As I write, Terri Schiavo is still alive but has been without food or water for more than a week. The Congress, in a startling attack on the federalism which conservatives claim to revere, passed a special bill, creating a previously nonexistent cause of action pertaining in her case only. A federal judge refused to intervene, as did the Court of Appeals and the Supreme Court.
My initial reaction as this spectacle played out in the press was "Oh my God, stay out of it, leave her alone." But my thoughts became much more nuanced as the result of seeing an extremely powerful photograph--one of those pictures, like the screaming girl with the napalm burns from Vietnam, that has the ability in itself to change the outcome of a debate.
In this photograph, Terri Schiavo, who is always described by her husband's doctors and lawyers (in words faithfully echoed by the press at all times) as being in a "persistent vegetative state", appears to be sitting up, looking into her mother's eyes, and smiling. This picture is a revelation. As an ambulance worker, I have carried many comatose people, and my understanding of "persistent vegetative state" would be that the patient lies supine, staring into space, with a vacant expression at all times. Now, medical people know that "comatose" does not describe just one state; we use something called the Glasgow Coma Scale, to determine if someone is more or less comatose, so consciousness is really a spectrum. A dead person (amusingly) scores a three on the scale, and someone in a completely normal state of consciousness a fifteen. The more ability the patient has to move muscles and to react to stimuli, the higher the GCS score.
The words "persistent vegetative state" suggest someone who is very low on the scale, not someone who can sit up and smile. In all fairness to the husband, and all those arguing that Terri is brain-dead, it has been suggested that the picture is a trick, that Terri is not sitting up but propped up on a pillow, that her eyes only appear to be focused on her mom, that the smile is nothing more than a "rictus". Like many of us, I would welcome the opportunity to spend a half hour with Terri in her hospital room, to decide for myself how aware she is. But when I heard the smile described as a meaningless reflex, an automatic act, little alarm bells went off.
It seems possible that we are assigning a woman who retains some cognition, and therefore some quality of life, to a lower mental status, for unspoken purposes.
The Derogation of Life
For years, I was an obsessive fisherman, getting up at four a.m. to haunt favorite ponds, where before daybreak I would catch and release a few bass or bluegills. Because I filed the barbs on my hooks to pop them out of the fish's lip more easly, and because I let every fish go, I told myself I was a humane fisherman, but in the back of my mind there lurked an understanding that I was engaged in the sadistic sport of hurting a living thing for my pleasure. That I was releasing it alive made me a torturer rather than a killer (and some of the fish died anyway, even though I didn't want them to).
Anyone who fishes with his mind and heart open can tell you that fish experience fear and pain. They fight ferociously to get away, pull out yards of line, shake their heads frenetically to throw the hook, leap and thrash. In 1995, when I started publishing The Ethical Spectacle, I wrote in the mission statement that an important goal of mine was to state the obvious, where in general people had conspired to conceal it from themselves, because it is too upsetting. At the time, I was still a fisherman, but within a year or two I quit, when I had to admit that I was obviously hurting animals for pleasure.
Although as a fisherman, I knew fish felt pain, I was aware of an entire literature, much of it written by very intelligent people, who claimed the contrary. In their opinion, fish only have nonsentient automatic reactions, which simulate pain but do not really represent any consciousness on the fish's part. For example, Dr. James D. Rose of the University of Wyoming, who comes to this colorful conclusion (from the Colorado Trout Unlimited web-site, http://www.cotrout.org/do_fish_feel_pain.htm):
The facts about the neurological processes that generate pain make it highly unlikely that fish experience the emotional distress and suffering of pain. Thus, the struggles of a fish don’t signify suffering when the fish is seized in the talons of an osprey, when it is devoured while still alive by a Kodiak bear, or when it is caught by an angler.
According to People for the Ethical Treatment of Animals, quoted on the ESPN web-site (http://espn.go.com/outdoors/conservation/s/c_fea_Becher_fish_pain.html), Dr. Rose is an angler (and Wyoming is certainly a fly-fishing hotspot for rainbow trout). If so, he would have been well-advised to mention it, as a possible conflict of interest, in his article.
There is a lot of other material on the web arguing both sides of this issue. In the end, I'm left with the impression that the only way to settle it would be to metamorphose into a fish--something that one would hope Dr. Rose would eagerly like to do (for one hour) as a way of testing his hypotheses. Since we can't settle it definitively without being a trout, I'm left to rely on my own intuition. Which tells me that if an animal appears in several respects to react the way that I would to the same stimuli--imagine your shock, confusion, and suffering if you suddenly had a hook in your lip--I can't easily rule out the proposition that it feels what I do. Occam's razor would suggest, in fact, that the simplest explanation for two creatures having the same reaction to the same stimuli would be that they are feeling the same thing. That something which looks identical to panic is born of some completely unrelated set of automatic responses is, of course, not impossible, but potentially violates Occam's Razor by seeking a more complicated explanation than necessary.
Why would anyone want to do that? Human arrogance, of the type that produces blindness, is a good reason. Here is Dr. Rose's colorful comparison of fish and human brains:
A fish brain is simple and efficient, and capable of only a limited number of operations, much like a 1949 Volkswagen automobile.... The human brain is more like a modern luxury car with all-wheel drive, climate control, emission controls, electronic fuel injection, anti-theft devices and computerized systems monitoring.
Humans, including very intelligent scientists, have applied these same arguments to the apparent suffering of much higher life-forms than fish. I think we do it because we would otherwise be horrified with our own culture, which slaughters cows, pigs and chickens by the millions for food, euthanizes cats and dogs, etc. But there is also something about science which is terribly reductive. I grew up believing that birds are not really sentient, but exhibit a few pre-programmed behaviors, which they repeat constantly (hence the phrase "bird brain"). Then, when I kept a pet cockatiel, I discovered that he had rather complex likes and dislikes (was irresistibly drawn to McDonald's french fries, always ate the green and yellow pellets from a particular brand of food but left the red ones, was terrified of a loose leather glove on the table and of a blue exercise mat, liked playing with uncooked pasta but was unmoved by most of the commercially available bird toys on the market). There was even some evidence that my bird had dreams, waking up in a thrashing panic sometimes on very quiet nights. If we ever really could acknowledge that birds have emotions and opinions, it would be hard to keep killing chickens (or we would have to transform ourselves into much harder people to continue doing so).
It has been worthwhile pursuing the "animals don't feel" thread because it is on a continuum with the "some humans aren't human" meme, which is in fact its logical conclusion.
The Assault on Language
The proprietors of autocratic murder-states know better than anybody that in order to kill people with impunity--in order to enlist a significant subset of the population in killing people cheerfully--you have to kill language first. The Nazi's grotesque assault on their own German language has been extensively studied:
The debasement of language, the stripping of its shading and moral intensity began in the West long before Hitler and continues after he is gone. It will help us to explain a kind of cauterization of conscience by the use of metaphor and euphemism; to understand that in official Nazi language the extermination of Jews was precisely that-- the disinfectant of lice, the burning of garbage, the incineration of trash, and hence language never had to say exactly what acts its words commanded: kill, burn, murder that old Jew, that middle-aged Jew, that child Jew. Arthur Cohen, The Tremendum, (Continuuum 1993), pp. 7-8.
The Nazi attack on language has had some powerful echoes in our own time. Nazi administrators writing reports on the number of Jews gassed in trucks modified as gas chambers, referred to the victims as "the cargo". This happens to be the same phrase the serial killer Ted Bundy chose (probably without any irony or historical awareness) for the women he abducted and murdered. In order to kill people, we first deny them humanity through our choice of words. It is very instructive to study the extent to which Terri Schiavo has been dehumanized through language.
The constant, unremitting use of "persistent vegetative state" is an example, as it implies that Terri is a vegetable. (A state completely inconsistent with the smiling woman in the picture.) A remarkable article in The New York Times for Friday, March 25, 2005 (p. 14) lists many more euphemisms, without analyzing them as such (no disrespect to John Schwartz, the author, with whom I am slightly acquainted). The title is "Neither 'Starvation' Nor the Suffering It Connotes Apply to Schiavo, Doctors Say."
Everyone in the debate acknowledges that Terri Schiavo will die as a result of the removal of her feeding tube, through which she received nutrition and water. But, apparently, to complete the reductive process, we must not think of this as starvation. Schwartz quotes a number of doctors: "[W]hen a feeding tube is removed, death is caused by dehydration, not loss of nutrition." All right, so Terri will die of thirst before she starves, correct?
[D]espite the emotionally charged language, many doctors say that patients in a persistent vegetative state, like Ms. Schiavo, feel no discomfort when the flow of nutrients through a feeding tube stops.
Apparently Terri feels no more pain than a fish. And then things go really frighteningly overboard:
They contend that the provision of fluids and nutrition should not even be called "feeding". A statement from the American Academy of Neurology states that it should be considered a medical procedure "analogous to other forms of life-sustaining treatment, such as the use of a respirator."
(This last, by the way, suggests that when you disconnect someone from a respirator, you are not asphyxiating her, either.)
Is Terri Schiavo being starved? Obviously; think what it would feel like not to eat or drink for a week. The American Heritage Stedman's Medical Dictionary (at www.dictionary.com) defines "to starve" as "To deprive of food so as to cause suffering or death." Since it is incontrovertible that to deprive a patient of food, is to starve her, the physicians have adopted the really amazing measure of saying that anyone who receives nutrition through a tube is not actually being fed. This assertion would doubtless be startling--and quite frightening--to the many completely alert and oriented patients who, due to throat cancer or other causes, are fed through PEG or nasogastric tubes. The medical dictionary online at http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=feed&action=Search+OMD defines "to feed" as "to supply with nourishment".
What we have is actually a somewhat circular argument. I don't think the doctors really mean that feeding isn't feeding; they are saying, more particularly, that feeding a vegetable is not the same as feeding a human. Even though Terri requires nutrients and water to stay alive, what she does is not really eating, because she isn't conscious to enjoy it:
"No one is denying this woman food and water," Dr. Morrison said. People in a persistent vegetative state, he said, "have no knowledge of food."
But deliberately starving a dog, a bird or possibly even a fish to death would be considered cruelty to animals in most states. We are constantly reading about animal control officers raiding farms and seizing starving horses that the owner no longer has the means to feed. There is no legal or moral principle that I am aware of that says that a being must be able to discourse on food for its withholding to be an immoral or illegal act.
Before the Final Solution, the Nazis had a widespread but quasi-secret program of euthanasia, in which they murdered comatose patients, the mentally disabled, and others. The euphemism they picked for those people they wished to kill was "useless eaters". See Mark P. Mostert, "Useless Eaters: Disability as a Genocidal Marker in Nazi Germany", in the Journal of Special Education 36/No. 3 2002, pp. 155-168 (online at http://www.regent.edu/admin/ctl/uselesseaters/text/2743414051_1.pdf). Mostert quotes a Dr. Tergesten, in a 1941 propaganda film called Ich Klage an: "Would you, if you were a cripple, want to vegetate forever?"
Whenever we perceive an assault on language--like a disturbance in the force--we should look very closely at the underlying events, and ask, what is happening that is making people warp language?
I think that, in order to justify the killing of Terri Schiavo, we are sailing dangerously close to the Nazi use of words.
Killing Terri
By euphemizing everything, so that we are simply withholding life support from a vegetable, we bend language as far as we can away from the idea of a killing. But moral philosophers understand something that these doctors deny. When it comes to killing, what is important is intent, action, and result, not language or even instrumentality. In the movie Diva, a man kills another by holding a light cord over the edge of an open elevator shaft, so when the other leans out to grasp it, he falls. This is as much an intentional killing as if he had bashed in his head with a piece of pipe. To deny food and water to Terri Schiavo is morally indistinguishable from throwing her from an eighth floor window at the hospital. In fact, though we execute people by electrocution, gas, and lethal injection, we have never in this country executed them through starvation and dehydration. There can be no doubt that, if some American state tried this, the Supreme Court, not opposed to other forms of judicial killing, would reject it as "cruel and unusual". Again, the major rationale for killing Terri in this very cruel way is that she is a vegetable.
What Terri Wanted
Of course, the hook this whole proceeding hangs on is that we are carrying out Terri's own wishes. Here we depart from general rules and sink into the facts of the particular case. Terri's wishes are not well known. She did not sign a living will, and there were apparently not multiple witnesses testifying to what she said. The sole witness, as I understand it, was her husband, who said she had told him she would not wish to be sustained by artificial means. I think judges should be very careful about giving too much credence when this is the only testimony. Even noble individuals can have quite powerful unconscious motives in wishing for the death of an incapacitated spouse or relative. In assisted suicide cases, where the wishes of the decedent were quite clear, it is impossible ever to know whether the accused helped the decedent to die out of selflessness or extreme selfishness--the wish to be free, off the hook, to put away from one the distressing shadow of the healthy person whose company one previously enjoyed. Ignoble individuals may have financial or other motives to seek the death of the incapacitated. I think the Florida judge would have been better advised to decide not to pull the plug, in a case in which the parents are urgently asking that their daughter continue to live, and the evidence that she wanted to die is relatively thin.
If Terri's wishes were clearer, I have less problem with their being carried out, though death by dehydration and starvation still seems cruel. When my father was incapacitated, in the last stages of an aggressive lymphoma, and in terrible pain every day, he asked for help. No-one would assist him. When my own cancer comes, I hope to have a clear enough vision of the future, and the decisiveness and means, to look for the exit before I reach that point.
Terri as a Political Football
President Bush's and the Congress' intervention is despicable. The height of absurdity-- one of those rare moments which I created the Spectacle to capture and appreciate--was Tom Delay's comment:
"One thing that God has brought to us is Terri Schiavo to elevate the visibility of what's going on in America. This is exactly the issue that's going on in America [of] attacks against the conservative movement against me and against many others."
Here we have the very entertaining spectacle of one of America's most powerful men, one of the leaders of a party which has nearly absolute power at the moment, painting himself as a beleaguered victim of the ever smaller and more harried opposition.
Conservatives claim to want less powerful government. The Terri Schiavo bill was a slasher-style attack on federalism, promoting the concept that whenever it seems morally (or politically) valuable to do so, Congress can intervene in any issue, whether or not clearly reserved to the states by the Framers.
I felt certain, as events unfolded, that it would end in a Gore v. Bush type Supreme Court decision, with a 5-4 majority mandating the restoration of Terri Schiavo's feeding tube. Here is a rare case of my being too cynical, rather than too naive. Every federal court, up to the Supremes, properly refused to intervene. Not every wrong can be redressed at the federal level, without doing fatal damage to the system.
Of course--evidence of my naivete again--it is quite possible that the purpose of the exercise was not to save Terri Schiavo, but to create the appearance of having tried. Terri has become a political puck, knocked back and forth by the opposing parties and voices, each trying to score a goal or two.
The Case Has Nothing to Do with Abortion
The right-to-lifers feel that if they save Terri, they have scored points against abortion, but I don't see how. The killing of an adult, even one on a coma, has only a metaphorical relation to the D&C of a first trimester fetus. You will only impress people who accept the metaphor in the first place; therefore, they are only preaching to their own side. And for the opposing voices, as a registered Democrat who most often sympathizes with the views of the left, I don't think that by killing Terri we do anything substantial to protect the legal right to abortion. The approach most consistent with human dignity would be to accord Terri Schiavo some, and to regard her solely as a comatose human being, and not a symbol of anything else.
This is a good place to mention that in ten years, I have never written anything in The Spectacle about abortion. My feelings are too complicated, and still need sorting out. But one overlap I do see between the Schiavo case and the abortion debate is that we will resolve both only by fronting realities, and not by warping language.