Terry Schiavo and the Good Death

March 21, 2005 | 137 comments
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Last weekend at the conference of the Society for Mormon Philosophy and Theology, Richard Sherlock presented a stimulating paper observing and explaining the complete absence of an LDS casuistry of medical ethics–that is, the absence of a body of literature exploring in a careful, ethically- and scripturally-bound way the trade-offs inherent in the excruciating panoply of choice that modern medicine demands of bereaved families and dying patients. This sort of literature abounds in most other religious traditions, made available to priests, pastors and rabbis as they counsel with congregants staggering through the worst day of their lives; Mormon bishops, on the other hand, rely on their own personal views, experience and inspiration of the moment to shepherd members through the throes. This has been on my mind during the last few days, as I’ve asked myself–as all of you surely have, too–”What would I do if Terry Schiavo were my daughter, my husband?”

My husband John, a physician and scientist, has asked himself these questions, as well, and not just over the past days: after a litle over nine months as a medical intern, he has faced situations ethically (if not legally) analogous to Terry’s. Last night, the final night of his two weeks on the night shift, John didn’t have to start admitting patients until 3:00 a.m., and he took advantage of the unexpected block of time to write some thoughts on the issue. I’ll post them in full here.

Over the weekend the Terri Schiavo situation has been brewing. For those of you who have missed the story you can catch up at CNN, and the New York Times . The NY Times also provides an opinionated review of the case’s legal history here.

The quick summary is that Ms. Schiavo was a bulimic who, following lots of vomiting, dropped her potassium from the normal range of 4 to around 2, causing cardiac arrest. During this arrest she suffered significant brain injury and has been maintained by artificial feeding tubes for nearly 15 years. To my knowledge she has minimal cortical function limited mostly to respiratory drive. Her physicians feel she is in a persistent vegetative state and has not improved since the injury. Tragically, her extended family has been deeply divided on her future. Her parents have relentlessly pursued legal channels to prevent the withdrawal of care while her husband has maintained, through seven years of court hearings, that his wife desired not to be indefinitely suspended in a vegetative state and has sought to withdraw care.

What has interested me this weekend has been the vigor with which the religious right has pursued the maintenance of her artificial feeding. I understand the religious position against abortion at the beginning of life, but I do not understand how Christianity might suggest we are morally obliged to provide all invasive treatment that might prolong life at any cost. In fact, a belief in an after-life, where a benevolent, loving Father in Heaven and deceased family members await to greet a dying person, would seem to lead one not to artificially prolong life, but rather to help dying people pass with dignity and grace to the bosom of their god. If this life is an eye-blink in the eternities, why should we suffer so greatly for a few extra days before succumbing to the inevitable? What will our patients and family members, who we helped or hindered die, say to us when we see them on the other side?

In “The Hour of our Death,” Philippe Aries describes two opposing paradigms of dying in the long history of our response to death. One, originating in Medieval times, he calls “the tame death,” which he idealizes as the knight dying an anticipated death, calmly in the presence of his companions, having made his peace with his people and his god. In contrast is our more modern death, where we are flogged to the bitter end with whatever invasive treatment is required to prolong life and we die in a hospital, painfully poked, prodded and probably intubated.

Recently there has been a shift in the medical and patient-advocate communities toward patient autonomy and away from medical paternalism. Hospice programs have arisen across the country that help patients and family members transition through the difficult journey to death. We have become more comfortable with respecting a person’s desires at the end of life. We have also become less reluctant to trade a prolonged course of inevitable suffering for a treatment course that focuses on comfort and dignity, even if it means foreshortening life.

End of life ethics is complicated to say the least. Few people are comfortable with active euthanasia, where medicines are prescribed that induce death. In contrast, many people are comfortable with passive euthanasia, where treatments are withheld that could delay an inevitable death in favor of providing dignity and pain relief. This can take the form of not performing CPR or cardioversion (shock) to someone who has undergone cardiac arrest and is dead, withholding fluids and nutrition as in the Schiavo case, removing someone from mechanical intubation, or even withholding antibiotics and letting someone with a terminal illness pass peaceful from pneumonia (known in the 19th century as “old man’s friend”).

Let me give a quick example to illustrate the active limits of passive euthanasia. I am a first year resident in Internal Medicine. When I was working in the ICU I admitted an 83 year old, emaciated woman with metastatic breast cancer. She came to the ICU with low blood pressure and cardiogenic shock. We started her on pressors (strong medicines that increase blood pressure) and got an emergent echocardiogram (an ultrasound of the heart). As the echo was being completed she began struggling to breathe and required intubation and ventilator support. I called her family. By the time they arrived, the results of the echo returned. She had a previously known blood clot in her inferior vena cava, which now had extended up into her right atrium and right ventricle. It looked like it was further extending into her pulmonary arteries, although it was difficult to see on the echo. There was no way to treat a clot of this size. With this obstruction in blood flow to her lungs, their function would continue to be too poor for her to manage with her emaciated musculature without mechanical ventilation. With her family, we decided it did not make sense to continue aggressive management. She was unlikely to improve, and given her weak and wasted state, would not be able to tolerate further chemotherapy even if she survived this blood clot. She was actively trying to die. We decided to assist her. Once the family had assembled and said their good-byes we gave her medicine to prevent her from struggling with air hunger and then took her off the ventilator. She did not last long without artificial support. It was a surreal experience writing orders to withdraw care. However, her death was inevitable. It was only a question of how much suffering she would endure before it occurred and this was the best medicine I had to offer.

Please don’t let this thread to break down into a bitter rant for or against the details of the Terri Schiavo situation. As this topic is obviously explosive, try and keep the emotions to a minimum.

My questions are: Does LDS doctrine (particularly our believe in a pre- and post-mortal existence) help us make decisions at the end of life? Does LDS doctrine help you feel more or less comfortable withdrawing or withholding treatment when a family member desires this course? What sources of LDS doctrine can we use to derive principles for end of life decisions? Why is the religious right, and recently Catholicism, so married to artificially prolonging life even at the cost of great suffering? Should Mormons feel compelled to follow? And most importantly, do you have a living will? (Ms. Schiavo would not be in her current situation if she had clearly expressed her desires in writing)

John’s insights as a physician don’t ultimately decide the question, but they show us that the categories most of us take for granted in anticipating our future actions–categories like “active euthanasia,” or “letting nature take its course”–are much messier, bloodier, and more uncertain in the hospital. Nor did Richard Sherlock’s insights from the lecture hall decide the question: a Mormon literature of medical ethics is absent, he argued, because Latter-day Saints are urged to seek personal revelation in these situations; absent a clear impression from the Holy Ghost, he continued, one may turn to the scriptures. But because the scriptures often provide spotty or inconsistent counsel on these matters, they’re best at merely ruling out those options that are totally unacceptable to God; beyond that, there often remains an array of possibilities that would seem to be equally acceptable to God. The choice is ours. So I’m back to where I started: what would I do? Terry Schiavo, in her hospital bed, will never know what reaches of untrodden legal and personal deliberation she has opened to her waiting, wondering nation.

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137 Responses to Terry Schiavo and the Good Death

  1. Ivan Wolfe on March 21, 2005 at 9:01 pm

    1 – Terry is not in a vegetative state.

    2 – Her husband only requested her death after being awarded nearly $1 million bucks to pay for her medical care. If she dies, he gets to keep the money. Oh – and he has been living with another woman (with whom he has had 2 children).

    So – in this one specific case, I don’t see why he should be allowed to make the decision for a women he is married to in name only and whom he stands to financially benefit from if she dies (if she stays alive, he has to use the money to care for her).

    I don’t see why we should try to draw any conclusions from this mess.

  2. Bill on March 21, 2005 at 9:09 pm

    I know exactly what I would do, since everyone in my immediate family has emphasized many times that if they were ever subject to the misfortune of being reduced to a vegetative state, they do not wish for any extraordinary measures to be taken to preserve their lives. I guess what I need now is to have them all make notarized statements.

  3. Steve Evans on March 21, 2005 at 9:16 pm

    Ivan, that is the least satisfactory and least accurate comment I have heard from you since I’ve first seen you post at this blog, except for your final sentence, which is the most satisfactory and most accurate comment I’ve heard from you.

  4. Ivan Wolfe on March 21, 2005 at 9:25 pm

    Steve-

    Go ahead and give me a back handed compliment, I don’t mind.

    My initial comments were just trying to show that this is a lot messier than most people report it. Rosalynde and her husband’s post above make the issue sound very simple and all about those evil conservatives versus a loving husband who just wants to di what his wife wished.

    My final comment comes directly from my earlier comments. Sorry if it upsets you. I wasn’t aiming for that. I just wish more reports on this issue acknowldeged that her “husband” may have ulterior motives. Nearly every news report I have read/seen paints him as a suffering saint.

    It’s messy, messy, messy but it’s become some sort of Platonic ideal for the “right to life” vs. the “right to die” crowd.

  5. Susan on March 21, 2005 at 9:26 pm

    Both of my elderly parents died of pneumonia. My dad had a series of strokes. My mom had Alzheimer and eventually fell and broke her hip. In both cases we definitely withheld treatment when in the midst of other problems, they aspirated food. And I think back to my ex-husband’s grandmother. An amazingly strong and unique woman until the day she had a stroke. A feeding tube was inserted, and she spent months and months into years in a nursing home. I could barely manage to visit her. This just seemed so wrong, knowing who she was. I know I would never want to be maintained in that kind of life. Allowing death can be such a blessing.

  6. Steve Evans on March 21, 2005 at 9:28 pm

    Nothing backhanded about it, Ivan.

  7. Jordan Fowles on March 21, 2005 at 9:28 pm

    Terry is not in a vegetative state.

    Perhaps not in your opinion. But there is a condition called a “persistent vegetative state” which does NOT mean that the person in that state just lies around like a “vegetable”. It means simply that doctors have defined that way of being as a “persistent vegetative state”. The medical community’s definition of PVS may not coincide with yours, but the fact is that for the medical community, Terry actually IS PVS, which means that as the medical community defines it, she is a “vegetable.” That doesn’t mean she can’t move or react.

    Claiming that she isn’t what the entire medical community agrees that she is adds nothing to the debate about whether people who, like Terry, are PVS should nonetheless be kept alive if there is no written will expressing otherwise.

  8. Ivan Wolfe on March 21, 2005 at 9:29 pm

    I think everyone should make a living will (in regards to the general principle, not the specific case). Even if they aren’t binding in every state, they will help avoid messes like this one.

  9. cooper on March 21, 2005 at 9:32 pm

    Why does the fact that he has children by another woman negate his obligation as her husband? As much as her parents would like to have charge of this situation playing that card is wrong. Her husband has not mentioned the fact that she suffered from an eating disorder. He has taken the high road her parents have not. He has every right to decide this by law.

  10. John Welch on March 21, 2005 at 9:33 pm

    Thanks for your quick comment, Ivan. Actually, I think the sum was $14 million, but what’s an extra digit among friends?
    I didn’t put this post up to argue the strengths, weaknesses or motives of either Ms. Schiavo’s husband or parents. I am also not particularly interested in whether she is actually in a persistent vegetative state, or simply extrodinarily close to one and making nominal recovery. Such discussions can be had around the water-cooler.

    My interest in bringing this question to T&S was to explore the possibility that LDS theology might have something to aid us in our personal journey toward death and our care of loved ones around us. The courts have granted increasing respect to the right of an individual to determine his or her own end of life course, provided his or her desires are made known. The right to refuse life-saving interventions (such as CPR, cardioversion, external-ventilator support, nutrition and even antibiotics) has been recognized by our legal system as inalienable. In contrast, in the name of Christian religion we have a large force mobilizing to protect the life of a woman despite the possibility that this may prolong inevitable suffering and may well be counter to her wishes. Do our religious tenets support such an ethic? Do they support any ethic? Or are we left to navigate this course exclusively by personal revelation without any principles to guide us? Does LDS theology support patient autonomy? Or does it require, like Catholicism, that we accept every technical advance, despite expense and suffering? How does a belief in an after-life and a benevolent God waiting to receive his children in his arms change end of life ethics? What principles does our theology share with the Christian right that would lead to similar end of life ethics? How does our theology differ that would lead to different end of life ethics?

  11. Steve Evans on March 21, 2005 at 9:36 pm

    John, those are some great questions you raise. In my opinion, our religion gives us little guidance on ending life.

  12. Rosalynde Welch on March 21, 2005 at 9:36 pm

    Come on, Ivan, aren’t you a grad student in literature? What a sloppy reading of our post. I stress time and again the messiness and uncertainty of the situation, on a number of levels, and neither of us has any intention (nor made any gesture toward) assuming a political stance on the issue. Perhaps your own strong views are coloring your reading of our post.

  13. Ivan Wolfe on March 21, 2005 at 9:38 pm

    Claiming that she isn’t what the entire medical community agrees that she is14 independent medical professionals (6 of them neurologists) have given either statements or testimony that Terri is NOT in a Persistent Vegetative State.

    Here are the names of some physicians who think she is not in a PVS:
    Dr. Ralph Ankenman, MD
    Dr. Pamela Hyikn, SLP
    Dr. Beatrice Engstrand, MD
    Dr. Jill Joyce, Phd
    Dr. Alyse Eytan, MD
    Dr. Philip Kennedy, MD, Phd
    Dr. Harry Sawyer Goldsmith, MD
    Dr. Kyle Lakas, MS, CCC, SLP
    Dr. Jacob Green, MD
    Dr. Richard Neubauer, MD, PA
    Dr. Carolyn Heron, MD
    Dr. Ricardo Senno, MD, MS, FAAPMR
    Dr. David Hopper, PhD
    Dr. Stanley Terman, MD, Phd
    Dr. Lawrence Huntoon, MD
    Dr. J. Michael Uszler, MD
    Dr. Richard Weidman, MD

    Their statments are here: http://www.terrisfight.net/press/030405medaff.html

    Yes – names don’t mean much and we could claim they are all quacks.

    But this shows the “entire medical community” does not think she is in a PVS.

  14. Stephen M (Ethesis) on March 21, 2005 at 9:40 pm

    Ivan reflects the dialog and meme (hey, an excuse to use the word “meme”) that drives the one side. It is important to express it to understand it. Ivan did miss other elements which are “She was denied the therapy the court settlement was intended to pay for” and “she sure looks alive.” Finally, Florida has a history of strapping people down and starving them to death when if just allowed out of their bonds they could go feed themselves (see an example, below).

    Of course the “denied therapy” is actually false. She had a good deal of intensive therapy. But she sure looks alive and if the husband transfers custody of her to her parents, he doesn’t get whatever is left of the money (if there is any). *BUT* is “looks alive” a good test? I meant that seriously. In the common parlance a severe vegatative state = a coma. People look at Terry and they go, “there is no coma there.”

    We have so many people hoping for miracles. I mean when they ruptured my daughter’s brain stem, it was hard to believe that a bubbly almost two year old with blood sugar under 200 when I took her in and she smiled and bounced around was never going to leave the hospital the next day. From “new diabetic” to “brain dead” in under 24 hours. It was hard to sign off on the organ donation paperwork (and harder still to get billed for the privilege later), but I had watched the neurologist running tests and watched the lines coming out and knew what they meant (even though he clocked out and left rather than explain it to me, mid-shift). I know, I should have sued them, gotten it out of my system or I should have refused to sign and just held on hoping for a miracle. They do happen.

    Which is the problem. Everyone has heard the rumor of a miracle. Worse, some of us have experienced them. From normal medical miracles (my wife once ran a code for over 12 hours, they ran out of drugs and had to have them brought in — and the patient later walked out of the hospital under her own power) to supernatural ones. When will a miracle occur and why?

    The choice is ours which is the problem, especially when a meme overtakes it.

    The groups in Texas have no problems cutting off the life support when it is obvious hope is gone (as in the case of the poor, five pound baby who could not breath without a vent and was afflicted with a birth defect that blocked any further growth — though her mother claimed the father was the Sun and that the child had grown fifteen pounds in the ICU). But when there is a meme, driven by looks, it is very hard.

    If it were me, I would hope for someone with God’s inspiration or to be able to take control myself. But I meet too many people who feel all of the disabled need the warm embrace of death and too many disabled who disagree and who find joy in life.

    I don’t have an answer, but I did want to point out that Ivan comes from a meme that drives the entire debate, and that without understanding it you can’t understand why those who are acting have done as they have.

    BTW, on the earlier legal case in Florida:

    “Marjorie Nighbert, a 76-year-old Florida woman, was hospitalized in 1996 after a stroke. Before her hospital admission, she signed an advance directive that no “heroic measures” should be employed to save her life. On the basis of that directive and at the request of her family, the hospital denied her requests for food and water … Until her death more than 10 days later, Nighbert was restrained in her bed to prevent her raiding other patients’ food trays.”

    The Washington Post National Weekly Edition, January 13, 1997, page 23.

    I read the Washington Post article myself, in 1997, and was struck by it. Nighbert died while an appeal in her case was pending.

    I do know that I don’t want to starve to death in a hospital, strapped down and prevented from feeding myself.

  15. Steve Evans on March 21, 2005 at 9:40 pm

    Give it up, Ivan. Stop threadjacking a thoughtful post for your personal agenda.

  16. Matt Evans on March 21, 2005 at 9:41 pm

    Please present this to a court if it’s ever pertinent:

    If I, Matt Evans, am unable to make a medical decision regarding life-sustaining treatment, and my wife is living with and bearing the children of another man and wants me to die, and my mom, dad, brothers and sisters all want me to live, let me live.

    - Matthew R. Evans 3/21/2005

  17. Jeremy on March 21, 2005 at 9:47 pm

    And if, heaven forbid, you find yourself in that situation, but your wife isn’t bearing the children of another man, what’s the instruction?

  18. Ivan Wolfe on March 21, 2005 at 9:48 pm

    Rosalynde:
    Perhaps your views are influencing the back handed compliments I keep getting!

    here, I’ll quote from your original post:

    What has interested me this weekend has been the vigor with which the religious right has pursued the maintenance of her artificial feeding. I understand the religious position against abortion at the beginning of life, but I do not understand how Christianity might suggest we are morally obliged to provide all invasive treatment that might prolong life at any cost. In fact, a belief in an after-life, where a benevolent, loving Father in Heaven and deceased family members await to greet a dying person, would seem to lead one not to artificially prolong life, but rather to help dying people pass with dignity and grace to the bosom of their god. If this life is an eye-blink in the eternities, why should we suffer so greatly for a few extra days before succumbing to the inevitable?

    That indicates a dismissal (and misreading) of the stance of the religous right. Telling them what they should believe, rather than looking into what they actually believe and why.

    More:
    Her parents have relentlessly pursued legal channels

    “relentlessly” is not a word that carries many positive connotations. It is usually used when describing something the writer generally disapproves of.

    her husband has maintained, through seven years of court hearings,

    This paints him as a long suffering saint and says nothing of other possible motivations he may have in wanting his “wife” dead.

    I dunno. Pehaps I’m off. Ignore me. Chalk it up to a bad day, where I was chewed out by a faculty member who told me I was too conservative and needed to “liberal up” in order to make it in English, and this is just me being over sensitive and trying to establish some conservative credentials.

    I’m done, because the more I post, the more I dig myself into a hole. I shouldn’t have made my original comment. So – no more from me on this subject.

    Have a nice night.

  19. Steve Evans on March 21, 2005 at 9:49 pm

    Matt, some would say that you’re already in a vegetative state, couch potato.

  20. Matt Evans on March 21, 2005 at 9:50 pm

    Please present this to a court if it’s ever pertinent:

    If I, Matt Evans, am unable to make a medical decision regarding life-sustaining treatment, and neither my mother nor father nor any brother nor any sister supports my wife’s decision to withhold life-sustaining treatment, ignore my wife.

    - Matthew R. Evans 3/21/2005

  21. Ann on March 21, 2005 at 10:00 pm

    In the wake of the Terry Schiavo case, I downloaded the advanced directives (living will) forms for my state, and my DH and I looked them over. We were not satisfied. In the absence of advance directives, the state does not assume that you want extraordinary care, and can still appoint guardians to make the decisions for you. In the presence of advance directives, we are concerned that the opinions of two medical professionals can override the need a grieving spouse may have for some time to come to grips with what’s happened.

    So, we’re counting on each other, and our children, to make sure that we don’t suffer needlessly, and that our lives are not artificially prolonged when there’s no reasonable hope for recovery. We’ve told each other, and we’ve told the kids. But we aren’t willing to relinquish control of such an important decision to two doctors. The alternative is to write our own advance directives that may not be legal in our state.

  22. Matt Evans on March 21, 2005 at 10:07 pm

    Ann, I think the best solution is to create a legal document listing the people you want to make any decisions and the procedures you want them to follow. Because medical technology changes so quickly, a procedural directive makes more sense to me than a substantive one.

  23. Jordan Fowles on March 21, 2005 at 10:12 pm

    John, Steve, et al.,

    I think the gospel DOES offer some insight into end-of-life decision-making. First of all, I think the gospel does not leave much doubt that we have autonomy to decide what sort of medical treatment we will allow into our own body. This does not seem scriptural, per se, but there is plenty of anecdotal evidence supporting a great deal of autonomy in medical decision-making and probably transferring to end-of-life decision-making as well. Joseph Smith refusing wine as an anesthetic when he had his leg surgery. A family prayerfully deciding to release a loved one from this life by switching off life support. A priesthood blessing releasing an individual from life and an individual deciding pursuant to this to cease medical treatment and live or die naturally. An LDS family deciding that there are other options besides chemotherapy to whip cancer.

    I just did a quick search on “life support” at lds.org. Lots of examples of life support being disconnected and even a few articles urging people to get a “living will” so that they can avoid a life support conundrum like Terry’s. I definitely think that personal autonomy is supported in the gospel with regards to people deciding what to allow into their bodies in medical procedures.

    However, I also think that the gospel provides guidance regarding what to do in an end-of-life situation where there is no clear personal directive instructing loved ones what is to be done. Gospel teachings about the spirit and element being inseparably connected would seem to dictate that where there is life, there is spirit. The gospel requires us to not take the life of another, where taking the life of another means prematurely ending the spiritual journey on this earth of a fellow spirit son or daughter of God. If there is any doubt as to whether there is still spirit in the flesh, we should be very cautious and err on the side of life- I think that our teachings of the body being inhabited by a spirit dictate that result, thus giving us some guidance into end-of-life conundrums like this one.

    I don’t think that the injunction to “endure to the end” means that we have to suffer for years by submitting to every medical advance which comes along. Would the gospel force us to have open-heart surgery if that were the only option remaining? I think the Lord would allow us to allow nature to take its course, unless of course we had a spiritual impression not to.

    Anyway, I think the gospel does support patient autonomy, based on examples from our Church history and from recent church publications. That does not mean there aren’t examples of faithful Latter-day Saints, such as Elder Maxwell, for example, who medically prolong their life for as long as possible, despite the suffering. That is also fine. Since there are examples on both sides, I think we can see a support for personal autonomy in the realm of medical, even in end-of-life, decision making. I think it provides less support in situations where it is someone other than the patient who is making the decisions, however.

  24. Russell Arben Fox on March 21, 2005 at 10:19 pm

    “If I, Matt Evans, am unable to make a medical decision regarding life-sustaining treatment, and neither my mother nor father nor any brother nor any sister supports my wife’s decision to withhold life-sustaining treatment, ignore my wife.”

    Forgive me, Matt, but, well, aren’t you kind of dissing your wife there? I’m not interested in granting extraordinary authority to spouses (or biological parents, for that matter) when there is plausible reason to doubt the trustworthiness of their decision (remember, I think it takes a village and all), but even I think that courts ought to at least start with granting the basic family unit, beginning with the spouse, certain privileges. Though I suppose if you believe the preservation of biological life is an absolute imperative, then such privileges could be reasonably dismissed as necessary.

    I don’t, in fact, believe that the preservation of biological life (meaning, the functioning of our bodies) is an absolute imperative, because I don’t believe being “pro-life” or in favor of a “culture of life” is compatible with extracting any one element or argument out of the whole garment and making it an exclusive demand. That’s not to say that some strands aren’t, depending on the time and place, more important than others; clearly that is the case. But as important as it may be to draw a line against any slippery slope which would lead us towards euthanasia or anything like it, any talk of absolutes I think nonetheless warps things. But I’ve made that point here.

    As for Terri Schiavo, I happily admit I’m on the fence. The law allows Michael Schiavo the right to make decisions for his wife, and as much as I would personally like our marriage laws to be written so that the privileges they confer to be contingent upon marital fidelity, that isn’t the case (and perhaps necessarily so), and so the only way to get him out of the way is to prove that the medical diagnosis upon which he grounds his claim to speak for Terri isn’t, in fact, the case. And I have not been persuaded by the “evidence” presented that the original decision got the medical data so dreadfully wrong. As for Congress’s efforts to step in, I don’t mind much; I prefer these things to be fought out in the political rather than the legal arena anyway.

  25. Jeff Hoyt on March 21, 2005 at 10:33 pm

    I took great exception to the comments of my Elders Quorum instructor (a physician) just yesterday. His position was the same as most of the posters here, that since heaven is such a wonderful place, we should be willing to aid in sending Terri there. A few points:

    1 – I cannot imagine ever allowing my wife to die when her parents strongly objected.

    2 – I am very uncomfortable with the attitude that certain life is unworthy of living. That is after all what you are saying.

    3 – Food is not medical care. The court and her husband are also not allowing her to be fed orally.

    4 – My mother was advised by my fathers physician that his feeeding tube should be removed at the last stages of Alzheimers. She was assured he would die a peaceful death. What transpired was her agonizing over making a decision that she came to realize was based upon either a lie or horrid medical advice. My Dad died a protracted agonizing death. My mom deals with that now.

    5 – I know you do not want to hear this, but if you really want a discussion of the LDS life ethic you should know better than to present a scenario so at odds with the facts. Were you unaware that the husband had effectively abandoned Terri? (My Elders Quorum instructor was unaware of any of the facts of the case) The husband has not allowed Terri any therapy since 1993. The family suspects that her husband may have been involved in her initial illness. Terri had confided to her closest friend that she was going to ask for a dicorce before she became ill. The husband has been quoted by one of the caretakers of his wife as saying “when is the b**ch going to die”. Rather than defend this lowlife, why don’t you pick another case for discussion?

  26. Rosalynde Welch on March 21, 2005 at 10:34 pm

    Ivan, I’m sorry for adding insult to injury on an already bad day. You’re right that John doesn’t understand the position of Terry’s parents and those who support her, but he’s not arguing against that position, and you’ve read a lot more into his words than he intended (the connotations of “relentless” and “maintain” were definitely not on his mind at 3:00 a.m.!). Should you feel inclined to return to the thread, and would like to stick to the parameters he set out, I know he’d be very interested in hearing a justification of your general position from a religious and/or scriptural standpoint.

  27. Matt Evans on March 21, 2005 at 10:36 pm

    Russell, my wife is wonderful. Besides having a smart and loving wife, I have two smart and loving parents and seven smart and loving siblings. If my wife is unable to persuade any of those nine good people that she’s right, then she’s probably not right. It’s also easier for me to imagine circumstances where a spouse has conflicts-of-interest regarding their spouse’s future. Plus I would trust a group more than a lone individual for such an important decision. For those reasons I structured it as I did, making my wife plus one a majority, which still offers a strong spousal privilege (2 votes would defeat 8, so long as hers was one of the two). How would you structure yours?

  28. Matt Evans on March 21, 2005 at 10:39 pm

    Jeff, your points 1, 2 and 3 are spot-on. Thanks for bringing them up.

  29. Jordan Fowles on March 21, 2005 at 10:40 pm

    Jeff,

    I am not sure who you are addressing, but nobody here seems to be of the opinion that heaven is so nice that we should be willing to aid in helping send someone there. I also did not see anyone saying that a life like Terry’s is not worth living. John asked whether the gospel provides any insight into end-of-life care and personal medical autonomy. I think it does. That does not mean that life is not worth living, or that we ought to just always as a matter of fact refuse medical treatment. It does mean that when a person prayerfully decides to do so, the gospel will not prevent him/her from refusing medical treatment necessary to sustain life, in my opinion. It also means the same when a family AGREES that this is the way it should be.

    In a situation like Terry’s, let me re-emphasize that I think the gospel and LDS teachings about the spirit body of humans would require us to err on the side of life IF THERE IS ANY DOUBT- i.e., if the family disagrees about what to do.

    Nobody is saying the things you seem to be arguing against.

  30. Steve Evans on March 21, 2005 at 10:44 pm

    I’m no prophet, but I suspect this will be one of those threads that gets closed down. Or at least, we’ll all be wishing so in a few days. The topic is just too volatile and speculative for us to handle.

  31. Jordan Fowles on March 21, 2005 at 10:45 pm

    Steve,

    I think we are pretty mature. I haven’t seen anything too bad yet. Let’s just hope that people stick to the question which John asked. I think they can. :)

  32. Eric Russell on March 21, 2005 at 10:51 pm

    Apologies if posting from the Church Handbook of Instructions is inappropriate, if so, feel free to delete my post. But, as far as I am aware, this is the only formal doctrine we have on the subject.

    Euthanasia
    Euthanasia is defined as deliberately putting to death a person who is suffering from an incurable condition or disease. A person who participates in euthanasia, including so-called assisted suicide, violates the commandments of God.

    But there is another applicable entry,

    Prolonging Life
    When severe illness strikes, members should exercise faith in the Lord and seek competent medical assistance. However, when dying becomes inevitable, it should be seen as a blessing and a purposeful part of eternal existence. Members should not feel obligated to extend mortal life by means that are unreasonable. These judgments are best made by family members after receiving wise and competent medical advice and seeking divine guidance through fasting and prayer.

    It seems to me that there is an awful fine line between these two. At what point is refusing to prolong life “deliberately putting to death”? It seems the issue comes down to whether or not our actions constitute killing, but isn’t all failure to extend life a form of killing in some way? The lines are all too blurry to say.

    I think the best we can say is the last line above, “seeking divine guidance through fasting and prayer.”

  33. Matt Evans on March 21, 2005 at 10:52 pm

    Jordan, John wrote: “In fact, a belief in an after-life, where a benevolent, loving Father in Heaven and deceased family members await to greet a dying person, would seem to lead one not to artificially prolong life, but rather to help dying people pass with dignity and grace to the bosom of their god.”

    We can deduce a person’s belief that Terri’s life is not worth living from their belief that it is okay to stop nourishing her so she will die. Said person does not believe it is okay to stop nourishing infants, who would also die without our affirmative involvement, presumably because, in their eyes, an infant’s life is worth living.

  34. Stephen M (Ethesis) on March 21, 2005 at 10:54 pm

    What transpired was her agonizing over making a decision that she came to realize was based upon either a lie or horrid medical advice. My Dad died a protracted agonizing death

    That is too often true.

    The problem is that SVS is understood by the general public as being in a coma. I’m not saying that is correct, but that is the public belief.

    “Peaceful death” is understood as calm, gentle, short and sweet smelling. (added for Nate and because the smell aspect is one of the common shocks people encounter).

    These things color the debate (and no one rose to my use of “meme” — darn).

  35. Jordan Fowles on March 21, 2005 at 10:55 pm

    True, Matt. I guess I was so interested in the questions raised that I skimmed over a lot of the prose. Still, I think there is no reason for anyone to take offense at sincere question and curiousity.

  36. Russell Arben Fox on March 21, 2005 at 10:56 pm

    “For those reasons I structured it as I did, making my wife plus one a majority, which still offers a strong spousal privilege (2 votes would defeat 8, so long as hers was one of the two).”

    That’s an interesting way of putting it, Matt; I hadn’t conceived it in those terms. Maybe you’re right. Though I can easily imagine conflicts-of-interest which pit the family against the spouse–what if you are your wife had converted to the church from Catholicism, and at your death your parents and every one of your siblings insisted on a funeral mass, dismissing the concerns for this strange woman you married you deluded you into joining a cult. (There was a case like this involving a church member in Montreal, not too long ago.)

    Still, your rule of thumb has some possibilities to it; thanks for sharing it. If something like that were the law in Florida, it might make it legally possible for people to get at the central issue of who should have and how one ought to distribute responsibility for Terri Schiavo, rather than having to constantly return to the medical diagnosis, which I strongly doubt will ever change.

  37. Matt Evans on March 21, 2005 at 10:59 pm

    Eric, thanks for posting that. It’s interesting to note that the handbook says the decision should be made by “family members.” As I’ve made evident in this thread, I think the central and most important issue is the question of who makes the decision.

  38. Ivan Wolfe on March 21, 2005 at 10:59 pm

    Rosalynde -

    thanks. But others were right, I should have stuck to the parameters originally set. Perhaps after a decent night’s sleep I’ll try to come at the subject with a clearer head.

    There have been some very good comments on this post recently. I think I’ve learned a little.

  39. Jeff Hoyt on March 21, 2005 at 11:06 pm

    Jordan;

    Matt beat me to the punch in quoting John, who was exactly in agreement with the EQ instructor.

    Regarding judging certain life not worth living, what else could we possibly be saying? Why would it ever occur to anyone to facilitate taking a life unless one felt that way.

    I guess I am sensitive to this issue living in Oregon where assisted suicide is the law. Deep down though I guess my belief is that mankind cannot handle the responsibility of making these kinds of decisions. I think history has repeartedly shown us the consequences.

  40. danithew on March 21, 2005 at 11:08 pm

    The main thing that bothers me is that she is being starved to death. I hope she has some medication that assures she isn’t in pain or agony from hunger/thirst. In my opinion, spousal rights should trump parental rights. But a loving spouse and son-in-law should still be sensitive to the feelings of a ailing spouse’s parents.

    Matt, your comments seem a bit odd to me. Isn’t your wife supposed to be the most important person in your life? More important than parents, siblings or children? That’s the principle my mother taught me and its stood me well. I find when I put my wife first, everyone and everything else falls into its proper place. I really have a hard time imagining a situation where I’d tell anyone to “ignore my wife.”

  41. Rosalynde Welch on March 21, 2005 at 11:14 pm

    John’s gone to bed now (on call tomorrow!), and probably won’t be able to return to the thread–just so you don’t think he’s become disgusted or cowed by the comments!

  42. Jordan Fowles on March 21, 2005 at 11:15 pm

    Based on what I know about John, I would not expect him to be cowed by anyone! :)

  43. Matt Evans on March 21, 2005 at 11:20 pm

    Danithew, my wife is definitely the most important person in my life, and I don’t think she would ever make a decision contrary to my best interests. But even though she’s more important to me than anyone else, she’s not yet perfect or omnicient, and for that reason I would want her to consult other people I respect and trust before deciding to let me die. If she is right, I have every confidence in her ability to persuade at least one other good person.

  44. Rosalynde Welch on March 21, 2005 at 11:29 pm

    Leaving aside the Schiavo situation for a minute (which is marred by speculation about motives), let me make a point about the case John discusses in his post. Either decision made by the family–to prolong life through extraordinary measures, or to shorten life by eschewing those measures–would lead to the death of the patient. In a situation like that, the decision is not between life and death, it’s between two different kinds of death, and between the degrees of pain and panic associated with those kinds of death.

    As far as the comparison to infant feeding (Matt, why is it that whenever you bring up breastfeeding, no matter the context, it gets me a little steamed? I love breastfeeding, and I’m usually an annoying advocate for it! :)), it’s a question of “extraordinary measures,” not of judging which lives are worth living.

  45. danithew on March 21, 2005 at 11:30 pm

    Matt, I see what you are saying … if your family (besides your wife) could form a unanimous opinion and your wife was in disagreement, your family’s unanimous decision should take the greater weight?

    If I’m understanding you right, I think that’s an interesting idea. Which in my mind raises another question.

    What if your whole family wanted you to pass away and your wife wanted you to remain plugged in or still have the feeding tube? In that case, whose opinion should have the greater weight?

  46. danithew on March 21, 2005 at 11:36 pm

    You know, this might seem like a strange thing to say … but this is really a situation where (if the family were Mormon) a priesthood blessing could really be helpful. I know of circumstances where a person near death was told in a blessing that he/she could pass on peacefully … and other circumstances where further life and health are promised to the person being blessed. I wonder if this is one of those situations where something other than government and family needs to play a role.

  47. Jeff Hoyt on March 21, 2005 at 11:47 pm

    Rosalynde;

    I appreciate what you are saying, but the specific case your husband cited is not one I believe anyone would take exception about regardless of the ultimate decision. That is entirely different from a (any) starvation case. Those I contend always involve a judgement about life worthiness.

  48. Matt Evans on March 22, 2005 at 12:06 am

    Rosalynde,

    I don’t know why you’d get steamed by my mentioning breastfeeding (I’m an advocate too!), but I didn’t actually mention breastfeeding this time. (Actually, the reason you’re probably irritated when I mention breastfeeding is that I don’t typically have reason to discuss breastfeeding except in discussions about women’s issues. Because we sometimes disagree on those issues, you might associate my mentioning breastfeeding with my disagreeable comments.)

    Anyway, in this instance I brought up infant feeding to point to a class that everyone agrees should be nourished even if though it requires active intervention by others. The difference between Terri and infants in some people’s mind, it seems, is that Terri’s life is not worth living. I don’t believe these people are making their decision based on Terri’s not having a sucking reflex and needing a tube rather than a bottle. (I admit it’s possible that if she had a sucking reflex the whole country would support her right to life, but I doubt it.)

    It doesn’t seem to me that feeding someone pureed food through a tube is an “extraordinary measure.” The technology appears to be simple; as simple as the special artificial-nipples and baby formulas some babies need. (In a spirit of good will I avoided all possible breastfeeding talk. Hey bottlebottlebottlebottle, suh-whing, bottle!)

  49. Guy W. Murray on March 22, 2005 at 12:13 am

    Rosalynde, thank you for this post. I’ve wondered how some of the thinkers over here at T & S would respond to this issue from an LDS perspective. The Encyclopedia of Mormonism also cites the Church handbook of instructions as reflected in post number 32 above. I would also think basic common sense gospel principles come into play: alleviate the suffering of our fellow brothers and sisters whenever and whereever possible. Certainly a good argument can be made in Terri’s case (and those like her) that making the decision her husband did, falls in that category. Furthermore, I am aware of no mandate either from scripture, or prophets, ancient or latter-day that requires the use of life prolonging measures for the sake of perpetuation life—despite the quality and/or suffering that life affords.

    I would hope everyone would seriously consider an advanced healthcare directive for themselves and their family; however, given the recent intrusion of Congress into this personal, private decision I am concerned about whether in Terri’s case, or any other there would have been any different reaction by Congress.

    I would also suggest reading A REPORT TO GOVERNOR JEB BUSH AND THE 6TH JUDICIAL CIRCUIT IN THE MATTER OF THERESA MARIE SCHIAVO by Jay Wolfson, DrPH, JD, Guardian Ad Litem for Theresa Marie Schiavo 1 December 2003. I think it helps lay out some of the facts behind Terri’s case that are either not presented, or are glossed over for one reason or another. Mr. Wolfson was appointed by order of the Hon. David Demers, Chief Judge, Florida 6th Judicial Circuit as Guardian Ad Litem in the matter of Theresa Marie Schiavo, Incapacitated. You can read his final report at:

    http://floridahealthinfo.hsc.usf.edu/TheresaSchiavoFinalReport1December2003.pdf

    It has an excellent recitation of the history of Terri’s case and helps give it a bit more perspective than we traditionally hear on televison or read on blogs.

    Thanks again for this post, and to all the commenters in their analyis. I find them all very enlightening and helpful.

    Guy

  50. Pete on March 22, 2005 at 12:28 am

    John and Rosalynde:

    I appreciate the interesting thread. I have to say though, as strong as Ivan’s initial position was stated, I don’t think his reading of John was “sloppy.” In my opinion, you have (at a minimum) made gestures toward assuming a political stance on the issue. Like it or not, a fair reading of John’s paragraph beginning “What has interested me this weekend is the implication that the “religious right” (as pejorative and totalizing as “secular left”) supporting Teri take the position that “we are morally obliged to provide all invasive treatment that might prolong life at any cost.” Taking a guess based on this thread alone, I would guess you lean toward keeping the tube removed. Nothing wrong with that. But is it possible that your feeling “colors” your reading of Ivan (and of the “religious right” for that matter)?

    I appreciate Eric’s citation to the Church Handbook because I do think LDS doctrine gives us guidance and if we hold the traditional LDS belief in the reality of God, we know that He will give guidance to those who seek it. I do think this case is genuinely difficult under both legal and gospel-doctrinal standards. On the other hand, if this life is an eye-blink in the eternities, why shouldn’t we live (even suffer) for a “few” extra days under circumstances like Terri’s where it is impossible for our loved ones to know our wishes.

  51. Milo on March 22, 2005 at 12:35 am

    Maybe the legal question is, who gets to decide, but the moral/religious/Mormon question does turn, for me, on the sanctity of life. People have given examples of situations where they would rather die than live with the pain. Why shouldn’t this apply to emotional pain as well? I mean, people with severe depression go through living hell. Wouldn’t it be merciful to put them out of their misery, into a better place? I am not being snarky, I’m serious. If living is only a good thing insofar as you are to a specific degree free from pain, why is physical pain hogging the discussion? Not to mention all those kids with brain damage who will never learn to feed or clothe themselves, and can’t enjoy their lives the way we can?

    This, to me, is one of the worst situations for unrighteous judgments. We are asked not to judge another’s worthiness for heaven or hell, but we have no problem judging whether their quality of life is sufficient that they should go on living? I understand the compassionate impulse to spare our loved ones from pain. But as parents will attest, that’s not always the right thing to do. Alleviation of pain of others is a good thing, but is it the highest good?

  52. Sheri Lynn on March 22, 2005 at 1:25 am

    If it’s okay to take out the feeding tube and let her die over a period of many days, why isn’t it legal for Judge Greer and Schiavo to walk into her room and shoot her? How is that different in intent and effect from what is being done?

    Why hasn’t she been offered a spoonful of yogurt, an ice chip? Oh yeah, she might aspirate something, get pneumonia, and die, and it might take awhile and cause some suffering (to someone supposedly unable to suffer.)

    I’m with her parents and Matt Evans. (That’s twice in a row, Matt…oops.)

  53. Guy W. Murray on March 22, 2005 at 1:37 am

    Some good points in today’s N.Y. Times editorial. One has to question the Congress and the Presidents’ wisdom in taking the action they have.

    http://www.nytimes.com/2005/03/22/opinion/22tue1.html?

  54. Guy W. Murray on March 22, 2005 at 1:45 am
  55. Jeff Hoyt on March 22, 2005 at 2:36 am

    Guy;

    I find your comments demonstrate my point exactly, the notion that some will judge others as not worthy to live. And you seem able to do so without any hint of embarrasment. You mention your reading the posts and finding them helpful, but apparently not that helpful I guess.

    I read the Wolfson piece and frankly found it chilling in its ability to make matter of fact assessments that surely Terri would prefer death to whatever.

    Regarding “obeying, honoring and sustaining the law” – gee, I thought thats what the president and congress were doing.

    I am still amazed that the number of attorneys here do not seem fazed by the obvious conflict of interest of the husband. (I admit I do not know exactly who is an attorney and who is not. For the record I am not an attorney, but consult with attorneys as an expert witness on financial conflict of interest cases so perhaps I am just overly sensitive in these matters)

  56. Sheri Lynn on March 22, 2005 at 4:01 am

    What part of “right to life…” do so many people not understand? If she had left a living will/durable power of attorney…but ‘if’ means nothing here. She didn’t. And it took seven years and two babies out of wedlock for the man to decide to tell the world this was her choice. Ha.

    –Not posting again. I can’t follow the rules of the thread. Going to try to sleep. I strongly believe I belong in Florida standing with the Schindlers and that he should let them take care of their daughter.

  57. Bill on March 22, 2005 at 5:17 am

    I find it amusing that all those who want Mrs. Schiavo kept alive at all costs have such a transparent view of her husband’s motives.

    In my view, the president and congress are not “obeying, honoring, and sustaining the law.” That would be to accept the manifold rulings over many years by many courts, and not to grossly abuse their power interfering in an individual case when their proper function is to pass general statutes to be applied, interpreted and adjudicated by the courts.

    I too would be interested to hear from the lawyers, but on their opinions as to whether the executive and legislative have overstepped constitutionally.

    Incidentally, who was or was not “obeying, honoring, and sustaining the law” in this story?:

    http://www.chron.com/cs/CDA/ssistory.mpl/metropolitan/3094518

  58. derren on March 22, 2005 at 5:27 am

    There is a right to live and there is a right to die but neocons seem to forget about that.
    The God of George W. Bush gives the right to kill a man on the death-row and denies the chance to terminate with dignity the life on a human being that is not capable of running its vital functions autonomously. My personal view, as stated before, is that there is a right to live and a right to die, but if the second one is denied, then, this has to apply in every occasion and death penalty should be scrapped, now. Here there is, a big flow for all the Evangelicals, Mormons and neocons. How are you going to deal with it ?

  59. Eric James Stone on March 22, 2005 at 5:52 am

    Senator Frist, who is a medical doctor, had some interesting comments based on his review of the court documents regarding Terri’s medical state. http://thomas.loc.gov/cgi-bin/query/z?r109:S17MR5-0078:

    Based on what he says, I have serious doubts about whether she actually is in a persistent vegetative state, and I think Congress has done the right thing in having a court take a closer look.

    Of course, maybe we’ve just found a way to get around liberal objections to the death penalty. We’re always hearing about how the death penaly process in this country is flawed because of the remote possibility we might execute an innocent person. Well, all we need to do is diagnose criminals as being in a persistent vegetative state, and not only don’t we even need proof beyond a reasonable doubt in order to starve them to death, they can even be innocent and it doesn’t matter.

  60. Bill on March 22, 2005 at 6:04 am

    And since criminals are often uneducated, unsophiticated, and poorly represented, it probably wouldn’t even be that hard to trick them into signing some kind of consent form, after which even more objections would doubtless melt away.

  61. Stephen M (Ethesis) on March 22, 2005 at 7:55 am

    Bill

    When I did mental commitment work I was amazed at the number of times fairly bright, but very mentally ill, patients were tricked into signing consent forms and waivers that meant exactly the opposit of what they thought. It was chilling and I and the system soon parted ways.

  62. danithew on March 22, 2005 at 8:01 am

    This case reminds me of the story of Solomon and the baby that was disputed between two mothers. I’m not saying anyone should be cut in half … but this is one of those situations that is begging for finality based in juristic wisdom.

  63. Stephen M (Ethesis) on March 22, 2005 at 8:09 am

    Hmm, the Senator Frist material is interesting. I’m going to post a quote:

    So my curiosity piqued as I asked to see all of the court affidavits. I received those court affidavits and had the opportunity to read through those over the last 48 hours. My curiosity was piqued even further because of what seemed to be unusual about the case, and so I called one of the neurologists who did evaluate her and evaluated her more extensively than what at least was alleged other neurologists had. And he told me very directly that she is not in a persistent vegetative state. I said, well, give me a spectrum from this neurologist who examined her. To be fair, he examined her about 2 years ago and, to the best of my knowledge, no neurologist has been able to examine her. I am not positive about that, but that is what I have been told in recent times. But at that exam, clearly she was not in a persistent vegetative state, and of 100 patients this neurologist would take care of, she was not at the far end of being an extreme patient in terms of her disability. He described it as if there were 100 patients, she might have been the 70th but not the 80th or 90th or 100th.

    The entire address is worth reading.

  64. derren on March 22, 2005 at 8:24 am

    Eric, very unlikely in US prison they would have to diagnose criminals as being in a persistent vegetative state in order to kill them. They don’t have to bother for the hassle. As long as they are black or latinos they stand already a good chance to be neglected a fair trial and to be found guilty of crimes they never were responsible for. This is the reality of prisons in the US, particularly in Texas and Florida (check http://www.amnestyinternational.com). So, please, do not mix the topics here. Neocons, and 99% of Mormons (mainly a Republic electorate) accept the death penalty but now are turning all pro-life, supporting a ban on euthanasia. How hypocritical is that ? It’s the old same story, persue the moral agenda that suits my middle-class-white-environment and that’s it. It doesn’t matter if I vote for a president that does not grant grace and kills thousands of prisoners when is willing to stop his holiday to jump in the political arena to deny a woman the right to die. I believe in the right to die and I accept that you and some other people might not. I am perfectly fine with that but then the right to live would have to prevail everytime. If you don’t want Terri to die campain against the death penalty ans stop supporting George W. Bush, as easy as that.

  65. Scott on March 22, 2005 at 8:27 am

    Senator Frist is not above putting politics above medical facts to suit his politiacal agenda. Remember when he stated that HIV could be transmitted by tears or sweat?

  66. Guy W. Murray on March 22, 2005 at 9:01 am

    Jeff Hoyt wrote (#55):

    I find your comments demonstrate my point exactly, the notion that some will judge others as not worthy to live. And you seem able to do so without any hint of embarrasment. You mention your reading the posts and finding them helpful, but apparently not that helpful I guess.

    Jeff,

    It’s clear you and I have different opinions on this issue. Yes, I am not embarrased by my position or comments. I find all the comments helpful in that they help me understand the ideas of others (like yours) which are different from mine. They don’t necessarily help me in changing my own beliefs or opinions.

    JH:

    I read the Wolfson piece and frankly found it chilling in its ability to make matter of fact assessments that surely Terri would prefer death to whatever.

    GM:

    And I found it to be one of the more objective pieces written about Ms. Schaivo based on his qualifications, his appointment by a neutral judge, and his review of the entire case, both legal and medical, consisting of over 30,000 pages of documents and evidence, as well as his personal one on one interaction with Ms. Schaivo as her appointed guardian ad litem.

    JH:

    Regarding “obeying, honoring and sustaining the law” – gee, I thought thats what the president and congress were doing.

    GM:

    And I thought the President and Congress were making up new law as they were going along. They disagreed with the law and the interpretation of that law by a series of Florida trial and appellate courts along the way. So, rather than obey, honor and sustain that law, they (read President and Congress) undertook it upon themselves (without any apparent legal authority) to create a new law more to the liking of the majority members of Congress and the President.

    JH:

    I am still amazed that the number of attorneys here do not seem fazed by the obvious conflict of interest of the husband. (I admit I do not know exactly who is an attorney and who is not. For the record I am not an attorney, but consult with attorneys as an expert witness on financial conflict of interest cases so perhaps I am just overly sensitive in these matters)

    GM:

    I am one of those attorneys of whom you speak; however, after reading, particularly the Wolfson piece I was only more convinced of the appropriate result of the Florida trial and appellate courts in Ms. Schiavo’s case. I have a strong belief in our legal system, the history and theory of separation of powers between the executive, the legislative, and the judicial branches. From a legal perspective I found the conflict of interest of Congress and the President to me much more troubling in their actions and approach to this particular case. From an LDS perspective I found their actions troubling given my belief that The United States Constitution to be inspired–See D & C 101:77.

    I further am troubled and fazed by Congress and the President’s actions in light of: D & C 134 1-4 that men and women should make and administer laws for the benefit of society. Society has not benefited by the actions of Congress or the President here. Rather our constitutional system of separation of powers has come under viscious attack.

    D & C 134: 5-8 requires that men and women should uphold their governments and give deference to its laws. Congress and the President did not show such deference to the law of Florida, and the judicial intrepretation of that law. (Neither did the Florida executive or legislature in a similar unconstitutional abuse of power 2003).

    D & C 134: 9-10 wisely points out believe it is not just to mingle religious influence with civil government. The (what I believe) abuse of power by Congress and the President in passing Terri’s law over the last two days is exactly the type of religious influence of which the Doctrine and Covenants discourages here.

    I believe Ms. Schiavo’s parents have the right to petition the courts for redress, which they have done for several years. As a professional litigator, I believe in and give great weight to the litigation and appellate process. That occurred here, several times, at the state level, where these types of issues are traditionally litigated and decided; however, I am offended, and fazed a great deal when that process is ultimately ignored and abused by those who do not agree with the final outcome. I am heartened to read that the Federal Judge who now has jurisdiction over the case has halted (at least for the moment) the abuse of our judicial and legislative system perpetuated by Congress and the President. We are a nation of laws, not of men. We should be act accordingly.

  67. gary on March 22, 2005 at 9:17 am

    If you have a gospel perspective, can you really say that this is about whether Terry’s life is worth living? Could you not just as easily argue that it is about whether we should allow her to live her more life fully, freed from the constraints of a brain that does not function?

    If it is morally justified for an individual to direct that no measures such as forced feeding be used to maintain her life if she is ever in this state, why is not also morally justified for a third party to do what he truly believes she wants? I am not focusing on this particular case when I say because I don’t know the facts of this case.

    What of the golden rule? It is quite clear what I would want others to do unto me in this circumstance. I would want desperately to be released and to be allowed to die and move on. Am I not obligated to do for them what I would want them to do for me?

    How can we justify active killing based on our belief that justice is being served, or based on our belief that our duty to our country so requires it, but we cannot justify removing feeding tubes as an act of love and mercy on behalf of a loved one?

  68. Mark B. on March 22, 2005 at 9:18 am

    Great post Rosalynde/John, and difficult issues you raise. It’s remarkable how your requests to avoid making this a firefight about the specifics of the Shiavo case have been ignored so completely–beginning with Ivan the Wolfe.

    Of more interest to me are the legal aspects of the case, particularly the extraordinary actions taken by the congress last weekend. I don’t want to threadjack this line of comments, so I’ll just suggest a new post dealing with the constitutional implications of the “Terri Shiavo law.” It may well be that hard cases make bad law, but this hard case, IMHO, seems to have made a terrifically bad law. (Please note that this comment is not intended to express any opinion whether Ms. Shiavo should be maintained alive through artificial nutrition/hydration–that’s another matter altogether.)

  69. Charlene on March 22, 2005 at 10:55 am

    #48–Anyway, in this instance I brought up infant feeding to point to a class that everyone agrees should be nourished even if though it requires active intervention by others. The difference between Terri and infants in some people’s mind, it seems, is that Terri’s life is not worth living…

    I don’t think it has anything to do with a “life not worth living” It has to do with future potential. We nourish and care for the helpless baby in the hope and expectation that he will grow to be a fully functioning adult. There is no hope that Terri’s life/existence will ever change. Ever.

    My first question is: What is the purpose of life? Abraham 3:25–”We will prove them herewith to ssee if they will do all things…” It seems to me that in her present state, Terri can make no choices, can do nothing to improve or alter her eternal progress. What would be the *purpose* in prolonging her life? How would it bless her or make her a better person in the eternities?

    This is different than a “life worth living”–at least I think it is. “Life worth living” is usually subjectively and emotionally defined. We need to define life from God’s perspective–what is HIS purpose in granting us life and when does prolonging it cease to serve His purposes?

    Long before this case became the cause du jour, dh and I had discussed this topic extensively. We agree the line separating a life with eternal potential and one that has no more hope may be fuzzy or indestinct. But there IS some territory which is clearly in the “this serves no eternal purpose” territory. I believe Terri’s is such a case.

    I am adamantly pro-life. Where there is hope, even the faintest glimmer, life should be protected and treated with dignity. I have serious misgivings about witholding medical care in some of the seemingly desperate cases. I would be the last person to give up hope. But I can tell you that if I were Terri Schaivo, I would bless the person that would release me from such an existence. It seems to serve no good purpose, other than to ennoble those around her who serve and care for her. If I were her and could speak I would say “My life is over. I can do no more towards my personal salvation. Go find some other worthy person to serve and let me go to my Father.”

    P.S. I’ve heard and read much by Terri’s Guardian Ad Litem. I think he makes many valid points that have gotten lost in the emotion of this case.

  70. John H on March 22, 2005 at 11:14 am

    Without referring specifically to the charged Schiavo case, where both sides are using her to promote their own agenda, I’m more interested in the interaction of medical science and religion.

    Particularly in Mormonism and other conservative, evangelical faiths, science is often the brunt of criticism. When it comes to creationism, stem-cells, or even DNA studies, we’re told of the limitation of science, and age-old arguments are dragged out again to remind us that science gets things wrong and is always changing, unlike religion (ha!). In other words, why is using stem-cells playing God but artificially keeping people alive not?

    I find it ironic that we rail on science when we don’t like it (despite our own lack of knowledge on the subject or expertise) and then support it when it serves our own purposes. That’s not to say we should never trust medical science or rely on it – Christopher Reeve was kept alive by a ventilator, and he seemed to live a fulfilling life after his accident until his recent death. But where do we draw the line, and why do some people feel like they can have it both ways?

  71. annegb on March 22, 2005 at 11:15 am

    Of course, Rosalynde, having an eternal perspective makes it easier to contemplate death in all its forms. I personally have a living will, so does my husband, and frankly, I can’t wait to get out of this wacko world.

    But I think you touched on this (I’m trying harder to stay on topic today), if it was my daughter, my beloved child, that is night and day in the decision. I don’t know if I could do it. I was fortunate in not having to make that decision when my son drowned, but at the time, if I could have, I would have kept him alive no matter what.

    Pearl Buck wrote in her biography of her mother about how we love their bodies, especially us moms, those bodies are so precious to us. I longed for years for that little body.

    Michael Schiavo comes across as a black mustached villain here, I personally think he’s despicable, and don’t understand his refusal to give Terri to her parents, what does he lose (except a million dollars?).

    But I would want my mother to let me go, if I was Terri—if I was Terri’s mother, I would be holding on for all I was worth. They would have to kill me to keep me from sticking that tube back in.

    I think, conversely, that this modern medicine doesn’t necessarily do a service in prolonging life. You guys, being alive isn’t all it’s cracked up to be, and there is a wonderful world awaiting Terri when she eventually does die, free from pain, with loved ones from before and during this life. She has a God, she is not alone, and ultimately His will will be done. There, she will walk and talk and feel and progress. Not doing too much of that now. From an eternal standpoint, this is just another small dot in the map of humanity learning how to be gods.

  72. Cordeiro on March 22, 2005 at 11:46 am

    I’m usually pretty quiet when it comes to commenting here. As a matter of fact I think I’ve only done it once or twice. I try not to get caught up in the doctrinal discussions. I’m perfectly happy to let the regulars engage the details of the subject.

    That said, this whole Shiavo case has me steamed.

    From what I can gather (and I’m sure you’ll correct me if I’m wrong) Terri suffered a heart attack brought on by a low potassium level resulting from an eating disorder – most likely bulimia. Brain damage resulted from lack of oxygen during the cardiac incident. She has been in her current state since said incident.

    Here’s my problem: The “husband” – due to the fact he lives with a woman who has borne him two children I use the term “husband” loosely – began the litigious battle to terminate life sustaining care some seventer Terri’s heart attack.

    There are no machines to turn off that would result in Terri’s immediate death. The only thing that can be witheld from Terri is food and water. Absent that, Terri’s life can end – in two weeks or so.

    Whatever your opinion on this matter may be, this is not a painless death. I took that walk through the Valley of the Shadow of Death by Dehydration years ago (complications from the onset of diabetic ketoacidosis). I can think of few more painful ends to a life.

    We can all sit in our overstuffed chairs and pontificate as to what should or should not be done in this case. The bottom line is nobody can speak for Terri. Her “husband” wants her dead. He has obvious motivations for wanting her that way. Her parents want to keep their daughter alive.

    In my view, her parents are acting much more like loving parents than her “husband” is actiing like a loving spouse. If its all the same to everyone, I’ll err on the side of life. Death is (until the ressurrection anyway) very irreversible.

    Until someone can convince me that death by starvation and dehydration can be shoe horned into the definition of love and compassion, I’ll stick to that position.

  73. Bryce I on March 22, 2005 at 12:04 pm

    Mark B., a question:

    One of the things that makes me (and many others) uncomfortable about the actions taken by Congress this weekend is that they were intended to benefit just one person, but may inadvertently end up affecting many others. I heard someone comment on the radio that Congress takes actions on behalf of individuals several times each year, but generally in immigration matters. Can you elaborate?

  74. Jeff Hoyt on March 22, 2005 at 12:06 pm

    Guy #66

    Guy – It’s clear you and I have different opinions on this issue. Yes, I am not embarrased by my position or comments. I find all the comments helpful in that they help me understand the ideas of others (like yours) which are different from mine. They don’t necessarily help me in changing my own beliefs or opinions

    Response – I uderstand that, just wanted to demonstrate to others my point that there are those (even some LDS) that believe that certain life is of no worth. I obviously thought that in being confronted with the reality of their position they might be embarassed by the implications of what they believed and reassess.

    Guy – And I thought the President and Congress were making up new law as they were going along. They disagreed with the law and the interpretation of that law by a series of Florida trial and appellate courts along the way. So, rather than obey, honor and sustain that law, they (read President and Congress) undertook it upon themselves (without any apparent legal authority) to create a new law more to the liking of the majority members of Congress and the President.

    Response – This may come as a surprise to you, but the only role of Congress is to “make up new law as they go along”. If there is any danger to our inspired Constitution regarding separation of powers it is the judicial branch that poses the danger.

    Guy – D & C 134: 9-10 wisely points out believe it is not just to mingle religious influence with civil government.

    Response – Again I am flabbergasted at this comment coming directly after citations from Scripture as to how men in government should behave. Which is it? Should religion influence men in gevernment or not?

    As to your claim that the President and congress have a conflict of interest, you totally lost me, as well as ignored my point by changing the subject. I can only conclude that you have no problem with the husbands conflict of interest because you agree that Terri needs to be put down.

  75. Jeff Hoyt on March 22, 2005 at 12:19 pm

    Danithew #62

    You have me a little red faced for not having invoked Solomon myself. Very appropriate.

    Cordeiro #72

    Very well stated. Thank you. I too am “steamed” about this case. It helps me a great deal to hear fellow believers defend the life ethic.

  76. Bill on March 22, 2005 at 12:21 pm

    “Response – This may come as a surprise to you, but the only role of Congress is to “make up new law as they go along”

    but hopefully not in capricious, willful and quite probably unconstitutional fashion

    “If there is any danger to our inspired Constitution regarding separation of powers it is the judicial branch that poses the danger.”

    How do you figure? It seems to me that they are acting as a last bastion of good sense while the other two branches are succumbing to hysteria.

  77. A. Greenwood on March 22, 2005 at 12:27 pm

    Here’s Robert P. George’s discussion of the Schiavo case and of medical care for the very ill in general. He ends up taking a position similar to the one in the Church handbook. I found it useful, I hope others will also:

    http://www.nationalreview.com/interrogatory/george200503211140.asp

  78. Jeff Hoyt on March 22, 2005 at 12:36 pm

    Bill

    “but hopefully not in capricious, willful and quite probably unconstitutional fashion”

    I hope they are not capricious, are willful, and if what they have done is not constitutional then the courts will address. Frankly I prefer to see them defending an innocent person from a painful death versus 99% of what they normally do.

    “How do you figure? It seems to me that they are acting as a last bastion of good sense while the other two branches are succumbing to hysteria.”

    I guess our disagreement is that what you see as “good sense” I see as inhuman. I do not think there is much that can be done to bridge the gap between us.

  79. Nate Oman on March 22, 2005 at 12:40 pm

    I’ve no television and have been too busy to read the papers. I’ve no idea who Terri Schiavo is. I am, however, struck by two comments in the above discussion. The first is John Welch’s claim that we have by law an inalienable right to refuse medical treatement. My question is whether or not it is really inalienable. Could I sell it or give it to another? Certainly, under some circumstances I can give the exercise of that right to another, ie through a permanent power of attorney. I am not so sure that I could sell it, ie enter into a contract where by I promise to accept any and all life saving medical treatment (or forego the same) for a fee. I would love to see the court opinion construing such a contract. Sorry about this, but one of my pet peeves is the use of “inalienable” to mean “really important.” It actually means “cannot be transferred or abandoned.” The pernicious misuse of the term — like so many other pernicious things — comes from Thomas Jefferson, who famously claimed that the rights to “life, liberty, and happiness” were inalienable. This is nonsense of course. I work with lots of people who seem to have sold their right to be happy.

    With regard to John H’s series of rhetorical questions I think that he is being too cute. One can “have it both ways” by thinking carefully about the nature of the claims that are being made. There is no law of intellectual honesty that says that one must accept all of an intellectual system’s claims to accept any of them. Let me put it starkly: Saying that Carl Sagan’s claim that science demonstrates the nonexistence of God is epistemological overreaching does not entail that I reject modern medical science. It is a matter of looking at the epistemological basis of science and figuring out what sorts of claims it can support and what sort of claims that it cannot support. For example, there are many categories that superficially appear to be medical or clinical but in reality are moral and normative. The concept of insanity in the criminal law is a good example. It does not refer to a pyschological condition but to a moral judgment. Much pernicious law has resulted from confusion on this point, despite the fact that this law was backed by many eminent physicians and scientists who were quite certain that they knew better than the poor benighted judges.

  80. Kaimi on March 22, 2005 at 12:42 pm

    Bryce,

    Immigration laws lead to exceptionally screwy results in many cases. Two famous cases were Knauff and Mezei. In Knauff, a soldier married a Czech woman. The attorney general refused to grant her entry, and refused to say why. She appealed all the way to the Supreme Court and lost. At that point, Congress passed a private bill requiring that the AG give her a hearing. At her hearing, she was found to be admissible and was admitted to the country.

    Mezei is even more odd. He was a longtime resident alien who left the country to visit relatives, and was detained on his return. The AG refused him entry, again based on undosclosed reasons. Mezei could not return to the other countries, either. He was stateless, and was forced to reside on Ellis Island for years. He also was eventually admitted through a private bill.

    (There is a lot of discussion of both cases in the law review literature. One good article is at 143 University of Pennsylvania Law Review 933 ).

  81. Nate Oman on March 22, 2005 at 1:03 pm

    There is no federal constitutional prohibition of which I am aware on passing a law designed to benefit a single person. There was a time when so-called “class legislation” — ie legislation designed for the sole benefit of some discrete group or individual — was constitutionally suspect under the due process clause. This idea, however, was tied up with the so-called Lochner era of jurisprudence. Lochner and its progenitors and progeny were essentially rejected in 1937, killing off the idea of “class legislation” as a constitutional category. There are some state constitutions from the late 19th century that contain prohibitions on “class legislation” but to my knowledge none of these state provisions is interpretated so as to have any real bite.

    There is a prohibition in the constitution on congress passing what is known as a “bill of attainder.” This was a device much used by the English Parliament, especially in the 17th century against unpopular royal ministers. Essentially it was a piece of legislation finding that a particular person was guilty of a crime and then specifying a punishment — in some cases death and confiscation of all property. Hence, Congress cannot single out a particular person and criminally punishing them.

    The seperation of powers arguments are much merkier and are based on the structure of the constitution.

  82. Kaimi on March 22, 2005 at 1:10 pm

    FYI, Steve Evans thinks that the Schiavo bill is itself a Bill of Attainder, based on the theory that it punishes Terry Schiavo by potentially reinserting the feeding tube.

    I think he’s a crazy Canadian. And I recommend that people of good sense tell him that he must be crazy to think that this is a Bill of Attainder. A good location to do so is at http://www.bycommonconsent.com/2005/03/hard_cases_make.html .

  83. Steve Evans on March 22, 2005 at 1:17 pm

    It’s hard for me to see how forcing a surgery on someone isn’t singling them out for punishment…

  84. John H on March 22, 2005 at 1:30 pm

    “With regard to John H’s series of rhetorical questions I think that he is being too cute.”

    Gee Nate, you’re onto me now. I was trying to be too cute, not ask some honest questions and hope for some honest answers in how science and faith ought to interact.

    I wonder if it’s possible for me to post anything online without you immediately dismissing it as too pedestrian, too blaise for your brilliant, incisive mind. Next time, I won’t waste your time so you won’t have to pretend to be bored to tears by anything other than long-winded posts about chess or the law.

    Now that I’m reminded why I haven’t visited T&S for a while, I’ll crawl back into my hole of heathens and weak-thinkers and only interact with people several notches down on the evolutionary chain from Nate Oman.

  85. john fowles on March 22, 2005 at 1:38 pm

    Steve, is death by starvation less of a “punishment” than reinsertion of a feeding tube?

  86. Steve Evans on March 22, 2005 at 1:44 pm

    John, death by starvation is less of a punishment than a surgical procedure — if you want to die, which is an evidentiary issue.

  87. john fowles on March 22, 2005 at 1:46 pm

    Nate wrote I work with lots of people who seem to have sold their right to be happy.

    Beautiful. But don’t you think that, if based on nothing else than Jefferson’s use of the term “inalienable” in this way, the word has acquired, in addition to the technical commerce-related meaning you note, the meaning that Jefferson meant it to have, i.e. that it “cannot be taken away” (not, as you interpreted his use of it as “really important”)?

  88. Shawn Bailey on March 22, 2005 at 2:00 pm

    Nate (no. 81): legislation to resolve individual claims against the government is a notable example of the type of legislation you discuss. The Court of Claims (predecessor to the Federal Circuit and U.S. Court of Federal Claims) was created in 1855 to remove from Congress the burden of resolving such claims. To this day, the Court of Federal Claims hears Congressional Reference Cases—legislatively created causes of action for the benefit of particular parties who for whatever reason have a grievance but not a remedy against the government (i.e., no waiver of sovereign immunity for that particular claim, the claim is time-barred, etc.) Far from being unconstitutional, legislation for the benefit of individuals seems to be a well-established institution. One might try to make an argument distinguishing between types of individual legislation. But as you note, there is little specific constitutional text upon which such arguments can be hung.

  89. Nate Oman on March 22, 2005 at 2:06 pm

    John H.: Yikes! Cool down buddy. I actually like your comments here, which is why I am more likely to respond to what you say than to what someone else says. I don’t think that your comments are blaise or boring or stupid. I don’t think that you are a heathen or a weak thinker. I did think that the double standard that you set up in your comments was a bit forced. (On rather forced questions and comparisons compare some of my posts on law and chess.) In my mind, the question is not whether or not people should accept some of what science says or accept all of what science says. It seems to me that the question is whether the criteria that people use for rejecting certain claims while accepting others are justified. (Chances are the criteria are not even articulated yet alone justified. Most of the time we are basically ignorant and confused. No surprises there.) The fact that the criteria, however, lead us to reject science in some cases but not in others really has nothing to do with the value of the criteria. That after all, is what criteria are for!

  90. Nate Oman on March 22, 2005 at 2:10 pm

    Shawn: That is an interesting point. I didn’t know the history behind the Court of Claims. What exactly do you mean by a legislatively created cause of action without a remedy? Can you give me an example? I recently read a bunch of Court of Claims opinions from the turn of the century and they all dealt with pretty run of the mill issues of breach of contract by the government with some supplier. Was the Court of Claims given some sort of special equitable jurisdiction as well?

  91. Shawn Bailey on March 22, 2005 at 3:05 pm

    Nate (no. 90): the general jurisdiction of the Court of Claims and congressional reference cases are two different (but in a sense parallel) things. At first, the Court of Claims’ jurisdiction was limited primarily to contract cases. The Tucker Act (1878) extended the court’s jurisdiction to include money claims (read: no equittable jurisdiction) based on “money-mandating” provisions of the constitution or federal laws. [An extremely interesting thread of this history (both pre- and post-Tucker Act) is the history of takings jurisdiction in the Court of Claims.] Only recently, the Court of Federal Claims has obtained something like equittable power in bid protest (government contract) cases.

    In addition to this, Congress has apparently always been empowered to grant relief to individuals with grievances against the federal government. Generally speaking, only those who cannot litigate under the Tucker Act, Federal Tort Claims Act, or some other jurisdictional head pursue this route these days. For example, assume a party has an otherwise valid claim under the Tucker Act or FTCA, but that party let the statute of limitations run. Or assume a party is injured by the government in a way that does not give rise to a claim under the the Tucker Act, FTCA, or any of the other odd statutes that permit people to sue the government. In both cases, the parties can ask Congress to help them out. Congressional reference cases result when, rather than seeking relief directly from Congress, the aggreived party convinces Congress to pass a law directing the Court of Federal Claims to hear the case despite the time-bar, or lack of a general waiver of sovereign immunity, or whatever other obstacle to relief there may be. As I understand it (I must admit I haven’t read a wide range), such legislation can be fairly particular in its directions to the court. I hope that answers your question.

  92. Carleh on March 22, 2005 at 3:30 pm

    Ok, guys, so we decide to take Terri off the feeding tube according to what we consider the best moral view of the situation. If our moral interpretation is correct according to the laws of God (that’s what we’re trying to figure out, right? What our religious views would lead us to decide?), then hurray for us. BUT WHAT IF WE ARE WRONG??? What if we killed her and we weren’t supposed to? That seems like a MUCH bigger moral problem than letting someone live when we weren’t supposed to. In the end, Terri’s life (which is in our hands) and death (which is inevitable) might be expensive, protracted, and terribly inconvenient. But so what? I’d rather hedge my bets on the side of life.

  93. Eric Russell on March 22, 2005 at 3:34 pm

    While all this legal stuff is interesting, what particularly interests me are John Welsh’s original questions. Particularly,

    “Does LDS doctrine help you feel more or less comfortable withdrawing or withholding treatment when a family member desires this course?”

    Though it’s entirely counterintuitive, my reaction is: more comfortable. After all, the church does recognize death as a blessing, and not necessarily the worst case scenario. This life is a test, and after the test is complete, we move on to the next life. It would seem to me that, whether Schiavo is in a vegetative or near-vegetative state, her test in life is over. When there is no agency, there is no test, when there is no test, there is no real purpose to life anymore. It seems as if, from a religious perspective, our purpose in living extends only so far as we have agency.

  94. lyle on March 22, 2005 at 6:20 pm

    Eric:

    Great point. Agency is really key here. LDS doctrine doesn’t have any ‘fear’ of death; excepting what the wicked should have (well…i guess that is all of us). However, how can one ‘know’ re: when the agency of another is active or not?

    In many ways, this is the abortion debate all over, but instead of a fetus that can’t speak/protect itself, we have a disabled adult. So…when does the ‘spark’ of life, the spirit, leave the body? Has her soul already fled? Isn’t that the _real_ doctrinal question everyone is pussyfooting around (my apologies to everyone’s cats)?

    Is Terri’s “soul” trapped in a body, one which it has _no_ agency over? Or is that “soul” struggling to master the “new” (condition of the) body she finds herself in, i.e. a disabled one, much like a newborn baby? Or has the soul already left, is hanging out with God and wondering why we are all making a huge deal out of nothing? Hm…

  95. JKS on March 23, 2005 at 1:50 am

    Personal revelation is available to every chuch member. I would say that it is the greatest gift in a situation like this. No two medical situations are the same. When deciding on treatment, or non-treatment for yourself or someone who you are responsible for, you should pray for guidance.
    I’d rather have that than an extensive list of what we should do or what we shouldn’t do in every medical problem.

  96. Stephen M (Ethesis) on March 23, 2005 at 8:11 am

    I guess that the government has to honor the government and thereby not engage in any activity to check or balance the other branches? ( http://nipomoblawg.blogspot.com/ commented here and seemed to think so). So, Courts should never issue injunctions or hold laws unconstitutional? The congress should never impeach (executives or judges)? I’d agree that this particular example seemed ill advised and now seems futile, but that doesn’t mean that it somehow violates the doctrinal injunctions.

    BTW, for more on this thread, see the rameumpton version and comments at:

    http://www.bycommonconsent.com/2005/03/hard_cases_make.html

  97. Stephen M (Ethesis) on March 23, 2005 at 8:29 am

    I really think that this thread could use a discussion of GOMERs, end of life care, euthenasia (really, if you are going to just let someone starve to death shouldn’t you, perhaps, allow them anesthesia too? Once you start down that slope, what about just a little more?) and so forth.

    Terri’s real problem is endemic to the medical field. She is a well preserved GR (I’m going to shorten GOMER, even though it is a well used medical term, it seems too harsh). Her limbs have not contracted, so someone has been providing her therapy. She isn’t really 100% vegatative (not to mention how she fits the popular meme for that as I’ve noted before), not in the classic sense, so some neurologists look at the scans and go “hey, she isn’t SVS,” but she is operating below the mental level of a fish.

    Nursing homes are filled with people in her position. As I noted before, probably 30% of the public health dollar, probably around 10% or more of your tax dollar, goes to the care of GRs in the last six months or so of their lives.

    Most are receiving drugs for a numerous host of problems, have bed sores (Terry S. does not — she was getting good care in the SNIF [skilled nursing institutional facility] unit), are contracted, and have random emotional states. There is a huge question of just what should we do “to” these patients vs. “for” these patients.

    It is a topic that also gets raised a great deal in grief support groups for people who have lost children.

    Generally, there comes a point when the technology can still keep things going, but there isn’t any hope. Because Jessica was poisoned so badly by the doctors who screwed up, she was in such terminal failure that by the time they told my wife, if she had not already called me and told me to turn around and come back to Dallas, Jessica would have died before I got there. I was spared that decision.

    With Courtney, she ruptured down to the brainstem, which means that they had real trouble keeping her stable which is why when they ran all the tests on her a second time (something often done to bulk up revenue in transplants), they lost most of her organs.

    Robin died in her sleep and CPR failed. Obviously no way to keep her going there. I’ve managed to bury three children and not face that decision myself.

    But I listened to a lot of parents who did have to make that decision with their children who were terminal. The first gamma knife in Texas. Too late, too harsh, went mets. At that point they realized that they could make their daughter’s life more painful, but they couldn’t make it last much longer. Heroin overdose followed by heart stoppage followed by brain loss, followed by SVS. How hard do you figh the random organ failures. Tylenol overdose. Kid looks completely alive, but their liver is gone. As they burn and die from the toxins, how hard do you fight once they are so bad they no longer qualify for an organ transplant? What about a heart transplant? Once you have one, they are temporary.

    What do you do when the new heart starts to go and you don’t qualify for a new one? How hard do you fight once your child slips into unconciousness? How long? How often do you bring them back before you consent to a DNR?

    All of these issues come together more strongly with non-children.

    Children we preserve for their futures. Others we are, for the most part, delaying their entry into the past — and doing it not ourselves, but by proxies.

    TS is in the position we wish to see them all in. She gets physical therapy. She has no bedsores and room and light. By reports, unlike most facilities, hers does not stink of urine (and I’ve been in expensive facilities that stunk of urine and poor ones that did not. Some of the best nursing homes in this country are run in what used to be segregated facilities in the poor parts of towns). Her family visits regularly.

    But what are we doing for those whose minds have failed and whose families can not bear the burden of them? What does it say about us that we do what we do. What would it say if we did not?

    Which I think is the problem. What does it say when we do not. I had clients who had been greeted at the doors of the hospital with organ donor paperwork, asking for immediate authorization to harvest their loved one — who were in my office with the “donor” who recovered completely and was in to hire a lawyer (about unrelated matters). Had a friend who quit doing transplant work at her facility because they harvested patients much too often who were not terminal enough for her tastes. Had a child in for the flu and got the advice not to let them linger but pull the plug quickly (what plug? Yank the IV out for them perhaps?). You will meet handicapped people who have had offers to put them out of their misery one to many times.

    It is complex and the issues are growing faster than we are.

  98. Carleh on March 23, 2005 at 10:18 am

    I don’t know what to say to that. It’s too much – I don’t think I can bear it.

  99. Guy W. Murray on March 23, 2005 at 10:24 am

    Stephen M (Ethesis) # 96 Wrote:

    I guess that the government has to honor the government and thereby not engage in any activity to check or balance the other branches? ( http://nipomoblawg.blogspot.com/ commented here and seemed to think so). So, Courts should never issue injunctions or hold laws unconstitutional? The congress should never impeach (executives or judges)? I’d agree that this particular example seemed ill advised and now seems futile, but that doesn’t mean that it somehow violates the doctrinal injunctions.

    Stephen,

    My legal blog which you cited does not comment on whether there should be any checks between the brances of government; however it is a proposition with which I fully agree. Rather, there I provide legal commentary on legal issues, only one of which happens to Ms. Schiavo. I do, however, agree with your comment that government, as well as individuals should obey, honor, and sustain the law. This phrase, as you know comes directly Twelfth Article of Faith, which I believe was inspired, and accurately reflects a basic tenent of the LDS faith and doctrine.

    In appropriate circumstances, and based on sound legal principles, courts should declare laws unconstitutional, issue injunctions and afford relief where indicated. Just this morning, the Eleventh Circuit Court of Appeals upheld the district court’s opinion in denying the legal relief sought by Ms. Schiavo’s parents–see

    http://news.findlaw.com/hdocs/docs/schiavo/32305opn11.pdf

    The court relied on well established legal principles of remdies law in its analysis of whether an injunction was appropriate here. The majority held, as did the district court, an injunction was not appropriate here. As an attorney, I am certain you understand this process well.

    I believe the judicial process currently unfolding, and the judicial process that proceeded it at the state level is a prime example of institutions and individuals obeying, honoring, and sustaining the law. I believe the abuse of the Constitution (a document which I also believe to be inspired), undertaken by Congress, and the Executive branch in this particular case does not reflect individuals, or institutions obeying, honoring, or sustaining the law. It also is an affront to the inspired legal principles embodied within that inspired Constitution. It is that part of this process which I find offensive, and contrary to my understanding of the Twelfth Article of Faith and the concept of an inspired Constitution.

  100. chab on March 23, 2005 at 3:37 pm

    Stephen M (Ethesis)

    “I really think that this thread could use a discussion of GOMERs, end of life care, euthenasia (really, if you are going to just let someone starve to death shouldn’t you, perhaps, allow them anesthesia too? Once you start down that slope, what about just a little more?) and so forth.”

    Do not forget he slope falls on both sides. I saw many times where we kept the elderly alive far beyond what they themselves wanted. Obviously these GOMERs wanted to die but we would not let them. Maybe we should give them food (if they are unconscious), then why not antibiotics, then why not shock them if their heart stops, dialysis, extracorporeal blood oxygenation, ILVAD… How far do we go to keep someone alive? At all costs?

    Do we agree that Jehovahs Witnesses can refuse blood products for themselves? Can we refuse chemotherapy when we cannot be cured, but the therapy might give us 2 months extra? I think we should be able to make the final decision in our own care, and Ms. Schiavo told her husband she did not want to live the way she currently does. We should respect that wish.

    A couple of comments on topic that I remember reading in the posts above:
    Ms. Schiavo is vegetative, she will feel no pain because of withholding food and hydration.

    Someone made a comment about withholding food from someone terminal, but conscious. This can not happen, a health care agent (under a durable power of attorney) does not have the power to withhold feeding (at least in NH) if you can eat and drink normally. A durable power of attorney only is in effect when someone is incapacitated.

  101. Stephen M (Ethesis) on March 23, 2005 at 6:40 pm

    Do not forget he slope falls on both sides. I saw many times where we kept the elderly alive far beyond what they themselves wanted. Obviously these GOMERs wanted to die but we would not let them. Maybe we should give them food (if they are unconscious), then why not antibiotics, then why not shock them if their heart stops, dialysis, extracorporeal blood oxygenation, ILVAD… How far do we go to keep someone alive? At all costs?

    Well said.

    But … as to someone terminal, but conscious

    “Marjorie Nighbert, a 76-year-old Florida woman, was hospitalized in 1996 after a stroke. Before her hospital admission, she signed an advance directive that no “heroic measures” should be employed to save her life. On the basis of that directive and at the request of her family, the hospital denied her requests for food and water … Until her death more than 10 days later, Nighbert was restrained in her bed to prevent her raiding other patients’ food trays.”

    .

    The Washington Post National Weekly Edition, January 13, 1997, page 23.

    Nighbert died while her case was on appeal.

    I don’t know the answers, but I do believe we need more dialog.

  102. A. Greenwood on March 23, 2005 at 6:47 pm

    “LDS doctrine doesn’t have any ‘fear’ of death; excepting what the wicked should have”

    I don’t think this is right. Death is an evil, even if it is the only way to shuck off the mortal coil. Like sin, ignorance and bitterness, it is an integral but horrible part of our learning experience. There is nothing wrong with clinging to life. Death will come when it comes.

    I’m sure that Chab is right: sometimes people are kept ‘alive’ too long. I also know that Stephen Marsh is right: sometimes people are declared dead or killed awfully fast. One of these seems a lot awefuller to me than the other.

  103. John Welch on March 23, 2005 at 9:31 pm

    Thanks for the many comments, and even a few that responded to my questions.

    I apologize for not being more active in the thread. I finally got my patients tucked about 2:30 last night and just didn’t have the wherewithal to write anything cogent.

    The thoughts that lead to my original post largely revolved around the dissonance I felt last weekend. Other Christians were drawing very different ethical conclusions than I was, but claiming moral authority based on their religious principles. Was I misunderstanding Christianity? Or is my Christianity fundamentally different? And could I articulate ethical principles and their derivations?

    In broad strokes, end of life decisions revolve around competing values. Two of the most important are autonomy and paternalism. Autonomy grants the will of the individual over the will of any power that be: governmental, medical or even familial. Autonomy is based on a belief that only the individual has access to the personal knowledge and preferences required to chart a delicate decision. In contrast, paternalism grants the will of a group or institution over the individual as the individual is insufficiently trained and knowledgeable to adequately understand the risks and benefits of a decision.

    Other competing principles might include the following. Beneficence, one should do good when ever possible. Utility, one should maximize good with available resources. Professional autonomy, a physician may refuse to treat a patient based on a professional assessment of an unfavorable risk (medicine is not a smorgasbord). Futility, when an outcome is assured, one need not continue. Sanctity of life, all human life should be preserved.

    Does the gospel help us derive arguments to support any of these principles over others? How does our belief in a patriarchal order and familial structure influence the principle of autonomy? Should the patriarch, as presiding priesthood authority, have significant influence in the determination of familial end of life issues?

  104. Russ Frandsen on March 24, 2005 at 12:26 am

    Colleagues,

    Let’s have a good discussion of the issues John raises in the initial post and in his #103. Let’s leave out the legal and factual arguments for awhile. I am most interested in how our Mormon doctrine and community and illuminate these issues.

    Further, Rosalynde, is it possible to start another thread on this topic, and invite only those to comment who have actually had to wrestle with the issues of end of life decisions? I would like a thread composed only of those experience of LDS actually dealing with these issues. How were the issues resolved? What were the most salient points in making these decisions? Who contributed to making these decisions? What role did Home Teachers, Bishops, Stake Presidents, Visiting Teachers, and Relief Society Presidents play? What pratical role did prayer play? How influential and/or distinct were answers to prayer in these circumstances? What were the nature of priesthood blessings given in these circumstances? How many of these blessings were granted the wishes or hopes expressed in the blessings? How many foundered? I would like to see this thread without the interruptions of irrelevancies (no matter how valuable otherwise).

  105. Rachel on March 24, 2005 at 1:43 am

    Oh, my father, I love you.

  106. Rosalynde Welch on March 24, 2005 at 9:12 am

    Daddy, I think that’s a great idea for a thread. I think it will be most likely to be successful after the Schiavo case has been resolved and feelings on that matter are less volatile.

  107. Mark B. on March 24, 2005 at 10:09 am

    Looks like the Frandsen’s are taking over. To the barricades, all!

  108. A. Greenwood on March 24, 2005 at 12:59 pm

    I don’t think that leaving the Schiavo case out of it would be that helpful. One of the lessons the law has taught me is that it’s more productive to look at real life examples and explore them then it is to resolve abstract questions in the abstract. For me, the Schiavo case has really helped me see that I’m willing to respect patient autonomy to end their own lives but only grudgingly. I want a clear and formal indication of intent and that intent better be durn well informed.

  109. Patricia Gunter Karamesines on March 24, 2005 at 1:50 pm

    Hello All,

    I know I’m a stranger here, but please allow me to say that I very much like the suggestion Russ Frandsen makes in comment #104. Importantly, it carries a presumption of end of life, which in cases like Terry’s may or may not apply. So I would humbly add to Russ’s suggestion that any discussion beginning over how our Mormon doctrines illuminate “these issues” include voices of Mormons who have given birth to/adopted/raised extensively to severely brain injured children or who have cared for adult individuals with similar challenges, especially those who may have faced seeminly insurmountable barriers in doing so, whether or not such decisions involved presumptions of “end of life.” I have raised an extensively to severely brain injured daughter and would be pleased to be given a chance to join a discussion of “these issues.” For credentials regarding my ability to participate in such a discussion, please see the current issue of Dialogue, Volume 38 Number 1 Spring 2005, the essay, “Flying in a Confined Space ” (pp. 119-129).

    Also in this same issue Dialogue has issued a call for papers (in the back) on “THE PROSPECTS AND PROBLEMS OF PERSONS WITH DISABILITIES AMONG THE LATTER-DAY SAINTS.” Dialogue proposes a series of careful questions I hope will open a very necessary, overdue, and responsible discussion that may benefit all, not only those who face the issues involved directly because they provide care for someone who is brain injured (the phrase brain damaged carries, in the opinions of many, harmful prejudicial connotations), but those in the community who face them indirectly because a brain injury sufferer lives in their ward or neighborhood.

    I have witnessed in the press and in blogs on the Terry Schiavo case, including Mormon blogs, much fear and possibly even loathing of the so-called handicapped and the prospect of being handicapped. Perhaps there are voices out there that may speak to the subject with experience and even optimism, but they have kept silent during the Schiavo melee because speaking against the outcry would have meant expending precious energy (for anyone caring for an extensively handicapped person, energy must be hightly focused and preserved) or laying bare sacred experiences, and for what? To face lightning blasts from a highly charged emotional storm.

    Well, enough from me. Thank you for allowing me this interruption.

  110. A. Greenwood on March 24, 2005 at 3:08 pm

    Ms. Karamesines,
    I can say from knowing three severely crippled people in my immediate family (two of whom were completely unresponsive and immobile before getting better) that the severely crippled life is like, all others, a life worth living and loving.

    I have found my own spiritually crippled life to be immensely rewarding and great gift from God.

  111. Patricia Gunter Karamesines on March 24, 2005 at 6:24 pm

    Adam,

    After you posted your comment I went back and looked at your other comments on this thread and found where you linked to an article with the National Review (comment #77). I thank you, and my husband Mark thanks you, for calling attention to that well reasoned and well spoken article! I especially find it interesting that Robert P. George is at Princeton, where Peter Singer is (was ?) the Ira W. DeCamp Professor of Bioethics in Princeton’s Center for Human Values. Singer advocates euthanizing infants born with serious disabilities and has gone to almost alchemistic lengths to render the concept of lebensunwerten Lebens golden.

    “End of life” decisions, or as I prefer to call them, mortal crisis decisions (a phrase broad enough, I hope, to contain “end of life” cases as well as those that have only an appearance of “end of life”), occur in a broad spectrum with colors some of us don’t even know the names for, let alone have the capacity to judge. Some shades many of us won’t even be able to see until someone articulates them for us. But as George points out in the National Review ariticle, sometimes the “end of life” conclusions people reach lie in ill-advised “quality of life” assumptions, and this is where I believe the true crisis has its roots. Before I gave birth to child with a serious brain injury, I might have been one to leap to hasty conclusions about what kind of life is worth living and what one is not.

    As I believe your comment #110 suggests, Adam, degree of quality of life may lie in our attitudes towards and our relationships with those who live under extremely challenging conditions–both our quality of life and the quality of life of the disabled person in question. The quality of all of our lives is perhaps most dependent not on shifting and disagreeable definitions of “productive human being” but on our relationships in this world with life in all of its (sometime terrifying) forms and perhaps even with God. Personally, the gospel has given me great opportunities to explore the question “What is love?” over and over as extreme circumstances demanded, expanding my belief so that not only could I love my daughter when she came to me, I could help her when others said she could not be helped.

    Here’s another thing: hasty “quality of life” assumptions tending towards hasty “end of life” decisions may have the unfortunate effect of curtailing medical and scientific advancements in treatment of the disabled and the serendipitous discoveries that shed light on life for all of us. (In fact, such hasty assumptions might hijack medical and other scientific advancements in favor of euthanasia technology.) I love my daughter as she is and in process of raising her have had the world revealed to me in ways I might never have experienced otherwise, but wouldn’t it have been nice if some interested party had developed a vaccine for cytomegalovirus that would have prevented her suffering her terrible brain injury in utero in the first place?

    Thanks, Times and Seasons, for giving me this opportunity to speak aloud about these things. And thanks again, Adam, for the link to the NR article.

  112. Christian Y. Cardall (TSM) on March 25, 2005 at 12:18 pm

    In responding to John Welch’s question about whether LDS doctrine has anything to tell us about these matters, I’ll go against the grain a bit: I think LDS doctrine does not have any special insight into what to do in these situations. The doctrine, instead of channeling us to manifest “right” conclusions, can only provide a setting for the narratives we construct to make a posteriori sense of decisions we arrive at by means other than syllogisms based on doctrinal premises.

    What I mean is that the Handbook guidelines posted in an earlier comment are not materially different from what many thoughtful unbelievers would come up with independently. Many on both sides of the question of the reality of an afterlife would readily agree that prolonging suffering when death is inevitable may well not be the wisest and most charitable course.

    Similarly considerations apply to the question of how to treat lives that are crippled or damaged in serious ways. The believer may see all life as a gift of God she did not create, and therefore something she cannot tamper with. The unbeliever may see life as an unimaginably rare, precious, and transient feature of an indifferent universe, and that any degree of it is worth treasuring and nurturing; for if we don’t take of each other, the unbeliever might say, there’s No One Else who will. Either way, similar operational prescriptions may be reached.

    Conclusions are not always the same, of course. Appreciating the unbeliever’s point of view on the value of life, one can see why, when it comes to questions like war, capital punishment, or biodiversity, unbelievers sometimes seem to have the stronger “culture of life.”

    At first blush, one might guess that because of their eternal hope, the faithful brand of stories surrounding such difficult issues are more satisfying. On the other hand, it might be that when it comes to beginning-of-life and end-of-life issues, seemingly unnecessary gaps in doctrine exacerbate our bewilderment.

  113. shredsurfergirl@netscape.net on March 25, 2005 at 9:08 pm

    Judge Greer is ” the Angel of Death ”
    I hope he has the pleasure to watch one of his children be starved to death !
    For that matter, anyone that has had the opportunity to save her and hasn’t !
    Including Michele Schiavo, any Congressmen , Senator, Governor and President .

  114. John O'Neal on March 26, 2005 at 6:36 pm

    I am new to this blog, having just found it while searching for doctrinal answers to end of life questions. This blog has confirmed to me that in Mormonism, like other religions, there is no absolute answer. It is apparently an area where churchwide revelation hasn’t been received and we are left to personal revelation. (As an aside, this is strong evidence for the need for ongoing revelation). I by no means am belittling personal revelation. There are many decisions in life that have to be made, each with its own circumstances. The scriptures leave out answers to many questions, and the prophet of the church can’t be expected (and is obviously unable) to make millions of prophecies per day. The beauty of the hierarchal structure of the temporal church is revealed by such gray areas. The scriptures and the church leadership lay down the broad guidelines and doctrines for us to follow, but not every circumstance in life and their permutations can be foreseen.

    As I was writing this, I was struck by the parallel to our own inspired federalist system of government. The federal government lays down the core principles; the states are responsible for a few more; and ultimately the individual is responsible for all the rest. Our court system is also at least partially based on the premise that all cases are unique within the federal and state guidelines, and must be judged on their own merits. So maybe Congress and the President were overstepping their hand.

    I would like to point out that end of life issues aren’t the same as beginning of life issues. An aborted fetus never had a chance to voice its wishes concerning the termination of its life.

    Thank you for this opportunity to be heard and thank you all for your insight.

    Johnny O’.

  115. Jed on March 26, 2005 at 6:43 pm

    “Thy days are known, and thy years shall not be numbered less” (D&C 122:9). Does anyone see any application to Terri Schiavo in this verse?

    I am arriving late to this post, which contains many excellent questions as at the outset, most of which, curiously, have been ignored. I want to sketch a few ideas using John’s categories at #103, with one of his original question as a springboard:

    “What sources of LDS doctrine can we use to derive principles for end of life decisions?”

    Autonomy. It seems to me that Mormons would want to steer away from a strictly autonomist position. Mormons do not see their own will as surpreme. We would not pit the “will of the individual over the will of any power that be: governmental, medical or even familial,” to use John’s phrase. Mormons cherish free will only to deliver it up freely to God. (Boyd Packer likes to emphasize that we are not truly “free” agents, but rather moral agents.) Mormons are not strict individualists. We are “bought with a price,” as Paul says, without Christ, nothing. The Proclamation proclaims the family, not the individual, the basic unit of society.

    Paternalism. Mormonism is ambivalent about paternalism. On the one hand, we have a strong paternalism in our scriptures, in the verses in the D&C calling us “little children,” in the one saying “ye cannot bear all things now,” in the verse in Abraham about the hierarchy of intellgences, all verses iimplying an order of heaven where the lesser intelligences require training from the greater. God speaks because we need training, fatherly care, help. Our cultural criticisms imply a strong paternalism–children cannot bear PG-13 movies, body piercing, etc–and adults should bear the strong entertainment, either. Mormon parents are under condemnation if they do not teach the children over whom they are stewards.

    On the other hand, Mormonism has an anti-paternalistic streak as well. The aged do not have all the power. JS had his 1V at age 14, we ordain boys to the priesthood, we send our missionaries when they are callow and unseasoned. We think little children have something to teach adults, in the monthly testimony meetings, and as implied in passages like 3 Ne 11 and 17. We assume a child of eight is sufficiently wise to understand the “risks and benefits” of baptism, one of the largest decisions anyone could ever make.

    In the Mormon scheme, people who are not capable of making a reasoned decision–little children, the mentally retarded–are not held to the same standard as those who are. They are free from responsibility, alive in Christ. They are under a different law. Perhaps the Terri Schiavos of the world, the people who can no longer exercise agency, are under a different law.

    Given these views, I think many Mormons would feel comfortable yielding their agency to the people to whom they have made covenants. In my view, community and trust mean more to us than individual rights. The issue gets stickier in cases where covenants have been broken or where birth family and spouse differ in decision.

  116. John Welch on March 26, 2005 at 11:59 pm

    Jed and Christian:

    Thanks for starting to approach the problem of deriving Mormon values. On NPR yesterday there was a set of interviews with different representatives of various religions (Catholic, Evangelical, Jewish, Muslim, Buddhist) concerning the ethical dilemmas and morals of the Schivaio case. ([url]http://www.npr.org/templates/story/story.php?storyId=4560681[url]) Each religion focused on different values. The Catholic priest derived a principle of sanctity of life from the Genesis creation. God created man in his own image. Thus, human life as God’s work and a reflection of the divine, is in all forms dignified and should be protected. The Rabbi focused on the difference between medicine and food. Medicine is not required if it is not curing the patient. He relates a story about a great Rabbi whose disciples prayed around his bed to sustain him until a maid ascended the roof and dropped a jar, disturbing the prayer and allowing the great Rabbi to depart in peace. This was considered praiseworthy as he was in the process of dying and their prayers were preventing his death. The Buddist monk suggested that all things are transient. Clinging to anything leads to suffering. She was also concern that Ms. Schivia’s prolonged death prevented her from finding serenity and would lead to difficulty in her next life.

    Each of these religions derives moral values from diverse sources. I think LDS theology is unique enough to support its own set of moral principles. Unlike the Catholic reading of the Genesis creation, I think our creation stories more strongly supports principles of autonomy than sanctity of life. First, we understand we existed as individual agents in the pre-existence. We were capable of autonomous decisions and God respected that autonomy sufficient to permit one third to make a gravely wrong choice. Second, we are complicity responsible with God for our mortal existence. God grants us breath, but we choose to come here and breathe. Third, perhaps less clear, and perhaps less important, Michael/Adam was involved in the creation of this earth. We also may have played a role in its creation. Fourth, we clearly understand this as a short temporal experience with an anticipated end and a return to a vast immortal life. All of this suggests that we were involved and responsible for entering mortality. If we personally chose to start mortality, and God absolutely respected that decision, then why should God expect to monopolize the decision of when an how the inevitable ending comes? I think LDS theology differs greatly from Catholic Christianity here. I think our theology strongly supports withdrawing care or refusing medical intervention. By doing so, we again are again complicit with God in a decision to transition from one life to another.

    With active euthanasia, we alone choose the end point. Such activity revokes God’s complicity in the decision making process. From this vantage active euthanasia is not morally justified.

    What other values do we derive from LDS theology and culture? Does our understanding of marriage require complicity in autonomy between husband and wife?

  117. Russ Frandsen on March 27, 2005 at 1:33 am

    I have read a number of thoughtful pieces from various points of view by non-LDS authors in the national media on Terri Schiavo. Here is the URL for a impassioned piece by LDS author Orson Scott Card: http://www.realclearpolitics.com/Commentary/com-3_26_05_OSC.html.

  118. Jed on March 27, 2005 at 1:43 am

    John Welch (#116): I find myself agreeing with your four reasons why Mormons might favor autonomy over the sanctity of life. All of them make sense to me, and they remind me that my own weak evidence mustered against autonomy undersold the Mormon commitment to autonomy in order to make a point about “strict” autonomy. (I was really arguing against people like Sterling McMurrin who argue for radical autonomy, which I do not think exists.)

    The four reasons support your claim that beings who actively participate in starting their earthly lives ought to be able to actively participate in stopping them. Again the conclusion makes sense to me if we assume that the person who participates in the beginning also participates in the end. But if the person does not particpate in the end–if the person is unconscious, incoherent, silent, or in some other way does not make her intentions to withdraw care known–does the conclusion still follow? I am doubtful.

    When you ask rhetorically, “If we personally chose to start mortality, and God absolutely respected that decision, then why should God expect to monopolize the decision of when an how the inevitable ending comes?” the “we” at the start has to be the same “we” at the end: John Welch who co-partipates with God in coming into the world cannot become “humanity” or “family” (in lieu of John Welch) co-participating with God in sending him out of it. If the premises hinge on individual agency so must the conclusion.

    All in all, I think your use of LDS creation to distinguish between euthanasia and withdrawing care is a powerful point.

  119. Jed on March 27, 2005 at 1:59 am

    John, an additional question. In the ideal Mormon case you describe, how does God co-participate in the exit from earth life? The beginning is chosen by the person assenting to God’s plan to go down to earth. The ending is chosen by the person assenting to withdrawn care, but how does God figure in. We have scripture about creation and premortal life, but we have no scripture, or only triangulated scripture, about the end of mortality.

  120. Christian Y. Cardall (TSM) on March 27, 2005 at 10:26 pm

    John (#116), it’s sounding like you’ve had at least one memorable run-in with Catholicism on these issues!

    The differences in background of the various religionists are interesting, and certainly lead to different stories and sometimes different operational outcomes; but I still don’t think any of the various doctrinal backgrounds is rigorously prescriptive. As an example, the priest and rabbi share the book of Genesis, but still come out with different conclusions.

    In any great religious tradition, what one has is a treasury of malleable sayings and stories waiting to be plundered, reworked, recombined, renewed…in short, likened unto ourselves. It’s true that these rich legacies are often regulated by some form of contemporary authoritative structure that maintains interpretive custody, but in any faith that remains vigorous there must always be a mechanism of agility that allows the generation of relevant contemporary stories to match evolving “real world” experience. Mechanisms of adaptability might include theological diversity and diffusion of authority (Buddhism, Judaism?), or tolerance in practice of widespread disregard of the pure views of the hierarchy (Catholicism?) The Mormon solution is interesting: strong hierarchy and a monolithic, obedient community are maintained, with some cost in lack of mainstream appeal and disaffection being pretty definitive when it occurs, but with sufficient flexibility sneaking in through Continuing Revelation.

    Anyway, my guess is that your experience leads you emotionally to a certain point of view on end-of-life issues, and a posteriori you plunder the treasurehouse of Mormon sayings and stories to come up with a sensible account that explains your view.

    I like your rendering, and happen to agree with it, but I can imagine other yarns being spun from the threads of Mormon doctine. For example, one might follow Isaiah about being chosen in the furnace of affliction, and Jacob saying wo unto him that wasteth the days of his probation, and Moroni (the warrior) saying we should fully utilize the means the Lord has prepared, and Mormon saying charity suffers all things… and come up with a Catholic-like prescription of all-out preservation of life, with the patient purified and coming to know God in the suffering, and the caregiver demonstrating and learning patience and charity.

  121. Christian Y. Cardall (TSM) on March 28, 2005 at 9:29 am

    In my haste to finish that comment before going to bed last night (10:30pm was the deadline), I forgot to execute my intention to link the phrase “likened unto ourselves” to this excellent post here at T&S. This is my belated response to that post: when we’ve hoarded our own share of treasure from the community treasurehouse, the likening occurs spontaenously, almost reflexively, in the time of need (D&C 84:85).

  122. A. Greenwood on March 28, 2005 at 6:14 pm

    “hasty “quality of life” assumptions tending towards hasty “end of life” decisions may have the unfortunate effect of curtailing medical and scientific advancements in treatment of the disabled and the serendipitous discoveries that shed light on life for all of us.”

    Just so.

  123. annegb on March 28, 2005 at 7:24 pm

    I say again, if it was my child, I would be right up there with the Schiavos, if it was me, no way would I want to live like that.

    Adam, death is not evil. How can you think that? Death is simply a change of the way we exist, usually into a much better place. It’s just a doorway to the next level of our life. If you think death is evil, then birth must also be evil to those in the spirit world who watch us leave for this life. There are ways that we leave this life that can be evil, but not the change itself.

    Then again, I hate when somebody I love dies.

  124. A. Greenwood on March 28, 2005 at 7:27 pm

    Annegb,
    Death is part of the fall. Christ had to defeat it. No one can look on a corpse and not think that something is amiss. Like most of the evils that come with the fall, much good comes of it, but its still an evil.

    No one ever sang, ‘Birth, where is thy sting? Where they victory now, o maternity bed?”

  125. A. Greenwood on March 28, 2005 at 7:29 pm

    Not that birth is an unqualified good either. The painful, bloody messiness of it, with the high risks of death to mother and child, are also evils and the result of the fall.

  126. christina on March 28, 2005 at 7:46 pm

    I think taht this is very sad.Terry deserves to live and i dont think she should be cremated. I think her parents should make the decision because they have known her the longest

  127. annegb on March 29, 2005 at 11:38 am

    God doesn’t say, “death, where is thy sting” a human being said it. Death is not evil. We all have to die in order to go on to the next life. Death is not an ending, only in human perception. Are you LDS? Do you believe in the plan of salvation?

    I understand suffering and mourning. For me, losing a loved one is agony, but for my loved one, death is simply a changing, most often for the better, of circumstances. It is essential to our eternal progression. It is a natural, and necessary, aspect of life in this world, but it is not an ending of life in any sense of the word.

    Jesus didn’t end death, He made it possible for us to be resurrected. His more important purpose was to overcome sin in the garden so that we are not eternally separated from God.

    I feel badly for what Terri Schiavo’s parents are going through, and for what Terri has gone through in this life, but her death is not the greatest tragedy in this story. Her suffering will immediately cease.

  128. Jordan Fowles on March 29, 2005 at 12:24 pm

    Adam-

    I’m with you. Perfect bodies don’t die. Death is a corruption of the fall. It may be a “necessary” corruption, but a corruption nonetheless. How great will be the day when people are changed in the twinkling of an eye (rather than dying) and parents can raise their children to adulthood, uncheated by death.

  129. A. Greenwood on March 29, 2005 at 1:31 pm

    “Are you LDS? Do you believe in the plan of salvation?”

    Yes.

    I think you misunderstand the plan of salvation. The plan is that bad things will happen to us–death, sin, misery, suffering–and that we will grow thereby. Experiencing these things all help us but they’re not desirable in themselves.

    Remember, the Atonement is the central saving event of all history, but Christ shrank from it and wished not to drink the bitter cup, and it was not sinful for him to want not to. Remember that the spirits in paradise see their separation from their mortal bodies as bondage.

  130. annegb on March 30, 2005 at 8:09 pm

    Adam, Adam, Adam, Adam. Jordan, Jordan, Jordan, Jordan.

    Sorry Adam, I didn’t realize you were a big cheese on T&S, therefore LDS, I honestly wondered.

    No, no,no,no,no,no,no, death is not evil. There are ways of death that can be evil (think serial killers), and it is sheer agony for the survivors, but death, guys is a necessary and natural part of life. Terri Schiavo’s death, now, whole different ball game. But when she dies, what evil will she encounter? None, you guys know that! You know that the spirit world is a good and peaceful place.

    No, you will never convince me of that. Never. I look forward eagerly to my death and already have the singers lined out to sing “O Happy Day.” (killer song).

    Okay, I do not look forward to the death of anybody I know (except my former brother in law, which would definitely not be evil, but for the greater good of the entire world), including you guys, who I barely know, but really know in another way.

    DEATH IS NOT EVIL. Painful, sad, hard to take, sometimes hard to get through, but not evil. Change your uh, adverb? Adjective? You guys are more educated than me, but you are not more experienced. Sometimes death can be a wonderful blessing and sometimes it can be a supremely spiritual experience, like when my former bishop died of cancer, surrounded by love and giving love in abundance to all of us. The spirit was thick. There was no evil there. Death is no more inherently evil than life.

    And the crack about birth, geez, messy, yeah, painful, yeah (which you have absolutely no room to talk about that since you didn’t endure it), but in the end glorious. Just like this crazy, mixed up life.

    No, no, no,no, no, I will never agree with you. Never. Being tortured upside down by Osama Bin Laden would not make me say that. Well, maybe, but I would be lying.

  131. Wishmaster on March 30, 2005 at 11:18 pm

    Firstly Terri’s husband was not awarded any money to care for her only if she lives he was awarded 1 million dollars for allionation of affections from his wife and this money was awarded by the state. Secondly this young woman should be able to die in peace and harmony and she should not be made to look like a spectacle on television. Tell me if it were your family member who was in a vegetative state would you want to see them like that everyday not knowing whether they are in pain, and that they cannot communicate their feelings to you. I think the very least is that unless the state is willing to care for her for the rest of her life because her parents certainly won’t live forever i think she should be allowed to die in peace. I think Terri’s parents are being selfish in thinking about what they want and not what Terri wants. Like really why is so hard for them to let her go and say this is the best thing for her unless there is something wrong with them or maybe their brains have been deprived of oxygen.

  132. Mike Kaiser on March 31, 2005 at 3:31 pm

    OK so everyone believes the husband had some unseen but the public reason he wanted her to die… With the things I have read lately that have been publicized NOWHERE I am beginning to believe that it is her parents who had an agenda. The husband was offered millions of dollars by various people to give custody to the parents which he refused. Obviously he wasn’t after money. The father less than a year ago pulled the plug on HIS OWN MOTHER. The sister and brother have both alluded to the fact that they would never want to be in a PVS which she IS IN and would rather be let go. These doctors have never examined Ms. Schiavo and if they give a diagnoses on something like this based on heresay and short videos then that DEFINES them as quacks. I think that since there are still medical malpractice pending the family was after money which is why they wanted responsibility for her care. BTW anyone who thinks this relates to abortion in anyway you are an idiot. She made the choice as an adult to not CONTINUE her life if it came to this. A unborn baby never has that choice. I think I have a way to make both sides happy. Abortions are illegal without the consent of the baby. So at 18 you can ask the person if they wish to be aborted and if they say yes then you can abort them.

  133. Julie K on March 31, 2005 at 4:06 pm

    Threadjack alert:

    Does anyone else find it even slightly ironic that Terri
    who starved herself to be skinny (on purpose)
    was starved to death (on purpose)?

  134. Kingsley on March 31, 2005 at 4:08 pm

    No, not even slightly. It’s seems a kind of twisted observation, to tell you the truth.

  135. Kingsley on March 31, 2005 at 4:09 pm

    It seems. O.K., so maybe it’s a little ironic.

  136. A. Greenwood on March 31, 2005 at 4:19 pm

    Death is sometimes the lesser of two evils, Annegb (in fact, from an eternal perspective, it always is, since it allows us to return to the father), but its still an evil. Like pain, suffering, and so on. Every good thing comes from Christ, but not death.

    I am, however, willing to agree to disagree.

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