radek2166
03-31-2005, 09:31 PM
link (http://www.usatoday.com/news/opinion/2005-03-30-end-of-life-decisions-our_x.htm)
Another tragic case casts Schiavo's in new light
If the path to wisdom begins by understanding those with whom you most vehemently disagree, everyone captivated by the Terri Schiavo case might consider the plight of a less famous patient 1,400 miles away.
Her name is Barbara Howe, and she, too, is tragically disabled and caught in a battle over whether life support should be withdrawn — only the circumstances are flipped. It is the hospital that wants to pull the plug, while her daughter, empowered to make her medical decisions, is fighting for her life.
The case, set side-by-side with Schiavo's, raises fresh questions about the state of the law, the power of doctors and hospitals in deciding the value of life, the role of money and even the consistency of President Bush's actions.
Howe's problems began in 1991, about a year after Schiavo sustained severe brain damage. She was diagnosed with Lou Gehrig's disease, an incurable ailment that slowly decimates its victims. Eventually, they lose all ability to move or communicate, but remain conscious, locked in their deteriorating bodies. Howe, 79, is in that condition today.
Unlike the Schiavo case, there's no family dispute over the patient's wishes. Howe stated that she wanted aggressive treatment as long as she had some brain function and could still enjoy her family. She legally designated her daughter, Carol Howe Carvitt, to act for her when she became incapacitated, and Carvitt argues that her mother can still appreciate family contact and should live on.
Howe's condition couldn't be more fragile. She has been on a ventilator since 1997 and has been a patient at Massachusetts General Hospital in Boston for five years. She can't eat or express pain. She cannot even blink her remaining left eye. Her right eye ruptured in 2003 and was removed. Bones have broken in the simple routine of moving of her.
Hospital officials say she couldn't have anticipated her present state. Keeping her alive, they argue, amounts to torture, not medical care, and violates the Hippocratic oath. So they asked a judge to override her daughter and allow the ventilator to be withdrawn.
The message from the courts in end-of-life cases has been that patients have the right to decide when treatment should be withdrawn. If they cannot speak, wishes expressed through a living will or a designated surrogate must be honored.
That's what a judge ruled a year ago in the Howe case. But he instructed Carvitt to base her decisions on her mother's best interests, not necessarily what she'd stated before her condition became so desperate.
Three weeks ago, Carvitt agreed that the ventilator could be withdrawn by June 30, but only because she believes the hospital will prevail in court.
There are further issues as well.
The cost of hospital care for someone in Howe's condition is $1,000 to $2,000 a day. Who should pay? The government doesn't, and only the richest patients can, adding incentives to let people die. Further, at least three states — California, Virginia and Texas — have laws allowing hospitals to deny treatment against a family's wishes in some circumstances. The Texas law was signed by then-Gov. George W. Bush, who has been prominent in insisting on Schiavo's right to live.
Is it, indeed, sometimes right to overrule the patient's will to live — or to die? Our view is that it is not, either in Howe's case or Schiavo's. No one is entitled to impose his or her beliefs on another.
For those arguing over Schiavo, all of this poses tough questions. For one, do those who think that Michael Schiavo, despite years of court review, has no right to decide his wife's fate also believe that Carvitt, backed by the courts on similar grounds, has no right to decide her mother's?
In both cases, the rule of law must prevail, not religious fervor to preserve life at any cost. But the Schiavo case is putting the law under review. Congress plans hearings, and states are tackling the issues as well.
There's much worth discussing. But the starting point should remain unchanged. The decisive factor must be the patient's will — whether it is to live or to die.
So Bush is playing both sides of the fence.
Another tragic case casts Schiavo's in new light
If the path to wisdom begins by understanding those with whom you most vehemently disagree, everyone captivated by the Terri Schiavo case might consider the plight of a less famous patient 1,400 miles away.
Her name is Barbara Howe, and she, too, is tragically disabled and caught in a battle over whether life support should be withdrawn — only the circumstances are flipped. It is the hospital that wants to pull the plug, while her daughter, empowered to make her medical decisions, is fighting for her life.
The case, set side-by-side with Schiavo's, raises fresh questions about the state of the law, the power of doctors and hospitals in deciding the value of life, the role of money and even the consistency of President Bush's actions.
Howe's problems began in 1991, about a year after Schiavo sustained severe brain damage. She was diagnosed with Lou Gehrig's disease, an incurable ailment that slowly decimates its victims. Eventually, they lose all ability to move or communicate, but remain conscious, locked in their deteriorating bodies. Howe, 79, is in that condition today.
Unlike the Schiavo case, there's no family dispute over the patient's wishes. Howe stated that she wanted aggressive treatment as long as she had some brain function and could still enjoy her family. She legally designated her daughter, Carol Howe Carvitt, to act for her when she became incapacitated, and Carvitt argues that her mother can still appreciate family contact and should live on.
Howe's condition couldn't be more fragile. She has been on a ventilator since 1997 and has been a patient at Massachusetts General Hospital in Boston for five years. She can't eat or express pain. She cannot even blink her remaining left eye. Her right eye ruptured in 2003 and was removed. Bones have broken in the simple routine of moving of her.
Hospital officials say she couldn't have anticipated her present state. Keeping her alive, they argue, amounts to torture, not medical care, and violates the Hippocratic oath. So they asked a judge to override her daughter and allow the ventilator to be withdrawn.
The message from the courts in end-of-life cases has been that patients have the right to decide when treatment should be withdrawn. If they cannot speak, wishes expressed through a living will or a designated surrogate must be honored.
That's what a judge ruled a year ago in the Howe case. But he instructed Carvitt to base her decisions on her mother's best interests, not necessarily what she'd stated before her condition became so desperate.
Three weeks ago, Carvitt agreed that the ventilator could be withdrawn by June 30, but only because she believes the hospital will prevail in court.
There are further issues as well.
The cost of hospital care for someone in Howe's condition is $1,000 to $2,000 a day. Who should pay? The government doesn't, and only the richest patients can, adding incentives to let people die. Further, at least three states — California, Virginia and Texas — have laws allowing hospitals to deny treatment against a family's wishes in some circumstances. The Texas law was signed by then-Gov. George W. Bush, who has been prominent in insisting on Schiavo's right to live.
Is it, indeed, sometimes right to overrule the patient's will to live — or to die? Our view is that it is not, either in Howe's case or Schiavo's. No one is entitled to impose his or her beliefs on another.
For those arguing over Schiavo, all of this poses tough questions. For one, do those who think that Michael Schiavo, despite years of court review, has no right to decide his wife's fate also believe that Carvitt, backed by the courts on similar grounds, has no right to decide her mother's?
In both cases, the rule of law must prevail, not religious fervor to preserve life at any cost. But the Schiavo case is putting the law under review. Congress plans hearings, and states are tackling the issues as well.
There's much worth discussing. But the starting point should remain unchanged. The decisive factor must be the patient's will — whether it is to live or to die.
So Bush is playing both sides of the fence.