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Leaving Athens, returning to Sparta
The following is a statement by the head of the International
Federation of Catholic Medical Associations concerning the case in the
United States of Terri Schiavo, who died on Thursday, 31 March, after
nearly two weeks of being refused food and water.
Now that the sad story of Terri Schindler Schiavo [has come] to an end,
some reflections are urgently needed in the attempt to face the
devastating tide that will inevitably wash over [Italy] too, sweeping
away long-held values and violently altering the map of a people's
convictions.
The symptoms of this cultural tsunami have already been sighted in
the ocean of nonsense published in the past few days by authoritative
opinion leaders, and affirmed with disarming ease in television talk
shows.
People have said that poor Terri was in a "vegetative coma", that she
no longer had a brain, that she should be "unplugged", that she was
being kept alive by life-support machines, that there should be an end
to aggressive medical treatment for a person terminally sick or whose
condition, in any case, is irreversible.
Some have compared Terri's life to that of a vegetable, incapable of
feeling any sensation or pain. There have even been television
"philosophers" who have declared that hers was no longer a human life,
whereas former ministers have spoken of intermediate conditions between
life and death.
Authoritative scientific reviews have even fallen into the trap of
sensationalism, saying that we have before us a patient with a flat
brain scan, the condition seen in brain death. For such a patient there
are many "masters of thought" who have been scandalized at the inhuman,
invasive tubes with which they claimed the patient was being kept alive
artificially, and they called for a merciful death for her "without
suffering", subsequent to the suspension of food and water.
The truth of the matter
It is necessary to begin by explaining the boundaries of things,
calling them by their proper name for those who, in cases such as
Terri's, have only heard about them on television.
Patients in a vegetative state are not brain dead, because their
brains, even if more or less imperfectly, have never ceased to function.
They are not even in a coma, since they are awake and their eyes are
open. Their electroencephalogram is not flat and can even alternate
between phases of sleep and wakefulness.
There is no plug to unplug, for the simple reason that these patients
are not connected to any machine. They are not terminally sick, given
that they can survive for many years with only basic assistance
(primarily, hydration and nutrition).
They are not necessarily patients who will never recover, if one
considers that the definition "permanent vegetative state" has no
diagnostic but solely prognostic value, merely indicating that the
possibility of recovery diminishes with time.
They are not patients who feel nothing, given that the potential
mentioned can demonstrate that a stimulus has reached the cerebral
cortex. Although there are often no indications of further cortical
processing of such a signal, there have also been well-documented
scientific cases in which a rudimentary process of discrimination and
recognition was nonetheless possible.
Patients in a vegetative state do not tell us whether they feel pain,
but the painful stimulus reaches their brain and we do not yet know
enough about the physiology of pain to be sure that the absence of
evidence is proof of the absence of all pain.
Patients in a vegetative state are not all the same. The images that
explore the anatomy (such as NMR) or functionality of their brains (such
as PET and functional NMR) show a great variety of responses from case
to case.
For these reasons too, the diagnosis of a vegetative state is far
from easy and important studies show error margins superior to 30
percent, even in qualified centres.
Another myth to explode is that of the tubes through which the
patient is fed. They are described as infernal devices with little
respect for the dignity of the patient.
In point of fact, the insertion of a nasal-gastric tube is a common
procedure and usually practised only at the initial phases of the
vegetative state, whereas with regard to the PEG, it is a matter of a
very well-tolerated and manageable procedure that can be handled at the
patient's home by persons who are not health-care professionals. It is
invisible since it is hidden beneath the patient's clothing. Some
patients suffering from non-cerebral diseases have to be fed with a PEG
tube for years, and this is not an obstacle to their working life or
their relationships.
Lastly, we must reflect on the "beautiful death" inflicted on poor
Terri, a death that has been described as serene, peaceful and devoid of
suffering, caused by making an organism, defined a priori as
incapable of feeling pain, die of hunger.
Actually, death from hunger and thirst is a slow agony that gradually
ravages the whole organism. Patients in a vegetative state can suffer in
ways we do not know, to the point that the very champions of this
procedure at the same time totally sedate patients with morphine to
avoid the risk of the telltale signs on their bodies of a reaction to
the pain they might feel.
This is such an inhuman death that should someone inflict it on a dog,
he or she would be condemned for cruelty and abuse.
Three falsehoods exposed
In order to shed a more realistic light on the vegetative state and
before proceeding to examine the consequences of this disgraceful case,
it is necessary to explain that the deliberate and barbaric killing of
Terri Schindler Schiavo was perpetrated on a poor patient who was not
even in a vegetative state.
From an examination of the films and in accordance with the opinions
of distinguished American colleagues, the patient could at most be
described as in a condition of minimum consciousness (MCS) or in a
low-level neurological state (LLNS), capable of certain elementary
movements, of rudimentary expressions and with a partial ability to
swallow. In the past 10 years, this patient was denied further
diagnostic investigations (such as the PET and f-NMR) and
rehabilitational interventions, even to the point of being denied
Communion during her days of hunger and thirst, so that no indiscreet
eye might observe the suffering caused by the suspension of nutrition
and hydration.
Terri Schiavo was put to death on the basis of three falsehoods.
The first is that assisted nutrition and hydration is a form of
"medical treatment" and not a fundamental element (on a par with
mobilization and hygiene) of basic nursing assistance.
The second lie is that Terri Schiavo had to be put to death out of
respect for her own desire not to receive the "medical treatment" of
assisted nutrition and hydration. This would be, therefore, a matter of
respect for the principle of the patient's autonomy.
A discussion on the limits of anticipated directives go beyond the
intentions of this brief article. But we cannot avoid stressing how, in
this specific case, the revelation of the presumed wishes of the patient
was based only on general comments in an informal conversation, dating
back many years and revealed by a husband who can at the very least be
suspected of having a conflict of interests and of being opposed to
Terri's presumed desire as expressed by her parents and siblings.
How is it possible to base a decision concerning human life on a
general conversation on nutrition by artificial means that took place
some years ago? This would be judged as insufficient proof in criminal
proceedings, especially when it is a matter of putting to death a woman
who is indisputably innocent!
When such a conception of the patient's autonomy is subjected to
criticism, those who established that Terri had to die in any case
finally invoked the ultimate falsity in this sad case: they claimed that
the suspension of basic assistance (hydration and nutrition) is not only
justified but also obligatory, on the basis of the principles of
futility, exceptionality (disproportionality) and the excessive burden
it entails, on which every ethical judgment on treatment is based.
It is a pity that only at the price of falsifying the truth can a
treatment be described as futile, disproportionate and excessively
burdensome, when for years it has effectively fulfilled its purpose of
providing nourishment that is inexpensive, requires no special machines
and is well tolerated by millions of patients for the widest range of
pathologies.
How can a large section of American society be in agreement with a
bad husband, such as Michel Schiavo, in wishing at all costs to put
Terri to death?
Seeing universal values
The Terri Schiavo affair conceals worrying truths that go beyond the
specific case and acquire universal value. It is right to reflect on
these tremendous truths before it is too late for our society.
It is not that hydration and nutrition are futile, but the very lives
of patients like Terri that are deemed futile and meaningless.
It is not the PEG that is disproportionate, but the obligation to
nurse patients whose return to "health and beauty" may not be granted.
It is not the "treatment" that is excessively burdensome for the
patient, but the very life of so many persons with serious chronic
disabilities, considered by our society as a burden of which we should
be glad to rid ourselves.
To mask the intrinsic immorality of these conclusions, people have
recourse to very dangerous digressions on the inadequate quality of life
that would qualify patients in a vegetative state and those who, like
Terri, resemble them.
On the basis of a final external judgment, the quality of a patient's
life is deemed insufficient for the protection of life itself when the
patient is unable to maintain a sufficient capacity for relations, when
he or she fails to show sufficient awareness, when there is no hope of
an acceptable recovery, when the patient cannot express his or her
autonomous will, when he or she is unable to communicate his or her own
decisions. In these conditions, the life in question is deemed no longer
human, or, with more subtle sophism, we are facing a human being who
henceforth lacks what are held to be the minimum prerequisites in order
to qualify as a human person.
At this point, it is easy to draw conclusions and to realize why the
Schiavo case unfolds bleak prospects.
First of all, [not long] after Terri's death, the same opinion groups
that had clamoured for the suspension of her hydration and nutrition
will demand a quicker and less painful death (without the need to inject
the patient with morphine). This will be a decisive argument for the
legalization of euthanasia in the U.S.A., and then, throughout the
world.
Moreover, if an opulent society, such as American society, deems
henceforth that assistance to the sick who have no hope is a waste of
money, it is the overall degree of attention to frailty that is called
into question, with irreversible damage to the principle of solidarity
in assistance.
Finally, if patients in a vegetative state are to be considered human
beings whose lives are henceforth not worth living, whose status and
rights as human persons are no longer recognized, then this
discriminatory principle can be extended to many other categories of
patients who likewise lack autonomy, a life of relations, awareness, the
ability to communicate their own decisions. They are the demented, the
mentally-handicapped, those in prolonged comas, seriously deformed
newborns.
In the name of a superior tribunal of human dignity, a discriminating
regime will be set up that is in stark opposition to the Universal
Declaration of Human Rights and heralds further dangerous, aberrant
democratic trends. Having left Athens and humanism, they will return to
Sparta and eugenic selection.
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