Tag Archives: medical science

A Life Deemed ‘Useless’ – The Terri Schiavo Case

As I write this essay, a woman’s body is shutting down from starvation and dehydration because of the decision made by her husband and a court order issued by Florida judge, George Greer. Terri Schiavo collapsed on 25 February, 1990, when her heart stopped momentarily, resulting in severe brain damage. Fifteen years later, her husband, Michael Schiavo, who now has two children with another woman, is insistent that his wife would not want to be kept alive. He succeeded in obtaining a court order from the Florida Supreme Court to have the small feeding tube removed. Terri’s parents, Bob and Mary Schindler, fought the court order but were unsuccessful at overturning the decision, and on 18 March, the feeding tube        that supplied nourishment and hydration to the 41- year old patient was removed. Despite appeals by Governor Jeb Bush, the Florida judge refused to allow Terri Schiavo to be taken into protective custody. President George Bush and the Republican leaders of the U.S. Governor said that all legal options have been exhausted and that they would not go any further. Barring a miracle, Terri Schiavo will be starved to death.

The Schiavo case has polarised ethicists and the general public alike. Clarity can only be achieved when ideological agendas are set aside and the facts of the case are carefully and thoroughly examined. The first step is to understand Terri Schiavo’s medical condition. She is not brain-dead, but is in a permanent vegetative state (PVS). This means that her brain is severely damaged, and as far as doctors can tell, she is unaware of her surroundings, although she has emerged from a comatose state. It must be added that medical science has yet to fully understand this condition, and doctors are often reduced to resorting to educated guesses – there are no blood tests, scans or other investigations that could confirm the diagnosis. The degree of awareness exhibited by such patients, cannot be ascertained with any exactitude by doctors, and the view which categorically states that such patients have     no awareness of their surroundings is at least debatable. Those who are close to Terri, including her mother, have noticed some responses when they speak to her (see video at www.Terrisfight.org).

Although patients seldom recover after being in a permanent vegetative state for 12 months, there are isolated cases of such recovery. An article by N. L. Childs and W. N. Mercer in the Journal of Neurology, Neurosurgery and Psychiatry (1985, 48: 1300-1303) reports the case of a girl who recovered sufficiently after being in a PVS for six years to communicate with simple sentences.

Terri is not dependent on any machine that artificially enables certain of her organs to function, only a small gastric tube that supplied nutrients and water. In other words, Terri is not hooked on a life-supporting machine. She is a healthy woman with a disability and merely requires to be artificially fed. She is disabled, not terminal. The gastric tube cannot be seen as an ‘extraordinary’ measure or a therapeutic measure; it is an essential means through which Terri receives the required nutrients and hydration. Although Terri is deprived of full consciousness, she must be seen as a living human being, whose judicial rights and dignity must be recognised, respected and defended. As Cardinal Keeler of Baltimore has rightly insisted, ‘Deliberately to remove them in order to hasten the patient’s death … would be a form of euthanasia, which is gravely wrong’.

The American Medical Association defines euthanasia as the ‘act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy’. This is done through ‘the medical administration of a lethal agent to a patient for the purpose of relieving the patient’s intolerable and incurable suffering’. Terri Schiavo is being euthanized by starvation and dehydration.

Her death, however, will not be ‘quick and painless’. In his article published in The Straits Times (28 March, 2005, p.20) Andy Ho describes the harrowing process that a person dying from starvation and dehydration goes through. The mouth dries out while the tongue becomes swollen and cracked. The eyes sink and the cheeks are hollowed out, while the nose bleeds and the skin becomes loose and scaly. The urine gets very concentrated, burning the bladder even as the lining of the stomach dries out resulting in vomiting. The brain cells begin to dry out as the body temperature rises uncontrollably, causing fits to occur. Before the vital organs start to fail resulting in death, the lungs also dry out and they are clogged by their own secretions causing the patient to choke on their own sputum.  This is the process that Terri Schiavo is going through as her body slowly shuts down because it is deliberately deprived of food and water.

The removal of the feeding tube from Terri Schiavo is a direct violation of the commandment ‘not to kill’. No one has the right to take a human life, not even his or her own. Life is never our own possession but is always to be received from moment to moment as a gift from the Creator, and cannot be disposed of as we wish. Supporters of euthanasia have often presented the right to autonomy and self-determination as its justification. This is especially true of voluntary euthanasia, which the AMA Council defines as ‘euthanasia that is provided for a competent person on his or her informed request’. This principle is behind the ‘right-

to-die’ argument, although almost always with the qualification that it applies only to those who are terminally ill and in great pain. The question, however, is that if the right-to-life is so fundamental, why should it be confined only to this category of people? Why should this principle not apply also to those who are not terminally ill, but who feel that their lives are meaningless?

Those who supported Michael Schiavo’s decision have appealed to the quality-of-life argument. Without doubt, the quality-of-life argument in favour of euthanasia is the most harmful for life in society because it works on the basic presumption that there are certain people who have the right to judge whether the lives of other persons are worthwhile or valuable. However, as moral theologian Bernard Häring has rightly observed, their judgement ‘can not only be contemptuous, but it represents a death sentence’.

Michael Schiavo and the Florida judge have decided to execute Terri on the basis of their evaluation that she does not enjoy the quality-of-life that she should. Because of their evaluation, they are willing to subject Terri to the most inhumane execution. The people who speak so passionately and nobly about the quality of life are willing to force upon an innocent human being such an undignified death. As Cardinal Renato Martino, President of the Pontifical Council for Justice and Peace, puts it, ‘If it is true that the process has been fair, and that all legal avenues have been exhausted, how is it that this woman, who has done no wrong, will suffer a fate which society would never tolerate in the case of a convicted murderer, or anyone else convicted of the most horrendous crimes?’ Because of their verdict they were willing to submit Terri to such acts of cruelty from which even animals are protected by law. For in the State of Florida it is unlawful to keep an animal in a place while failing to supply ‘a sufficient quantity of good and wholesome food and water ’.

The case of Terri Schiavo brings much darkness to our modern society. Are we so blinded that we fail to see that we cannot inflict this sort of death on a human being without each individual and society as a whole suffering its terrible consequences?

*** Terri Schiavo died on 31 March, 13 days after her gastric tube was removed. This essay was written three days before her death.


Dr Roland Chia


Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity.
This article was originally published in the Trumpet (TTC).

A Good Death?

May 2015 Feature Article

Many reasons are being offered to support making euthanasia (meaning “good death”) and assisted suicide legal. Some arise from sensitivity to the suffering of terminally ill patients, who desire to end their sufferings by speeding up their death through medical intervention. On the surface, it seems the most compassionate action that society can take to allow this. However, there are serious problems that require careful consideration.

Firstly, there is the question of suicide. In assisted suicide, the patient voluntarily takes his life. Hence the term “suicide” is used, as it was by Singapore’s Minister of Health in 2008. In many societies, including Singapore, suicide is an offence. While social values may be changing, suicide is still prohibited by the law, and for good reasons. The underlying logic, whether legally, socially or religiously expressed, is that the right to life cannot be extrapolated to the right to die. Life is sacred and one does not have the freedom to take one’s own life, no matter what the extenuating circumstances might be. This was echoed in 2002 by the European Court of Human Rights in its interpretation of Article 2 of the European Convention of Human Rights.

Proponents of euthanasia argue that patients have the absolute right to exercise autonomy. Even so, can a patient make a free and voluntary decision? In the first place, he depends on information regarding diagnosis and prognosis given to him by doctors whose knowledge is not perfect. Chief Justice Sundaresh Menon, in his lecture to the Singapore Medical Association in 2013, rightly cited the case of Singapore lawyer Suzanne Chin who was diagnosed with brain stem death. Her husband was advised by doctors to “pull the plug” but against all odds she recovered completely and is well.

When doctors are involved in the decision making, there is potential conflict of interest. Patients may also depend on information from the internet which may be misleading. In addition, patients may make their decisions in a state of depression, and if treated, studies show that they may think differently. There is also potential pressure on the patient from family and care-givers, and society at large.

Secondly, there is the problem of murder. Physicians are asked to be involved in euthanasia and assisted suicide, an involvement that would contravene the nature, identity and ethics of the medical profession. For more than 2000 years, physicians have held to the principles of the Hippocratic Oath: the goal of medicine is to heal, care, and bring relief. Harming patients or killing them is strongly prohibited. The World Medical Association has, over the years, repeatedly stated that euthanasia and physician-assisted suicide are unethical and contrary to the practice of medicine. In its most recent statement in 2013, it reiterates the call for “physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions.” The doctor-patient relationship which is based on trust would be adversely affected if physician-assisted suicide is allowed.

The medical profession will be under pressure to attend to patients who want assisted suicide. Though the involvement of doctors is voluntary, there is no guarantee that it will be strictly so, especially if there is pressure from superiors or from one’s institution. Dr Christoph Hufeland, Goethe’s doctor, articulated it well in 1806: “The physician should and may do nothing else but preserve life. Whether it is valuable or not, that is none of his business. If he once permits such considerations to influence his actions, the doctor will become the most dangerous man in the state.”

Some argue that the practice of euthanasia can be well-regulated to prevent abuse. But actual experience proves otherwise. Sundaresh Menon notes: “These concerns are not to be dismissed as patently fanciful. One study shows that whereas legal restrictions and safeguards have been enacted wherever euthanasia or assisted suicide has been legalised, these have been ‘regularly ignored and transgressed’ often without prosecution…”

Thirdly, allowing euthanasia and assisted suicide would have negative social consequences. There would be a widening of its application.

In Belgium, legislation was passed in early 2014 to extend euthanasia to children who can request for it if they are “in great pain” and no treatment is available. Not only is this open to abuse (for studies show that many doctors have been practising euthanasia without following the rules), but it will be a door to many more applications. In the Netherlands, one need not be terminally ill to be euthanized. That one cannot have a “livable life” is ground enough, as the Groningen Protocol (which allows infant euthanasia) shows.

Recently, a court in Belgium granted the request by a prisoner for assisted suicide. He is imprisoned for murder and rape and has pleaded to be put to death because of mental anguish caused by his violent impulses. It is significant that he is not suffering from terminal illness or physical pain but from mental anguish. Will this open the flood gates to those who are in a similar situation?

Terminally ill patients would not be able to escape pressure, either imposed by others or by themselves, to seek death and not trouble their loved ones and care givers or incur significant medical costs. In the longer term, legalising euthanasia would shape our society and affect the way we look at ourselves, and how we care for the vulnerable. It has been noted, for example, that hospices are not as well developed in the Netherlands (where euthanasia is legal) as in other European nations. A social mindset that has a “cure or kill” solution would have inadequate space to explore the responsibility to care for the dying and to help them die with dignity. It would affect private and public conscience and alter our society where utilitarianism will dominate and social responsibilities will diminish.

Some use pragmatic economic reasons to argue for euthanasia. However, economic concerns should not be used to support euthanasia. Patients’ lives should not be shortened simply because they occupy hospital beds or it costs money to care for them. We cannot reduce the value of human life to dollars and cents. If we do, we reduce human dignity and value and will think likewise about those who are considered a “burden” to society.

How, then, can we care for the dying? How can we help people dying painfully and feeling that their continuing suffering is pointless and meaningless? The solution of offering euthanasia or physician-assisted suicide has many serious moral and practical problems, a situation where the medicine offered is worse than the malady. A study in Holland showed that in 10% of euthanasia and 30% of assisted suicide, untoward complications arose. They included patients who recovered from an induced coma, vomiting and fits, and technical problems with administering the lethal substance.

Our response to such patients should be one of compassion. There are two points that will help us enable people in such situations to receive compassion and care and die with dignity, without resorting to solutions that will end up with patients taking their own lives or physicians being asked to terminate their lives. It is humane to want to do something to help someone who is suffering. However, euthanasia and assisted suicide are not as humane as they may seem. Pope John Paul II observed that in reality, “what might seem logical and humane, when looked at more closely seem to be senseless and inhumane”.

We should not seek to eliminate the sufferings of a person by eliminating him. There are better and more humane and ethical ways.

Firstly, we have the Advanced Medical Directive. This allows people to express their wish that should they be terminally ill, that “heroic” but futile medicine be excluded in their treatment so that their lives are not artificially and needlessly prolonged. This is different from speeding up death through suicide or homicide. It is a decision that can be rationally and carefully taken before the storm of pain and suffering that may mark terminal illness and cloud judgement.

Secondly, palliative medicine is being significantly improved and offers dying patients relief of pain and compassionate care that enables them to travel the last stage of their lives with dignity and in the company of caregivers. As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.

Palliative medicine must be mainlined to become part of the normal course of health care. As a medical science and art it must be further developed and offered to all who are dying, so that they can die comfortably and in dignity as recipients of compassionate care.

As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.


GWY_8581

Bishop Emeritus Dr Robert Solomon served as Bishop of The Methodist Church in Singapore from 2000-2012. He had served previously as a medical doctor, church pastor, principal of Trinity Theological College and president of the National Council of Churches of Singapore. Dr Solomon has degrees in medicine, theology, intercultural studies, and a PhD in pastoral theology from the University of Edinburgh. He has contributed many articles to books, theological dictionaries and journals and authored 20 books, including ‘The Race’, ‘The Conscience’, ‘The Enduring Word’, ‘The Virtuous Life’, ‘The Sermon of Jesus’ and ‘Apprenticed to Jesus’. He now has an active itinerant ministry of preaching and teaching in Singapore and abroad.