I hadn’t checked in on the Kausfiles in awhile and was interested to find him raving about the Terry Schiavo case at length — largely in the service of his chronic desire to skewer NPR. Kaus frequently prefaces his most juiced-up rants with a statement that he had almost made up his mind the other way (” I was just growing more sympathetic to the cause of those who want to pull the plug on Terri Schiavo…”) until he heard such-and-such. Then he’s off and running.
In this case, he seems to be upset that the neurologist on whom an NPR report depended for a definition of persistent vegetative state had been an expert witness for Michael Schiavo, the husband who favors pulling the feeding tube and around whom, if you haven’t been following the issue, swirls innuendo about possible unsavory aspects to his motives. That he supports Schiavo’s right to die does not mean that his definition of PVS is biased, as Kaus suggests without coming right out and saying it (although he makes more egregious use of italics than I do); if it happens that scientific opinion is on your side of a case, it makes sense to hire an authoritative expert to say so, wouldn’t it? Kaus does have a point, that NPR’s coverage was not counterbalanced by interviews with anyone representing the ‘parents’ side’, although that may be because it is mostly Rabid Right right-to-lifers who are on that bandwagon.
Kaus’ greatest error, and one he publishes an erratum for further down in the column after he reads some legal sources, is one I suspect is a common and quite prejudicial confusion. He bandies about the term “surrogate” to refer to his assumption that Michael Schiavo has decision-making power with respect to his wife’s affairs. (He says, at one point, “Notice to All Potential Mickey Kaus “Surrogates”– If I’m ever in Terri Schiavo’s situation, and not in any pain, please follow these simple steps: Keep the feeding tube in, and keep Dr. Nuland out”, referring to prominent death-and-dying author physician Sherwin Nuland, who supports stopping life support in this case. Does Kaus leave himself open to the obvious rejoinder, that this might already be the case?) In fact, as Kaus’ correction notes, the standard for making decisions on the behalf of someone who cannot make decisions for themselves is not what anyone else wants for them, but what they would have told us they would have wanted themselves if they had been able to articulate it, so-called ‘substituted judgment’. (Of course, I am not a lawyer, although I have been involved in many incompetency cases as a clinical psychiatrist, usually involving determining whether a currently psychotic patient refusing treatment would have, when of sound mind, consented to medical care for a life-threatening condition. If what I am saying needs correcting fro a legal standpoint, please do not hesitate to do so.) It is the courts that make decisions in such case based on evidence about what the person would have wanted from those who know/knew her. I would be a fool to assert that the evidence presented by ‘loved ones’ would not be tainted at times by their own hidden agendas. But one would be a fool to think that courts are blind to such covert intentions. A guardian in such a case where a court has made treatment decisions based on ‘substituted judgment’ is really just monitoring adherence to the court-ordered treatment plan. There are far more safeguards against a malevolent or conspiratorial hijacking of decision-making authority over you when you are debilitated than the pop-culture horror stories animating your worst nightmares would lead you to believe.
Kaus also falls prey to the misunderstanding about PVS that animates most of the emotion surrounding this case. It is very unlikely that medical professionals will rush to judgment and make a hasty diagnosis that soemone is not sentient and that the condition is irreversible, and it is less and less likely as more sophisticated tools to identify and recognize the pattersn of brain activity (or lack of it) in a vegetative patient have come into play. As Kaus raises the spectre that “just occasionally a Susie (might arrive) from Dubuque to find exhausted relatives and cost-conscious doctors ready to give up on a PVS or coma victim who still has a chance to snap out of it,” he commits the quadruple sin of lumping coma and PVS together irresponsibly; letting wishful thinking get the better of him; and derogating the motives of both family members (who if they are hanging in there at the bedside by and large need to be persuaded to give up their last hopes for their lvoed one; the ‘exhausted’ ones aren’t there) and caregivers (who invariably fight a pitched battle against the ‘cost-conscious’ bean counters in hospital administration to give ongoing care to their patients).