I demand to know where the human rights and women's rights groups are over the case of the Floridian woman Terri Schiavo. Where are her civil rights? Did she lose them the moment she could no longer audibly answer or respond for herself?
Human rights organizations stand and give tirade after tirade to defend the war criminals at Guantanamo Bay, but where are they over a woman supposedly living in a 'persistent vegetative state'? Where are her rights? Why haven't the women's rights groups spoken out against Terri's 'estranged' husband, Michael, who wants to pull the feeding tube and let his wife die a slow death of dehydration and starvation? Should Michael's desire to have his wife die be classified under spousal abuse? Truly, if this case is a reflection of how Americans are moving forward in handling bio—ethics then we are all in trouble.
This case, which should never have become a topic at America's water coolers, has many facets and layers to it. When it comes to the topic of bio—ethics, we've only begun to lift the lid off a deadly and dangerous box of medical morality.
In 1972, two neurologists stated they had identified a condition of "wakefulness without awareness." This state is caused when a patient, due to head injury, lack of oxygen, degenerative disease, or loss of all upper brain functions, enters what has been termed a persistent vegetative state (PVS). This wide—ranging term has delivered only uncertainty in diagnosis, treatment and ethical decision—making. PVS has become one more thing out of a bio—ethics Pandora's Box that shouldn't have been opened.
A large portion of the danger in using such a general term derives from the fact that many people who only hear sound bites of news and discussion over the condition of PVS are deeply misguided and uninformed. Most of us when we hear the word 'vegetative' immediately think of an individual who is brain dead. This is a misnomer. Patients who are unable to live without being hooked up to tubes, beepers, electronic regulators, and waste removers, and with no hope of ever recovering brain activity, are classified as brain dead. Brain death is defined as the irreversible loss of all functions of the brain.
PVS is different, but nonetheless conjures up the image that without bells and whistles this body is nothing but an inconvenience and a burden, or a last will and testament needing to die so, darn it, I can obtain my inheritance! There are citizens, judges and lawyers who don't even comprehend PVS and they are deciding if it's okay to go ahead a murder someone...how does this make sense?
PVS, has come to be applied to people who actually do show some signs of awareness, e.g., Terri Schiavo.. Appallingly, "right to die" advocates and Terri's husband Michael have used fuzzy notions about PVS to seduce people to their rationale. It has even tainted the wording in some states laws, altering them to classify the basics of life (food and water) as medical treatment!
Imagine a cup of chocolate malted flavored protein drink...it has now become classified as medical treatment. I didn't know feeding someone sustenance or giving him or her a cup of cold water was considered medical treatment. I thought it was just caring for those who can't care for themselves due to their physical challenges or financial inabilities. I guess all the quadriplegics had better watch out, not to mention those citizens of third world nations. Human rights organizations may see you eating and drinking H2O and decide no, you've no right to medical treatment— give me back that bowl of rice, now!
PVS is not easily diagnosed. Although accepted signs of PVS include the absence of awareness of oneself or one's environment, we cannot measure thought or awareness —— only behavior and movement. Today's medical tests are not specific enough to make a certain diagnosis of PVS. As a result, the rate of misdiagnosis is high, approximately 40 percent in some studies. Physical disabilities experienced by many of these patients, such as blindness and paralysis, can stop them from exhibiting behaviors that could make their awareness known. Recent video footage shot of Terri Schiavo shows her smiling and responding to her surroundings, leading many to question whether she is actually in the state of PVS. If you really want to know the answer to this, ask her parents and friends.
Reality check: the 1972 definition and the recent attempts to define PVS are not clear enough to tell the true state of patients who've suffered serious brain injury. According to Cindy Province (cofounder and associate director of the St. Louis Center for Bioethics and Culture and holder of master's degrees in medical surgical nursing and bioethics), we cannot let the death sentence of PVS fit all situations.
'Part of the reason is that consciousness is a continuum, not an all—or—nothing phenomenon. In general terms, human brains aren't like light bulbs that are either on or off. Instead, they are more like irons, which, while turned on, may be anywhere from warm to hot. Unfortunately, medical treatment and ethical decision—making have not always taken into account that there are many things still unknown about severe brain injury.'
Do we understand this? How can we make a judgment of life or death based on knowledge that is still incomplete? Neuroscience has barely touched the cusp of understanding the smallest part of our grey matter...we've a long ways to go before we can mark someone with a death sentence.
So what if someone is in the position of a Terri Schiavo or, say, someone were in a PVS state for seven years or more... is life not worth allowing the injured brain time to go from lukewarm to hot? Are those like Terri, who are alive, allowed the same pursuit of happiness, protection, and equality? Or do we want to give only preferential treatment to ourselves and to what we define as 'living'? Will we make the same applications to our elderly folk as we are to those who appear to be in a state of PVS? Your children, Grandma, may decide you don't deserve medical treatment (i.e. food and water) when you get too feeble to go to the kitchen and cook it. How cold—hearted have we become?
Ms. Province relayed recently that on the, 'medical horizon, a large amount of work with severely brain—injured patients is taking place.' This research is happening inside and outside the United States. Not long ago, at the Royal Hospital for Neuro—Disability in London, a diagnostic tool was developed to help medical professionals identify awareness in patients previously diagnosed as unaware. Some of these patients have begun to communicate, and to recapture some physical function, but more significantly — for ethical concerns — to express their wish to live. Shouldn't we all be given the right to express our wishes?
Terri Schiavo, and others like her, deserve the right to live. Everyone deserves food and water. Sometimes it seems we treat our criminals sitting in today's penitentiaries better than we treat those who cannot defend themselves. Whether its patients like Terri, our elderly or our unborn human children, the question of ethics, of who we are as a race, must address the moral standards of love and compassion for humanity. None of us living in a nation so full of plenty should knowingly and willingly deny another human being nourishment. The right to life, to the basic necessities of food and water, cannot be considered using only textbook definitions, filled with nuanced variables. There is still so much we don't understand about the human brain and how it functions. We have barely scratched the surface of the brain's amazing recuperative abilities. With our minimal knowledge of how this all works do we dare to starve another human to death simply because we were given guardianship rights over her?
Terri Schiavo please hear me now. If the human rights advocates and the women's right organizations don't take a stand for you I want you to know there are those who will fight for you, pray for you, and believe you've the right to live. And Terri, I am one of those here for you. God Bless you.
K.L. Marsala's website can be found here.