and worked in support groups for the area.

You have completely failed to engage my arguments about how this actually would play out in real life. I don't think you've been anywhere near this sort of decision--I haven't been all that near to it as these things go, but if you had even the little knowledge I have, you could not possibly make the arguments you're making.

Enough; this is too upsetting.

Worse than a decision some may find reprehensible is hypocrisy about the decision.

"if you had even the little knowledge I have, you could not possibly make the arguments you're making."

Not a convincing line of reasoning. I disagree with felix here but he has an admirably consistent worldview based on a sensible moral position.

Except for the part where it leads to more deaths than it saves. "Admirable consistency" divorced from the reality of human life has disastrous results.

You will never, ever, ever know with 100% certainty what someone's wishes were

Will you ever, ever know with 100% certainty that someone is guilty of a death penalty crime?

You may not wish to use certainty as an argument against capital punishment, but I do. It's not my only argument against capital punishment, but it is one of them. I will apply that argument consistently. And in this case, that means you don't risk taking an innocent life. The person in question may not be alive, whatever that means, but I don't know that with certainty. And the person in question may have wished to have life support removed in the circumstances she is in. But I don't know that with certainty.

Given those facts, I can't go along with what is being done, I think it is wrong.

And thanks, rilkefan. I'm not trying to irritate people and I'm not trying to take an unpopular position just for the sake of doing so. I'm trying to treat others as I would have them treat me.

I don't think "maximizes number of breathing human beings" is a safe moral standard but I'll leave that sort of question to those more qualified to answer it.

Last in response to Katherine in anticipation of hilzoy.

But, if it is too impolite to argue this in concrete human terms: I think there are at least two areas of conceptual confusion here:

1. The difference between killing a person and not giving life saving medical care to a person.

If you think that killing and declining treatment are the same thing, then a patient who chooses not to go on a respirator or not to undergo a painful operation or chemotherapy treatment that has little chance of success is trying to commit suicide. Normally when someone tries to commit suicide we will do everything in our power to stop them, even against their will—pump their stomach, place them in a psychiatric hospital, etc.

I have seen one person actually argue that the same should apply to refusal of medical treatment, but I doubt you would agree with that argument.

2. The difference between the state deciding to withdraw life-sustaining medical care, and the state’s not overruling a family member or guardian’s decision or a patient’s “clear and convincg” intention to withdraw life-sustaining medical care.

You keep saying, “when it comes to taking life, I’m going to be very conservative.” But no one is suggesting that you or I take Terry Schiavo’s life and no one is suggesting that Congress vote to take Terry Schiavo’s life. We are suggesting that the decision should be left to patient if possible, and to her closest legal guardian if not, and to a court acting in the patient’s interest based on a “clear and convincing evidence” standard if there is a dispute about the patient’s wishes or the patient’s proper guardian.

"In 1999 then governor Bush signed a law which allowed hospitals to withdraw life support from patients, over the objections of the family, if they consider the treatment to be nonbeneficial."

This sort of seems reasonable from my point of view, but also very different from my understanding of people's take here. Say Mrs. Schiavo would have wanted to die in these circumstances but her husband and family refused to honor her wishes - I would feel uneasy about the state intervening, even if it's in some sense for the best.

The difference between killing a person and not giving life saving medical care to a person.

If she isn't fed, she'll be dead in a week or two. There is no substantial difference here.

Normally when someone tries to commit suicide we will do everything in our power to stop them, even against their will

If I believe 100% that someone is trying to commit suicide, I have no problem with that. That's not what we're talking about here. I may or may not have moral qualms with helping someone commit suicide if I believe that is what they want to do, but that is not the issue at hand.

You keep saying, “when it comes to taking life, I’m going to be very conservative.” But no one is suggesting that you or I take Terry Schiavo’s life

Nor am I jumping to man the prayer barricades of those protesting the decision. I am just saying I think it is the wrong decision. It's simply wrong.

We are suggesting that the decision should be left to patient if possible, and to her closest legal guardian if not, and to a court acting in the patient’s interest based on a “clear and convincing evidence” standard if there is a dispute about the patient’s wishes or the patient’s proper guardian.

And I am suggesting that is too weak a standard, given the fact that you can't undo mistakes if you make them. How do you undo the damage if you are wrong?

felix: Are you, in fact, arguing that either a) you are uncertain of Terri Schiavo's wishes or b) you are uncertain as to whether or not she can recover, or c) is this entirely hypothetical? I'm having a hard time figuring out your stance relative to the matter at hand.

Are you, in fact, arguing that either a) you are uncertain of Terri Schiavo's wishes or b) you are uncertain as to whether or not she can recover,

Both are less than certain, in my opinion. Note that certain means 100% sure - please compare to the certainty you would need to put a convicted murderer to death. If your estimates of probability differ from mine, your assessment of the situation will necessarily be different than mine.

Not trying to score points here, but this 100% certainty notion is really baffling for me. I understand that some people can be 100% certain about things, but I have honestly never been 100% certain of anything. I just signed up for the bone marrow donor program here, and even in that, after going through all of the explanations and working out the Japanese brochures, just before I put my pen to the form, I hesitated.

Bizarrely enough, this makes me less inclined to the pole that felix occupies (recognizing that this is his heartfelt opinion and I don't begrudge his right to hold it) because it seems like we would be completely paralyzed. At some point, we have to turn over responsibility. That's why this case is so problematic, that the people that this decision should rest with are deadlocked.

Felix, the difficulty is that we don't know that Ms Schiavo isn't feeling pain. (She has, by her brainscan, no human mental functions left - she literally can't think about her situation, because not only is there no capacity for thought, there is probably not even an "I" any more to do thinking.) Say she's about the level of a shellfish. Pain is something that even a shellfish can feel - back when I was in high school, I was handed a living shellfish to dissect, and saw for myself that it moved inside the shell to get away from the sharp metal point. It felt pain. I am a vegetarian, but not a believer that "animals have rights": still, I believe that deliberately causing pain, or letting an even an animal suffer unnecessarily, is wrong.

Ms Schiavo may be feeling pain. Keeping her alive in a state where (a) it's as clear as it can be that she'll no longer recover (b) the courts have, in a lengthy and careful process, established that she wouldn't want to be kept alive (c) she has no mental functions left (d) she has still the capacity to experience pain/discomfort is not a morally neutral thing to do:

You take an admirably consistent moral position. But it's not my moral position: I think that when a person has gone into the state Ms Schiavo is in, if it can be clearly established that she would have wanted to die, she should be let die. This to me is different from deliberately killing someone who wants to live.

Can I ask a question? Supposing that instead of going through all this careful legal procedure, Ms Schiavo's husband had simply gone into the care home, waited till he was alone for fifteen minutes, and smothered her with a pillow?

Would you feel he ought to be tried for first-degree murder, and punished accordingly, or would you recognise a degree of extenuation in the circumstances?

The other difference between this and capital punishment is the relationship of society's action to the desires of the (soon to be) deceased. In the case of capital punishment this relationship is clearly one of opposition. Society is clearly opposing the individual's will, and an error takes on a particular significance. In the Schiavo case society should be trying to accommodate the individual's will, which gives error a different significance. Hilzoy's point about harm being done by keeping someone alive against their will intertwines with this one in more ways than I can explain when I'm supposed to be wrapping up so I can take a turn at baby care.

I wonder how much of an issue this would continue to be if, taking as a given that the courts had decided on a infinitesimal possibility of recovery, complete brain death, and a clearly expressed wish to die, doctors in this country were allowed to just administer a massive overdose of cyanide or morphine rather than simply remove a feeding tube and let the process take place slowly (and, perhaps, painfully). It seems wrong to me that, even in situations where we will allow people artificially kept alive to finally die, we can't treat them as humanely as we would a housepet.

Since this is an open thread, I thought people here might be interested in this NYT piece about a Kurdish immigrant/terrorist(?) facing deportation.

I'm very puzzled by felixrayman's contention that he can't be 100% sure Terri Schiavo won't recover.

Her cerebral cortex is gone. It has necrotized and turned to liquid. CAT scans show vast dark areas where there should be brain tissue.

What part of this does felixrayman think can be reversed? And what therapies does he think will accomplish the reversal?

Do most people here regard as "admirably consistent" the position that life begins at the moment fertilization--or at least life may begin at fertilization--and therefore the birth control pill must be banned and the morning after pill must be banned even in case of rape?

Least cordial dragons at a tea party

Niddhog (too Norse)
Smaug (too Tolkienian)
Jormungandr (too world-eaty)
Tiamat (too Leviathany)
Fin Fang Foom (loud, impetuous, often eats Iron Man)
Smoky Joe's Hot-Hot Dragon Salsa (very messy, but delicious with chips)

I disagree with that position but consider it a sensible moral one coupled with an anti-death-penalty/anti-euthanasia/anti-war stance.

Kleiman on the Schiavo, Hudson, and Nikolouzos cases.

For the record, I don't think fafnir's position on anything is sensible and moral or even nutritious.

Well then rilkefan you just try an host a tea party for Jormungandr. He barely fits in the door is all I'm sayin.

via Atrios, terror and the right to die, all wrapped up into one.

Yeah, figured fafnir for one of those door-hugger types. Also like him not to know the dragon moral code as regards tea parties.

"Do most people here regard as "admirably consistent" the position that life begins at the moment fertilization..."

The word "life" as used here makes no sense, both the sperm and egg are alive. "Personhood" unless "life" here is shorthand for "a unique human life."

"Personhood", "unique human life", "viable" are words individually and socially/politically defined, and don't strike me as particularly factual or scientific. And very complicated. The moral difference for some, at 3 weeks pregnancy, between a miscarriage and an abortion is not the condition of the foetus but the intent of the mother.

fafnir, I'll see your tea party, and raise you the entire Galapagos island chain. With saucers.

oh, and btw I think this ought to simplify matters considerably:


The patient in this case left no written instructions as to how she wished be treated in case of irreversible brain damage of the kind that she suffered fifteen years ago. But a court acting on her behalf, having consulted many people who knew her and having reviewed all of the medical evidence, reached a judgment as to what she would have wished, and that judgment has been upheld by a court of appeal. The patient has a right for her medical treatment to be guided by this judgment of her wishes. That's all there is to the case.

First of all, I utterly reject the idea that a moral position's "sensibility" is determined purely by its internal logical consistency. If you believe that Jews are doomed to hell unless they convert to Christianity, it is perfectly logically consistent to force them to convert by the most brutal means imaginable--you're only making them suffer now to guarantee them paradise later. It's admirable logically consistent; it's also, insane and immoral and just plain evil.

Second of all, you need more than that for consistency. You also need to believe that:

1. in vitro fertilization as it is currently practiced in this country ought to be illegal.

2. The IUD must be illegal. (Not a major issue here; big issue in the dedveloping world.)

3. There is no moral difference between preventing a fertilized egg from implanting, an early term abortion, or a late term abortion. This is necessary for consistency because eliminating the pill & morning after pill would guarantee that more abortions took place, later in the pregnancy, under more dangerous conditions that led to more women's death. It would also guarantee more deaths in childbirth or because a parent could not adequately provide food or health care for their child, especially in the third world.

You could argue that you're only responsible for the effects of your decision that you intend, not the ones you merely know of. But you cannot consistently do this, because you are arguing that the government has a responsibility to illegalize abortions even though it does not actually wish or intend that any woman would have an abortion; they merely know that more abortions will occur if it's legal. You are arguing that family members have a responsibility to keep their relative on a feeding tube even if they don't want their relative to die when they take out the tube; they merely know that it will happen.

4. If you believe #3, then for consistency's sake women whose negligent care for their own health leads to a miscarriage should face criminal charges.

5. If a complete stranger needs one of your kidneys to live, and you could survive without it, it would legitimate for the government to force you to donate it against your will.
There are two ways we normally distinguish this situation from abortion:
--the women assumed a duty to care for the embryo/fetus/child by having sex. But that cannot be true of a rape victim.
--Failing to provide someone with life-saving medical treatment is not quite the same thing as killing them. But this is inconsistent with the views about declining medical care at the end of life.

6. A patient who declines medical treatment that might prolong his life because he is in too much pain or does not want his body living when his brain has died is attempting to commit suicide, and should not be allowed to do so.

7. Hospitals have an obligation to provide every single potentially life-saving medical care to everyone, indefinitely, regardless of their ability to pay for it, their own wishes (we do not honor a wish to commit suicide), or their family's wishes.

also:

8. we cannot deport any immigrant to any country where his life would be in more danger than it is here, regardless of the source or degree of that danger.

9. we have a moral obligation to fund life-saving medical care in other countries as generously as we fund it here.

List:

people I'd like to be able to argue like: Katherine
people I'd like to be able to free-associate like: fafnir

I know, I've got a *right* to free associate, it's just mine never come out quite as funny.

Does anyone know the official right-to-life position on identical twins? Seems like at least a puzzle on their view. The soul arrives at fertilization--welcome new person! We'll name you Fred! Then at some later time the blastoma splits into two pieces, each of which will develop into Ed and Ned. So what's the view:

1) Fred's soul split in two when the blastoma did?
2) Fred's soul continued on as Ed's soul, but Ned's soul arrived, not at the moment of fertilization, but at the moment of blastoma-fissure?
3) In this case, there was no soul at the moment of fertilization, because God could see the future fission of the blastoma? So there never was a Fred?
4) At fertilization, an accounting mistake implanted two souls in one fertilized egg, and they quarreled and split up the act?
5) First there was Fred's soul. But Fred died when the blastoma fissioned. Ed and Ned killed him.

Or what? Presumably Catholic theologians have this all worked out.

One final thing: I was initially very, very angry at Senate Democrats for becoming part of this abuse of power. I am still very angry at some of them--Reid, Dorgan, etc.--for their statements about the issue. But some of them may be trying to prevent a much worse abuse of Congressional power. I base this on reading the Congressional record's debates on these bills.

The House bill sounds much, much worse than the Senate bill. See these remarks by Congressman Nadler:

"So what does this bill do? It would place the Federal judge and then Federal appellate judges in the middle of a case, after State courts, doctors, family members, counselors and clergy have struggled with that case perhaps for years. After everything is over, everything determined, everything adjudicated, and the participants finally sighing a sigh of relief that it is over, then a Federal judge jumps in. It does not deal just with feeding tubes. It would allow intervention in any decision affecting any kind of medical care. Read the bill. It even says that the cause of action does not include a claim or cause of action in which no party disputes and the courts find that the incapacitated person while having capacity executed a written directive, et cetera.

What does that mean? It means that after someone writes a living will and says I do not want to be resuscitated, or do not use painful treatment beyond a certain point or whatever, and after the courts in that State have found that that is what happened, that that is what the person meant and that those instructions are to be followed, some busybody from outside can now come in and start the process all over again, notwithstanding the fact finding in the State courts, because we do not trust State courts any more. We do not trust the elected State courts, we want the unelected Federal judges that we normally excoriate in this Chamber. Now suddenly they are trustworthy and we want to come and say they should start a whole new proceeding after everything is over and drag the case on, to the anguish of the family members, for another few years.

This bill allows a large number of people, not just the spouse or a relative, to intervene in these cases, years into the proceeding, or even after everyone thought the proceeding was finished. Even if the incapacitated person has executed a written advance directive, any party can drag the matter into Federal court simply by ``disagreeing.'' That is what the bill says.

Do we have no respect for families? Do we have no respect for the carefully established procedures our State legislatures and courts have set up to wrestle with these difficult situations? Do we have no interest in writing a law for the whole country that might actually do the job right?

Unfortunately, the leadership is determined to vote on this important life or death issue without giving the Members of this House the opportunity to actually look at the issue or even read the bill or to think about it.

These things should not be done in haste tonight. That may be par for the course these days, but it is irresponsible and shows real contempt for the families who will have to live with this.

If you think this is the only way to prevent the disconnection of Terri Schaivo's feeding tube, that we should not legislate this way, we should give Members the opportunity to read bills, we should not ride roughshod over State judiciaries, but here we have an emergency because the case is coming down right away in Florida, consider this: The Florida legislature is considering its own legislation on this matter. There is no need to enact radical legislation unconsidered for the whole country just for this one case. Florida, for better or worse, is addressing it.

We should take back this bill and look at it carefully. People should at least read it. We should hold hearings. We should get expert witnesses. We should tighten up the drafting so that not any busybody can come and insert himself or herself into a family's anguish. We owe American families that much.

I urge that this bill not be passed tonight, and that we stop, look, listen and think.

Madam Speaker, I reserve the balance of my time.

And these remarks by Senator Levin:

Mr. LEVIN. Whoever has time, could they just yield 1 minute to me? Mr. President, first of all, I want to thank people who have worked out the changes in this bill, which make it a better bill. From my perspective, it is still a mistake, and I intend to vote no if there is a rollcall vote.

A number of people have asked me whether I now favor this bill with the changes. My answer is no. I think it is a better bill with the changes. It is a bill which avoids some damaging precedents.

We can explain the changes. The most important one is explicitly this does not create a precedent. Secondly, it is not a 12-month period the parents can proceed in. It is a 30-day period that they have. So we do not have a situation where they wait 12 months prior to initiating the case.

The court has discretion to issue a stay. It is not mandatory. It is not a bill for the relief of Theresa Marie Schiavo . It is a bill which gives the parents the opportunity, within a short period of time, to go to court, so it is technically for their relief, not for her relief.

So I wanted to make it clear to the people in the Senate who asked, ``Does this mean you now favor this?'' If there is a rollcall, I intend to vote no. I think it is a mistake. If it is a voice vote, I intend to vote no, for whatever relevance that has, except I do not want to mislead anybody, by proposing these things, that now suddenly I think this is the right thing to do.

I yield the floor."

It may be that Frist had the votes to push the House bill. They may have been afraid that people who otherwise would never vote for such an awful bill would do so under these circumstances. With the prospect of the end of the filibuster rule on the horizon, and the Democratic caucus' general inability to sustain a filibuster, this seems to me like a realistic fear.

It's also possible that even if the House bill couldn't have passed the Senate, Frist would have passed a worse version of the Senate bill that would have allowed the litigation to drag on for years and years longer and set a much worse precedent.

If that's what's going on--and Carl Levin, one of the Senators I most admire, certainly seems to think so based on his statements and actions--then I think the Democrats' may have cut a deal that represents the least bad alternative. But if that's what's happening, they should say so, just as Levin has done; they should explain that this is an abuse of power that they're only allowing because the alternative is a worse abuse of power. Their general failure to do this, along with Reid's remarks, Bill Nelson's & Tom Harkin's role, Dorgan's remarks--lead me to believe that some of them are also motivated by the 2006 midterms, the fear of being labelled as Terry Schiavo's killers, and/or a careless failure to actually fully examine the facts of the case. So I wouldn't let them off the hook entirely.

But I was shocked that some of the senators I most trust and admire were allowing this on unanimous consent. I now think I may understand why.

Only one twin gets the soul, the other is a souless monster that must be destroyed for the good of all mankind.

Thanks, Katherine. That explanation makes me a little less uneasy, too.

"First of all, I utterly reject the idea that a moral position's "sensibility" is determined purely by its internal logical consistency."

What else does it have? I thought moral precepts were just happenstance opinions blessed by some tradition.


"If you believe that Jews are doomed to hell unless they convert to Christianity, it is perfectly logically consistent to force them to convert by the most brutal means imaginable--you're only making them suffer now to guarantee them paradise later. It's admirable logically consistent; it's also, insane and immoral and just plain evil."

Actually, I would think Christians _should_ take this tack (except Catholics post-Vatican II) if they thought it would be effective in saving souls. I was puzzled about this for many years as a child, thinking the absence of attempts to proselytize me indicated a lack of true belief.


"1. [etc]"

Since I think we're all heaps of elementary particles bouncing around in deterministic fashion, I'll leave the list to felix, but I don't think your logic is at all sound here since it elides many complex interests.

fafnir, I'll see your tea party, and raise you the entire Galapagos island chain. With saucers.

Best Island Chains with saucers:

1) The Aleutians (long, proud, noble, balanced enough for fine China)
2) The Andaman Islands (incredibly easy to clean: just submerge for a few minutes and everything's washed away)
3) The Galapagos (uniquely designed, but God will punish you for using them by making you watch Mel Gibson get crucified)
4) The Lesser Antilles (humble flatware made of coconut, the saucer equivalent of that grail thingy in that Indiana Jones movie)
5) The Marianas (deep, widebrimmed saucers suitable for Friends-sized coffees)
6) The Big 12 (noble islands of blue scattered in a deep sea of red, although the natives haven't mastered dishware or cutlery yet)
7) The Sulu Archipelago (too bitey)
8) Hawaii (not really an island chain, but great with chips and pineapple)
9) The Florida Keys (if you can remember where you put them)
10) The Greater Antilles (full of jerks)

The Kuril Islands are unfortunately too Japanesey to count as a saucer, even if they are great for sushi.

The real story of this whole episode is the political maneuvering behind the scenes, not the tearful mothers and husbands appearing on tv. Thanks for the heads up, Kathrine.

"What else does it have? I thought moral precepts were just happenstance opinions blessed by some tradition."

Is that your view or what you see as my view? If it's the latter: I don't think that. I don't know what I possibly could have written to lead you to believe that I think that.

Have you ever seen Jumpers by Tom Stoppard?

Katherine, that's my view of moral precepts. I don't know how one reconciles opposing sets of moral precepts otherwise. I assume that as a religious person with a strong belief in morals you have a different take.

The usual jftr that I don't see how heaps of elementary particles can have morals.

I haven't seen Jumpers, just Arcadia and of course Rosencrantz etc., the latter one of my favorite plays and the film version one of my favorite films.

Gosh, rilkefan, I am really going to have to do a metaethics post one of these days...

But until then: I assume the idea is not that you don't see how heaps of atoms can have moral beliefs (whether true or false), but how they could be bound by moral laws (that are true.) Do you have a similar problem seeing how heaps of atoms' beliefs can be subject to the rules of logic? (Just trying to gauge whether the problem is with our being subject to any non-physical rules, or with morality in particular.)

Note in advance: if your response is: no problem about logic, but then logical laws aren't on the same level as physical laws, or in potential conflict with them, I will say the same about ethics.

I thought ethics were the same as above - and that's how people understand them - logical systems of acceptable behavior based on some axioms - whereas morals are the same but are based on axioms handed down from some higher authority for which there is no place in a reductionist universe. Sorry not to be clear - I often have trouble talking about stuff I can't intellectually conceive of.

Btw how does logic deal with Goedel in this context? It's my feeling that logic does not describe a physical universe if there's some issue there but can't think of an example.

Uhh, considering this is making my head hurt.

Btw how does logic deal with Goedel in this context? It's my feeling that logic does not describe a physical universe if there's some issue there but can't think of an example.

Ask, and I shall answer! If you're lucky, I'll even manage to answer the question you ask!

Go for it.

Bad baseball story - Red Sox and rendition.

Go for it.

Yeah, but I don't know what question you're asking. What does it mean to say "how does logic deal with Goedel in this context"?

rilkefan: ah. I don't usually distinguish between ethics and morals. (There's a relevant distinction in German, of course, but then I'm not speaking German, and in fact have always thought it was inconsiderate of Kant to have written in it, thereby forcing me to spend time in Germany learning it, when he could just as easily have been born in a country I actually like. Germany being more or less the only country I don't enjoy traveling to.)

Anarch, you'll have to ask hilzoy for a coherent explanation, but if there is such a thing as a set of physical laws and initial conditions, and if one can make logical inferences about this system, then are there false things that can't be disproven? I guess now that I try to think about it, I only admit statements of the form "at time bar the state of the universe will be foo(bar)", and that's not a rich enough system for goedelization. Uhh, what was the question again?

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