Friday, June 17, 2005

The Schiavo case and my recent loss

Here is a copy of a comment I made over at Dov Bear, brought over here for archival purposes:

First, I extremely dislike this insistence on calling Ms. Schiavio "Terri" by people who have never even met her. It's terribly disrespectful. I am leaving instructions that upon my death, I shall be referred to as "Mr. Apikorus" by all except close family and friends when talking amongst themselves. If the rabbi gets up and does a hesped and calls me "Conservative" (my first name), I will send my ghost down from shamyim and haunt him as a dybbuk for his impertinence.

As for insisting on heroic medical measures if there's any "hope," let me tell you all that I lost a very close family member last month. This person had been fighting cancer for a year. About a week before the death, I accompanied this family member to a medical appointment, where the doctor more or less told us that the chemotherapy wasn't working, and he more or less took the patient off the chemo and prescribed some additional painkillers and some other stuff to deal with the associated gastrointestinal side-effects of the painkillers.

Now, the doc wasn't quite so blunt with the patient, he spun a web of bullshit as he described his suggestions, but it was pretty obvious to both of us that we were at the point where all you could do was wait for the malach hamaves to show up. This was confirmed when the doc took me into his office for a private chat. (Though the doc didn't use the term "malach hamaves," even though he was a Jewish doc.)

Now, was what this doc did any worse than what Mr Schiavo wanted to do for his wife? It's possible that we could have found some quack-quack MD who would give us false "hope" that some additional chemotherapy might work, but, basically, our doc was perfectly competent, and he realized that at that point, for all practical purposes, there was no hope left, and it was check-out time for the ol' neshama.

Sure, it was different from Ms. Sciavo's case in that the patient was still concious and even mobile, and had the capacity to make decisions about care, but, really, the decision was to let the patient die.

In fact, I get the impression from the way the "pro-lifers" yammer on that they would appose pulling Ms. Schiavo's feeding tune even if there had been a written living will and power of attorney. They way they talk about their moral code being the only proper code, I would fear that these sort of people would want to change the law to forbid any of us from leaving a directive to let ourselves die.

What would this have meant to my dear departed family member? That this person would have to use all the life savings to pursue treatments of dubious value? That this person would have to die in a hospital surrounded by strangers in a noisy, stressful, unpleasant place? At least this person died at home with family members present.

These aboslutist moral pronouncements sicken me. What do these "halachic experts" and "religious conservatives" know about real people and their the problems? All they do is tell us how to live our life by using instructions from a book. Believe me, the instruction book is just the first step (and a very small one) in learning about something.


Blogger Mirty said...

I'm sorry for your loss. You are right. My husband recently lost his aunt to cancer. (I wrote about it some here - ) .

In her case, she and her daughter had found a doctor who did take further measures, when all other doctors would not. It was their decision to go ahead with additional chemotherapy. It's no use second-guessing it now. But even this doctor, after a point, said enough. It was time to let her go.

3:47 PM  
Blogger Z said...

You're right. And this witchhunt to somehow implicate him and "punish" him for her death is just that...sour grapes.

3:47 PM  
Blogger dilbert said...

I am sorry for your loss. In defense of the physician, it is hard to talk to patients with a terminal illness, and find the exact proper way to convey bad news. If you are direct, some will appreciate your directness, and others will consider you brusque and unfeeling. If you couch your words in uncertainty and only get to the point indirectly, some will appreciate your approach, and others will think that you are full of "bullshit". Sometimes different members of the same family will have totally different views, having heard the same talk. Some doctors are quite good clinically but are not very intuitive and dont find the right words to fit the occassion.

As far as what halacha has to say about prolonging life, when the situation is clearly terminal, and the patient is suffering, most if not all do not mandate prolonging suffering. There is a precedent in the Talmud(recited in the Mussaf liturgy on Yom Kippur) about the Sage who was being burnt to death, and a water soaked sponge was keeping him alive. The sage asked the executioner to remove the sponge, and he did so, in exchange for life in the world to come.

I reccomend the works of Dr. Fred Rosner(a neurologist) and R. Moshe Tendler, who together have written many articles and a number of books on Jewish medical ethics and the nexxus of halacha and medicine. You will find a compassionate, humane ethic, with a deep respect for human life, quite unlike what appears to be your impression of orthodox halacha on the matter.

btw, if you are interested, I posted a response to you at the DovBear blog with a reference to an article in the British medical journal(a peer reviewed journal, highly respected) regarding 3 patients who recovered somewhat after being given a diagnosis of persistent vegetative state.

4:08 PM  
Blogger Conservative Apikoris said...

btw, if you are interested, I posted a response to you at the DovBear blog with a reference to an article in the British medical journal(a peer reviewed journal, highly respected) regarding 3 patients who recovered somewhat after being given a diagnosis of persistent vegetative state.

My undertsanding that (1) PVS is a hard diagnosis, (2) if it's source is trauma (abang on the head) there's a significant greater than zero chance of recorver, if its source involves brain deprivation of oxygen (what happened in the schiavo case) the chance of recovery approaches zero, especially after 3 or 4 months.

I only adocate "pulling the plug" in cases where the chance of recovery approaches zero. Which, as far as I understand what I've read, was the circumstances surrounding the Schiavo case.

The religious community was severely miguided in taking on this case as a cause.

But personally, I would not want to partially "recover" from such a thing, especially if mt mental functioning was imparied. In fact, I'
m not so sure I'd care to be physically handicaped, either.

And if I ever had to face a diagnosis of terminal cancer, I hope that thje doc will be straight with me and not feed me some bulshit "hope" that has me taking chemo and spending my last days tired and in pain. Better he should say:

"Go dowm to the chevra kadisha and pre-arrange that funera, then come back here and I'll give you a nice big fat joint and a big bottle of strong opiate painkillers." The I'd head to the hospice and spend the rest of my days blissfully stoned out of my mind until the malach hamaves made his visit.

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