Friday, April 1, 2005 - Page updated at 12:00 AM

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Guest columnists

Compassion and choice in end-of-life decisions

Special to The Times

As a minister and as a physician, we each have sat with many families facing the decision of whether to continue life-sustaining therapy for a loved one. It happens, privately, thousands of times in American hospitals every year.

Most Americans no longer believe that life should be sustained at all human cost. Most physicians now recognize that death may bring an end to interminable suffering. Few churches teach that forgoing life support is a sin.

The public's understanding of the full tragedy of Terri Schiavo's case is flawed. As her court-appointed guardian ad litem reported, "toxic clouds of public opinion" surrounded Schiavo, obscuring the true medical and theological issues that faced this family.

Her husband, Michael Schiavo, acted heroically. He was logical, loving, compassionate and unwavering. The guardian ad litem specifically lauded his "explicit love." He dedicated many years of his life to Terri, demanding aggressive physical therapy for her, and taking her across country to specialists who offered no hope. So perfect was her care at his insistence that, after 13 years, she had not experienced even a single bedsore.

Michael Schiavo was vilified by many. He stood accused of a greed for which there was no evidence. He did not control money in her trust, he agreed to renounce inheritance rights, and he refused millions of dollars to abandon her cause. He declined to divorce Terri and leave her care in the hands of parents who would continue interventions that he believed were against her will.

He has been faulted for having a relationship outside of his marriage. But human needs are complex and human relationships are often imperfect. His choices in those matters should not distract us from recognizing the devotion he consistently displayed in his care for Terri.

Her parents, Mary and Bob Schindler, were caught in circumstances that few people can even imagine. Persistent vegetative state imposes a confusing and cruel delusion of life and awareness. How much simpler would it have been had Terri simply been deeply asleep, with her eyes closed, making no noises? In their own devotion to her, the Schindlers, too, dedicated their lives to Terri, and fought for what they believed was right.

Every credible medical expert agreed that Terri Schiavo was in a persistent vegetative state and would never improve. Time had already proven them right. In almost 15 years, no objective observer ever demonstrated that her wake-sleep cycles, strange noises, smiles and grimaces were anything but random events. The videos didn't reveal what most medical experts knew: that tapping her forehead would elicit a reflexive blink or grimace, and that the noises and smiles also occurred in an otherwise empty room, in the dark, alone.

We don't know what Terri Schiavo's true mental state was. If there was indeed consciousness left, this woman may have been in deep and daily suffering, even horror, trapped in a body from which the only release — death — had been denied for over 15 years.

Witnesses testified convincingly under oath that Terri Schiavo did not want to remain alive under such conditions. Fewer than 20 percent of patients say they would want tube feedings if they were in a persistent vegetative state. Yet, less than one-third have living wills that make those wishes clear. In Terri Schiavo's case, without her explicit guidance, the courts were left to make the final decision for normal and decent people who were unable to agree on what to do. In Schiavo's case, it appears that the legal system worked, and Terri was granted her final wish.

Compassion is the operative theological and medical theme for end-of-life decisions.

From this minister's perspective, this has not been a simple question of "right to life." The United Methodist Church, like other Protestant denominations, asserts the appropriateness of withdrawing life supports "... when they cease to be of benefit to the patient." Florida's Catholic bishops have noted that the presumption to maintain fluids should be followed "unless it is burdensome to the patient."

All major religious traditions value life, but theological values also recognize that death is part of God's plan, and that denial of the inevitability of death is a contradiction of God's created order.

From this physician's perspective, it has not been a simple question of letting one person die, but about the sacred rights of all patients, whether handicapped or not, to have choice in the most private of all matters — their death.

Faith tells us that now, in death, in God's arms, Terri has found her final peace and her one true home. God's final healing has come.

The Rev. Dr. Sanford Brown is executive director of the Church Council of Greater Seattle. His wife, Dr. Gail A. Van Norman, is a clinical associate professor in anesthesiology and a faculty affiliate in the Department of Biomedical History and Ethics at the University of Washington.

Copyright © 2005 The Seattle Times Company


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