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The Other Terris
Defenders of Michael Schiavo's decision to remove the tube supplying food and water to his estranged wife often point to the many courts which have reviewed his action. Terri has indeed been lucky to have had an extensive review of some aspects of her case. But what about the countless patients, in Florida and elsewhere, who die of dehydration with no review whatsoever?
According to dicta in the Florida Supreme Court's 1990 Browning case, unless there is a family dispute, all legally incompetent patients-not only those alleged to be vegetative, but those fully alert and talkative-can be denied artificially-supplied food and water by their guardian or surrogate, without a living will or any prior judicial hearing whatsoever. Although recognizing "that a surrogate might act contrary to the wishes of the patient," the court required in Browning only that the surrogate be able to prove (not actually prove to a judge) what the patient would want with "clear and convincing" evidence and be satisfied that the "evidence of the patient's oral declarations is reliable."
A dissenting judge in Browning pointed out that judicial approval is required before a guardian can even sell property of a ward, and he worried presciently "that, if there is no judicial involvement, those decisions could be made by surrogates who would benefit financially from an early termination of the ward's life." This is just what might have happened to Terri long ago, if she had not had parents ready to fight for her. Have there been other Terris who have died defenseless and unnoticed?
Why is the Florida legal system so cavalier about the lives of most people like Terri? Is it because the fate of minimally communicative people-or even of all incompetents--doesn't matter much to the rest of us? The Browning majority remarks that the only alternative to death for such people is "a bare existence."
Florida is by no means the worst state in terms of its lack of concern for the lives of those with serious disabilities. In many hospitals across the U.S., the prior wish of a patient to be supplied with food and water through a tube can actually be overridden by doctors who think such feeding "futile" because her life is worthless-even if her desire to live has been clearly expressed in a written advance directive.
The leading legal theorist Ronald Dworkin explains more deeply why such a patient would (for him) lack worth, why it could be right for judges and doctors to weigh a wish to die more heavily than a wish to live on in a state of dependency. He writes: "We are distressed by, even disapprove of, someonewho neglects or sacrifices the independence we think dignity requires." For Dworkin, a person who chooses to live in great dependency denies that she is someone "whose life is important for its own sake." He quotes with approval the nineteenth-century death-of-God philosopher Friedrich Nietzsche on this point: "To go on vegetating in cowardly dependence on physicians and machinations, after the meaning of life, the right to life, has been lost, that ought to prompt a profound contempt in society."
Nietzsche called this philosophy "practical nihilism" and complained that, in his day, Christians stood in the way of its success. "This universal [Christian] love of men is in practice the preference for the suffering, underprivileged, degenerateThe species requires that the ill-constituted, weak, degenerate perish --and not [live on in] a feeble, vegetable existence in expectation of a false afterlife."
Not surprisingly, some Christians
still stand in the way of this philosophy. Pope John Paul II
declared last year that even those who, unlike Terri, are terminally
ill and exhibit "no evident sign of self-awareness or of
awareness of the environment, and seem unable to interact with
others or to react to specific stimuli" still "retain
their human dignity in all its fullness."
The Pope insisted further that "it is necessary to promote
the taking of positive actions as a stand against pressures
to withdraw hydration and nutrition as a way to put an end to
the lives of these patients."
Who is right, Dworkin or the Pope? Does someone who does not count equality a thing to be grasped, who accepts the loss of all independence, thereby diminish her dignity and the value of her life?
Richard Stith teaches at the Valparaiso University School of Law. Besides his law degree, he has a Ph.D. in Religious Ethics, both from Yale, and has served as Director of Medical Ethics at the St. Louis University School of Medicine. All capitalization and italicization in quotations presented in the essay were already in the originals.
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