For Terri Schiavo's Family, No Easy Answer to Ethics Questions

The legal battle over the fate of 41-year-old Theresa Marie "Terri" Schiavo may be close to an end. Judge George W. Greer of Pinellas County, Fla., has ruled that at 1 p.m. on Friday (March 18), Terri's husband, Michael Schiavo, "shall cause the removal of nutrition and hydration." For years, over the objections of Robert and Mary Schindler, Terri's parents, Michael has sought authorization to remove the plastic feeding tube that keeps Terri alive.

Now that Michael can legally end his severely disabled wife's life, should he do it? And should he have spent all those years seeking her death, anyway? The Schiavo case raises ethical questions about whether human life is too precious to end, but also about whether we have a moral obligation to yield to the wishes of fellow family members who want to keep helpless kin alive.
Terri Schiavo lies on a hospice bed in what doctors call a "persistent vegetative coma," fed through a tube. She lost consciousness when she was 25, after a heart attack cut off the flow of oxygen to her brain.

The Schindlers have argued in the Florida courts that their daughter is not clearly in a hopeless coma, and that she could perhaps benefit from therapy, if only Michael would allow it. Terri opens and shuts her eyes. She even responds to sounds and touch. However, medical experts have persuaded the Florida courts that Terri's grunts, grimaces and smiles are not the products of self-aware, voluntary behavior.

The Schindlers question their son-in-law's motives for wanting their daughter dead. They have accused Michael of misappropriating Terri's share of a medical malpractice award won in the case he brought against the doctor who failed to diagnose Terri's abnormal, heart-stopping potassium level. The Schindlers have also accused Schiavo of wanting to get rid of Terri so that he can marry the girlfriend by whom he has already fathered two children. In fact, on Feb. 28, Robert Schindler filed for divorce on behalf of Terri, arguing that Michael is guilty of adultery and abandonment.

Michael Schiavo has questioned the purity of the Schindlers' motives. In an appearance on "Larry King Live," Schiavo asserted that Robert Schindler angered him by greedily demanding a share of Terri's money.

So far as the courts are concerned, this case is supposed to be about Terri's rights, not her family's competing wishes. In the United States, each individual has a right to refuse life-sustaining medical care. Feeding tubes, chemotherapy and respirators may not be imposed on the unwilling.

A New Jersey woman's case resulted in the first major American court decision basing a comatose individual's right to die on the right to privacy: Karen Ann Quinlan had been in a vegetative coma for a year when her father won the right in 1976 to remove her from a respirator. In another important case -- Cruzan vs. Director, Missouri Department of Health -- the U.S. Supreme Court held in 1990 that the 14th Amendment guarantee of liberty includes the right to refuse life-sustaining medical care.

Thus, it is Terri Schiavo's own constitutional right to privacy that explains why the Florida courts are forced to grant her husband permission to order the removal of her feeding tube over the objections of her parents. When people are unable to choose for themselves, legal guardians can choose for them. Constitutional privacy requires that legal guardians choose on the basis of what the courts deem "clear and convincing evidence" of the individual's own preferences.

Millions of Americans have executed "living wills" or "advance medical directives" in recent years. These written documents set out preferences for medical treatment. Terri Schiavo had no living will or advance directive. But her husband, along with some of her friends and acquaintances, say Terri revealed in conversation that she most certainly would not want to continue living in a persistent, brain-damaged state. This is all the evidence of choice the courts required before authorizing Terri's death.

In October 2003, the last time a court authorized Michael to have Terri's feeding tube removed, the Florida Legislature and governor hastily intervened to save her life. A statute known as "Terri's Law" was enacted. The law authorized the governor to issue a one-time executive order preventing the termination of life support over the objections of a close family member. As soon as Gov. Jeb Bush issued his order, Terri's feeding tube went back in and remains in place today.

But Michael Schiavo is set for what he hopes is a final feeding-tube removal Friday.

Right-to-life and disability activists with no personal ties to Terri are urging Michael Schiavo to keep his wife alive. They say no innocent human being should be intentionally killed, especially by starvation.

Schiavo may be justified in ignoring the pleas of strangers. But is he justified in turning down the pleas of his wife's parents, who have formally offered through their lawyers to assume complete responsibility for Terri's care?

Students of bioethics know the true story of Lia Lee, the epileptic child of Hmong immigrants to California. As described in Anne Fadiman's 1997 book, "The Spirit Catches You and You Fall Down," 7-year-old Lia was declared brain dead after a major seizure and infection.

Her mother, Foua, and father, Nao Kao, stunned doctors when they asked to take Lia home. They saw no reason to part with their daughter just because she was unable to move about, speak or think. Fully expecting the child to die soon, puzzled physicians released Lia to pacify her angry, heartbroken family.

Lia survived. The Lees brushed Lia's hair until it shone like black satin, rubbed her skin rosy and dressed her floppy body in beautiful clothes. They fed her with ordinary utensils, not through the plastic tubes supplied by the hospital.

Perhaps the Schindlers are a bit like the Lees. Perhaps the Lees' wish to continue an intimate relationship with their daughter despite her brain-damaged state is their wish, too. Outsiders cannot pretend to know the Schindlers' actual motives. But parents in the position of the Schindlers could, in theory, find rich meaning and satisfaction in a shared existence with a person classified by others as comatose, vegetative and hopeless.

Morality, I believe, calls on people like Michael Schiavo to take account of the sincere wishes of emotionally involved close kin. But genuine moral sensitivity to in-laws will not result in yielding to them in every case. Like law, morality demands that we respect the life-and-death wishes that we can reasonably impute to persons who cannot speak for themselves.

Based on the available evidence, it appears that force-feeding Terri disrespects her wishes and is a kind of cruelty. Michael Schiavo's efforts to let his wife die are thus morally defensible -- as long as he is relying on sound medical advice and he has been truthful about the certainty of his wife's preferences.

There is still a place in the world for the Schindlers' wish, however. Where good evidence of what loved ones in long-term comas would want for themselves is lacking, erring on the side of preserving life can serve at least two worthwhile goals: expressing the special value we ought to place on human existence and respecting the wishes of family members for continued intimacy on their own terms.


Anita L. Allen wrote this article for The Star-Ledger of Newark, N.J. She is a professor of law and philosophy at the University of Pennsylvania and author of `The New Ethics: A Guided Tour of the Twenty-First Century Moral Landscape.' Copyright 2005 Religion News Service.

Wolfowitz and the Coming Wars

Despite the spurious claims that Wolfowitz's experience with Tsunami victims "changed his outlook"; he will continue the same debilitating programs that are the mainstay of World Bank activity. All the talk about poverty reduction is pure nonsense. His task will be to entice corrupt foreign leaders to plunge their countries further into unsustainable debt so the World Bank (and their sister organization, the IMF) can offer "bail-out" loans and apply harsh austerity measures designed to pry-open markets, destroy the public sector and deliver valuable natural resources to US corporations. (These usurious policies have frequently been compared to legalized loan-sharking) The bank has always operated this way. Moreover, this is the process that ensures America's continued economic hammerlock on developing nations. The policies are devised to perpetuate poverty not reduce it.
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The nomination of Paul Wolfowitz to the World Bank has brought on the widespread gnashing of teeth among America's liberals, but there's no real reason for despair. The World Bank has never operated according to its mandate, (to reduce poverty in the developing countries through financial assistance) so it's better to have someone like Wolfowitz at the top-spot where the activities of the bank draw greater public scrutiny. His appointment will serve the same purpose as a warning label on medicine vial; cautioning needy third world states that overuse could be hazardous.

The World Bank has operated below the radar for too long. Rather than reducing poverty, it's strategies of readjusting economies to meet the needs of global industrialists, have only created greater disparities between rich and poor and a 20 year cycle of economic stagnation. Wolfowitz's appointment will show the public how political decision-making has contributed to this malaise, and demonstrate how the bank functions as an extension of the US Treasury; working tirelessly on behalf of US financial institutions and big business. For those who think the bank should be done away with entirely, Wolfowitz provides an identifiable "name-brand" that will connect the bank to the egregious policies that keep most of the developing world in perpetual debtor peonage.

Wolfowitz dismal record on Human Rights

Wolfowitz's resume is bound to draw brickbats from anti-war Europeans. He brings with him the baggage of two unprovoked wars, 100,000 dead and a constellation of gulags strung out across the globe; not the type of qualifications we normally expect for leadership in the World Bank. So far, his nomination has been greeted with either exasperation or derision, and many believe that his personal history should preclude him from the top position. The ACLU has condemned the nomination citing recently discovered FBI documents that confirm that Wolfowitz "specifically authorized torture techniques" for interrogations at Guantanamo. Such allegations would normally be career ending if not grounds for criminal proceedings. However, in the new Bush paradigm these actions simply indicate a readiness to move up the political food-chain.

What Qualifications?

By any standard, Wolfowitz is unqualified for his new task. He has no experience in finance or administration. As for his skills at managing large reconstruction projects; his history in Iraq speaks for itself. A full year after the initial invasion less than 2% of the $18 billion provided by Congress for reconstruction had been spent, even though electrical power, sewage treatment and clean water were nearly non-existent. In fact, Wolfowitz's performance would suggest that the administration never had any intention of rebuilding Iraq ("We don't do nation building") Whatever money couldn't be sluiced off to Bush's constituents (Halliburton, Bechtel etc) simply ended up disappearing in what may be the greatest corruption scandal of all time. (To date, an independent UN commission has acknowledged that over $8.8 billion has gone missing from Iraqi oil receipts.) We should also take notice of Wolfowitz unorthodox manner of awarding contracts. After the fall of Baghdad it was Wolfowitz who said that contracts would not be issued to any country that hadn't participated in the illegal invasion. Saving money for the American taxpayer was never a serious concern for the Deputy-Secretary. Contracts were issued strictly according to a feudal-system deigned by Wolfowitz to reward those who were loyal to the administration. (Reconstruction in Afghanistan has been equally abysmal, where only 1 in 5 Afghanis has access to clean water and yet, two-thirds of reconstruction money goes towards Karzai's security apparatus)

Despite the spurious claims that Wolfowitz's experience with Tsunami victims "changed his outlook"; he will continue the same debilitating programs that are the mainstay of World Bank activity. All the talk about poverty reduction is pure nonsense. His task will be to entice corrupt foreign leaders to plunge their countries further into unsustainable debt so the World Bank (and their sister organization, the IMF) can offer "bail-out" loans and apply harsh austerity measures designed to pry-open markets, destroy the public sector and deliver valuable natural resources to US corporations. (These usurious policies have frequently been compared to legalized loan-sharking) The bank has always operated this way. Moreover, this is the process that ensures America's continued economic hammerlock on developing nations. The policies are devised to perpetuate poverty not reduce it.

In his new role Wolfowitz will oversee construction and development loans to Iraq's fledgling government. The new Iraqi leadership will be expected to rubber-stamp the many enormous loans that pay for the services of American mega-corporations and security services. This way, Iraq will stay in a permanent state "colonial dependency" (Noam Chomsky) even while its vast natural wealth is spirited out of the country.

The Israel connection

Wolfowitz's appointment comes at an opportune time for Israel. Now, that Arafat is out of the picture, the World Bank is expected "to supervise the implementation of hundreds of millions of dollars worth of projects in Gaza." (Jerusalem Post) Newly elected Mahmoud Abbas will be able pay off the corrupt Palestinian Authority with funds from the World Bank to do the job that Arafat always rejected; disarming the militias and cracking down on their own people.

As one senior official said, "Wolfowitz is a no-nonsense administrator who knows what needs to be done in terms of reform and democratization".

"Democratization?"

Hardly. When we look at the affect of Wolfowitz's policies in Afghanistan, Iraq and Haiti, it's difficult to believe that his influence will produce better results in the world's last sanctuary for apartheid. Realists would expect that Wolfowitz's involvement will only exacerbate already-existent divisions by expressing an institutional bias in favor of Israel. It is impossible to imagine that Wolfowitz could be even-handed about an issue for which he has expressed virulent partiality his entire adult life.

Preparing for War

The inserting of Paul Wolfowitz at the World Bank is actually part of a global war strategy. The idea is to put Bush loyalists and ideologues wherever they can advance the neocon agenda and undermine international organizations. The Pentagon's new "National Defense Strategy" released this week makes this perfectly clear.

The document states that America's strength will continue to be challenged by "a strategy of the weak".

Asked to explain the paper Douglas Feith (no. 3 at the Pentagon) said, "There are various actors around the world that are looking to either attack or constrain the US, and they are going to find creative ways of doing that, that are not the obvious conventional military attacks. We need to think broadly about diplomatic lines of attack, legal lines of attack, technological lines of attack, all kinds of asymmetrical warfare that various actors can use to try to constrain our behavior."

Feith is not talking about the nebulous threat of terrorism. He's talking about the nations of the world that are looking for ways to deter future American aggression. ("diplomatic, legal, and technological") This is an administration that sees the entire world as a potential enemy. The amount of paranoia in this statement epitomizes the bunker-mentality that pervades the current White House. Enemies are everywhere, trying to constrain the US with "international forums, judicial processes and terrorism".

"Judicial processes?"

The administration holds itself above the law, and those who would make it conform to the law ( Guantanamo, Iraq etc) are the de facto enemies of the state. The Wolfowitz appointment is a part of the "asymmetrical warfare" to which Feith alludes. The administration plans to extend its grip by filling every available position of authority with Bush loyalists; undermining the efforts of the international community to resolve crises through multilateral means. It's all a straight forward attack on the current world order and, tragically, a prelude to even bigger and more catastrophic confrontations.

Mike Whitney lives in Washington state. He can be reached at: fergiewhitney@msn.com

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