The Magazine

No Mercy in Florida

The horrifying case of Terri Schiavo, and what it portends.

Oct 20, 2003, Vol. 9, No. 06 • By WESLEY J. SMITH
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Some of the worst such conflicts come not from family members but from a medical establishment eager to remedy the chronic shortage of organ donors. The literature is brimming with advocacy that death be "redefined" to include a diagnosis of permanent unconsciousness. An article just published in Critical Care Medicine, the journal for doctors who specialize in treating the most seriously ill and injured patients, urges the adoption of an even more radical policy. Drs. Robert D. Troug and Walter M. Robinson, from Harvard Medical School and the Medical Intensive Care Unit at Children's Hospital, Boston, want to discard the "dead donor rule" requiring that vital organ donors die before their organs can be procured, writing: "We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead."

The authors urge that the relevant question about organ donors should be changed from the current query--is the patient dead?--to, "Are the harms of removing life-sustaining organs sufficiently small that patients or surrogates [e.g., Michael Schiavo] should be allowed to consent to donation?" This is a prescription for moral freefall. Not only do the authors strongly imply that some of us have less value than others but that those so denigrated can be killed for utilitarian ends.

Troug and Robinson attempt to justify their homicidal proposal by claiming that we already take the organs of those declared brain dead but that such patients are really alive. I don't believe this is true, assuming proper diagnosis. But if I am wrong, it is a scandal of the highest order, for it means that society was sold a bill of goods about brain death by bioethicists and organ transplant professionals.

The answer to such a moral travesty would not be to expand medical homicide beyond patients who have suffered a total cessation of brain activity. Rather, it would be to permit doctors to procure organs only from donors who have been declared dead in the traditional manner; because their hearts have ceased beating without hope of restarting.

Advocacy in Critical Care Medicine for discarding the dead donor rule follows on the heels of the Ethics Committee of the Society of Critical Care Medicine's advocacy for legalizing "futile care theory," which would permit doctors to refuse wanted life-sustaining treatment--including "low tech" treatments such as antibiotics--based on the doctor's perception of the "quality" of the patient's life. "Given finite resources," the Ethics Committee stated in 1997, "institutional providers should define what constitutes inadvisable treatment and determine when such treatment will not be sustained."

This plan is currently being implemented. Medical and bioethics journals have reported in recent years that futile care protocols are being adopted quietly by hospitals throughout the country.

The Schiavo case has drawn attention only because her family is in profound disagreement about the care she should receive. If futile care theory takes hold, we may see fewer such cases, if only because the unilateral refusal of treatment will quietly take place without anyone speaking up for the patient.

The sad truth is, many practitioners of bioethics, medicine, and law no longer believe that people like Terri Schiavo are fully human. As a consequence, these patients are being systematically stripped of their fundamental right to life and, perhaps worse, are increasingly looked upon as mere natural resources whose bodies can be plundered for the benefit of others. If it is true that a nation is judged by the way it treats its most vulnerable citizens, a lot is riding on the Schiavo case.

Wesley J. Smith is a senior fellow at the Discovery Institute. His most recent book is "Forced Exit: The Slippery Slope From Assisted Suicide to Legalized Murder."