Tuesday, August 25, 2015

Review: The Right vs The Right to Die: Lessons from the Terri Schiavo Case and How to Stop It from Happening Again by Jon B. Eisenberg

I attended a presentation by Robert Rivas of Final Exit Network, a group which, after a screening process to confirm a terminal condition and informed consent, provides information to people who want to kill themselves. He recommended to me The Right vs The Right to Die: Lessons from the Terri Schiavo Case and How to Stop It from Happening Again by Jon B. Eisenberg.

Eisenberg did pro bono legal work on behalf of Michael Schiavo, who had requested the State of Florida to order the withdrawal of a feeding tube from his wife Terri Schiavo, who had been in persistent vegetative state for several years. Terri’s parents objected, and lawyers representing the parents littered the Florida and Federal court systems with motions and appeals to delay the withdrawal of the tube. Eventually, the original Florida county court judgment was upheld, after years of litigation, Terri’s feeding tube was withdrawn, and she died of dehydration.

Eisenberg’s book, in addition to documenting the tortuous legal route the case took and the political shenanigans some anti-right-to-die advocates like former Florida Governor and Republican Presidential contender Jeb Bush undertook, lays out the legal history of the right-to-die in the United States and the networks of wealthy people, their foundations and their operatives opposed to the exercise of this right. The Journal of the Islamic Medical Association has published several articles, in sequence of increasing permissibility, on euthanasia, suicide, physician-assisted suicide, assisted suicide, suicide and refusing treatment. According to these articles, Muslims should adopt the narrower definitions of right-to-die and autonomy in refusal of treatment.

Eisenberg asserts at length that death by dehydration and starvation is not cruel, and many of the articles cited above recommend maintenance of hydration and nutrition.

Eisenberg noted that these issues are not as urgent in parts of the world where available medical care at the end-of-life is not as intensive. Many of the authors of the articles in JIMA are immigrants from such countries, and immigrants tend to be younger, which makes personal experience with end-of-life issues in one's immediate family less likely. As more and more USA Muslims age and deal with medical ethics issues in their own families, I expect their positions in bioethics to become less rigid.

At the same time, I think it would be incorrect to attempt to use the state to enforce on people these ideas. Muslims, IMO, should support the current regime of allowing medical powers of attorney and advanced directives to guide guardians’ decisions when patients are incompetent and should support the right of competent patients to refuse treatment. I also support others’ right to kill themselves, and, if needed, seek the help of others (assisted suicide). We shouldn’t enjoy the benefits of the US Constitution and then turn around and deny others rights we don’t choose to exercise.

I am perhaps more sympathetic than the author to the arguments of disability rights activists who worry that promoting refusal of treatment and suicide may prejudice access of the poor to healthcare. When Governor Palin attacked the Affordable Care Act’s support for physicians’ education of patients on advanced directives and medical powers of attorney by warning of “death panels,” I took to announcing news items describing mortality among poor for lack of healthcare “death panels for the poor.” So the solution is encouraging as many people as possible to understand the limitations of end-of-life treatment and the utility of advanced directives and medical powers of attorney, facilitate their use and make standard health care available to all regardless of income and ethnicity.

Finally, I believe the author makes a great case that some people in the United States will spare no expense in trying to use the state to reduce personal autonomy, whether it be in restricting abortion, disseminating information on assisted suicide, allowing consenting adults to marry regardless of gender, rezoning a building in a strip mall to be a masjid or protesting the ongoing USA occupation of Afghanistan. Some Muslims seem to believe that resistance to government encroachments on autonomy can be selective. I hope reading this book will help them understand the dangers of such a political stance.