Saturday, July 23, 2011

"Allowed to die" a quick lesson in media manipulation

Today the Daily Mail is running a poll with the question, "Should 'minimally conscious' patients be allowed to die?

As of this writing, 29% said No, 71% said yes.

I have to wonder though, if the people who clicked Yes had given much thought to the form of the question. Something I learned as a lobbyist paying close attention to various pieces of legislation is to always look very closely indeed at the pages of the bill that give the definitions of terms. What does it mean to be "allowed to die"? And what, exactly, are we talking about when we refer to "minimally conscious" people?

I'll help here with some research I have done into the question at hand. In the cases I have studied closely, that of Terri Schiavo in the US and Eluana Englaro in Italy, neither woman was a) terminally ill, b) on a respirator c) sick in any way. Both were brain damaged, but the damage did not impair any of their vital bodily functions. In both cases, the only care they needed was ordinary nursing care, bathing, clothing and, most crucially, feeding. Both of them could have lived a normal lifespan if these had been continued.

In the case of Terri Schiavo, her family made it public knowledge that she was not "in a coma," not in a "vegetative state". In her case, the public was shown video and photographs of Terri awake and responsive to the people and stimuli around her. In the case of Eluana Englaro, although we were shown no photos, it was revealed to the public that she was not ill, was not on a respirator, was not in a coma and required only food and hydration via a feeding tube. In the US, the delivery of food and water via a tube is classified as "medical treatment" that can be refused by a patient or (and here's what killed Terri) by a patient's guardian. In Italy this is not the case, but the artificial delivery of food and water was not specifically dealt with in law. However, in both countries, "assisting a suicide" is an offense, as is homicide.

We are all aware of the media frenzy, including a great deal of misdirection, surrounding the case of Terri Schiavo. In Italy, there was also a loud uproar and the media paid a great deal of attention to the case, particularly towards the end of Eluana's life. In most cases, the media consistently used this phrase: "allowed to die," a piece of deliberate and conscious misdirection, that I maintain is maliciously motivated to promote the cause of legalised assisted suicide and euthanasia, a favourite cause on the left in Europe and the US.

In parliaments too, the phrase is consistently used as a type of pacifier by legislators trying to lift prohibitions on assisted suicide. It sound quite natural and harmless doesn't it, and it plays on the perfectly moral principle that patients who are near to death from illness should be able to refuse extraordinary, aggressive or painful procedures if there is little chance that they will significantly prolong life.

If a cancer patient is in the last stages of the disease and all normal measures have been taken, everyone agrees that it is not only perfectly licit but in fact desirable to provide palliative care and allow the patient and their loved ones some quiet time before the end.

But the question asked by the Daily Mail above doesn't mention "terminally ill" patients. It doesn't specify that a person who is potentially to be "allowed to die" is about to do so anyway and is being plagued with aggressive extraordinary treatments. All it says is "minimally conscious" and "allowed to die".

Let's examine the following scenario. A healthy person has been drugged into minimal consciousness. He is strapped to a gurney and wheeled into a room and left there without provision for food and water.

Now, ask the following question: Is he being murdered or is he being "allowed to die"?

Now, let's examine another scenario. A healthy person is in a car accident and is rushed to the hospital with a severe head injury. It is determined in the hospital that although she remains otherwise healthy and undamaged, her brain function is never going to be what it was and she will require help with feeding, dressing and bathing etc., very likely for the rest of her life which, barring future illness, should be a normal span. She is taken to a nursing home run by nuns who are happy to take on the duties of caring for her for the rest of her life. This includes delivery of food and water via a stomach tube.

If the nuns then removed her food and hydration tube and refused to care for her and she died, should they be liable for charges of neglect causing death? Perhaps even homicide?

Is it "allowing a person to die" if he is helpless and is refused food and water?

I wonder how the British public would be answering a poll question like the following:

"Should vulnerable patients be deliberately starved and dehydrated to death when their lives are deemed to be worthless by a hospital ethics committee?"



Happy walker said...
This comment has been removed by a blog administrator.
Hilary Jane Margaret White said...

Tell you should be allowed to die: spammers and people using my commbox for advertising.

Die spammers!

Sean M. Brooks said...

Hi, Hilary Jane!

I absolutely agree with your latest column. Injured or ill persons who are not TERMNINALLY ill should not be MURDERED by the deliberate refusal to give them food or hydration.

And it is a correct principle of Catholic ethics that patients who are not likely to recover can rightly refuse extraordinary means of treatment unlikely to succeed.

Sincerely, Sean M. Brooks

Anonymous said...

The brilliant television program Yes, Minister covered this topic years ago:

In short, you can get any result you want on any poll about any subject, without ever actually lying about the results.

Michael Demers said...

The devil is in the details. Look at the mess Obamacare is creating for us Americans.

Anonymous said...

This issue probably troubles me than any other. I've had relatives effectively starved to death (they were comatose, but perhaps stayed that way because they were being starved). Recently had a young, smart, pretty doctor lobby for permission not to treat an elderly loved one if perhaps reversible cardiac arrest occurred, essentially for quality of life reasons.

The trouble is: there are some legitimate arguments the other way.

First, feeding by a stomach tube (for example) is indeed medical treatment, regardless of what JPII said. Try and get the average person off the street to insert a tube for arterial feeding, and see what happens.

Second, it could be argued that a lengthy indeterminate period of inability to feed oneself or to consent to artificial feeding does place one in the "dying" category. Certainly, in the rural Canada of a couple of generations ago one would be dying in that case, and no one was being murdered.

So, it seems to me that it boils down to what is morally demanded of us, given the level of wealth and expertise in a given society. It may be that rich Western societies are morally obligated to provide artificial feeding and care. However, in that case we would not be dealing with moral absolutes, like the principle not to kill the innocent. What is due and required would turn on a variety of factors.


hyoomik said...

I see people in their 90s routinely getting quadruple bypasses (probably the cost of a new house). Meanwhile other people are dying of c. difficile in hospitals where the rooms are not even cleaned thoroughly in the course of a week. In a socialist and utilitarian health system, the concept of extraordinary vs. ordinary treatment gets really confused.
(verification "word": kninate)

Anonymous said...


An excellent observation.

I recall reading 1940s-1960s American Catholic medical ethics texts during my undergrad days. The private payment model also brings these issues - and the distinction between ordinary and extraordinary - into stark relief. Indeed, the choices and questions are heightened and clarified when it involves what individuals (and families) owe to themselves and to their family members.

When it comes to positive care, one must ultimately ask: (1) Who must provide this care? (2) Who must pay for it? (3) For how long must it be provided? (4)(a) What other goals, things, aspirations, needs, desires are we obligated to sacrifice - on a moral level - to provide this care? (4)(b) Sacrificed by whom?
(4)(c) For whom?

In another context: What quality of life is owed to California prisoners? Should they be released if the standard of care mandated by the courts is not met by the public authorities? I'm not equating prisoners with law-abiding medical patients, but it does illustrate the question: Who owes what to whom, and why?

Anonymous said...

Sorry, comment #8 was by GJJ.