Wednesday, June 1, 2005
I know, I know - many people have been Terri Shiavo'd out but you might want to take the time to read this week's The New York Review of Books, which contains a feature essay by Joan Didion on the Terri Schiavo case. Didion has many criticisms of how the case was handled and of our current use of living wills and other advance directives. She states:
In fact any notion about what Theresa Schiavo wanted or did not want remained essentially unconfirmable, notwithstanding the fact that a Florida court had in effect accepted the hearsay assertions that she had said, at one point, in reference to her husband's dying grandmother and at another while watching a television movie about someone with a feeding tube, "no tubes for me." (Imagine it. You are in your early twenties. You are watching a movie, say on Lifetime, in which someone has a feeding tube. You pick up the empty chip bowl. "No tubes for me," you say as you get up to fill it. What are the chances you have given this even a passing thought?) Most commentators nonetheless seemed inclined to regard Theresa Schiavo's "directive" as a matter of record, even as they undercut their own assumption by reminding us that the "lesson" in the case was "to sit down tonight and write your living will." Living wills, it was frequently said, could be "Terri's legacy."
There was considerable fuzziness here, not least in the reverence accorded the "living will," which seemed increasingly to be another of those well-meant and seemingly unassailable ideas that do not quite work the way we are encouraged to think they work. The chances of being admitted conscious to a hospital without being pressed to produce a living will have become virtually nil, yet any "living will" prepared in advance (as in "advance directive," exactly the document we are pressed to produce) requires us to make specific medical decisions about situations we cannot conceivably anticipate. According to studies cited last year in the Hastings Center Report by a medical researcher and a law professor at the University of Michigan, Angela Fagerlin and Carl E. Schneider, almost a third of such decisions, after periods as short as two years, no longer reflect the wishes of those who made them. The "health care proxy" or durable power of attorney, through which we assign someone we trust to make the decisions we can no longer make, is the better document, but it optimistically presupposes that we will each have with us at end of life "someone we trust."
It is a very interesting read. [bm]