COMMENTARY: CASE POINTS UP URGENCY OF WILL TO LIVE

By Burke J. Balch, J.D.
Director NRLC Department of Medical Ethics

It is evident from e-mails and other communications coming in to NRLC's Department of Medical Ethics that many grassroots pro-lifers are shocked and appalled by the denial of food and fluids to Terri Schindler-Schiavo. Apparently, they cannot believe this is happening in America. (See story, page 6.)

It is appropriate to be appalled, but no one should be shocked.

Denial of food and fluids to people who cannot speak for themselves has been going on for 15 years in this country. It is routine practice in hospitals and nursing homes across the country. And for over a decade, the law on this, established by numerous court decisions and statutes, has been largely settled. If someone who is now incompetent to make health care decisions has not left clear instructions in a legal document (variously called an "advance directive," "durable power of attorney for health care," "living will," or the like), then a surrogate decision-maker can legally decide to cut off the person's food and fluids.

The surrogate decision-maker is normally whomever is classed by the particular state as the closest relative, but if no relatives are available it may be a guardian or even the person's doctor. Such surrogates are daily authorizing the cutoff of food and fluids to patients who are unable to speak for themselves and never gave any indication that they might want to be starved.

Only in the comparatively rare cases when there is some dispute among relatives, such as in the Wendland case in California, the earlier Hugh Finn case in Virginia, and the Schindler-Schiavo case now in Florida, do these cases reach public attention, normally in the context of lawsuits.

It should come as no surprise that, with important exceptions, the prevailing view in the judiciary, as in the medical profession, is receptive to the quality of life ethic. Judges are often dismissive of our position that all human beings possess dignity and the right to live, regardless of their age or degree of disability. When the relative or other individual designated by state law to make health care decisions for an incompetent person who has left no clear advance directive chooses to cut off food and fluids, courts are rarely willing to agree with other relatives who seek to overturn that decision.

Indeed, the current battleground is over efforts by health care personnel to cut off food, fluid, and lifesaving treatments from patients they think have a poor quality of life AGAINST THE WISHES of the patient and family. A large body of medical and ethical opinion holds that even when there is no doubt that a patient wants to live, or when family members are united in saying the patient should get lifesaving treatment, doctors and hospitals should be able to say no.

We may hope and pray that recent developments in the Schindler-Schiavo case, drawing into question the accuracy of key testimony by her husband, lead the judicial system to order that she continue to receive assisted feeding. Whatever the final outcome, however, the publicity surrounding this case should sound a warning siren.

It is CRITICALLY IMPORTANT that we ensure our friends and family members fill out a "Will to Live." The Will to Live is a legal document, varying in its form from state to state, that makes clear a person's wishes concerning treatment if no longer able to make health care decisions. It provides for designation of who the person wants to speak on his or her behalf in such circumstances. Copies may be downloaded from www.nrlc.org.

PROTECT YOUR FAMILY TODAY! DOWNLOAD YOUR STATE'S "WILL TO LIVE"!