Know something before ya talk... or pass knee jerk legislation
"People are talking a lot about the Terry Shiavo case. A lot of these people do not seem to have done ANY research into the medical ethical-legal issues surrounding the case. I thought I would give a little review for the masses (or the 3 people who read this).
First, let’s talk about the existing legal precedents.
#1 Karen Ann Quinlan/ Substituted Judgment Standard:
This case was very similar case to the Shiavo Case. Karen Ann Quinlan was in a persistent vegetative state and her father asked to have the life support terminated. He said this was based on his understanding of what she would have wanted. Quoted from the decision, "if Karen herself were to miraculously lucid for an interval... and perceptive of her irreversible condition, she could effectively decide upon discontinuance of the life support apparatus [a competent patient can ALWAYS refuse treatment], even if it meant the prospect of death." The court allowed the termination of life support, not because the father asked for it, but because it decided the fathers wishes were based on what Karen herself would decide if she were capable.
Basically, the Substituted Judgment Standard says no one can make the decision for a patient. Decisions must be made based on an evaluation of who has the most knowledge of what the patient would actually do if competent. This tenant is trumped by a Living Will or Health Care Power of Attorney, neither of which exist in the Shiavo case. The idea is to protect the patients wishes and not allow people to impose their own wishes on a defenseless patient.
#2 Eicher vs. Dillon: Best Interest Standard
This precedent is less relevant to the Shiavo case. It basically comes into play when a patient has never been competent or no one knows the patient well enough to enact the Substituted Judgment Standard. In this situation, decisions are made as a hypothetical "reasonable person" would decide. This is not relevant due to the fact that Mr Shiavo has the intimate knowledge of Terri's mindset on this issue.
Now, the parents are arguing that she has a chance of recovery and she is aware of her surroundings. In 1996 she had an EEG that showed no brain activity. Folks, you don't come back from that. Also, more recently she had a head CT that should severe (75%) atrophy of the cerebral cortex. Basically, that rules out any cognitive function ever occurring again, as brain cells are finite and once they atrophy, they are GONE. The parents claims she smiles, and moves her eyes. This kind of activity can persist because of brain stem reflexes without any cortical activity.
The politicalization (maybe a word?) of this issue disgusts me. I have sympathy for the parents, having to watch your daughter die is not something I can not even begin to understand. However, any politician trying to make his credibility in the conservative movement by waging some Right to Life war using this poor family makes me want to vomit. Jeb Bush and the Florida Legislature were wrong to get involved. W Bush and the Congress are wrong to get involved. I have heard right wing talk show hosts demonizing Mr Schiavo, saying he has an ulterior move, he is hiding some sort of abuse and wants Terri to die so she can't expose him. She was injured in a CAR WRECK people. Not only is this an example of politicians with misunderstanding of the facts and standards, they may degrade Patient's Rights in the process. Do you want your family to be allowed to fight it out in that situation, or would you like to be able to have your own wishes honored?
One way to ensure this is a living will and/or Health Care Power of Attorney. It's never to early to do one of these. I plan on getting the forms in digital format, if anyone would like to make one as well. All it takes is the prefab forms and then getting them notarized.
end rant">
First, let’s talk about the existing legal precedents.
#1 Karen Ann Quinlan/ Substituted Judgment Standard:
This case was very similar case to the Shiavo Case. Karen Ann Quinlan was in a persistent vegetative state and her father asked to have the life support terminated. He said this was based on his understanding of what she would have wanted. Quoted from the decision, "if Karen herself were to miraculously lucid for an interval... and perceptive of her irreversible condition, she could effectively decide upon discontinuance of the life support apparatus [a competent patient can ALWAYS refuse treatment], even if it meant the prospect of death." The court allowed the termination of life support, not because the father asked for it, but because it decided the fathers wishes were based on what Karen herself would decide if she were capable.
Basically, the Substituted Judgment Standard says no one can make the decision for a patient. Decisions must be made based on an evaluation of who has the most knowledge of what the patient would actually do if competent. This tenant is trumped by a Living Will or Health Care Power of Attorney, neither of which exist in the Shiavo case. The idea is to protect the patients wishes and not allow people to impose their own wishes on a defenseless patient.
#2 Eicher vs. Dillon: Best Interest Standard
This precedent is less relevant to the Shiavo case. It basically comes into play when a patient has never been competent or no one knows the patient well enough to enact the Substituted Judgment Standard. In this situation, decisions are made as a hypothetical "reasonable person" would decide. This is not relevant due to the fact that Mr Shiavo has the intimate knowledge of Terri's mindset on this issue.
Now, the parents are arguing that she has a chance of recovery and she is aware of her surroundings. In 1996 she had an EEG that showed no brain activity. Folks, you don't come back from that. Also, more recently she had a head CT that should severe (75%) atrophy of the cerebral cortex. Basically, that rules out any cognitive function ever occurring again, as brain cells are finite and once they atrophy, they are GONE. The parents claims she smiles, and moves her eyes. This kind of activity can persist because of brain stem reflexes without any cortical activity.
The politicalization (maybe a word?) of this issue disgusts me. I have sympathy for the parents, having to watch your daughter die is not something I can not even begin to understand. However, any politician trying to make his credibility in the conservative movement by waging some Right to Life war using this poor family makes me want to vomit. Jeb Bush and the Florida Legislature were wrong to get involved. W Bush and the Congress are wrong to get involved. I have heard right wing talk show hosts demonizing Mr Schiavo, saying he has an ulterior move, he is hiding some sort of abuse and wants Terri to die so she can't expose him. She was injured in a CAR WRECK people. Not only is this an example of politicians with misunderstanding of the facts and standards, they may degrade Patient's Rights in the process. Do you want your family to be allowed to fight it out in that situation, or would you like to be able to have your own wishes honored?
One way to ensure this is a living will and/or Health Care Power of Attorney. It's never to early to do one of these. I plan on getting the forms in digital format, if anyone would like to make one as well. All it takes is the prefab forms and then getting them notarized.
end rant">