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The Schiavo tragedy

IN THE 1970s, 21-year-old Karen Quinlan suffered brain damage that left her in a ''persistent vegetative state." Her parents requested that her respirator be removed, but her doctors refused, claiming that it was against the law. Karen's parents petitioned the courts, and the New Jersey Supreme Court ultimately ruled that, not only was it lawful to remove the respirator, but that adults had the constitutional right to refuse life sustaining treatment. The court also ruled that in the case of people who could not exercise this right themselves, surrogates, such as guardians and family members, could exercise the right on their behalf.

Over the last 30 years, virtually all courts that have decided similar cases have agreed with the Quinlan decision's approach.

Indeed, in 1990 the US Supreme Court ruled in the case of another young woman in a persistent vegetative state, Nancy Cruzan, that life-sustaining artificial nutrition could be removed as long as that was consistent with her wishes.

It is notable that the Supreme Court drew no distinction between removal of the artificial means of respiration and artificial means of nutrition. Both are forms of medical treatment that may be refused.

An important foundation underlying these kinds of cases is that current medical technology requires us to make end-of-life decisions. These decisions are made thousands of times every day in hospitals.

Perhaps the most remarkable aspect of the Terri Schiavo case is the appearance that it raises novel questions.

The legal and ethical issues this case presents are routinely resolved in hospices and hospitals across the country.

Indeed, the very existence of hospices, institutions where no medical ''treatment" to prolong life is rendered but which care for people at the end of their lives with respect and dignity, is proof that we have come to a broad consensus that medical treatment to prolong the dying process is not always required or even desirable.

The Schiavo case is a dispute between family members. Terri's parents argue that she would want to receive artificial feeding if she were able to make her wishes known; her husband believes she would not wish to be so treated if she were aware of her condition. The many Florida courts that have heard this case have consistently sided with the husband.

This case would have been ''easier" if Schiavo had created a living will or similar document that specified her wishes as to how she would wish to be treated in this circumstance.

But, in the absence of such a document, a decision to treat or not to treat still needs to be made. With the extensive scrutiny of the Florida courts, it is hard to conclude that her husband's decision was wrong or abusive in any way.

It is understandable why Schiavo's parents wish to continue treatment. There is no greater tragedy a person can suffer than the death of a child. But recognizing this does not lead to the conclusion that the parents should make this decision. It is wrong to subject a person to inappropriate and unwanted medical interventions as a way of treating the grief of a parent.

The scandal in the Schiavo case does not involve her parents or her husband. The scandal starts with the grandstanding of Florida Governor Jeb Bush and ''right to life" groups who wish to use this sad family dispute to make political points in their antichoice agenda.

And the scandal continues in Congress, where some conservative members have tried to interject themselves into this heart-wrenching family dispute as an apparent sop to their evangelical right-wing constituents.

Indeed, Senate Majority Leader Bill Frist, a surgeon, has gone so far as to say that his review of televised videotapes indicates that Schiavo is not in a vegetative state.

Frist's long-distance diagnosis clearly deviates from anything resembling good medical practice. It is nothing short of remarkable that this surgeon, who has never been in the same room with Schiavo, feels free to disregard the diagnosis of the neurologists who have had extensive contact with her and who have been subject to the scrutiny of the Florida courts.

These people are not conservatives. They are radicals who eagerly ignore the needs and desires of Terri Schiavo to further their own agenda.

Real ''conservatives" do not believe the federal government belongs in the hospital room to tell families what they can and cannot do.

Leonard H. Glantz is professor of health law at Boston University School of Public Health.

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