Patterico's Pontifications

9/13/2006

More on Trusting the “Experts”

Filed under: General,Schiavo — Patterico @ 12:38 am

The other day I told you about those doctors who are shocked, stunned, and amazed every time a “vegetative” patient turns out not to be — and are similarly gobsmacked whenever the physiology of the brain reveals a new and previously unknown wonder.

Now See Dubya brings word of another such story: Ambien waking up “vegetative” patients:

For three years, Riaan Bolton has lain motionless, his eyes open but unseeing. After a devastating car crash doctors said he would never again see or speak or hear. Now his mother, Johanna, dissolves a pill in a little water on a teaspoon and forces it gently into his mouth. Within half an hour, as if a switch has been flicked in his brain, Riaan looks around his home in the South African town of Kimberley and says, “Hello.” Shortly after his accident, Johanna had turned down the option of letting him die.

Three hundred miles away, Louis Viljoen, a young man who had once been cruelly described by a doctor as “a cabbage”, greets me with a mischievous smile and a streetwise four-move handshake. Until he took the pill, he too was supposed to be in what doctors call a persistent vegetative state.

Louis was hit by a truck, and the doctors had written him off:

Doctors expected him to die and told his mother, Sienie Engelbrecht, that he would never regain consciousness. “His eyes were open but there was nothing there,” says Sienie, a sales rep. “I visited him every day for five years and we would speak to him but there was no recognition, no communication, nothing.”

But then he took zolpidem, known in the United States as Ambien.

The results shocked, stunned, and amazed doctors. And they defied brain scans that seemed to show portions of the brain that were allegedly dead:

After Louis’ awakening was publicised in the South African media, Dr Ralf Clauss, a physician of nuclear medicine – the use of radioactive isotopes in diagnostic scans – at the Medical University of Southern Africa, contacted Nel to suggest carrying out a scan on Louis. “The results were so unbelievable that I got other colleagues to check my findings,” says Clauss, who now works at the Royal Surrey County Hospital in Guildford. “We did scans before and after we gave Louis zolpidem. Areas that appeared black and dead beforehand began to light up with activity afterwards. I was dumbfounded – and I still am.”

But we’ve been told that patients are more likely to recover when their coma was caused by a blow to the head. Recovery after years of being in a coma can’t happen when their brains are starved of oxygen, like Terri Schiavo’s. Right?

Wrong.

Perhaps the last word should go to Pat Flores, the mother of George Melendez, the 31-year-old coma patient who reassured his parents that he wasn’t in pain after taking Ambien, as zolpidem is known in the US. He was starved of oxygen when his car overturned and he landed face down in a garden pond near his home in Houston, Texas, in 1998. “The doctors said he was clinically dead – one said he was a vegetable,” says Pat. “After three weeks he suffered multi-organ failure and they said his body would ultimately succumb. They said he would never regain consciousness.”

He survived and four years later, while visiting a clinic, Pat gave him a sleeping pill . . . His improvements have continued and we talk every day. He has a terrific sense of humour and he carries on running jokes from the day before.

“It is difficult to describe how it feels to get someone back who you were told you had lost for ever. There is a bond that has been restored and it validates our absolute belief that all along George was locked inside there somewhere. It tells us that we were right and the doctors were wrong. George, and his personality, were in there the whole time”.

That is the lesson here, if you’re willing to listen. Not that doctors and “experts” are always wrong, or that they’re usually wrong.

Just sometimes.

When the doctor says you are going to die, you might not. When the doctor calls you a “cabbage,” you might not be. When the doctor says the brain scan shows your brain is dead, it might be alive.

Sometimes they’re definitely wrong. When the doctor says nobody has ever recovered after being in a diagnosed persistent vegetative state for more than 3 months — he is wrong. Make sure he doesn’t testify at your court proceeding; the guy who said that has testified at a bunch of them.

Don’t blindly trust the “experts” on issues like this. They’re wrong far too often, and your life is far too important.

P.S. Dean Esmay has more, including a history of the vitriol that came from those who trusted the “experts” in the Schiavo case, and claimed that anyone who didn’t was [fill in the blank and make sure it’s ugly]. For what it’s worth, I think the extremes on both sides were nasty.

52 Responses to “More on Trusting the “Experts””

  1. but they were correct about terry.

    joe (066362)

  2. joe, I believe the point is that perhaps we ought to consider erring on the side of “alive” if there’s a doubt. Apparently there are doubts as to what doctors are “sure of.”

    Seems to me that we weren’t “sure” about Terri until the autopsy, though the doctors assured us that they “knew.” Lucky call. Hope starving to death didn’t hurt. The doctors said they were “sure” it didn’t. Back to Pat’s posting.

    Harry Arthur (b318a5)

  3. Of course you weren’t sure until the autopsy. How can you be sure until the autopsy? A body is found riddled with bullets in a pool of blood. The ME isn’t going to announce a cause of death until they do an autopsy. That’s when they’re sure. Unfortunately, in the real world decisions have to be made with less than 100% certainty. I got his point. Sometimes the experts are wrong. How often? How wrong? His implication is that they’re often wrong and that we shouldn’t have removed life support from Terry.

    So to make a general rule out of what you’re saying: We as a society should never remove life support from a patient? Do i have that correct?

    joe (066362)

  4. joe,

    Why don’t you click on the first link in the post and then tell me if that’s what I’m trying to say?

    Patterico (de0616)

  5. “Sometimes the experts are wrong. How often? How wrong?”

    That’s for the lawyers to decide.

    “His implication is that they’re often wrong and that we shouldn’t have removed life support from Terry.”

    Actually, that wasn’t his point. His point was that they CAN be wrong and are not infallable. There was considerable evidence that Michael Schiavo didn’t want to starve Terri to death because he thought she was brain dead, but because he wanted the money from the settlement he got when he said he was going to take care of her for the rest of her natural life.

    That there’s a growing number of instances where supposedly vegetative patients have come back is evidence that we should be much more cautious about pulling the plug on anyone. It shouldn’t be based on convenience of the party most likely to benefit from the death.

    sharon (03e82c)

  6. Sleeping Pill Awakens Patients In Persistent Vegetative State…

    It makes me wonder about Terry Schiavo’s supposedly “liquidfied” cerebral cortex and what would have happened if she had been given this medication. Read the whole thing.

    Sensible Mom (72c8fd)

  7. Of course you weren’t sure until the autopsy. How can you be sure until the autopsy?

    You can’t … unless they wake up. Which is the main point of Pat’s post. Also, unlike your ridiculous body riddled with bullets in a pool of blood, we’re not talking here about the autopsy revealing cause of death. It’s about revealing the cause of the apparent vegetative state.

    Anwyn (d24425)

  8. I hate thinking of the Terry Schiavo case, I really do. Not in the how dare anyone try to save someone’s life way, but in that consistently amazed at how many people were going out of their way to ensure that she did not receive life sustaining care.

    I used to read John Cole alot, after Terry, it was all downhill, in the past something like this would come out and he’d be like ‘So totally different than the Schiavo case.’ But like he knew, like any of us knew. I still can’t believe the way completely differently people took the knives out of the drawers to maintain the “right” of Terry Schiavo to die.

    It’s stuff like this that always makes me think gosh we should be careful before deciding to “let someone die.”

    Joel B. (d5a883)

  9. The schiavo case really was interesting because of the way it seemed to split people along lines that often didn’t match the usual party/ideology divides.

    There are ideological disconnects revealed in the schiavo case that I have trouble figuring out.

    For example, how the same “conservatives” who are generally perfectly happy to support a death penalty process that could result in the death of an innocent human, and generally accepting of collateral killing of civilians in Iraq as a necessary sacrifice also insist that a fetus the size of a fingernail clipping should never be aborted or used for stem cell research, and that a woman that dozens of experts insisted was brain dead should be kept alive indefinitely for the ghost of a chance she might wake up.

    Or, conversely, how some “liberals” who insist that the death penalty should be revoked if one innocent person could possibly be executed, and that any civilian casualties in Iraq are unacceptable, and that society owes an absolute duty to the helpless/unfortunate to provide tax-payer funded healthcare were outraged at the suggestion that Terri Schiavo should be kept alive because her parents had a glimmer of hope she might have some possibility of consciousness in her somewhere.

    Phil (88ab5b)

  10. It’s not so hard, Phil. The difference is pretty simple.

    1. Our system of laws and justice is designed to prevent the execution of innocent people. The number of innocent people is so far below the tipping point that most people are willing to accept the risks because most people in our country still believe there are crimes worthy of execution.

    2. The deaths of innocent civilians in a time of war is part of war. There’s never been a war without civilian casualties, and as long as one side continues to fight from residential areas, there will be more civilian casualties.

    3. A lot of people see life as a continuum, from conception to death, because any place other than conception as a starting point is an arbitrary marker. For those people, we aren’t talking about a clump of cells but about a human being and according to Western culture, harvesting human beings is barbaric and unacceptable.

    4. Dozens of experts said Terri Schiavo was brain dead, yet to the layman, she still exhibited behaviors that some thought indicated brain function. More than that, Michael Schiavo, with his mistress and illegitimate children in the wings, didn’t make a very sympathetic figure as a husband who lovingly wanted to respect his wife’s wishes, even though she never wrote them down and only mentioned not wanting to live “that way” under the most casual circumstances. Couple his suspicious conduct with the clash with her parents and you had the makings of more than just “keeping a braindead woman alive.”

    sharon (03e82c)

  11. Joe,

    My problem with the Schiavo case has nothing to do with the results, and everything to do with the process. During the Dark Ages in Europe Trial by Combat and Trail by Ordeal were common. Almost inevitably some such trails resulted in verdicts that amounted to justice. That does not mean that the practice wasn’t wrong.

    So far as I can discover the initial judicial decision in the Schiavo case was made almost exclusively based on the husband’s testimony concerning a passing remark he claims his wife made years ago; in short, on hearsay evidence from a financially concerned party. During the long, drawn out fight, with competing expert testimony, and legislative moves the impression I had was that the huge hurdle that the defenders of Terry could not overcome was the judge’s disinclination to reverse himself.

    Terry Schaivo was starved to death because a man who would benefit from her death testified that it was a swell idea. OK, Terry has about as much capacity to understand what was happening to her as a dissection-class frog. Fine. That does not mean that the judicial decision was not terribly, terribly flawed. At some point, while I was busy living my life, the legal standard changed from ‘when in doubt, preserve life or its appearance’ to ‘when in doubt, kill’. If that doesn’t scare the living crap out of you, I have to assume that your level of mentation isn’t all that much higher than Terry’s.

    C. S. P. Schofield (c1cf21)

  12. The Schiavo autopsy revealed the areas of the brain where extensive neuronal loss had occurred. Given these data and the potential areas (speculation) where Ambien might work to cause this phenomenon, it is extremely unlikely that she would have responded. That’s JMHO given the little bit we know about this interaction of Ambien in the persistent vegetative state so far.

    Talking up Schiavo here really does a disservice to what’s being reported: a potentially novel, though seemingly still somewhat anecdotal, finding that could impact treatment and our understanding of pharmacology and neural circuitry.

    Sir Oolius (10ed8a)

  13. the part i liked best: although zolpidem is now in the public domain, the original patent having expired, regen therapeutics, a south african company, is applying for a new patent on it!
    tip to the loved ones of comatose people for avoiding paying royalties to regen: “doctor, i’ve been having trouble getting to sleep!”
    big pharma overreaches again. can some republican here explain to me why it’s good policy to prohibit medicare from using its vast market clout to negotiate lower drug prices?

    assistant devil's advocate (0fe5d2)

  14. I believe ,for the most part, anyone who undergoes what they claim to be a “traumatic experience” and then reaps the windfall by writing a book is an opportunistic fake. This encompasses Mike Schaivo and both of her parents.

    Such things are best kept to oneself.

    Grief shouldn’t be a public spectacle, nor a means of profit.

    Leviticus (3c2c59)

  15. Why is it not a good idea to use Medicare’s ‘clout’ to lower drug prices? Because what that amounts to is price fixing by the State, and will inevitably lead to either a glut or shortages, depending on whether the State fixed the price too high (because of direct political influence by the drug companies), or too low. This is basic economics understood by almost anyone, until their ox is gored and then it flies out of their head. True, though.

    C. S. P. Schofield (c1cf21)

  16. And, C.S.P., I think a more appropriate legal standard would be “When in doubt, let nature take its course”. I realize that in this case the meanings are the same, but when applied to other contexts, your statement is definitely melodramatic.

    Leviticus (3c2c59)

  17. On the assumption that the majority of conservatives are Christians (which may or may not be unfair), allow me to pose a question?

    What are you so afraid of?

    I am a liberal evangelical Christian. If conservatives have true faith in God, and are living according to His Word, then what is to be feared in death. In such situations, the only consequence for a given individual is eternal enlightenment?

    So, being that Terri Schaivo was a confessed Christian (right?), and being that no one (not her husband, not her parents) knew her will on the subject…
    Let her go.

    I’m sure that what she found in heaven was better than a life in limbo.

    Leviticus (3c2c59)

  18. This post is such piss ant nonsense.

    Doctors, the kind that heal you, not sue you, are always coming up with discoveries; medicine is reasearch. Why drag Schiavo into this. She was DEAD! as she lie in her bed.

    RJN (e12f22)

  19. Damn, that’s pretty messy punctuation on my part…

    Leviticus (3c2c59)

  20. I completely misconstrued patterico’s point. I should have read the post more closely. I’m sorry about that.

    joe (066362)

  21. Sharon,

    “A lot of people see life as a continuum, from conception to death, because any place other than conception as a starting point is an arbitrary marker”

    But that’s exactly the contradiction I’m talking about. People refused to place an “arbitrary marker” between preserving life and letting it go for practical reasons in the case of abortion and cutting off teri’s life support, but then were perfectly drew those same “arbitrary” lines by saying that some death of innocents was OK to maintain war and the death penalty.

    Conversely, those refusing to give any ground on their principled preservation of life by opposing the death penalty and the war in Iraq seem perfectly willing to compromise these principles with regard to terri’s feeding tube (and often on abortion).

    Phil (88ab5b)

  22. My problem with the Schiavo debacle was that the Congress (with Presidential support) of the United States felt that it was legal and appropriate to intervene in a family’s private affairs where existing law was capable of guiding the outcome. I don’t care what side you were on, I find it completely outrageous that Congress thinks that any law in any jurisdiction that it happens to disagree with can just be scratched out and replaced as they see fit.

    It was a disgraceful affront to the principles of the Constitution.

    If it had happened before the 2004 election I probably wouldn’t have voted for Bush as a result, and I am going to vote against any and all of my Congress people that voted for that travesty of a bill. Anyone that did is unfit to run our Federal government, as I think it should be.

    Justin (747191)

  23. All I have to say is that if I end up in a state like that and someone decides to “pull out the feeding tube”, I will only allow it if they come in with a .38 Special, put it to my temple and pull the trigger.

    None of this “starvation” BS.

    Techie (6cd00b)

  24. “But that’s exactly the contradiction I’m talking about. People refused to place an “arbitrary marker” between preserving life and letting it go for practical reasons in the case of abortion and cutting off teri’s life support, but then were perfectly drew those same “arbitrary” lines by saying that some death of innocents was OK to maintain war and the death penalty.”

    There’s a difference in all of those circumstances which I already pointed out. It’s comparing apples and oranges.

    sharon (dfeb10)

  25. Those so called experts dont know as much as they think they do

    krazy kagu (1f0194)

  26. Leviticus,

    Doesn’t “When in doubt, let Nature take its course” amount to “Scorn pain, either it will go away or you will”?. I mean, a lot of conditions not even classified as ‘life threatening’ require that the patient be fed by an outside agency – losing both arms springs to mind. Had the judge wanted to rule in favor of NOT maintaining brainless bodies he could have hung his original decision on another aspect of the case. He didn’t. In effect he listened to Mr. Schaivo say “My wife isn’t waking up and, gee, I remember that she always said she’d hate that. No she didn’t make out a living will. No I haven’t any witnesses. Can I stop her being fed please?” and went with that. Certainly that is what the decision read like.

    OK, in this case the Judge was not guilty of murder, just of mushroomcide. But by what he says he based his decision on, that was an accident.

    C. S. P. Schofield (c1cf21)

  27. CSP,

    Interesting analogy with the “no arms or legs” thing. I hadn’t thought of that.

    The difference, in this case, is the awareness of the situation. An armless, legless person still has the awareness to know, if you abandon them, that they are helpless. In addition to this realization comes an entire slew of emotions related to betrayal by their loved ones, fear of future suffering, etc. Schaivo didn’t have these.
    If she felt pain, it was on one level, the physical level, and, lacking the ability to put that pain in context, I doubt she suffered.

    As I said, I have no respect for either Mike Schaivo or Terri’s parents at this point, and I am not defending his actions. On a personal level, I would want to be let go.

    Leviticus (43095b)

  28. Sharon said: “It’s comparing apples and oranges.”

    I think what I’m saying is like pointing out the inconsistency of someone who is eating an orange saying “don’t eat fruit” to someone who is eating an apple.

    Phil (88ab5b)

  29. My problem with the Schiavo debacle was that the Congress (with Presidential support) of the United States felt that it was legal and appropriate to intervene in a family’s private affairs where existing law was capable of guiding the outcome. I don’t care what side you were on, I find it completely outrageous that Congress thinks that any law in any jurisdiction that it happens to disagree with can just be scratched out and replaced as they see fit.

    It was a disgraceful affront to the principles of the Constitution.

    Justin,

    What if I could convince you that Schiavo’s parents had a sound legal argument that the Florida courts had improperly applied the Federal Constitution? Might that change your mind?

    I invite you to read this argument I made as to why the federal courts should have reinserted the feeding tube to consider a constitutional argument that I show to be strong.

    If I’m right, then Congress simply provided federal jurisdiction for the courts to review the Florida courts’ decision under federal law and the federal constitution — much like federal courts review state criminal cases on habeas.

    Now what’s so outrageous about that?

    (By the way, for the lefties with the long knives out — I’m not at work now, I’m at home tending to a son with a fever. He’s asleep right now.)

    Patterico (de0616)

  30. On the money: doctors are sometimes wrong, and them being sure is no guarantee that this isn’t one of those times, for most values of “this.”

    Joel Rosenberg (7f106d)

  31. By the way, I never say in this post that Terri Schiavo could have taken Ambien and been fine. I consider that impossible given the autopsy results. But until we saw those, all we had to go on was brain scans and doctors’ opinions — just the kind of evidence that would have doomed these patients if their relatives had succumbed to the doctors’ advice.

    Patterico (de0616)

  32. “But that’s exactly the contradiction I’m talking about. People refused to place an “arbitrary marker” between preserving life and letting it go for practical reasons in the case of abortion and cutting off teri’s life support, but then were perfectly drew those same “arbitrary” lines by saying that some death of innocents was OK to maintain war and the death penalty.”

    Speaking only for myself, Phil, I am willing to draw some lines.

    I don’t have a huge problem with, say, the morning-after pill. But we allow abortion too late in this country. I have a whole abortion series of posts if you care about my opinion. Here is a sample post.

    On the death penalty, I believe that, after a murder conviction, jurors should be told that *any* “lingering doubts” about the defendant’s guilt should bar the death penalty. That rule would, I think, strongly reduce the chance of an innocent being executed.

    I hate war, and supported the Iraq war very, very reluctantly — viewing it in the context of 9/11, and thinking that we can no longer afford to take chances with people who hate our country and have shown themselves willing to use WMD. Obviously, I want to minimize the killing of innocents — but I also believe that war can *save* lives in the long run.

    As for the Schiavo case, I have dozens of posts about it. In essence, she was entitled to be treated the way she wanted to be treated — but it’s not clear to me what that was. In such cases, I’d err on the side of life, for reasons the above post makes clear.

    Patterico (de0616)

  33. Leviticus,

    I guess, for me, the ideal ruling would have been along the lines of “You don’t want the responsibility for a human mushroom anymore? Good. Fine. You’re out of there. Marriage terminated. Ms. Schaivo’s parents want responsibility? Great. Done. Keeps the Stare out of somewhere it doesn’t belong anyway. Mr. Schaivo is mad because he won’t get some insurance or something? Life is tough all over. Deal with it. Next case.”

    It makes me nervous when the State starts deciding when a person isn’t worth supporting with even so basic a prop as a feeding tube. It makes me even more nervous when the State seems reluctant to hear testimony from one side (or the other). It makes me more nervous yet when the State has a person or persons willing to undertake the burden involved, and doesn’t duck the issue by passing it to them.

    The history of State intrusion into healthcare is not a good one. The NHS in the British Isle, in Australia and New Zeeland, and in Canada is in a state of scandalous collapse. Government run systems in good and liberal countries like Sweden are plagued with recurring euthanasia and Eugenics scandals that apparently won’t go away….. there ‘s always one more self-anointed medical twerp who knows better, in spite of all previous trouble.

    I think that the Schaivo case came out, by blind chance, as close to a good ending as it was going to get…which wasn’t very. It’s the WAY it came out there that bothers me. It seems symptomatic of a wider trouble; a desire by some people for the State to import itself into the healthcare business. It doesn’t work, and as it doesn’t work it drives the representatives of the State to ration care and make excuses. This in turn tempts them to devalue whole classes of people as not having sufficient ‘quality of life’ so as to make the State’s expenditure of care worthwhile.

    In a capitalist system, if you don’t have the cash to save Granny, you can beg, borrow, or steal. In a Socialist system if Granny belongs to category that is denied care as a matter of policy, Granny is dead – you might as well plant her.

    C. S. P. Schofield (c1cf21)

  34. I think that we may be failing to take into account the whole concept of “power of attorney” here.

    If Mike Schaivo had power of attorney in his wife’s case, he had the legal right to pull the plug, prsumably because he believed that that was what she would’ve wanted. If he had power of attorney, he knew, in the eyes of the law, what was best for his wife.

    I understand that her parents may have wanted to keep her alive, but maybe he knew something they didn’t. Maybe he just needed closure in order to move on after seven years in a holding pattern. We don’t know. Legally, he knows what’s best, and I think that that was the decision that court after court decided to uphold.

    Leviticus (35fbde)

  35. And I agree that there should be no monetary compensation for either party in such a case as this. If one’s motives are genuine, then money should play no part in influencing them.

    Leviticus (35fbde)

  36. Do you think that because you’re familiar with applicable Florida law, and you’ve read the relevant court decisions?

    I don’t think they say what you are saying.

    Patterico (de0616)

  37. Leviticus,

    Consider this, if you will:

    WHEN did he get the power of attorney? Was it after she became incommunicado, and therefore no decision of hers? How would that effect your position?

    C. S. P. Schofield (c1cf21)

  38. “I think what I’m saying is like pointing out the inconsistency of someone who is eating an orange saying “don’t eat fruit” to someone who is eating an apple.”

    Again, your analogy falls short. Being against abortion but for the death penalty is quite easy to distinguish. The baby is completely 100% innocent and couldn’t possibly have been guilty of anything. The person being executed has been put through the rigorous system we have to ensure that innocent persons aren’t executed. In the one case, we can be 100% sure that the person dying was innocent. In the other case, you can be 99.99999% sure the person was guilty.

    sharon (dfeb10)

  39. Patterico’s blog is filled, every other day, with stories of lawyers eating each others eyes out.

    Now, just because a partial cure for short term persistent vegatative state is discovered, we have lawyers eating doctors eyes out because it didn’t happen sooner.

    The gripe about doctors, we discover, is that they don’t already know everything and therfore can’t know anything for sure. Damn those doctors.

    We have so much surplus cash left to spend on patient care that we should simply keep everybody “hooked up” until they rot out of their hookups.

    Also, that Mr. Schiavo is some kind of bum because he wants a life after all these years of watching a woman in bed with no brain.

    I had a flat tire today, and now I discover that a set of tires for my newish car costs $580 + tax + installation. Terri Schiavo doesn’t know what she is missing.

    RJN (e12f22)

  40. You’ve convinced me, RJN. Why even bother living when tires cost so much?

    Patterico (de0616)

  41. Patterico asked:”Now what’s so outrageous about that?”

    What’s wrong with it is that it was an attempt to deny Michael Schiavo the equal protection of the laws. The Florida courts had found he had the legal right to have Terri Schiavo’s feeding tube removed. In our system legal disputes are supposed to be decided by the courts in accordance with the law. They are not supposed to be decided by who can mount the best PR campaign. In this case Congress attempted, on an ex post facto basis, to deny Michael Schiavo and only Michael Schiavo his legal rights. I find that pretty outrageous.

    James B. Shearer (fc887e)

  42. What’s wrong with it is that it was an attempt to deny Michael Schiavo the equal protection of the laws. . . . In this case Congress attempted, on an ex post facto basis, to deny Michael Schiavo and only Michael Schiavo his legal rights. I find that pretty outrageous.

    I find that a misstatement of what happened. You write as though Congress wrote a law that said: “Michael Schiavo may not remove Terri Schiavo’s feeding tube.” Although that is the cartoonish and no doubt widely accepted view of what happened, it is not so.

    Rather, Congress provided simply federal jurisdiction to review whether there were claims to be brought under federal statutes, or the federal constitution.

    In our system legal disputes are supposed to be decided by the courts in accordance with the law.

    That’s what Congress did. It allowed the legal dispute to be decided by the courts in accordance with the law. It just gave the federal courts a role. That’s all.

    Patterico (de0616)

  43. A few things:

    Yes, doctors don’t know everything, and the ones who act like they do are the ones to stay away from.

    Those who think Mr. Schiavo is a bum think so primarily because he promised to care for Terri when he sued to get the money to care for her. Years later, after the money was awarded, he remembered that “she didn’t want to live this way”. Doctors have a saying, “When you hear hoofbeats, think horses.” Or we quote a criminal of renown (whose name I can’t remember) who, when asked why he robbed banks, replied, “Because that’s where the money is”. Or, in more common usage, “If it flies like a duck, sounds like a duck, looks like a duck, walks like a duck, its probably a duck. Regarding Mr. Schiavo’s behavior as above, “If it smells like a skunk, it probably is.”

    Parents have “power of attorney” rights/responsibilities over their minor children. Yet we know that when someone abuses or neglects those responsibilities society may take those powers away for the good of the individual involved. So it is not only whether Mr. Schiavo had the legal standing to make choices for his wife, but whether he was fulfilling his responsibilities appropriately. Many felt that someone who had a mistress and two children by her was not in a very good position to make a decision on behalf of his virtually-exwife.

    Leviticus- a “conservative Christian” indeed should not fear death, to a degree. But to whom does God give the wisdom to decide what people should be “put out of their misery”?

    Phil- you raise points that have often been made. The answers are very easy in one way, but that doesn’t mean there is agreement. When a “typical conservative” (if that menas anything) thinks about the dignity and sanctity of human life, that means it needs to be protected. If a person has wantonly destroyed the lives of others, particularly in a premeditated and cruel manner, for the sake of protection of others from that individual and as a statement to society, the criminal has forfeited their right to life. The death penalty should be reserved for situations that are “exceptionally evil”, not because someone died in a drunken brawl and no one knows who started what. If you have read Patterico very long, you may have seen discussions on whether the death penalty should require a higher degree of certainty than “beyond a reasonable doubt” to help prevent an innocent person being executed.

    Likewise in war. War is thought as just when defense of the innocent is required, and if in the conduct of a war there is innocent loss of life it is reasonable primarily if the loss is much less than if the aggressor were allowed to continue. The question hence is not whether there are innocent people dieing in Iraq, but whether there are less or more than if Saddam were in power, and who is doing the killing. If Iran and Syria are sending and supplying terrorists into Iraq trying to destabilize the country, that is not “our fault”, except to the degree we don’t stop it if we can. (The Lancet article a few years ago claiming an excess of 100,000 killed after the invasion had gross errors in it, that we could discuss if necessary).

    MD in Philly (3d3f72)

  44. Saletan on this issue.

    Dan Collins (c568a0)

  45. Patterico said:

    “That’s what Congress did. It allowed the legal dispute to be decided by the courts in accordance with the law. It just gave the federal courts a role. That’s all.”

    No, Congress attempted to change the law to give Michael Schiavo’s opponents and only Michael’s Schiavo’s opponents an avenue of appeal which was otherwise unavailable.

    James B. Shearer (fc887e)

  46. That’s about the only possible objection: that it wasn’t a generally applicable law. I wish it were.

    Patterico (de0616)

  47. I invite you to read this argument I made as to why the federal courts should have reinserted the feeding tube to consider a constitutional argument that I show to be strong.

    If I’m right, then Congress simply provided federal jurisdiction for the courts to review the Florida courts’ decision under federal law and the federal constitution — much like federal courts review state criminal cases on habeas.

    I’m no lawyer, but it seems to me that you can make a similar claim about “due process” for any legal matter. So, I guess everything falls under federal jurisdiction, then. We should just get rid of state law altogether and let the ever-competant federal government decide what’s best for everyone at every level of society.

    Sadly, we’ve been heading down that road for a least the past 70 years or so… maybe even going back to the war between the states. It was probably inevidable, but I do wish it was at least commonly known how far we’ve strayed from the founders’ vision of the country.

    To make it worse, whenever the federal government tries to solve a problem, it usually just ends up making the problem worse. Thus, I’m always wary of the government reacting to any perceived problem.

    Don’t forget, Congress’ motive wasn’t to ensure a due process to Terri’s parents; their motive was to ensure the process went in favor of the parents. Doesn’t sound very “due” to me.

    Justin (747191)

  48. In the legal battle concerning Terri Schiavo, Michael Schiavo had money for nationally known lawyers and expert witnesses, largely because he had control of the money awarded for Terri’s care. Those who thought Michael should not be making the decisions did not have the resources and depended on volunteer effort, some of which was felt not to be the best. (I applaud those willing to help, it’s not their fault if there wasn’t a trial attorney with lots of experience in the opening rounds). Michael was also fully alert and communicative. Those who wanted the federal government to have a role (at least some of us) felt that it was in keeping with the idea that protection of the defenseless is a role of government. There has been wide acceptance of civil rights legislation at the federal level to provide an extra layer of protection. What is more in need of protection than the right to life of a disabled person who cannot defend themselves?

    Obviously, those in opposition saw it as an issue of interference with Michael Schiavo’s right to care for his wife as she had instructed him. Others felt that the fact finding in early legal proceedings was faulty and wished for a mechanism to allow further investigation and clarification. (At least that’s how I understand the legal issues involved). Unless one thought an injustice was being planned, why all the name calling about simply wanting to better establish facts in the case?

    Whatever issues exist about a need for further review, exist for other situations. It has been amazing to me to see firsthand what can happen in the care of a seriously ill person when money is involved. I once was actually “fired” from taking care of a patient who was responding remarkably well to a new treatment, not by the legal power of attorney but by a relatively distant relative who had no real legal standing, but the POA was unwilling to stand her ground/ fulfill her resposibilities/ put up with the mess. Indeed,the love of money is the root of all sorts of evil.

    MD in Philly (3d3f72)

  49. Those who wanted the federal government to have a role (at least some of us) felt that it was in keeping with the idea that protection of the defenseless is a role of government. There has been wide acceptance of civil rights legislation at the federal level to provide an extra layer of protection. What is more in need of protection than the right to life of a disabled person who cannot defend themselves?

    That means you can’t complain when they do it again on an issue you don’t agree with. What if they had passed legislation making it clear that Terri’s husband got the final say. Would you still be so supportive of their action?

    It’s state law, so the state legislature should be only one considering such intervention. The fact that they didn’t should not be ignored; that implies that not only did Congress intervene in a state matter, they did so when the state government found it unnecessary.

    Justin (747191)

  50. First, I meant to say earlier to joe we appreciate your willingness to engage in discussion.

    Second, to Justin, Patterico already referred you to a previous blog where he explained the legal reasoning. I do not know if you read it or not. My posts were simply trying to state clearly the position of many who were concerned about the case. My position was mainly that the circumstances and facts were so blurred that making a wise decision seemed was impossible, and further investigation and review were needed. In my mind, further review could have led to the conclusion that Michael Schiavo was acting appropriately, but the details presented did not give clear evidence of that. Even when all was said and done, if she was so unaware, why did they feel the need to give her morphine, as has been reported?

    The issue had become, and still is, one wrapped up in politicizing. In that regard the Florida Legislature refused to take it up. I would not equate their decision with there not being an issue that needs to be addressed.

    I’m not sure if Congress wanted things to go in agreement with terri’s parents, or they wanted a review of the case which appeared to be in line with Terri’s parents, or likely some mix, depending on who you asked. Is it appropriate for the Congress to get involved in every familie’s issues? Of course not, neither is it at the state, county, city, nor township level. But the way our system works it is often the individual situation before the courts that leads to action. “Megan’s law” doesn’t deal with just one girl named Megan or all girls named Megan, just as the “Ryan White Care Act” was not just for the family of Ryan White.

    “Everything” does fall under federal jurisdiction IF it concerns rights guaranteed by the Federal Constitution, doesn’t it?

    MD in Philly (3d3f72)

  51. MD in Philly, laws like “Megan’s law” are for future cases, they are not intended to change the outcome of a past case. Putting aside the wisdom of such laws, it is the role of the legislature to modify the laws if the legislature feels experience has shown problems with the existing laws. So Congress could have said we feel there should be more safeguards required before feeding tubes are pulled from comatose patients. They could have passed a law to that effect and even called it Terri’s law.

    That of course is not what Congress did. Congress in effect said we like the existing laws just fine in general and have no intention of changing them, however in this particular case we think Michael Schiavo is unpopular so we will pass an ex post factor law (deliberately written to be ineffective) applying only to him.

    BTW, if I recall correctly the Florida legislature did not refuse to act, it in fact did something similar passing a law aimed at Michael Schiavo alone which the Florida courts mulled over for a few years before deciding that the Florida legislature couldn’t do that.

    James B. Shearer (affbaa)

  52. James,

    Let’s try to focus on main points. Megan’s law couldn’t have applied to Megan because she was already dead, it happened quickly. Terri Schaivo was still alive, whether aware or not. Many legislators wanted to make a widely applicable law, others didn’t. The “real time” factor is not something Congress usually deals with.

    Thank you for the clarification about the role of the state legislature. I had responded to Justin’s comment that it was in the realm of the state legislature. I think we remembered that
    at the time of crisis the state legislature did not act, and you point out that they had previously tried and declined to try again.

    You see it in terms of Michael Schiavo being denied his rights. I see it as trying to protect the rights of Terri Schiavo and anyone else in her condition. Yes, Congress cannot write laws to try to correct every perceived individual case of misjustice.

    Do you think that terri’s interests were adequately represented by her husband, in spite of his self interest that conflicted with his ability to judge objectively? Or do you think she was served poorly, but Congress intervening was not the answer anyway?

    MD in Philly (3d3f72)


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