TERRY SHIAVO

by Pastor Steve Lagoon

Now that Terri Shiavo has passed from this life, I would like to take the opportunity to reflect on the issues raised by her case, and the great implications involved. For the record, while the issues involved in Terri Shiavo's case are more complex than the soundbites we hear in the media, one thing is clear; there was no justification for disconnecting her feeding tubes and it is hard to escape the conclusion that Terri Shiavo was murdered while a nation watched.

However, in an effort to be fair, I have tried to understand those who supported removing Terri Shiavo's feeding tube. As I understand it, their basic argument is that since Terri Shiavo was in a "Persistent Vegetative State" or "PVS," there was no moral obligation to use extraordinary means to keep her alive (dialysis, ventilators, feeding tubes etc). For those in a PVS, the argument goes, feeding tubes are indeed an extraordinary medical measure since those in a PVS cannot eat and would naturally die without them.

Therefore, removing the feeding tube(s) was not an act of killing, but rather was allowing Terri Shiavo to die with dignity. It was no different, then, from the many families who have had to make the difficult decision to "pull the plug" on other medical equipment, and allow a loved one to die. The only difference is the amount of time it takes for the patient to die when feeding tubes are removed (one to two weeks), compared with the much shorter time when dialysis or ventilators are discontinued.

Further, since Terri Shiavo was in a PVS, she had no awareness of her own existence or her environment, and therefore, keeping her alive through the administration of a feeding tube was pointless. Removing the feeding tube was actually an act of mercy that saved Terri Shiavo from enduring years of needless and purposeless existence.

It is also argued that persons in a PVS should be able to choose whether they want to be kept alive, either through some form of a living will or through the decisions of their loved ones. Since Terri Shiavo did not leave any type of living will, her husband was legally empowered to make healthcare decisions for her. His claim was that she did not want to live in a PVS.

This seems to be a powerful position. What do we say in response?

To begin with, I agree that it is difficult to argue that food and water through a feeding tube is essentially different from other extraordinary medical procedures like dialysis or ventilators. On the surface, there are similarities. Just as feeding tubes aid the body in eating (the digestive system), so ventilators aid the body in the process of breathing, and dialysis aids the body in cleansing the blood.

Yet, there is widespread instinctive or intuitive understanding that there is a difference, and the evidence supports this conclusion. For example, Terri Shiavo's body was fully functional, including her digestive system (which is controlled by the autonomic or involuntary muscle system). The problem was that she was not aware enough to control the voluntary muscles involved with chewing and swallowing food. If Terri Shiavo had suddenly regained her previous mental state, she would have been fully healthy.

On the other hand, those who have need of dialysis or ventilators have a true need for lifesaving equipment to keep them alive. In our culture, we respect the right of folks to refuse such advanced medical treatments (organ transplants, dialysis, ventilators), but we don't allow people to refuse to eat which is a form of suicide. This means that while it may be reasonable for people (or those acting in their interest) to refuse extraordinary medical procedures like dialysis, it is never acceptable to discontinue a patient's food and water (even at their own request, which would be a form of suicide).

Further, the equipment used for life support (dialysis, ventilators) actually replaces or aids the body in functions the body cannot perform. For instance, because of the failure of kidneys, dialysis performs its function in its place. But what about a ventilator? It may be argued that it is similar to a feeding tube in that it merely gets air into the body's respiratory system. But whereas, a feeding tube gets food into the digestive system because the patient cannot feed themselves, a ventilator does not just get air into the airway (obviously air is always available), but it actually takes "over respiration (and thus maintain life) in a person who has lost or who lacks the ability to breathe naturally" (The American Medical Association Home Medical Encyclopedia, Random House, 1989, Vol. 2, p.1044).

So, if a patient is in a PVS and on a ventilator, even if they regained their normal mental state, they would still die without the ventilator. On the other hand, if a patient in a PVS (like Terri Shiavo) who only has a feeding tube regained their normal mental state, they would be completely healthy and not need any extraordinary medical equipment to live. It is clear that a feeding tube does not replace or aid the body's digestive system, but merely gets the food into the body, so the fully functioning digestive system can do its work.

It is important that people understand key terms in this debate. When a person is truly "brain dead," they cannot live very long, even with aggressive medical intervention. Often they are only kept alive long enough to harvest any donated organs. People who are diagnosed as being in a PVS are not brain dead. There is brain activity in those who are in a PVS. Nor are those in a PVS facing immanent death. Further, there are cases of people who were diagnosed as in a PVS who later returned to normal. Even more amazing, some who are diagnosed as brain dead make a recovery as was the case of John Cordero who was diagnosed as brain dead at Saint Luke's Hospital in Duluth Minnesota in 2004 (Duluth News Tribune, July 22, 2004). This should give us pause and cause us to err on the side of life.

Sometimes you hear it said that it is acceptable to discontinue food and water because the patient is dying anyway. But if they are really dying, you don't need to discontinue their nutrition or hydration; they are going to die anyway. The only time that it is justified to stop nutrition and hydration is when it as a result of the actual dying process, the food and hydration are no longer absorbed by the body, or even causes the suffering of the dying patient (i.e. lungs filling up with fluid).

Those who are informed by the Bible approach the situation with a unique perspective. At the very beginning,
the Bible informs us that man is made in the image of God (Genesis 1:26-27). This means that man's value is
not dependent on what he can do (his so-called quality of life), but on whom he is: a creation of God with
inherent value.

We also learn here that life itself is a gift of God, and that no one has the right to take the life of an innocent person (Exodus 20:13). It also makes clear that though suffering is tragic, God can bring meaning and purpose to it (i.e. the book of Job). Jesus also taught that "it is more blessed to give that receive" (Acts 20:35). That is, there is more real satisfaction and joy in life in serving others than there is in living life for one's own pleasure.

This is all to say that it should not and does not matter what the intellectual level of, or the quality of life of a person is. It is simply wrong to kill innocent human beings. If starving those who are in a PVS is justified because of their limited awareness, is starving those who are suffering from Alzheimers or other forms of dementia also justified? We answer with an emphatic no.

Against our self-centered, self-serving culture, the Bible shows the great value in caring for those less fortunate than us. Rather than starving them, let us embrace the Terri Shiavo's of the world with the love of Jesus Christ.

Steve Lagoon, Woodbury Minnesota
April 2, 2005
Steve Lagoon is the Director of Christian Apologetics Ministries and
Pastor of Faith Community Church of Independence