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Mama Deb
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Mama Deb [userpic]
Thoughts shallow and deep

There is a young Marine lieutenant in the office. He is tall and redheaded and in a dark blue uniform, and I keep sneaking looks at him. Especially when he left to make a cellphone call...

1. The Federal government has absolutely no place in this, and no one should make political hay out of a family's tragedy.

2. To my husband and others: If I am *ever* (God forbid!) in such a position, do not do anything to hasten my death. Do not starve me to death or deny me essential care. Maybe do not do anything prolong life other than essential care and whatever is needed for comfort, and please consult our rabbi at every turn, but do not hasten it.


Talk to your doctor and get a legal 'advance directive' made up specifying exactly what kinds of interventions you would prefer to have, or not, and under what sorts of situations. It's really difficult for a lay person to make these kinds of decisions at the time, especially if they feel pressured on all sides (one relative saying, "don't prolong it", another relative saying, "if there's a 0.0000001 chance, I don't care, radiation, no matter what, do whatever it takes" and on top of that perceived pressure to consider organ donation before the patient's condition deteriorates--though they will not, ever, do anything to hasten your death to get the organs, which many people misunderstand--actually, the reason they want to know early is that they will treat causes of potential organ failure more aggressively, which is better care, not worse).

This is why I specified a rabbi. Because this whole thing is fraught with halachic ramifications (and organ donation is even more fraught) and those are the most important considerations so far as I'm concerned.

This is a total side note, but I'd been told at some point that organ donation was forbidden for observant Jews. Is that correct, or was it another case of close-but-no-cigar misinformation?

Or, perhaps, one of those things where the answer varies depending on whether one is Reform, Conservative or Orthodox?

It's amazingly complicated, is what it is, because bodies are supposed to be intact when you bury them (which means that if someone dies by violence, they are buried in the clothes in which they were killed instead of being washed and dressed in burial clothes so as to get all the blood). On the other hand, an organ transplant will save or prolong a life and that's a good thing, and may well outweigh other considerations.

It's already a battle to not allow autopsies.

Fascinating. I did not know that. I knew the Orthodox did not allow embalming.

I'm Methodist, and there was never a question. As soon as I got a driver's license, I signed the organ donation form, and my folks witnessed it. I've always believed "Take whatever you want, I'm not in it anymore."

If I'm persistantly vegitative, I don't want to be fed through a tube until my family has used all the insurance, all the savings, lost the house and is utterly bankrupt from the cost of it. (Mom was a nursing home nurse and saw such cases frequently)

If, otoh, I have a real chance of a fully functional recovery, please, take whatever measures you can. We'll work out the payments when I'm back at work.

To the best of my limited knowledge it's a controversy :)

You're absolutely right, a rabbi *should* be involved. I hadn't been thinking first and foremost of halachic considerations (though I should have been) because I'm at work, heh--but you're quite right, there are rather a lot of them. Somewhere I have a paper someone sent me on that topic.

I was thinking more along the lines of the doctor in terms of explaining to you what some of the interventions are and how they are used.

I am always hearing people say, oh, they never want to be on X machine, but X machine is a perfectly acceptable treatment for a number of conditions that are *not* permanent, and they don't know that. Or that there are lots of people who are living pretty good lives with the use of X machine. People have visceral reactions to this stuff, which is why I don't think it's appropriate to take a remark someone makes in response to seeing something on TV or in the papers as an indication of what an unconscious patient 'really wants' (and that is what Schiavo's husband is saying).

A lot of people think that Schiavo is on 'heroic measures' but a feeding tube is not a heroic measure. I had a feeding tube once for all of two days.

I wonder if your rabbi could serve as one of the people to help you draw up the documents and to witness them. In California we don't let the patient's physician do this, because of potential conflicts of interest, nor anyone who is a potential inheritor of the patient's estate. Your rabbi is neither.

It's the feeding tube thing that's bothering me right now. Because starving someone to death doesn't strike me as a good thing. Ever.

And I really hate that death seems to be default for so many people.

But many, many people have spent a few days on a ventilator and then been weaned off - or not, but still managed decent lives.

Christopher Reeve, for example.

Thank you for being willing to say that the government should not be involved in this case, even though you would personally want the exact care that's being taken away from Ms. Schiavo. It terrifies me that if it were my husband in her condition, someone who neither knows him nor loves him could come in and tell me that I can't make decisions on his behalf. At least the one good thing that seems to be coming out of this is that people are thinking about what they would want in a similar situation and making their health care wishes known.

ianmcduff, alexandriabrown, and a few others make the most excellent point that the litigation is primarily procedural, and concerning making sure that Ms. Schiavo's right to due process here is observed points of order. They also not that there are other complicating factors, such as her husband refusing to allow tests that would definitively prove that she is in a PVS, and that her family is afraid that he is letting her die so he can take the money from the resulting malpractice suit and use it to support his mistress and her children, and that -- no matter which side of the situation you believe is right -- the case, as it stands stinks to high heaven. They also make the point that what we are mostly seeing in the papers is spin to either one side or the other.

While everyone is certainly entitled to his/her opinion, I would request that even while espousing one side or the other, we remember that these are only opinions, since many of us do not know all the facts of the case.

A good editorial from the New York Sun

The Sages and Mrs. Schiavo

New York Sun Staff Editorial
March 21, 2005

The story is told in the Talmud of the aged and dying rabbi who had become a goses - a person between life and death. The great rabbi cannot die because, as Jonathan Rosen relates in his book "The Talmud and the Internet," outside "all his students are praying for him to live and this is distracting to his soul. His maidservant climbs to the roof of the hut where the Rabbi is dying and hurls a clay vessel to the ground. The sound diverts the students, who stop praying. In that moment, the Rabbi dies and his soul goes to heaven. The servant, too, the Talmud says, is guaranteed her place in the world to come.

We found ourselves thinking of that story as the crowds of citizens gathered outside the hospice of Terry Schiavo - and in many other places - to pray for her, while inside doctors, given the go-ahead by a court in Florida, disconnected Mrs. Schiavo's feeding tubes on instructions of her husband. As the drama intensified Mrs. Schiavo's parents scrambled with allies to gain in the Congress passage of a law that would enable the federal courts to take over the case, and President Bush returned to Washington from Texas to be in a position to sign it.

What an extraordinary country America is that such a drama can erupt over the life of a single individual. It seems to us plain on its face - given the way things have gone so far - that the secular law, at least up until the weekend, was with Terry's husband, who wants to let her die and had already before the weekend's drama proven himself prepared to remove the feeding tubes. But it is also plain that millions of Americans, Christians and Jews and Muslims, are praying for an outcome that can be summed up in the biblical admonition, "choose life." That is certainly the formulation that President Bush has cited.

The drama sent us to reading about our obligations in respect, first, of a goses. The term derives from the troubled breathing sound that a dying person makes in what is sometimes called the death rattle, when death is actually coming, irreversibly, and is imminent. Even in the case of a goses, Jewish law requires that everything must be done to save a goses and no action may be taken that would hasten death. And there is another category than a goses, called a terefah, which is an incurably ill person. According to Maimonides, as cited by a contemporary American rabbi, Elliott Dorff, one who kills a terefah is not subject to the death penalty for murder, but may be subject to divine punishment.

Yet Mrs. Schiavo is neither a goses nor a terefah. She is a woman who can breathe well on her own. Mrs. Schiavo is more like an infant or a helpless old person or an Alzheimer's patient, unable to eat or drink on her own, but able to breath and survive if helped to eat and drink. This is why many religious Americans are praying so fervently for Mrs. Schiavo's life to be spared and this is why the Congress is scrambling. Were Mrs. Schiavo's husband or nurse able to rush, figuratively, to the roof of her hospice and drop a clay pot onto the pavement below, startling those who are praying for her and interrupting their prayers, it seems that Mrs. Schiavo's soul would not be released. She would continue breathing on her own and become hungry and in need of food and water.

Is the intensity of the contest for the life of Mrs. Schiavo a cipher for a larger struggle in our polity, over values, say, or abortion? Here we think of another sage who took, late in his own life, to telling those who asked about abortion, "Let's talk, for a moment, about not the beginning of life but the end." We speak of Robert L. Bartley of the Wall Street Journal. He was wise enough to see that the two questions are at some deep level connected. And full of important subtleties and maddening, painful problems. It may be that the secular authorities will, and should, decide this. But in thinking about Mrs. Schiavo we have found ourselves impressed more than anything with the fact that the questions our country is facing are not new and have been wrestled with for centuries by the sages who interpret laws that are more enduring than those of any legislature.


Re: A good editorial from the New York Sun

The concepts in the editorial are mostly good. There's just one problem:

Mrs. Schiavo is more like an infant or a helpless old person or an Alzheimer's patient, unable to eat or drink on her own, but able to breath and survive if helped to eat and drink.

This is in serious dispute. From all accounts of the doctors who have examined her, and not the edited videotapes, she can breathe and may (I've heard conflicting reports of this) be capable of swallowing, as a reflex, if properly stimulated.

CAT scans from some years ago show that her cerebral cortex (in which all higher brain functions are performed) degenerated long ago, and has been replaced by spinal fluid. All medical knowledge indicates that adult brain tissue never, ever regenerates.

In my mind, that makes her at best a goses. I have inquired elsewhere about the definition of death under halacha; it's a serious inquiry, and clearly relevant. If there's no personhood remaining, and no hope of it returning, is the body alive or dead? And if dead, what should be done to bring cellular function in line with the definition?

Not easy, and not in any event anything other than tragic.

Re: A good editorial from the New York Sun

All medical knowledge indicates that adult brain tissue never, ever regenerates.

Please don't believe that I'm trying to make this point in the Schiavo case, of which I don't know enough; but this is not so certain. There have been instances of braincells re-routing information & expanding to allot brainpower to information usually otherwise processed. The correct assessment here, is that medical knowledge knows very little still.

Re: A good editorial from the New York Sun

With regard to rerouting, yes, the brain does that. What you're thinking of, though, is all done within the segment of the brain called the cerebral cortex. If it's damaged, thought and memory processes can happen in ways that would not normally have happened, taking alternate pathways and such.

The problem is that Ms. Schiavo apparently has essentially none of that portion of her brain left. The initial damage and further degeneration (common in this sort of case) have left only the portions of her brain responsible for reflexes, such as breathing and regulating heartbeat. There's nothing to reroute within.

While medical knowledge is, in fact, limited compared to what there is to be known, in all of the body of knowledge currently accumulated there is no indication of cerebral cortex material regenerating in an adult. That's what I was trying to say; not at all that we know everything about the brain. But everything I have seen, all the evidence, suggests that the portion that made her a unique and aware being, is gone.

I just wish there were some way to handle this that was less painful, all around.

The New York Sun is an interesting paper. I've heard the Talmudic story before, although the version I heard (or possibly misheard) was that it was the maidservant who was praying and who had to be stopped.

I do know that by Jewish law, she's alive. I also know that she's not Jewish, so it's not relevent to her - what's relevent to her are her wishes, her religion's norms and, yes, the wishes of her family.

And neither congress nor any but the local courts should have any say in the matter at all.