Janet Rivera: Case Overview
The Fresno Bee has an extended article on the Janet Rivera case today. Rivera is a profoundly cognitively disabled woman whose husband and family want her to live, but who has been ordered dehydrated by the public guardian, a matter we first discussed here at SHS last week. (I was interviewed for the piece and have a small quote.) Here is the general gist of article. From the story:
That's a very big deal, it seems to me. Otherwise, as I noted in my earlier post, we move toward medicalized tyranny in which the state or strangers can decide that the time has come for your loved one to die.Among the questions her situation has raised: Should a government agency be able to overrule family members and withhold life support when the patient's wishes are unknown?
The Schiavo family has taken an interest in this case. The Terri Schindler Schiavo Foundation helped find a lawyer to represent the Rivera family, said Schiavo's brother, Bobby Schindler.Rivera's situation is more alarming than his sister's, he said. "We had a family dispute," he said. "This is a family in agreement."
More from reporter Barbara Anderson's story:
Rivera has been comatose for two years following a heart attack. It's unclear what Rivera's preferences about life support would be. "We never really talked about life and death things much," said Rivera's brother, Michael Dancoff of Berkeley.Experts agree that the county is taking a chance by trying to make an end-of-life decision for Rivera without knowing her wishes.Not if futile care theory takes off. As I have stated repeatedly, choice is just the key that opens the door. The real agenda is that certain people not remain with us due to utilitarian considerations. To wit:
It's unusual for a conservator to argue for removing life support without evidence that's what the patient would want, said David Magnus, director of the Stanford Center for Biomedical Ethics and co-chair of the hospital's ethics committee.
Yeah right...Here's my part in the story:"The stewardship of scarce resources does require us to take resources into account," said Ben Rich, a University of California at Davis bioethics professor. "But it has to be done carefully.
Wesley J. Smith, a Castro Valley attorney who was an adviser to the Schindler family in the Terri Schiavo case, said there is a "potential for tremendous discrimination" if finances are ever taken into consideration in cases such as Rivera's. "If HMOs did this, people would be screaming," Smith said. "If we're going to do it because of public financing, people should be screaming also."All in all, a very nicely balanced piece of reporting. Well done Ms. Anderson.
Labels: Janet Rivera Case. Overview.
posted by Wesley J. Smith @ 3:45 PM
11 Comments
11 Comments:
Well, once it turned out she was breathing on her own, it shouldn't have been so surprising that she lived for a while. I'm referring here to the one comment (by someone on the county's side) that she "lived longer than expected" and that that was why her feeding was reinstated. That cannot refer to her being able to breath unassisted, because they could have determined that within, what, a day? An hour? No, it means she lived for _12 days_ without food and water. What is this, an endurance test? If you can make it for twelve days without water, they say, "Oh, maybe we should give her water, now"? And the rationale there would be... I mean, the whole point of withdrawing hydration is that you're going to sit around and wait until the person dies, even if it takes two weeks. I can't figure out if the guy who made that comment was just ignorant or what.
Do I understand correctly, Wesley, that the family thought she would die immediately without the ventilator and that this was why they didn't make more of a fuss when everything was withdrawn? That was the impression I got from the earlier linked article. But then they were shocked when she breathed on her own and the food and fluids were still withheld?
Lydia: The family has not contacted me. But I think what happened is the family was told she would expire very quickly after removing of the resperator. When that didn't happen, and now she was not receiving food and water, they realized that, perhaps, they had not been given accurate info, or perhaps, the expectations were wrong and so they thought the treatment issues should change accordingly.
"The stewardship of scarce resources does require us to take resources into account," said Ben Rich, a University of California at Davis bioethics professor. "But it has to be done carefully.
WS: "Yeah right."
Do you know the context of Mr. Rich's remarks or are you just assuming that by merely answering a general question on the issue of resource allocation that Rich is advocating some sinister system of non-voluntary withdrawal of life support on the broad grounds of medical futility? Do you know Dr. Rich personally? If you don't, such a remark comes off as both snide and unprofessional.
Okakura: Thanks for asking and for stopping by SHS.
The "Yeah right," wasn't aimed at him as an individual, but at the notion that we would be very careful once we decided to let bureaucrats, doctors, bioethicists, or anyone else decide that wanted care could be deprived based on resources/quality of life considerations. Once we let the wolf in the door, "careful" goes away and a new paradigm comes into place. And the victims end up being the powerless.
As it stands now, American health care is already effectively rationed by income, which greatly determines the type of regular preventative health care that you and your children can afford. The horrible effects of this income-based system is seen regularly in end-of-life care for these chronically underserved patients, many of whom die prematurely of largely preventable/manageable conditions. I don't see our present system providing any real protection against such discrepencies, even if it stops short of unilaterally 'pulling the plug' on such patients when they are either at death's door or irrevocably unconscious.
Nobody should be dehydrated to death, period. It makes it no better to dehydrate a person while that person is lying in a hospice bed than to dehydrate the person to death lying on the street. The killing by dehydration is the same. It doesn't matter of the person is "irrevocably unconscious." It's still wrong to dehydrate the person to death.
I don't always understand very well why people can't stick to those simple moral truths.
Lydia: You don't work in a hospital, do you? In many end-stage conditions, the body's digestive system naturally shuts down. To 'force-feed' or 'force-hydrate' in those situations because of some technological imperative (that any and all medical means must be employed at all times regardless of circumstance) is not moral - it's irrational at best and cruel at worst. I take it you are NOT morally offended when a totally obtunded PVS patient with a feeding tube dies "naturally" of a massive infected bedsore or an anyerism? Please explain the moral logic of this, or better yet, volunteer at your local hospital ICU and explain this line of reasoning to a grieving family.
Okakura; You haven't been around here long, apparently. We all know that distinction. It has been made frequently and often, by me, and by commentors.
Welcome to SHS, by the way.
Quite the contrary; my take from Lydia's comments is that there exists a blanket moral imperative to prevent people from dying regardless of their condition, and that death by dehydration - even when it is secondary to an underlying disease or condition - is therefore also wrong. Not seeing any distinction made in this particular thread (which I was responding to). Perhaps I have missed something.
Okakura: Well, I will let Lydia speak for herself. But I have made that distinction in my books and speeches often.
It never hurts to bring it up again, though.
Just to clarify my earlier post...I do realize that PVS (which may or may not be the case with Ms. Rivera) is not strictly speaking a terminal condition and the dysphagia associated with PVS is different than one's GI tract shutting down in the last days or weeks of, say, pancreatic cancer. Nevertheless, my point is that the mere invention of NG & peg tubes does not mandate their usage in all situations, and that dehydration as a proximate cause of death secondary to PVS is preferable to many other types of demise, I.e. infections, MI's, etc.
I also realize that some folks make a black & white distinction between ordinary and extraordinary means of life support and always consider food & fluids to be in the former category. Fair enough, but considering that dying in America is for most people more often a process than a moment, such a position begs the question: what then DO you want to die from? This is by no means a rhetorical question, and it is difficult for many people to reconcile intransigent ideological views with limited & bleak medical alternatives they encounter in situations like Ms. Rivera's or that of the Florida boy (Brad?) in another post.
The duty to care for the sick, vulnerable & disabled is a fundamental virtue for any moral individual or society, but the tricky task is to figure out how that care is meaningfully defined in specific cases and for specific conditions. Navigating this terrain by way of moral absolutes ("death by dehydration is always wrong!") is always tempting because it is easier than wading into the compicated and murky depths of extended life spans, evolving medical technologies, and limited health care systems. That said, I'll put my (guarded) trust with the waders.
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