Terri Schiavo's case offers a scary lesson to us all.

By Barbara A. Olevitch

Editor's note. This first appeared in the October 2 Philadelphia Inquirer and is reprinted with the author's permission.

In 1990, at 26, Terri Schiavo suffered a heart attack, and her brain was temporarily deprived of oxygen. She survived her medical crisis only to run into an equally threatening legal crisis.

Her husband and guardian, Michael Schiavo, has placed her in a hospice among the dying. He is trying to have her feeding tube removed, and he sees his struggle in the context of not needlessly prolonging his wife's suffering.

But her parents, Bob and Mary Schindler, to whom she still responds with radiant smiles, consider her severely handicapped rather than dying, saying that she wants to live but has not yet had the opportunity for rehabilitation. How can it be said that Terri Schiavo would not want to live in her condition, they ask, if she hasn't had enough rehabilitation to determine whether it is permanent?

After hearing testimony on both sides, Florida Judge George Greer found the pessimistic testimony more persuasive and ordered the feeding tube removed as of October 15. Terri Schiavo's parents have argued before U.S. District Judge Richard Lazzara that before that happens their daughter should be allowed to have speech therapy, which may improve her ability to swallow.

Terri Schiavo seems to have fallen out of a logical world into a weird, in-between space where the arguments do not make sense. For example, George Felos, her husband's attorney, contends that she can't be allowed to swallow because food might get into her lungs. As death is a certainty without food, this argument seems odd.

To understand it, we must enter into the hospice way of thinking, which is not easy to do. In hospice, the problem with food in the lungs is just that it is life-threatening. This situation is undesirable for different reasons, perhaps because it is something that the staff is responsible for avoiding, or because it causes discomfort.

The weirdness of the argument is caused by a warp in our ethical infrastructure. In the context of ordinary medicine, when a competent person refuses a medical intervention, the physician is careful to document it. However unpleasant the news, the patient must also be told of all the negative consequences of such a refusal. I have seen emergency room physicians chase a patient who needed treatment but walked out. They even call the police to help them catch such patients.

In contrast, once a patient is enrolled in hospice, any refusal on his or her part is unquestioningly honored. This is why it is so important to ensure that only dying patients are enrolled in hospice.

Terri Schiavo's husband testified that she told him, "No tubes for me," sometime before her heart attack and brain damage. We can see the dilemma about how to interpret her remark. It is a matter of dispute whether she is dying. It is therefore a matter of dispute whether she truly belongs in hospice. Why, then, should remarks that she made years ago be counted now? Why shouldn't they be evaluated in the context of curative medicine? An uninformed refusal, even if heard by 100 people, is still an uninformed refusal.

No one warned Terri Schiavo about the consequences of a blanket refusal of life support. No one showed her the positive side, that many people live happily with feeding tubes. No one questioned her about the limits of her decision.

For example, would she tolerate a feeding tube long enough to learn how to swallow? Or would she still want to die if she was only 39 and her parents, to whom she would never be a burden, were still alive and eager to help her?

We should change our laws so that remarks about not wanting medical care are evaluated according to a much stricter legal standard. For several decades, the public has been thoroughly exposed to the idea of living wills. Terri Schiavo did not formally indicate any wish to have treatment withheld in any circumstance, much less her current ambiguous circumstance. Don't we have to respect that?

Do we need to fear that our own remarks made during someone else's illness might come back to haunt us years later when we cannot, for some reason, speak for ourselves? Has the right-to-die mentality become so powerful that those who don't want to be euthanized are the ones who need a formal document?

[Editor's note. In order to protect themselves from involuntary or nonvoluntary euthanasia, readers should go to www.nrlc.org and download "The Will to Live."]

Dr. Barbara A. Olevitch is a clinical psychologist and author of Protecting Psychiatric Patients and Others from the Assisted-Suicide Movement: Insights and Strategies. She lives in St. Louis.