Terri Schiavo, Part II: The Ethical Post

(Read Part I: The Medical Post.)

People who have been reading Respectful of Otters since the start know that I am strongly opposed to euthanasia and physician-assisted suicide. Because the concepts of "euthanasia" and "killing" (as in, "so now it's okay to kill someone just because they have a mental disability?") are being thrown around a lot in the Schiavo case, I wanted to write about where I see the differences.

What is at issue in the Terri Schiavo case is not whether it is legitimate to kill her or actively promote her death (for example, by an overdose of morphine), but whether it is legitimate to refuse medical treatment intended to prolong her life. (Make no mistake about it: nutrition and hydration are medical treatment, when they're supplied through a stomach tube.) While the distinction between active promotion of death and witholding lifesaving medical treatment may seem like hair-splitting, in fact they are critically different.

No one has the responsibility to submit to everything that medical science could potentially do to prolong life. As individuals who own and have sovereignty over our bodies, we have a fundamental right to bodily integrity. No one has the right to invade our bodies without our consent, even if their purpose is apparently benign. If we are competent adults, we have the right to refuse medical treatment at any stage of an illness. That might mean opting out of a second round of chemotherapy after a first round of cancer treatments has failed, preferring to focus on preserving quality of life for the time we have left. It might mean deciding to die of a terminal illness at home, even if hospitalization could add a few extra hours or days. It might mean requesting aggressive pain management, knowing that it might depress respiration and shorten our lives. We have the right to say "enough," and let the natural dying process take its course. We have the right to have the integrity of our bodies unviolated by unwanted medical treatment - just as we have the right to insist on aggressive efforts for life extension. We have the right to choice. And when we are no longer able to exercise that right ourselves, we have the right to designate our closest others to do so on our behalf.

To define the exercise of that right as "killing" is to pervert the end of life unimaginably. My grandfather died at home at the age of ninety, after a slow decline from Alzheimer's disease. He died in his own familiar bed, surrounded by people who loved him. He was not in pain. His breathing slowed and slowed, and finally stopped. If it is "killing" to refuse life-preserving medical treatment, then my grandmother murdered my grandfather when she failed to call the paramedics. The others present at his death were accessories to murder. But who would have benefited had my grandfather been forced to squeeze out a few extra days in an intensive care unit, on a respirator, confused and disoriented? In what way would that have furthered a culture of life?

The natural course of life ends with death. To allow that natural process to take its course is profoundly different than hastening it along. Asking others to refrain from interfering with nature is profoundly different from asking them to make, or be complicit in, the decision that nature is not progressing quickly enough - as in euthanasia or physician-assisted suicide. Euthanasia asks the physician to play God, to decide whether another person's life is sufficiently without value that it should be actively terminated. The cessation of life support asks the physician to stop playing God, to refrain from intervening further in a disease process which has its natural terminus in death.

Terri Schiavo is under no moral or legal obligation to stay alive at whatever the cost to her bodily integrity, in order to assuage our fears of death or nuture her parents' unrealistic hopes of a miraculous recovery. A court has determined, based on the testimony of several witnesses, that Schiavo's wish would have been to remain unviolated by a feeding tube if she had no hope of recovering. That ruling has been affirmed and re-affirmed. It is our best estimate, our only estimate, of what Terri Schiavo would have wanted. If we want our own rights to bodily integrity preserved, we have no choice but to uphold hers.

Update: Whoa. Never mind me; go read Hilzoy.