Tuesday, March 22, 2005


I don't have much to say about this case. I have been watching it, transfixed and appalled, and all I really want to do here is post up some links. The links start with the more frivolous, move into the serious, dive into the political, and end with a Mormon flourish or two.

Here is a philosophical game about personal identity, designed by Julian Baggini and made available by the crazy people of The Philosopher's Magazine. Here's a sample question:

Strange as it may seem, it has been discovered that reincarnation of a sort does actually occur. It seems that there is some immaterial part - call it a soul - in all human beings. On death, it leaves the body and enters the body of a new-born animal or human. It does not take memory with it, of course, for if it did we'd have known this were true already! It is thought that it may have some effect in determining one's character, but given the evidence for the strong influence of genes and upbringing, this effect is thought to be relatively small.

Even stranger than the fact of reincarnation, it seems that our souls die if stored at below freezing point for longer than a week.

These facts are vital to the last choice you must make. You are very ill, but scientists have almost found a cure for the disease you have. Further, they have also developed a technique to 'deep freeze' humans, enabling them to be revived later with their memories and character intact. You have two choices:

The first choice is to let the disease take its toll. Your body will die, but your soul will live on. The second choice is to be deep frozen, then thawed and cured later. This will destroy your soul and only has a thirty per cent chance of success; that is, there is a 70 per cent chance that the thawing and curing won't work.

You must make the choice which you think will give your self the biggest chance of surviving.

In a somewhat flippantly phrased post, Matthew Ylgesias speculates about who would be alive or dead or what if his body fell into a persistent vegetative state and Schiavo woke up out of hers--but with Matthew's brain. He gets a lot of flack in his comments thread, but I suspect that everyone there is in a state of shock about the political overtones of this story. There's a real philosophical problem to work out, and it isn't easy: whether Schiavo is alive is perhaps a less fraught question than the question of who or what Schiavo now is. If the brain-damaged Schiavo is no longer the same person at all as the non-brain-damaged Schiavo, then decisions she made before this change in her identity might be construed as no longer binding onto this new entity. In more politically charged words, if this version of Schiavo is sufficiently different from the old Schiavo so as to constitute a new identity, then the old Schiavo's declared wishes about her body and medical treatment might be considered to be inapplicable to the new Schiavo.

This is a philosophically interesting line of thought, but of course it would be disastrous for legal policy. It slids speedily down the slope: if all it takes for a person's right to control his or her body to be voided is a simple change in conscious status and an inability to communicate, then we revert rather quickly to a rule of force. Whoever sleeps the least and can speak the loudest on other people's behalfs gets to determine the disposition of bodies and property.

On a very different note, this essay from UCSD bioethicist Lawrence Schneiderman gives a moving argument for accepting death in such cases. His argument gently moves from a technical description of the neurological condition of persistent vegetation, to a consideration of the increasing trend of people's dying in heath-care facilities (only 20% of Americans die at home, apparently), to a broader humanist plea for people to understand mortality as natural and even uplifting.

One well-put point that introduced a new word to me was this passage at the end of the medical description:
hat has given us this condition which was first diagnosed in 1972. It's really interesting, that that's a very new disease as far as medicine is concerned, and, in fact, it's an iatrogenic [doctor-created] disease. Vegetative state is the condition, as we call it, but persistent or permanent is what we do to keep that condition going.

This is the center of the conundrum: modern medical technology can prolong life, but in many conditions, this prolongation is at best a sustained death. The prolongation is the unnatural intervention; death, as the old syllogism presumes, is the human fate.

One commenter at Teresa Nielsen-Hayden's site, Making Light, posted this link to the US Living Will Registry, which stores on-line living wills to make available to heath care providers. I'm not sure how official such documents can be; the homepage looks a little schlocky, but the info and FAQs seem legit. The homepage notes that "Due to recent overwhelming demand, a new program has been added to allow direct registration by individuals. " If you don't have a participating health care provider or "partner" nearby, you can now register for a $25 fee.

More political links:

Rivka (a doctor of clinical psychology) has so far made three posts on the subject of Schiavo: an initial analysis of what the doctors' evaluations from court documents means, and above that, a summary of some ethical considerations involved in the distinction between euthanasia and refusal of treatment, and finally, a discussion of the weight that Schiavo's happening to have been a baptized Catholic should play in the court decision--short version, none.

Chris Bertrum of Crooked Timber, having two factors of distance from the debate (1. he lives in the UK, 2. their site was offline after a server explosion), gives a short n' meta comment here.

Obsidian Wings heats up, with 1) an open thread that turned into a massive (125 comments in about five hours) thread about the Schiavo case, 2) a truly moving post by hilzoy, resident bioethicist, who reframes the whole case around the value of patient autonomy, 3) another post by hilzoy, which points out the now-commonly known problem that the Texas Futile Care bill recently enabled a child's death against the wishes of his mother, 4) a comparison between Tom DeLay's grandstanding and the extralegal fundamentalism of Iran, by Edward, 5) an outraged post by Katherine that collects misleading or wrong Republican statements on the congressional floor, 6) a post about legal process in a tangential case by von.

The Rude Pundit has four posts on this subject, which the Rude One characteristically writes in as crass a style as possible while actually remaining logical. The posts begin with this one, titled "Terri Schiavo Must Die," and pretty much get crankier from there.

Billmon has finally started to move away from the quotation list sort of post back to some of the narrative satire I used to look for from him. The first post in this departure is a revisioning of the patient in question.

Digby seems to have been almost as transfixed by this story as I was; he writes a series of posts that start here and keep going for a while. He's looking more at the political fall-out from the Republican push, tending to agree with the Rude Pundit that Schiavo should probably go and that a judge or two has uphold due process.

From the Mormon blogs:
In a post that carefully avoids mentioning Schiavo's name, Clark Goble of the Bloggernacle Times thinks through the mind-body split as Mormons tend to understand it. Some excerpts from his concluding paragraph:
Mormons are materialists. Our very doctrine of the necessity of the resurrection tells us that a body is important for who we are. [...] Bodies were viewed as necessary [in the pre-existence] and we will look upon our separation from our bodies as a hardship [post-death and pre-resurrection]. That alone suggests to me that perhaps the brain is far more essential for who we are than some might wish to believe.

Jared, of the LDS Science Review blog, writes a number of posts. The most recent tries to work out the complexities of the family's interests against the interest in allowing Schiavo a dignified death, and generally is appalled at the state of discourse about the case.

At a Mormon blog that I hadn't linked to before, Times and Seasons, a smart post about abstract hypotheticals leads into a feisty thread with most commenters coming out in favor of individual autonymy (a not-uncommon value on the internet...). An earlier, very thoughtful post by a husband-wife tag-team, noting the absence of clear church position on such cases, asks commenters to think about Mormon theological signposts as regards to end-of-life decisions. The comment thread, of course, does anything but.

Anyway, that's enough on this sad case. The debate will continue, probably, although it looks very likely that the judicial system will rule to allow Schiavo to die. That would be the right decision in these circumstances, but it looks like Schiavo's parents will have a truly horrible grieving period. They'll blame someone else, and they'll have lots of company to blame that someone else with.


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