Friday, March 25, 2005

SCHIAVO -- A MUST READ

I implore you to read two new pieces in The New England Journal of Medicine on the Schiavo case. (Thanks to Bluest Fist reader Linda Berman for drawing them to my attention.) They are both thoughtful, informed and not polemical:

http://content.nejm.org/cgi/content/abstract/NEJMp058062

http://content.nejm.org/cgi/content/abstract/NEJMlim050643

The second piece concludes in this way:

"Erring on the side of life" in this context often results in violating a person's body and human dignity in a way few would want for themselves. In such situations, erring on the side of liberty -- specifically the patient's right to decide on treatment -- is more consistent with American values and our constitutional traditions. As the Massachusetts Supreme Judicial Court said in a 1977 case that raised the same legal question: "The constitutional right to privacy, as we conceive it, is an expression of the sanctity of individual free choice and self-determination as fundamental constituents of life. The value of life as so perceived is lessened not by a decision to refuse treatment but by the failure to allow a competent human being the right of choice."


As a side note, I was heartened this morinng to hear two typically right-wing sports talk radio hosts in Boston (John Dennis and Jerry Callahan) excoriating George and Jeb Bush for their manipulative use of Terry Schiavo. Perhaps their role as loving husbands trumped their role as Republican talking heads in this case.

Thursday, March 24, 2005

SHIAVO - A RESPONSE TO ONE OF MY READERS

One of my readers has posted two long comments in response to my post (and Dr. Jeff Wilson's guest post) on Terry Shiavo. You can read the below in the comments section of "Saving Private Shiavo." Joe V. is a very old friend of mine. I've known him since the 2nd grade. During those early years he battled cancer (as he notes in his comment) and I was witness to the physical and psychological turmoil he suffered as a result. I have always considered myself his friend, though perhaps I was not always the best friend I could be. Joe and I lost touch sometime after college, though I get word of him from mutual friends on occassion. Joe was, last time I knew enough to judge, a conservative Republican and an admirer of Antonin Scalia's political and judicial views. This is of course his right.

His comments presume to poke wholes in my earlier argument about the Shiavo case and Bush's motives for pursuing it -- but they really do nothing of the sort. First of all, Joe never addresses the incontravertible evidence (the "talking points" for instance) that the Republican Party (which doesn't go to the bathroom without the approval or George Bush and Karl Rove) has seen this case in purely political terms from the beginning. Secondly, he doesn't address the fact that Bush's position has flip-flopped since the signing of his hospital-friendly bill in Texas. Thirdly, his sense of what's at stake in this case -- and of what the case "is" generally -- is just all wrong. Let me see if I can explain.

Joe states that his personal battle with terminal illness makes this case near and dear to him, and gives the impression that this makes his opinion authoritative. But in fact the opposite is true. When a case is "near and dear" to you a judge throws you off the jury, and with very good reason -- namely, because your ability to be impartial (and thus to provide the sort of peer judgement the Constitution envisions) is seriously in doubt. I feel very badly that Joe is still battling cancer, having suffered it again as recently as two years ago -- but if anything, this makes me trust his opinion of the Shiavo case less, not more. I respect him too much to patronize him by pretending this isn't the case.

By the same token, I myself am having to struggle to keep my personal experiences from affecting my opinion of this case. In the last three months, two people I love very much have died -- too soon -- from terminal illness. Both of them were able to make conscious decisions about how they wanted to die and both chose to die with grace and dignity and without prolonging the inevitable beyond the time they needed to convene with their loved ones. These too are experiences quite differenent from those in the Shiavo case. Unlike Joe's situation and those of my two family members Terry Shiavo CAN NOT make her own decision.

And that is the central fact. Terry Shiavo has a husband who -- no one really disputes -- she loved at the time she slipped into a vegetative state. What the courts have said, over and over, is that, barring strong evidence that it would be illegal, the decision to withdraw various forms of life support is HIS, the husband's. Not her parents or her siblings or her uncles or her friends. Her husband's. When someone you love is dying, you have innumerable conflicting emotions. Sometimes you don't want them to go even though you know that they are needlesly suffering and that THEY want to go. Sometimes people within the circles of loved ones disagree as to how to proceed. So the court invests SOMEONE with the authority to make that decision. Imagine the absolute chaos that would ensue if they didn't! And in this case it is the husband. Terry Shiavo's parents can believe whatever they want -- and we as citizens can sympathize with them or not. But they simply have no legal roll in deciding her fate. Period. As a spouse, I think this is quite right.

As far as the attempts to discredit Michael Shiavo as some sort of con man, I find them absolutely appauling and insulting . Five years after his wife slipped into a vegetative state he started dating another woman. We're supposed to take this as evidence that he didn't love her? C'mon! If God forbid, I slipped into a vegetative state I'd certainly want my wife to start a new life after five years. Hell, two or three years of mourning would be fine with me. And as for the malpractice money, it's gone folks. DOES ANYONE ACTUALLY THINK THAT THIS GUY, MICHAEL SHIAVO, WOULD HAVE WENT THROUGH THIS LEVEL OF TOTAL HELL, FIFTEEN YEARS FIGHTING HIS WIFE'S PARENTS, FOR THE FEW BUCKS THAT ARE LEFT? Puh-lease. The guy simply wants his wife to die peacefully after being kept needlessly alive, it seems to me. You can disagree with him but to pretend that this is not a plausible response from a loving husband is completely ridiculous. (As an aside, the fact that Nat Hentoff -- "a liberal" as Joe puts it -- sides with Shiavo's parents means nothing to me. Nat Hentoff is a fine jazz critic but I don't think he has anything especially enlightening to say about this case or politics generally.)

Lastly, Joe posits that my view of George Bush's role in this case is clouded by my hatred of Bush himself. Well, okay, I do hate Bush with the white-hot intensity of a thousand suns. But, sheesh!, do you really need to dislike Bush to recognize what a pathetic pandering job he's doing in this case? He is doing what IN ALMOST EVERY OTHER CASE he would not do: get involved in a private matter obviously under the jurisdiction of the state of Florida. Indeed, the only other case I can think of where he meddled with the Florida courts was...um...the 2000 election which made him president.

Monday, March 21, 2005

SAVING PRIVATE SHIAVO

Most of you have probably heard that George W. Bush has gotten Congress and the White House involved in preventing a loving husband from acting on his wife’s wishes (stated to him when she was uninjured and conscious) that she be allowed to die gracefully after 15 years in a coma. Bush and Tom Delay think that the Federal government should be able to tell this husband that his wife has to be hooked up to machines unnaturally keeping her alive for decades because, well, all life is precious and it would insult George Bush’s faith to restore this woman’s dignity. The woman’s name is Terry Shiavo.

The Republican Party’s "Talking Points" on the Shiavo case were leaked to the press today. They include these two disgustingly calculating "bullets":

1. The pro-life base will be excited that the Senate is debating this important issue.
*
2. This is a great political issue, because Senator Nelson of Florida - has already refused to become a cosponsor and this is a tough issue for Democrats.

Add to these the fact that while he was Governor of Texas, George Bush signed a bill into law that gave hospitals broad discretion to "pull the plug" on patients who were on life support who had no hope of recovering. Why? Because, Bush argued back then, they were a needless economic drain on the Texas hospital system. How's that for a flip-flop?

Every day George Bush seems to top himself, revealing for us with greater and greater clarity what a vile human being he really is. I hope that even those of you who have supported him in the past will take a moment to imagine a moment where the White House tells you that their ideology supercedes your ability to let your spouse die with grace and dignity. But, listen, my good friend Jeff Wilson – like my wife Sue, an MD specializing in Family Medicine who has shepherded many family’s through the dying process – speaks with greater eloquence than I do about just how crazy this case has become thanks to right-wing ideologues. I’ll let him have the floor till the end:

Is anyone following the story of the women in florida? if not here is a quick update-15 yrs ago this lady had a heart attack leaving her in a coma. her husband says that she had verbally instructed him prior to the accident that she would not want to be kept alive with artificial means. her parents however, feel that she had/has a chance to improve and have pushed to keep her alive. the battle went to the courts and over that time period the 'feeding tube' has been removed THREE TIMES the most recent time a few days ago. each of the previous two times it was re-inserted after some legal maneuvering.

what has me so incensed at this story is the levels of government that have now become involved. the day before the tube was removed there were multiple motions in the house and senate (were talking in washington here, not in her state) to block this action. the motions/bills that they attempted to push through involved calling her as a 'witness' to various 'trials' involving end of life issues. this woman's daily life involves laying in a bed, unable to eat/drink or move essentially ANY of her body and is fed with what is called a peg or 'g' tube inserted into her stomach. her parents insist that she is able to respond by blinking and/or small hand squeezes and answers questions appropriately in that manner, however the truth to this is much up in the air.

IS THIS INSANE???? as of last night the president... that's right the actual president... now has cancelled a trip in order to stay home at the white house waiting to sign anything the congress can push through to 'protect' this woman and re-insert the tube. im so glad he has time to worry about this case in the middle of, oh, lets say a war, a major and horrible push to revamp and kill social security, crisis in medical coverage and insurance companies, record high oil and gas prices and lets not forget about all those heart-warming individuals in al-queda just itching for another chance to punch us in the face. maybe after signing the bill to open more drilling in alaska bush felt he could lay off on some of the 'other stuff' and help out another pet project.

as a doctor and a husband this story is eating at my soul. life is precious and god knows i work everyday to help it along but i also strongly believe in the idea of dying with dignity if someone wishes. i have sat at the bedside of patients and their families as they have let go peacefully and gracefully-it is really a beautiful thing. i have stood next to and participated in drawn out and dramatic codes where the patient SHOULD have been allowed to die peacefully but the family could not let go. my own family had to deal with this exact same issue when i was in college and, after a car accident, my aunt was left in a coma- six months later my mom and her sisters decided to withdraw support. to this day i applaud and am humbled by their courage and use it and that lesson to help other people through the same process.

if indeed this woman voice desire not to be kept alive under these means, and her husband should know- his story has not wavered from the start- this action is criminal. and now the president wants to get involved. to me, this reeks of a pet project for the religious right anti-abortion crowd to grab onto and flaunt and use to justify their misguided cause but instead they only cause more pain to the players and ultimately to the woman they are trying to 'save'. it stinks and shows how blind to the truth and divorced from reality they actually. some of them actually tried to bring the woman bread and water a few days ago... please excuse the detached nature of this next statement but actually i wish they had been allowed to give it to her,
maybe she would have choked and had her wishes fulfilled.

anyway, i really needed to get this out of my head. i picture myself in this position (my in-laws are awesome people, that is not what i mean!!!) of my most valued friend, lover and partner unable to speak or move and yet tortured for 15 years, made to endure a living hell that she did not want to be in. now put it in the media spotlight and turn it into a circus. if something good can come out of this PLEASE PLEASE talk to your partners and families and discuss these types of issues. it is not scary or depressing or macabre to do so, it is freeing and loving to your partner, kids and family to know what you want. how different is it from checking off the 'organ donor' box on your licenses?

i hope you are all very well, please know that you are all in my heart and thanks for listening.

Jeff Wilson


Peace and love from me too,

Michael

Sunday, March 13, 2005

HEADLINES

Sorry for the slowdown at The Bluest Fist. Life has overwhelmed me these last few months. Seems like it’s been a helluva winter for everybody. So, here are a few thoughts and updates in lieu of a long meditation. If you haven’t looked at the website lately, there are a number of items up that I did not email to you, so have a look and comment if you like.

I’d urge you to read the lengthy expose in the New York Times about how the Bush White House’s propaganda machine has infiltrated and manipulated the mainstream media (have people stopped calling it the “liberal media” yet or should I continue to pee myself laughing?).

http://www.nytimes.com/2005/03/13/politics/13covert.html

In other news, the Manchester Union Leader has the story on the Republican Party official in New Hampshire convicted for jamming Democratic Party phone lines the day of the 2002 elections. Chuck McGee (no relation!) looks startlingly like he could be Karl Rove’s more rotund brother and will now be doing 7 months in the clink. The dirty tricks of the Republican Party look more Nixonian by the minute.

http://www.theunionleader.com/articles_showfast.html?article=51820

And on Social Security, this actually appeared in the right-wing Washington Times (thanks to Talking Points Memo and Daily Kos for pointing it out):

A senior Republican senator said, "The message coming out of the White House is that we'll fix Social Security by raising your taxes and cutting your retirement benefits and, to get something passed, we'll forget about the personal retirement accounts we promised." The senator said that is like telling voters, "Never vote for Republicans again -- we lie."


Ouch! Sounds like someone actually told the American public the truth about Social Security…

I’ve been promising a piece on the Death Penalty for months now and I really do hope to get it out to you soon – I’d like it to be more of an essay than a news item and that’s why it’s taking so long. Meantime, you should know if you don’t already that the Supreme Court has now within the last couple years outlawed the Death Penalty for the mentally retarded and for minors. The right-wing is absolutely appalled that a Court would have the audacity to tell us that we are not allowed to remain part of that exclusive club (China, Iran, Syria) that allows the State to hang, electrocute or lethally inject with poison handicapped people and kids for the purpose of killing them. Imagine! The Bush Administration was of course highly critical of this outrageous decision by the Supremes.

Lastly, the latest official statistics state that 1513 American soldiers have died in Iraq, including 647 since the handover of power and 81 since the recent Iraqi elections. Well over 11,000 soldiers have been wounded. A minimum of 16, 231 Iraqi civilians have been killed as a result of the fighting, though estimates of civilian deaths resulting from the invasion go much higher.