CATHOLIC DOCTORS ASSOCIATION OF MALAYSIA

Wednesday, June 01, 2005

Beyond the Terri Schiavo Case

Here is an extract from Zenit regarding vegetative states, hydration and nutrition, which may interest you and the medical profession:-

LONDON, MAY 28, 2005 (Zenit.org).- During their visit to Rome last week Terri Schiavo's parents, Bob and Mary Schindler, thanked the Pope and Vatican officials for the Church's help in their attempts to keep their daughter from being starved to death.

The withdrawal of food and water that led to Schiavo's death in Florida last March 31 was condemned in a statement by Vatican spokesman JoaquĆ­n Navarro Valls. In a declaration issued the day of her death Navarro Valls described the event as "an arbitrary hastening of death." He also expressed the hope that the experience would lead public opinion to a greater awareness of human dignity and to improved legal protections for life.

The Schiavo case is by no means an isolated instance. Shortly afterward the Telegraph newspaper in British reported April 17 on an 81-year-old widow from the American state of Georgia, Mae Magouirk. In spite of having drawn up a living will she was deprived of food and water for 10 days after being admitted to hospital for heart problems, which, according to the Telegraph, were considered treatable by doctors.

The widow was not comatose or even in a so-called vegetative state. But a problem arose when her granddaughter, named in the living will as her guardian, decided that Magouirk was "ready to go home with Jesus." Her life was saved when other members of the family successfully took legal action to restore nourishment.

Last week the issue of withdrawal of food and water also came up in Britain, with what the Guardian newspaper described May 16 as "one of the most important right-to-life appeals to come before the English courts in recent years."

The case involves Leslie Burke, who suffers from a progressive degenerative disease. He fears that in the future, once his situation has deteriorated, doctors will decide to stop feeding him. Burke won a high court ruling last July, which declared the guidelines by the General Medical Council to doctors on the withholding of life-prolonging treatment were unlawful in some aspects.

Who decides?

The General Medical Council is now appealing the ruling and last week both sides presented their arguments before three appeals court judges. According to Burke's attorney, Richard Gordon, the issue was about "who decides," the BBC reported May 18. In the original case Burke argued that the General Medical Council advice, which gives doctors in cases such as his the final say on what treatment to give a patient in the final stages, was an infringement of his human rights.

In his ruling last year Justice James Lawrence Munby agreed with Burke, saying that if a patient is competent -- or, if incompetent, has made an advance request for treatment -- doctors have a duty to provide artificial nutrition or hydration.

A lawyer for Patricia Hewitt, the British health secretary, told the appeal court that the National Health Service should not have to give life-prolonging treatment to every patient who requests it "because that would mean a crippling waste of resources," reported the Times newspaper May 19. The Health Department is supporting the appeal against last year's ruling.

The government's position was criticized by Derrick Wilson, reported the Times. Wilson has a son who for the last eight years is in a "vegetative state" and he has refused to give doctors permission to end his life.

"I think this is the thin end of the wedge for euthanasia -- not only for people like Duncan but for people like me who are just getting old," he said. "It stinks of euthanasia, the government backing something like this. It's very distressing."

Last year's judgment does, however, have some defects, noted the Catholic bishops' conference of England and Wales. A note released May 17 by the Catholic Communications Network explained that the bishops are intervening in the appeal because they are concerned that by elevating the principle of patient autonomy to the level of an absolute, there could be "potentially dangerous implications for assisted suicide and euthanasia."

The declaration did stress, however, that the bishops are not opposed to Burke's attempts to ensure he will continue to receive nourishment.

Patients deprived of food and water die first of thirst, and this is not a pleasant experience, noted Dr. David Stevens, executive director of the Christian Medical Association in the United States.

On March 23, in the context of the Schiavo case, Stevens rejected claims made by some that dying in these circumstances is not painful. Based on his 13 years of work in Africa, where he saw many die of dehydration, Stevens criticized the "so-called experts" who have not seen someone die in this manner. "Contrary to those that try to paint a picture of a gentle process, death by dehydration is a cruel, inhumane and often agonizing death," he said.