Issues are like chemical elements; few stand alone. In the periodic table, there are only a few “noble gasses” that won’t (usually) combine with other elements. Oversimplification in commentary consists of pretending to separate out what is inextricably bound with another issue, and trying to address it in isolation.
So it is with Terri Schiavo. I count eighteen issues wound together:
- What did Terri Want?
- Did her husband know that?
- Assuming he did know, did he have a reason to lie about it?
- Did he have standing to speak on the issue?
- Did her parents know her wishes?
- Assuming they did know, did they have a reason to lie about it?
- Did they have standing to say what her wishes were?
- In absence of a living will, can judges (given the stakes) decide?
- What was Terri’s condition? Her prospects for recovery?
- Is it all right to refuse medical treatment?
- Is a feeding tube medical treatment?
- Do we withold a lethal injection of morphine just because we’re gutless?
- Isn’t letting her body die of dehydration much worse?
- If she is going to go live forever with God and have a new body and be happy, what are we holding onto?
- Does the federal government have an interest in the outcome of the case?
- Shouldn’t congress have stayed the hell out of it, if it’s a state issue?
- Shouldn’t all the braying opportunistic jackals who have latched onto this case all go straight to hell?
- How about all the idiots with their protest signs insisting that the rule of law has to be thrown out the window if they didn’t like the outcome? Shouldn’t they all go straight to hell, too?
That’s enough to keep a blogger in carpal-tunnel pain for weeks or months, but I would like to add another issue:
Why don’t we all just grow the hell up?!!
People die horribly all the time and we’re so wrung out with trying to pretend otherwise that we end up making life worse for people who are dying.
If you’re really hurting, you can’t have enough morphine because the federal government is afraid you might become addicted. Please, lie here in agony on this bed with tubes in your body, knowing you’re dying (or deceived by lying relatives and doctors). Or, insensible, your brain gone, please lie here because we just can’t face an ugly reality. This is an improvement?
I feel like taking a broom and sweeping those eighteen issues up in a dustpan and staying with that last one. Because – that’s the one for which I feel confident about an answer. I found a pretty good summation on James Randi’s website:
Please, don’t write accusing me of lacking respect for the human who was once Terri Schiavo; nothing could be further from my true feelings on the matter. I am deeply grieved and dismayed that we, as a community, could admit and accept that she died fifteen years ago, that we kept her tissue functioning for all that time, and then opted to starve her body until it failed. I could do nothing, in the face of the present attitudes and philosophies of those who administer our laws. We were all victims of this embrace of irrationality, and we must all take responsibility for the pain that the Schiavo family suffered because we encouraged their groundless hopes and their rejection of reality. They — understandably — clung to every hint that Terri might still have been “there,” because that’s what they wanted — needed — to be true. It was not true.
We have to grow up, at some point. We had this opportunity to move in that direction, and we failed.
- James Randi
If you’re really hurting, you can’t have enough morphine because the federal government is afraid you might become addicted.
We need to do a better job with palliative care.
When my father was dying (cancer) he had a prescription for morphine for that last couple of weeks. The home-care nurse explained that it worked best if you didn’t wait until the pain became unbearable. You’d use less if you took it at the first sign of pain, subject to the doctor’s instructions of course. So later I would say, “Dad, are you having any pain? Do you want a pill?” And he would say no, he didn’t need one yet, and didn’t want to get hooked on them.
Morphine is far from ideal as a end-of-life painkiller. The side effects are unpleasant and that also made him reluctant to take any. He didn’t really want to spend his time awake in a fog and his time asleep having weird opium dreams. Maybe they have some better pain killers today.
The nurse later took me aside and explained that this was timed-release morphine. The pill as a whole contained enough morphine to be fatal. She explained that if the pill were chewed and swallowed, or ground up and mixed with juice (as anyone might reasonably do if the patient had trouble swallowing) then the patient would fall into a deep sleep and then stop breathing. So I should be sure and not do that.
Well, I didn’t do that, and Dad didn’t either. He was able to die at home in his own bed. The church did far more for all of us than the doctors could. We had some nice talks before the end, and he got to spend a little time with his grandchildren and they with him.
So we need to grow up? Maybe. This is intended more to extend your point than to refute it. It doesn’t even really have much to do with the Schiavo’s troubles. Their circumstances were quite different. But my father didn’t lack for morphine, or for options. I would agree that the war on drugs impedes the development of painkillers. But it seems odd to me that it’s easier to change the law to allow euthanasia (indeed, it doesn’t even require legislation. It was already the law. Who knew?) than to encourage the development of effective painkillers.
Thanks for writing that, Tom. It’s a good thing you got to be there with him. I can empathize with your loss as my own father died a few years ago and sometimes it feels like it was yesterday.
The nurse was right to give you that option, and you and your father were right in making your own decision. No courts, no protesters, no idiot interference from people telling you how to live and die. Just the people most involved with the reality doing what they think is best.
Many churches take a positive role in supporting the dying and their families – MrsDOF’s church does. They’re wonderful and so very different from the yammering idiots going on about Terri’s death. I was directing the “we need to grow up” comment at the YI’s – not to them as there’s no chance they’d listen anyway.
You’re right about morphine and many documentaries have exposed how the dying don’t get pallative care as they should. I read somewhere that heroin is actually excellent for people in terminal pain – it is so potent that it quiets the pain in very small doses with minimal side effects so people can stay lucid. Interesting, if true. Then there are the well-documented benefits of marijuana for some people on chemo, but that’s a big no-no too. I guess the moral high-horse people want to make sure you feel your own pain no matter how bad it gets.
There’s a good discussion of this going on over at John Hoke’s Asylum and Stupid Evil Bastard.
Heroin (diacetylmorphine) is what is called a prodrug—it itself has very little affinity for opioid receptors. Rather, it breaks down in vivo into the active drug (morphine). The deal is, that morphine has a couple of functional groups which aren’t absorbed into the brain very readily, so comparatively large doses are required to get the desired effects. Heroin has fewer physical side effects (respiratory and smooth muscle relaxation, vomiting, constipation) per unit mental effect, and a much higher therapeutic index (ratio of lethal to therpeutic dose) than morphine. It’s a schedule 1 substance in the US (i.e. Congress decided that it has no medical use) *because* it has fewer side effects and is thus easier to “abuse”. However, virtually every other country in the civilized world has gotten by using it in medicine without creating an army of heroin addicts.
Marijuana is clearly a terrible pharmaceutical in that it must be smoked (which can cause nausea) to be used. Smoking of course has a number of undesirable side effects like respiratory disease and increased cancer risk (not that that’s much of a worry to most patients who would use it). There is a pill form containing synthetic THC dissolved in sesame oil under the trade name Marinol which has been shown to be effective at treating pain, nausea and anorexia in a couple of clinical trials. However, this form of administration is undesirable compared to inhalation due to its slow action and lack of control over dosage. Ideally, someone would develop a THC inhaler, like those used for asthma (it would have to be of a different design, since the dosage is over 100 times greater than for, say, albuterol) and conduct clinical studies. Of course, an organization called MAPS already tried that, and were unable to receive DEA approval despite a greenlight from the FDA. Interestingly, they had to sue to even get the DEA to tell them no (the whole procedure took over two years).