Deep divide seen on fate of incapacitated
WASHINGTON -- Once again, the collision of law, politics, and a tortured family saga has jolted America into a discussion of a complex social concern -- in this case, who should decide whether to remove sustenance from an incapacitated person.
As in the debate over race and justice in the O.J. Simpson case, and communism and child custody in the Elian Gonzalez dispute, emotions have run high across the country.
And like those previous episodes, the Terri Schiavo case may have done more to define divisions than to change minds, according to political observers, activists, and medical ethicists interviewed late last week.
''The Schiavo case clearly tapped into some very strong feelings," said Dr. Arthur Caplan, chair of the medical ethics department at the University of Pennsylvania Medical School. ''But the system actually worked pretty well."
Caplan noted that the original decision by a Florida judge in 2000, after an extensive hearing to determine whether Schiavo would have wanted to continue her life on a feeding tube, withstood repeated legal challenges. Polls suggested a majority of Americans agreed with the outcome.
But for many, even some who opposed 11th-hour legal and legislative attempts to keep Schiavo alive, the wait while Schiavo's body gradually weakened from lack of nourishment was painful. During that time, medical ethicists believe, many people sitting around their kitchen tables contemplated their own wishes should they become severely incapacitated.
''One legacy of this very tough case is that it triggered a lot of discussions among family members," Caplan said. ''There will be more clarity about what people want and how they want it handled."
Dr. Michael Grodin, chief ethicist for 26 years at the Boston Medical Center, said, ''More people are now talking about healthcare proxies" -- the naming of a relative or friend to make medical decisions for them if they are incapacitated.
''It's a moral obligation to find a healthcare proxy," Grodin added, noting that Massachusetts residents can simply write out their wishes, with two witnesses, and do not need a lawyer or notary public. He also said that while many people want their spouse or children to make decisions for them, others prefer a less emotionally invested friend or adviser.
Grodin, like Caplan, bristled at the efforts of President Bush and Congress to allow federal judges to intervene in a case where, in the course of a seven-year legal battle, a state judge had already ruled and many others had reviewed and upheld that ruling. Grodin said he believes doctors and relatives of patients will become more reluctant to authorize the use of artificial life-sustaining measures, believing that once those procedures begin, other family members could come forward to challenge any decision to end them.
''I always talk about trials with families -- 'Let's try it, see what happens,' " Grodin said, referring to life-sustaining measures. ''My fear is that people won't want to start it because they fear they won't be able to stop it."
Indeed, as Schiavo's life drained away, social conservatives vowed to use her fate to press for stronger legal protections against the removal of life support. Some leaders of conservative Christian groups called for the appointment of judges who value the ''culture of life" strongly enough to block the removal of a feeding tube in any case like Schiavo's.
''The grass roots is not only chagrined at left-wing activist judges who impose their views on a whole host of areas, such as gay marriage in Massachusetts; there is also simmering anger at the Republican Party for not being careful enough with their court appointments," said Gary Bauer, president of American Values, a social-conservative organization based in Washington.
Bauer and many other leaders of the religious right plan to press Bush and Congress to allow federal judges to review state-court cases involving the removal of life-sustaining equipment.
Some political observers believe that House majority leader Tom DeLay, the Texas Republican who led the efforts to get Congress involved in the Schiavo case, and Senate majority leader Bill Frist, the Tennessee Republican who cited his experience as a doctor to urge greater scrutiny of Schiavo's condition, will heed the call of religious conservatives.
Frist, who is widely believed to be testing the waters for a 2008 presidential race, has a political incentive to shore up his credentials with the religious right.
But public resistance to federal involvement in such cases -- 82 percent of those polled by CBS last week said they believe Congress and Bush should have stayed out of the Schiavo matter -- will give many members of Congress pause, even if DeLay and Frist push ahead with legislation, others said.
Moreover, polls suggest public opinion cuts across party lines: Some Republicans are skeptical of greater congressional involvement in such cases as Schiavo's, just as some Democrats favor it.
''This will be a litmus test issue for some -- but I think there are others who are put off by federal involvement in these cases," Caplan said. ''They may vote less on [Schiavo's fate] than on images of Tom DeLay interfering."
