Voices Online Edition
VOICES – Vol. XX No. 2 – Michaelmas 2005
About Medicine and Morality
A STUDY IN CONTRASTS: THE DEATHS OF POPE JOHN PAUL II AND TERRI SCHIAVO
by Nancy Valko, RN
In March 2004, Pope John Paul II shook the bioethics world with his statement calling medically assisted feedings ordinary treatment for people in the so-called “vegetative state.” He even went on to recommend further research, rehabilitation, family support and basic medical care. Especially because the Pope’s statement was issued during the legal fight about removing Terri Schiavo’s feeding tube, the media and others reacted with outrage.
The Pope’s statement was excoriated by many commentators who insisted that even Catholic teaching was in favor or withdrawing feedings from people in the so-called “vegetative state.” This included both Catholic and secular ethicists who thought they had settled the feeding tube issue. For example, Fr. John Paris, an ethicist at the Jesuit-run Boston College, “I think the best thing to do is ignore it, and it will go away. It’s not an authoritative teaching statement.” Arthur Caplan, a secular ethicist at the University of Pennsylvania joined Dominic Sisti, an ethicist at Villanova University, to write a commentary in the Chicago Tribune asking, “Would the Pope get a Feeding Tube?”
The Catholic Health Association claimed confusion about what the Pope really meant and recommended keeping the status quo “Until such time as we have a greater understanding of the meaning and intent of the pope’s allocution…”
A year after his statement, Pope John Paul II answered all his critics most eloquently by his own death. And, just days before the Pope’s death, the death of Terri Schiavo showed the world the exact opposite of the Pope’s death- the ugly face of euthanasia.
THE DYING OF POPE JOHN PAUL II
When Terri Schiavo’s feeding tube was removed on March 18, 2005, Pope John Paul II’s declining health was already in the headlines. The world had known for years that the Pope had Parkinson’s disease and even though his speech became slurred and his steps labored, he insisted on appearing and speaking until the very end.
This gave his profound words about the value of the elderly, the sick and the disabled even more poignancy and impact, especially in a world so consumed with maintaining appearance, individual independence and youth.
And in a world that increasingly views hastening death as a blessing and “living wills” as a necessity, Pope John Paul II’s acceptance of medical care-including both a tracheotomy and a feeding tube-was a powerful testament against those who believe that a certain “quality of life” must be achieved before life itself can be considered a benefit rather than a burden.
In the end, when death was inevitable, the Pope showed us all how to die with grace, acceptance and prayer.
THE DEATH OF TERRI SCHIAVO
The Pope’s peaceful death stands in stark contrast to the brutal, deliberate dehydration death of Terri Schiavo which occurred just days before the Pope’s.
When she died, Terri Schiavo was a 41-year-old woman whose parents had tried to legally save her for over a decade. The whole story leading to Terri’s death was rarely told in the mainstream media it but has been exhaustively chronicled at The Terri Schindler-Schiavo Foundation website at http://www.terrisfight.org for years.
In short, Terri sustained brain injuries from a lack of oxygen following a mysterious collapse in her own Florida home in 1990 when she was 26 years old.
After Terri did not regain full consciousness, her husband Michael won a medical malpractice lawsuit and a trust fund was established to pay for Terri’s lifetime care. But several years after the lawsuit, Michael Schiavo suddenly claimed that he now remembered statements his wife had made in the past about not wanting to be kept alive in such a condition. He petitioned a court for permission to stop her tube feedings and claimed that Terri was in a “vegetative state”, despite videotape evidence showing Terri smiling, responding to her parents and even apparently trying to talk. The judge in the case, George Greer, seemed to be sympathetic to Michael Schiavo’s arguments from the beginning. Judge Greer even allowed Michael Schiavo to use the funds set aside for Terri’s care to pay for “right to die” lawyers to argue that her feeding tube should be removed based on both Florida law and the alleged but disputed prior statement by Terri.
Florida law allows food and water to be withheld if a person meets the state’s definition of “vegetative state” as “the absence of voluntary action or cognitive behavior of any kind” and “an inability to communicate or interact purposefully with the environment”. Experts for the husband claimed that all of Terri’s visible responses were mere “reflexes” and disagreed with other medical experts for the family who testified that Terri had at least some basic awareness and could possibly be helped with therapy.
Terri’s parents and siblings volunteered to take responsibility for Terri’s care, but Michael Schiavo refused to relinquish guardianship or divorce Terri even though he had been living with a girlfriend for years and had fathered 2 children. He refused to allow further rehabilitation services and, despite the fact that Terri was not terminally ill, had her transferred to a hospice facility in 2000.
Twice before her death, Terri Schiavo survived for several days after Judge Greer ordered her feedings stopped but she recovered after other court decisions reinstated her feedings, at least temporarily. However in the end and despite efforts by President Bush, Congress and Gov. Bush of Florida, Judge George Greer chose to ignore even congressional subpoenas and ordered Terri’s feeding tube removed.
After 13 long days, Terri died after her family members were ordered from her room. According to her parents, siblings and Fr. Frank Pavone of Priests for Life, Terri continued to be responsive almost to the end even though she suffered greatly.
On June 15, 2005, Terri’s autopsy results were released and, not surprisingly, they showed severe brain damage and death from dehydration. Dr. Thogmartin, the medical examiner, said he could not determine the cause of her initial collapse, whether from trauma or, as the husband had maintained, from an eating disorder. He also admitted that the autopsy could not prove or disprove a “vegetative state.”
However, Dr. Thogmartin held a press conference in which he went on to speculate that no amount of therapy would have improved Terri’s condition, that she was blind and that she could not swallow. Although Terri’s family and others disputed these conjectures, a stampede of editorials and commentaries followed, claiming that Terri’s tortuous death was therefore justifiable and portraying those who opposed dehydrating her to death as cruel and politically-motivated extremists.
The media and “right to die” groups now use Terri’s case to motivate the public to sign “living wills” and other documents to, if effect, sign away their right to medical care in case they also become disabled and unable to speak for themselves.
The parents, prolifers, disability activists and others who supported Terri’s right to live vowed to continue the fight to gain legal protections for other non-dying, disabled people.
WHAT WE CAN LEARN FROM THESE TWO DEATHS
As a nurse, I often see patients and families totally confused about medical care and the real dying process.” They often make such statements as “Don’t resuscitate me if I’ll end up like Terri Schiavo, Nancy Cruzan, etc.” or “Mom said she never wanted to be a burden.” Like many people, these patients and families have bought the “right to die” myth that “I wouldn’t want to live like that!” is a compassionate and logical rationale for deliberately terminating lives including their own. Unfortunately, it is this widespread attitude that has allowed euthanasia to be portrayed as merely a question of “who decides?” rather than “what is being chosen?”
While there is the traditional ethical principle that a person can ethically refuse treatment that is futile or excessively burdensome, the definitions of futile and burdensome have been redefined by many ethicists over the past few decades in an attempt to justify withdrawal of basic medical care and even direct euthanasia from ever increasing categories of people with a perceived poor quality of life. The lethal error here is that the person’s life is being judged futile and burdensome rather than the treatment itself.
In Pope John Paul’s case, he had survived many a medical crisis in the past and when he developed problems with breathing and swallowing, he accepted reasonable medical efforts to improve or maintain these functions. When it was obvious that death was imminent, he accepted his impending death without further medical interventions like kidney dialysis and, according to all reports, he died a peaceful death.
In Terri’s case, she was not in danger of death but instead had serious disabilities. She had no “living will” but both the mainstream press and the judge immediately accepted her husband’s questionable claim that she would not want to live in her present state. Since Terri only required food and water to live, the only way to make sure she died was to remove that food and water.
But even if Terri Schiavo had made a “living will” stating that she would not want to be fed if mentally disabled, the harsh truth would be that she was requesting an especially cruel form of assisted suicide not the refusal of a burdensome or futile medical treatment. It is telling that the medical examiner admitted that Terri had been given at least some morphine and generic Tylenol during her ordeal despite the claims that she couldn’t feel pain.
The media, “right to die” groups and many ethicists have had much success convincing the public that death is a control issue rather than an inevitable reality. However, the Bible talks about the existence of “a time to die” and as a nurse who has witnessed hundreds of deaths over three decades including those of several family members, I have come to understand the wisdom of that phrase. Natural death does have its own timing and blessings, not the least of which are relatives and friends whose bereavement process is not further complicated by the searing guilt and defensiveness that seems to routinely accompany euthanasia.
Thus it is not surprising that there would also be a stark contrast between the reactions to the deaths of Pope John Paul II and Terri Schiavo: The Pope’s death led to an outpouring of respect and admiration for his life even from his opponents while Terri’s led to a torrent of media vituperation against those who stood up for her, even against her parents who begged for the chance to love and care for her whatever her condition.
With the Pope’s and Terri’s death occurring almost simultaneously and so publicly, the differences between natural death and death by euthanasia have seldom been made so excruciatingly clear.
If we will only open our eyes.
 “Responses to the papal allocution” by Rochester Right to Life newsletter. May 2004. Online at: http://www.righttoliferoch.org/zll0405.htm
 “Would the pope get a feeding tube?” By Dominic A. Sisti and Arthur L. Caplan. Published in the Chicago Tribune, December 26, 2003. Available online at: http://www.chicagotribune.com/news/opinion/oped/chi-0312260171dec26,1,7442270.story [broken link 06/28/2005]
 “Persistent Vegetative State and Artificial Nutrition and Hydration: Questions and Answers”, Resources for Understanding the Pope’s Allocution on Persons in a Persistent Vegetative State. Online for CHA members on website http://www.chausa.org
 “An Eyewitness Account” by Fr. Frank Pavone, National Director, Priests for Life. April 2005. Online at: http://www.priestsforlife.org/euthanasia/terrisfinalhours.htm
 “Schiavo Autopsy Says Brain, Withered, Was Untreatable” by Abby Goodnough, New York Times, June 16. 2005. Online at: http://nytimes.com/2005/06/16/national/16schiavo.html
 Schindler family statement issued June 16, 2005. Online at: http://www.wnd.com/news/article.asp?ARTICLE_ID=44830
“Schiavo Autopsy Leaves Most Important Questions Unanswered”, press release by Diane Coleman and Stephen Drake of the disability rights organization Not Dead Yet. Online at: http://www.notdeadyet.org/docs/schiavoautopsyPR0605.html
“Terri Schiavo Was Aware and Not Blind When Killed, Doctor Says” by Steven Ertelt, LifeNews.com Editor, June 20, 2005. Online at: http://www.lifenews.com/bio1041.html
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