The worst form of opportunism -- March 18, 2005

Carlton Vogt's

Enterprise Ethics

Volume 3 Number 8 March 18, 2005

The worst form of opportunism

The least competent people to make end-of-life decisions for others are politicians

As a medical ethicist, and one who has consulted on difficult end-of-life issues, I watched horrified this past week as Terri Schiavo, the unfortunate Florida woman at the center of a life-support case, became a political football.

In my book there are several people, or groups of people, who should be involved in these decisions. They are, in order of descending importance and authority:

The patient him/herself, either directly or through advance directives.
The patient's designated proxy medical decision-maker.
The family.

And, in the most tragic cases, the courts.

You'll notice that nowhere on my list is either a state legislature or the U.S. Congress -- and that's a deliberate omission. No politician or group of politicians should be involved in such personal and weighty matters.

Why do you suppose that is? Primarily, it's because politicians, with few commendable exceptions, are almost always looking to the nest election. They are always calculating what action today will get them the most votes tomorrow. We saw this with the Congress abandoning its Constitutional duties in regards to the Iraq invasion -- with members who opposed the invasion rolling over because they were fearful of being labeled unpatriotic in the next election.

Now, the group that gave us the horribly flawed Patriot Act, the duplicitous Medicare drug bill, and the predatory bankruptcy bill -- and is indulging itself in a pointless media circus about steroids in baseball -- wants us to think that it will deliberate the Schiavo case with an eye toward principles instead of votes.

That notion has been put to the lie at least three times in the last week alone. First, there was the grotesque spectacle of a subpoena to have Ms. Schiavo appear before Congress, treating her as some sort of circus freak. She is unable to testify. Members of Congress have no competence to evaluate her condition from a medical standpoint. And the only conceivable purpose of her appearance would have been a media feeding frenzy to sensationalize and emotionalize the case -- and, in the process, use her as a political pawn.

Had Congress needed a first-hand look at Ms. Schiavo -- although I'm not sure what knowledge that would have provided people without a medical or ethical background -- it would have been much less intrusive, although much less sensationalistic, to send a small delegation quietly to see her in her current surrounding. And, in fact, to move Ms. Schiavo, in her current condition, from her familiar surroundings into the carnival-like atmosphere of a Congressional hearing, could be considered a major harm to her.

Next, we saw the Senate majority leader, himself a physician, make a diagnosis based on a videotape which was produced and edited by activists on one side in the controversy. And although he is a heart surgeon, he felt competent to make this difficult neurological assessment long-distance and with flimsy, tainted evidence. Not surprisingly, his diagnosis meshed perfectly with what his conservative "base" wanted to hear.

Then, the cat got out of the bag. I was disappointed, but not at all surprised, when the following surfaced:

"ABC News has obtained talking points circulated among Republican senators explaining why they should vote to intervene in the Schiavo case. Among them: 'This is an important moral issue and the pro-life base will be excited...' and "This is a great political issue... this is a tough issue for Democrats.'"

What "this" really is is political opportunism at its most disgusting and immoral.

I don't know enough about the Schiavo case to offer an opinion about whether her feeding tube should have been removed or not. But I probably know a lot more about the principles involved than most of the people offering weighty opinions, And I'll wager that, even in my relative ignorance, I know more about her condition and its implications than they do.

Unfortunately, much of the information we're getting is being filtered through unreliable sources. And the media, as always, reports complicated issues in a watered-down version that obscures the important details. I suggest that if the media covered this case with one-tenth the vigor they spend on Super Bowl pre-game coverage, we'd all have a much better idea of what's at stake.

This hasn't been a good week for medical ethics or patients' rights. The Congress, by cravenly inserting itself in what is essentially a private matter has reached a new low in political opportunism.

This entire case could have been avoided -- or at least settled quickly -- had Ms. Schiavo left a clear advance directive outlining her wishes in just such a situation. My suggestion to you -- and a very strong one -- is that if you don't have such a directive, put it at the top of your "to-do" list. Don't assume that everything is in place and that your family will step in, somehow intuit what you wish, and then carry out those unspoken, and unwritten, wishes. Make it clear and put it in writing.