In responses to my article on Terri Schiavo, there was a common theme: nobody wants to wind up as she did: a person on a tube.
Neither do I.
But not winding up as she has will require specific steps on your part. I have doubts that the letter-writers have taken formal steps to avoid this condition.
Neither have I.
But I intend to. Soon. No, really. Soon.
STEPS TO TAKE
First, make a conscious decision regarding how much your life is worth to you. If you really don’t know, then don’t expect anyone else to know.
Second, decide how long you think is reasonable to be kept on the tube in a vegetative state. A week? Two weeks? A month? There are cases where someone has awakened after a decade in a coma. In 1999, on Christmas day, Patti White Bull of Santa Fe, New Mexico, awoke after 16 years of being on a feeding tube. Her husband, who divorced her three years into her coma, came for a visit. In 2003, Terry Wallis of Mountain View, Arkansas, awoke after exactly 19 years of being in a coma.
Third, decide who is going to pay if you do fall into a coma. Do you want these people to pay? An insurance company, Medicare (taxpayers), a physician who was successfully sued for malpractice, or your family?
Fourth, decide now how you intend to get your wishes followed. If you specify in writing that you will allow only three weeks on a feeding tube, then require removal, will the hospital allow this? Will it remove the tubes and send you home? What if members of your family are divided? What if one group threatens to sue the hospital for removing the tubes? It would be better to specify how much money you authorize to keep you on the tube, with a specific cut-off price for payment by any third party. When that limit is reached, you will have the hospital’s administration on your side. “Pull the tube!”
Fifth, what if the private money runs out? Will Medicare or Medicaid intervene automatically?
Sixth, what if Medicare’s money runs out? Will Medicare pull the tubes?
All of these are relevant issues. Almost no one has thought about them. Almost no one has taken steps to do anything about this.
Millions of Americans die each year intestate. A court has to divvy up the assets. A man who refuses to make out a simple will is unlikely to put in writing his wishes regarding feeding tubes.
What about you?
The letters I got regarding Mrs. Schiavo were all over the range of opinion: let her die, let her live, it’s her husband’s decision, it’s the state’s decision, it’s her family’s decision. In short, there was no agreement.
There is not going to be much agreement.
Widespread disagreement is the state’s opportunity. Legalized euthanasia is consistent with legalized abortion. If the state sees a way to cut costs, it will eventually cut costs.
Taxpayers are not strongly committed to cost-cutting in general. Instead, they are adamant about making sure that the services they want at below-market prices are not cut. If that means cutting some other special-interest group’s feeding tube, that’s fine with them.
One by one, the feeding tubes will be cut — all except the salaries for the state’s tube-cutters. That will be the last tube to be cut.
On the day that it is cut, free men should celebrate.
THE DILEMMA OF TECHNOLOGY
Nobody felt guilty in 1900 when grandma, age 86, died of pneumonia. That was how millions of people died in 1900. There was no way to prevent this. Guilt arrived on the day that wonder drugs made it possible to give granny another breath.
The technological imperative says, “If it can be done, it must be done.” The medical technological imperative says: “If he can be saved, he must be saved!” Medical technology has increased everyone’s level of guilt.
Technology is not free. Someone must pay. Who? We cannot decide as a nation. This is why the country is divided over the Schiavo case. Yet it is a life-and-death issue. It has to be dealt with judicially. It will set a legal precedent.
Mrs. Schiavo need not die in the near future, economically or technologically speaking. But if she lives, there are legal issues regarding divorce and remarriage. The legal precedent seems to be that if a self-interested third party wants to pull the plug for either judicial or economic reasons, irrespective of the willingness of others to pay, then that person’s wishes will be respected.
What Mrs. Schiavo’s wishes were when her wishes counted judicially are unknown and unprovable. They are a matter of hearsay. This is not true of your wishes today.
Most of us would say, “Send me home after [xx] weeks on the tube.” But this is irrelevant. After we are in a coma, what we might say today is judicially irrelevant — a matter of hearsay. This is why we should put this in writing and have it notarized. Then we must make sure we have signed over the power of attorney to someone we know will follow our instructions. This may not be a spouse.
The problem is guilt. “I want him [her] to have the best care possible.” The key question: At what price? The second question: Who will pay?
If you do not want to disinherit your heirs, you had better get question #2 answered, so that no one feels compelled to pay a heavier price than you prefer today.
Far more people have opinions about what should be done with Mrs. Schiavo than have left written instructions to keep them out of Mrs. Schiavo’s condition. Opinions are cheap. Actions are not.
If you have an opinion one way or the other, then make sure that you have left notarized instructions to the person to whom you have transferred in writing the power of attorney. If you think Mrs. Schiavo’s case should be decided in a particular way, make sure that those who will decide on your behalf have written evidence of your opinion regarding your future condition.
“But be ye doers of the word, and not hearers only, deceiving your own selves” (James 1:22).
March 30, 2005
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