The Vegetative State: A Fate Worse
yourself being out of your body and in between two
worlds - a state of limbo. You are aware of what's
going around your body but you can't move or speak.
You feel pain but you can't tell anyone about it.
You are either in a coma or what is known as a
state. No matter
what you call it, it is certainly a fate worse than
death. This is because it is neither life nor death.
suffered major brain damage when her heart failed
which cut oxygen to her brain. She entered the unfortunate
condition of a persistent vegetative state. Her
eyes are open and she goes through periods of sleep
and wakefulness. But that part of her brain
that controls most motor functions has been destroyed.
She can breathe on her own, but cannot eat, thus
she is kept alive with a feeding tube.
legal fight over Terri Schiavo began almost immediately
in 1990. Court-appointed doctors declared that Terri
would never recover from the brain damage, and for
the last 13 years, she's needed feeding and hydration
tubes to stay alive. That's against her stated
wishes, says Terri's husband Michael. He's been
battling her parents in court, seeking to allow
her to die. For all of the medical knowledge,
legal wrangling and family anguish expended in the
past 10 years over the fate of Terri Schiavo, the
most pivotal question remains unanswered: Would
the 39-year-old Florida woman want to go on living
in her current vegetative state?
That mystery could have
been solved with a simple piece of paper - a living
will (see the bottom of this web page for more info)
written by Schiavo making clear how she would want
to be treated medically if she no longer could communicate.
Lacking that, her husband, her parents and
a succession of strangers
-- judges, the Florida Legislature and Governor
Jeb Bush -
have intervened to decide whether she should live
or die 13 years after collapsing in her home. This
should be an important lesson for anyone who does
not want to be kept artificially in limbo for decades.
Most people die in what
may be called a bad death. One study found that:
Medical writer John Horgan cited an
article in the Journal of the American
Medical Association for 1995-NOV which
described the results of a study called
"Study to Understand Prognoses and Preferences
for Outcomes and risks of treatments
(SUPPORT)." The study involved over
9,000 patients in five hospitals. They
reported "substantial shortcomings in
care for seriously ill hospitalized
adults." Horgan commented: "More often
than not, patients died in pain, their
desires concerning treatment neglected,
after spending 10 days or more in an
intensive care unit." A Massachusetts
legislature subcommittee report on pain
management mentioned that the SUPPORT
study "found that half of patients who
died in the hospital experienced moderate
or severe pain at least half the time
during their last three days of life."
Journal of the American Medical Association
(JAMA), 1995-NOV. Cited in John Horgan,
"Right to Die," Scientific American,
euthanasia originated from the Greek language:
"eu" means good and "thanatos" means death. One
meaning given to the word is:
"the intentional termination of life
by another at the explicit request of
the person who dies."
The term euthanasia normally
implies that the act must be initiated by the person
who wishes to commit suicide. However, some people
define euthanasia to include both voluntary and
involuntary termination of life. Like so many moral/ethical/religious
terms, euthanasia has many meanings. The result
is mass confusion.
It is important to differentiate
among a number of vaguely related terms:
Hastening the death of a person by altering some
form of support and letting nature take its course.
Removing life support equipment (e.g.
turning off a respirator)
Stopping medical procedures, medications
Stopping food and water and allowing
the person to dehydrate or starve to
Not delivering CPR (cardio-pulmonary
resuscitation) and allowing a person,
whose heart has stopped, to die
procedures are performed on terminally ill, suffering
persons so that natural death will occur sooner.
It is also done on persons in a persistent vegetative
The option of dying by
Patient Refusal of Nutrition
(PRNH), as it is referred to, appears to be a compromise
which allows terminally ill people to end their
lives and still have ministrations from hospice
and from a doctor. Hospice nurses know that this
is a painless and gentle death which obviates the
necessity of a more drastic end. Most hospice reports
of dying patients are within one or two weeks from
dehydration. But until
is legalized in the US as it is in the state of
Oregon, this crude method will have to do.
PRNH is a choice; it is
relatively gentle and painless in most reported
cases. It is certain, and loved ones can be there.
Hospice workers and doctors will regard this as
acceptable and treat the patient with compassion.
It is not offensive to most religious groups. But
it is not swift; the patient must be close to death,
and medical and nursing help should be available.
It may not be an option for everyone.
Terri Schiavo's husband
petitioned a Florida court to have the feeding device
removed, a step that would lead to her death within
a few weeks. But her parents strongly objected.
What would Terri Shiavo want? Her husband says she
would want to be allowed to die. But she left no
written instructions. After a hearing, a judge agreed
that given her medical condition, her husband had
the legal right to have the feeding tube removed.
The decision was supported by years of court rulings,
as well as a Florida law.
when the game of political Ping-Pong began. Her
parents didn't want to see her die. And Governor
Jeb Bush came to their rescue. Governor Bush ordered
that a severely brain-damaged woman be placed back
on life support, at the request of her parents,
although the woman's husband won a court order to
have his wife removed from life support six days
ago. This happened after Governor Bush tried to
stop the feeding tube from being removed, was rebuffed
by the courts, then got his state legislature to grant
him explicit authority to order the tube reinserted.
The highly unusual statute, dubbed Terri's Law by
Florida lawmakers, gave Bush the authority to order
Terri Schiavo, specifically, to have her feeding
tube be reinserted. Jeb Bush's intercession to put
the feeding tube back into Terri Schiavo in Florida,
places the government formally in the new role of
doctor to the nation. The husband of the severely
brain-damaged woman challenged the legality of a
hastily passed state law empowering Governor Bush
to keep her alive. In a court filing, lawyers for
Michael Schiavo contended that the law violates
Terri Schiavo's right to privacy and the separation
of power provisions of the Florida Constitution.
"It argues that her constitutional right
to refuse medical treatment was, in
essence, cast aside by a statute that
allows the governor to do that under
any whim and without any standards and
without any review," said George Felos,
who represents Michael Schiavo, after
filing the document.
parents have said that their daughter had no such
wishes and is not in a permanent vegetative
state despite what all court-ordered physicians
claim. Her parents state that she is responsive
and could improve with therapy. But this is only
wishful thinking and flies in the face of all medical
understanding of the persistent vegetative state..
The legal battle over
her fate is one of the nation's longest and most
contentious right-to-die cases. Florida courts have
repeatedly affirmed Michael Schiavo's legal right
to remove his wife's feeding tube. The state Supreme
Court has twice refused to hear the case; the U.S.
Supreme Court also refused to hear it.
"This dangerous abuse of power by the
governor and Florida lawmakers should
concern everyone who may face difficult
and agonizing decisions involving the
medical condition of a family member,"
said Howard Simon, executive director
of the American Civil Liberties Union
Terri Schiavo's well-intentioned
parents are missing the point altogether. And it's
tough to be critical of them. Anyone who has had
to watch a loved one die understands their emotions.
But they have helped make their daughter a pawn
in a great cynical chess game, shuttled from hospital
to hospice and back to hospital, having a feeding
tube inserted, removed, and reinserted, depending
on the state of the law on any given day.
The politicians, you can
be certain, have other motives. The speaker of the
Florida House sees the issue as his ticket to the
U.S. Senate. And right-to-life activists see the
Schiavo matter as their wedge to push their own
political agenda. Terri Schiavo is merely this week's
photo op. And she'll be forgotten by her new allies
as soon as they move on to their next battle.
The great untold story
is that what's happening to Schiavo occurs hundreds
of times a day in hospitals, nursing homes, and
bedrooms all over this country. People get very
sick. And after agonizing talks with doctors and
friends, often after prayer, families make the painful
decision about whether to continue artificial means
to keep a loved one alive. Sometimes, the choice
is to do everything possible. Many other times,
the choice is to let someone die.
Schiavo case is not, as some critics suggest, about
state-sponsored killing. An ethical, legal, and
theological gulf exists between allowing someone
to die and acting to hasten their death.
In a perfect world, everyone
would prepare a living will, in which everyone would
explicitly say whether they want to be kept alive
through extraordinary measures. But in this imperfect
world, many people don't, and someone has to make
the painful decision.
In the absence of a living
will, the choice should be made by the family, not
the state. If the family cannot agree, the courts
can resolve the matter. That's not a great option.
But do we really want politicians -- with their
own agendas and ambitions -- deciding who lives
and who dies? Make no mistake. That is what Florida
The president of the Florida
Senate, James E. King, got it right:
"I really do hope we've done the right
thing. I keep thinking, what if Terri
didn't want this to happen at all,"
he said. "May God have mercy on all
tragedy is he didn't figure that out until after
he turned Schiavo's life over to Jeb Bush.
The Right-to-life movement
has an honorable mission to protect the sacredness
of life. But for some strange reason, they do not
view death as a part of life. This attitude leads
to the false and dangerous belief that life should
be prolonged as long as possible, even artificially,
no matter what the quality of life or how much suffering
There are two main arguments
offered by Christians, and those of other faiths,
that advise against an individual seeking suicide,
for whatever reason:
Life is a gift from God, and that each
individual is the steward of that life.
Thus, only God can start a life, and
only God should be allowed to end one.
An individual who commits suicide is
God does not send us any experience
that we cannot handle. God supports
people in suffering. To actively seek
an end to one's life would represent
a lack of trust in God's promise.
Of course, there is a significant
and growing percentage of religious and non-religious
people who do not accept these theologically based
arguments. They might argue:
Each person has autonomy over their
Persons whose quality of life is nonexistent
should have the right to decide to commit
suicide, and to seek assistance if necessary.
Sometimes a terminal illness is so painful
that it causes life to be an unbearable
burden; death can represent a relief
of intolerable pain.
People facing a terminal illness may
not want to deplete their resources
to fight the inevitable when they can
instead have these resources remain
with the family after they die.
People facing a terminal illness may
not want to put themselves or their
family through the horrible ordeal of
a long and agonizing death.
active political question is whether individuals
should be allowed to choose suicide, or whether
they should be forced to follow the theological
beliefs of the dominant religion.
wills, Advance Directives, Power of Attorney
God forbid that you should
ever become comatose or vegetative. But if you do
and want to be allowed to die and not be kept artificially
alive for decades - you will need the following
documents listed below. Some you can just download.
Someday, you may be glad you did.
are Advance Directives?
Advance Directive is a
general term that refers to your oral and written
instructions about your future medical care, in
the event that you become unable to speak for yourself.
Each state regulates the use of advance directives
differently. There are two types of advance directives:
(1) a Living Will and (2) a Durable Power of Attorney
for Health Care. There is also a document called
a Do Not Resuscitate order. These will be explained
Do I Need an Advance Directive?
Advance Directives give
you a voice in decisions about your medical care
when you are unconscious or too ill to communicate.
As long as you are able to express your own decisions,
your advance directives will not be used and you
can accept or refuse any medical treatment. But
if you become seriously ill, you may lose the ability
to participate in decisions about your own treatment.
is a Living Will?
living will is a type of advance directive in which
you put in writing your wishes about medical treatment
should you be unable to communicate at the end of
life. Your state law may define when the living
will goes into effect, and may limit the treatments
to which the living will applies. Your right to
accept or refuse treatment is protected by constitutional
and common law. You can
download your state's
Living Will form here.
U.S. Living Will Registry
offers an excellent service where they electronically
store your advance directives and makes them available
directly to your health care providers anywhere
across the country by telephone and internet through
an automated computer-facsimile system. This is
handy because there may be situations where you
enter a hospital and your advance directives are
not known or available. This service will make certain
your wishes are granted.
is a Durable Power of Attorney for Health Care?
A durable power of attorney
for health care is a document that enables you to
appoint someone you trust to make decisions about
your medical care if you cannot make those decisions
yourself. This type of advance directive may also
be called a health care proxy or appointment of
a health care agent. The person you appoint may
be called your health care agent, surrogate, attorney-in-fact,
or proxy. In many states, the person you appoint
through a medical power of attorney is authorized
to speak for you any time you are unable to
make your own medical decisions, not only at the
end of life. You can
download your state's
Durable Power of Attorney for Health Care form here.
The form costs around $25)
is a Do Not Resuscitate (DNR) Order?
Do Not Resuscitate order is another kind of advance
directive. A DNR is a request not to have cardiopulmonary
resuscitation (CPR) if your heart stops or if you
stop breathing. (Unless given other instructions,
hospital staff will try to help all patients whose
heart has stopped or who have stopped breathing.)
You can use an advance directive form or tell your
doctor that you don't want to be resuscitated. In
this case, a DNR order is put in your medical chart
by your doctor. DNR orders are accepted by doctors
and hospitals in all states. DNRs can be obtained
by your or any doctor.
Medic Alert Make Your DNR More Prominent
For people who do not
want to be hooked up to a machine and those who
want to refuse resuscitation, there are ways to
prevent it from happening. Most states allow people
to have a DNR (Do Not Resuscitate) order. That means
that if you are in a supermarket, for example, and
your heart stops beating, you will not be resuscitated.
But this will only happen if you have a DNR that
is easily identified by medics. The problem with
DNRs is that medics do not look for them whether
you keep your DNR in your wallet or on your fridge.
Fortunately, DNR identification jewelry can be obtained
through the non-profit 45-year-old
Once you have filled out your DNR document, you
send MedicAlert the last sheet of your DNR. For
a small fee, you can join MedicAlert. Then they
will inform you about the choice of necklace or
bracelet that clearly states your wishes to
In some states, this jewelry and/or official papers
(which you might not have on your person) are the
ONLY methods honored by emergency medics. If such
a notification is not present, you
be resuscitated - meaning you will be denied your
A tremendous number of
NDEs I read about involve the person coming back
and being extremely upset that they were resuscitated.
Often it leads to severe depression. 4% of experiencers
commit suicide. Being revived from death is just
another instance of others deciding whether you
should live or die.
Forget About Organ Donation!
is probably no better gift than the gift of life.
But the number of people requiring a life-saving
organ transplant continues to rise faster than the
number of available donors. Approximately 300 new
transplant candidates are added to the waiting list
each month. Countless numbers of needy children
have died waiting for a life-saving organ transplant.
And the sad part is that it is entirely unnecessary.
It is so simple to have your organs donated when
you die. The irony is that adults who want to die
are often forced to live; but children who want
to live are forced to die because not enough people
donate their organs. We can't take our organs with
us! And we pass up such a great blessing to someone
else if we neglect such a tremendous opportunity.
Unfortunately, the vast majority of people who die
do so without thinking about or knowing how valuable
their body could be to someone else. What is the
price for giving someone life when they so desperately
want it? So, make your life review even better.
Donate your organs and give a child a new lease
on life. Visit the
National Organ and Tissue
website to see how.
Also read more about
the case for assisted
suicide and active voluntary euthanasia and
why someday you may beg for it.
about taking control of your own life and death.
Don't let some
religious zealots do it for you.
Take action now.