EthicsWalk addresses
spiritual care as an ethical enterprise.
It explores why relationships between
spiritual care providers and those
they serve need protection, and
examines what that protection entails. PlainViews invites
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which will be published in the
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Response
to End-of-Life Discernment:
Personal, not Political
Government's and the law's primary obligation at all levels is to promote the common good, guaranteeing protection under law for every person, especially when it is vulnerable, such as at the earliest stages of life, at the end of life, when the person is handicapped, or otherwise disadvantaged. This protection was denied Terri Schiavo. Judge Greer's final order reads that the feeding tube (basic humane care for a disabled, non-terminal person)"shall be removed." The court "intruded" to kill an American citizen. This is unprecedented in our history and reveals a departure from the guarantee of ordinary human rights which we have enjoyed until now.
Ruth Tapio
Hospital Chaplain
William Beaumont Hospital
Royal Oak, Michigan
One of the basic principles in Medical Ethics is the right of self determination and things usually stay at the level of patients and families within a healthcare facility until an impass is reached in which case the Ethics Committee is called. Sometimes we even resort to having a court appointed guardian or ask the legal system for an intervention. Most of these cases are handled locally.
When a patient is incompetent is is the right of the next of kin to provide guidance which in this case to Terri's husband.
For a situation to get this out of hand means that all of the basic levels of conflict resolution have been ignored or bypassed in some way. For a medical ethical dilemma to become politicized is more than a travesty. The case should have been sent back to a lower level for resolution with a mediator.
A last resort measure for me, in my opinion, would have been to have Terri's husband retract his right as the decision maker and allow Terri's parents to take over the responsibility, both emotionally and financially.
George Burn
DIrector of Pastoral Care
Mount Nittany Medical Center
State College, PA
End-of-Life Discernment: Personal, not Political
On the first anniversary of Terri Schiavo’s death, Boston Globe columnist Ellen Goodman[1] noted that people feel today pretty much the same about end of life issues as they did a year ago.[2] There is not a red state-blue state divide. Republican and Democratic law-makers have not kept Schiavo’s tragedy alive to cultivate votes.[3]
When confronting decisions about death and dying, most people want to rely on personal faith and ethics rather than public policy or laws. They want to be companioned by spiritual care providers not lawyers and legislators.
That being said, spiritual care providers need to be vigilant that government does not intrude on the privacy of prayerful and personal decision-making. Neither political expediency nor the provider’s own beliefs should exploit a patient’s, or designated surrogate’s, when appropriate, considered choices for end-of-life options.
Beneficent spiritual care requires a patient’s wishes be explored, articulated, and honored. The codes of ethics of the professional chaplaincy organizations emphasize the chaplain’s role in supporting patient autonomy in decision-making.
Political interference from Florida’s governor, legislature, the U.S. Congress, and President in Terri Schiavo’s case illustrates why privacy for patient and surrogate decision making cannot be taken for granted. Zealous religious leaders and opportunistic politicians can maneuver unwarranted governmental interference, especially when families are vulnerable to the attention.
Unlike the Schiavo situation, the federal government seldom if ever intervenes in matters of family law or medical decisions legitimate under relevant state statutes. Federal jurisprudence traditionally recognizes such areas properly governed by laws responsive to the opinions and needs of each state’s voters.
In recent years, attempts have increased to assert federal influence. In 2001 then Attorney General John Ashcroft sought to use the Controlled Substance Act (CSA) to thwart Oregon’s citizen approved Death With Dignity Act (ODWDA). He issued an Interpretative Rule [addressing the CSA] to de register pharmacists and physicians who dispensed or prescribed controlled substances to assist suicide under the terms of ODWDA. The Ninth Circuit invalidated the Rule.
On appeal, the Supreme Court held in a 6-3 decision January 2006: “The CSA does not allow the Attorney General to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide under state law permitting the procedure.”[4] Writing for the majority, Justice Kennedy quoted an earlier decision acknowledging, “Americans are engaged in an earnest and profound debate about the morality, legality, and practicality of physician-assisted suicide.”[5] He continued, “The dispute before us is in part a product of this political and moral debate, but its resolution requires an inquiry familiar to the courts: interpreting a federal statute to determine whether Executive action is authorized by, or otherwise consistent with, the enactment.”[6]
Chef Justice Roberts, Justices Scalia, and Thomas dissented, arguing “if the term “legitimate medical purpose” has any meaning, it surely excludes the prescription of drugs to produce death.” They seemed more concerned with achieving a particular substantive result (prohibiting physician-assisted suicide) than upholding the “usual constitutional balance between the States and the Federal Government.”[7]
The question becomes, will end of life medical options be characterized by uniform Federal laws, a mosaic of particularized state statutes, or respect for personal privacy to discern one’s own ethical choices?
I welcome any comments you might want to submit in response to these articles.
[1] “End-of-life issues being settled quietly,” Ellen Goodman, Portland Press Herald, editorial page, March 31, 2006.
[2] Id. Goodman reports that 63 percent a year ago thought Schiavo’s feeding tube should be removed and the number remains the same today. A Field Poll released March 15 showed “70% of adults in California believe terminally ill patients have the right to ask for and receive life-ending medication,” according to an article by Tom Chorneua at SFGate.com. The Field Poll has measured Californians attitudes toward euthanasia eight times since 1979 at which time 64% favored it. The 2006 Poll showed 65% of Protestants and 64% of Catholics support euthanasia but 76% self-identified born-again Christians oppose legalizing the option.
[3] Id. Goodman reports that “49 bills have been filed in 23 state legislatures seeking law that would leave any patient without a living will…on life support.” She observes that all “have stalled or been watered down.”
[4] Gonzales, Attorney General, et al. v. Oregon et.al, __U.S. __ (2006) (No. 04-623, January 17, 2006). The majority said CSA’s purpose is limited to preventing conventional drug abuse and excludes the Attorney General from medical policy decisions.
[5] Washington v. Glucksberg, 521 U.S. 702,735 (1997).
[6] Gonzales, p. 1.
[7] Oregon v. Ashcroft, 368 F. 3d 1118 (2004) cited in Gonzales. The Ninth Circuit noted that “by making a medical procedure authorized under Oregon law a federal offense, the Interpretive Rule altered the usual constitutional balance…”
Anne Underwood has an undergraduate
degree in religious studies, a
master’s degree in rural sociology
and a mid-life law degree obtained
after working over a decade as
a college administrator. She has
mediated for the Maine family courts
since 1983. Currently she serves
as an advisor to the ethics commissions
of ACPE, APC, the CCAR (Central
Conference of American Rabbis),
and NAJC, and consults with a variety
of Protestant faith communities
on issues of power, fair process,
and congregational conflict management.
Her articles on mediation and restorative
justice have appeared in the ACPE
News, The APC News and on the ACPE
web site. Articles on clergy accountability
and judicatory processes are published
by the Alban Institute and The
Journal on Religion and Abuse.
A
chapter, “Clergy Sexual Misconduct:
A Justice Issue,” appears in Body
and Soul: Rethinking Sexuality
as Justice-Love
, Marvin Ellison
and Sylvia Thorson-Smith, editors,
The Pilgrim Press, 2003.
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