A Cautious Man
August 25, 2009
 
Making Plans
I'm reading the latest on the "Death Book" lies being promulgated, specifically GOP Chair Michael Steele's embrace of that meme. As anyone can see, this whole episode is about a workbook intended to help veterans make a decision about an advance medical directive. It's difficult to address this topic, as anyone with older parents can attest. For younger people, it's well nigh impossible, if not actually ignored (leading to situations such as Terri Schiavo's, but more on that in a moment).

Politics is one thing, but right now the National GOP is misrepresenting an important discussion that every family should have, as some sort of suicide promotion. As a result, I've come to the conclusion that the National GOP is morally bankrupt, since I have no doubt that their arguments will prevent people from making those important plans and having those important discussions.

A few years ago, my Mom and Dad (who are still very much among us today) sat down with my brother and me to tell us, in plain and direct language, what their preference was if they were being kept alive by extraordinary means. My mother had gone through these issues with her mother years earlier, with a very clear decision that my grandmother preferred a "do not resuscitate" order on her chart. Instead of a conversation, of course, a legal document would be even better, in case the medical provider had any concerns about what my brother or I would tell them, should it ever be necessary to do so.

These types of discussions are important for all families. And, legal documentation is even more important, especially if there is a chance that family members might disagree on the course of action to take. Heck, if you listen to the Rush Limbaugh show, you can hear him do an ad for "LegalZoom.com" in which he notes a living will as one of the products his listeners could obtain from this advertiser.

The whole Terri Schiavo case was due to the fact that family members disagreed regarding the use of extraordinary measure to prolong Ms. Schiavo's life. Florida law actually covers this issue, on making these decisions in the absence of a legal document –

1) If an incapacitated or developmentally disabled patient has not executed an advance directive, or designated a surrogate to execute an advance directive, or the designated or alternate surrogate is no longer available to make health care decisions, health care decisions may be made for the patient by any of the following individuals, in the following order of priority, if no individual in a prior class is reasonably available, willing, or competent to act:

(a) The judicially appointed guardian of the patient or the guardian advocate of the person having a developmental disability as defined in s. 393.063, who has been authorized to consent to medical treatment, if such guardian has previously been appointed; however, this paragraph shall not be construed to require such appointment before a treatment decision can be made under this subsection;

(b) The patient's spouse;

(c) An adult child of the patient, or if the patient has more than one adult child, a majority of the adult children who are reasonably available for consultation;

(d) A parent of the patient;

(e) The adult sibling of the patient or, if the patient has more than one sibling, a majority of the adult siblings who are reasonably available for consultation;

(f) An adult relative of the patient who has exhibited special care and concern for the patient and who has maintained regular contact with the patient and who is familiar with the patient's activities, health, and religious or moral beliefs; or

(g) A close friend of the patient.

Of course, we recall that GOP meddling resulted in passage of a Federal law to override Florida law and the Florida judicial process, leading to the grotesque circus which followed.

By discouraging and disparaging any sort of counseling about an advance directive on medical care, the GOP is sowing the seeds for more Terri Schiavo tragedies. I use the word "tragedy" to refer, not to her unfortunate illness and death, but to the tearing apart of the family and the subjection of them all to the glare of partisan publicity. Nobody else should have to go through a situation like that, as described by the guardian ad litem (GAL) who had been appointed by then-Governor Jeb Bush, and whose report issued over a year earlier had been ignored by the Republican governor and his congressional allies. As noted by the GAL -

Sometimes good law is not enough, good medicine is not enough, and all too often, good intentions do not suffice. Sometimes, the answer is in the process, not the presumed outcome. We must be left with hope that the right thing will be done well.

We are, each of us, standing in Theresa Marie Schiavo’s shoes. Each of us is profoundly affected by the decisions that have and will be made in this case. Advocates of privacy rights and death with dignity, and advocates of right to life and rights of the disabled provide the compelling definitional parameters of this matter.

In the end, the GAL concluded (as the courts did later after Congress and President Bush got involved) that Mr. Schiavo could make the choice implementing what he understood Ms. Schiavo's wishes to have been. In so doing, the GAL wrote words about the tragedy of the dispute, which describe a situation nobody should have to face -

The Schindlers and the Schiavos are normal, decent people who have found themselves within the construct of an exceptional circumstance which none of them, indeed, few reasonable and normal people could have imagined. As a consequence of this circumstance, extensive urban mythology has created toxic clouds, causing the parties and others to behave in ways that may not, in the order of things, serve the best interests of [Ms. Schiavo].

The GAL concludes that the trier of fact and the evidence that served as the basis for the decisions regarding Theresa Schiavo were firmly grounded within Florida statutory and case law, which clearly and unequivocally provide for the removal of artificial nutrition in cases of persistent vegetative states, where there is no advance directive, through substituted/proxy judgment of the guardian and/or the court as guardian, and with the use of evidence regarding the medical condition and the intent of the parties that was deemed, by the trier of fact to be clear and convincing.


Now, from the top down, the GOP is attacking the concept of an advance medical directive, which cannot help but discourage the contemplation of these decisions by the men and women who do need to think about this issue, for the sake of themselves and their families. In order to score a few political points via distortion, the GOP is encouraging the potential creation of more family tragedies like that of the Schiavo and Schindler families.

And that is simply unconscionable.

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