March 22, 2005
Tuesday

Washington - As the country stood in rapt attention Monday over what will become of Terri Schiavo, the American medical community reacted with uncertainty and some criticism of Congress for injecting itself into the family battle over her fate.

Some saw in the congressional intervention and President Bush's signature the return of a more unsettled period over the legal status of end-of-life decisions.

The legislation, which cleared the Senate Friday on a voice vote and the House early Monday on a 203-58 vote, orders a new round of federal court review for a case that already had been before 16 judges.

U.S. District Judge James D. Whittemore heard arguments in the case in his Tampa, Fla., courtroom Monday but did not rule on the case, or say when he would. A feeding tube was removed from Schiavo on Friday after a judge ruled that doing so was consistent with her wishes.

At the White House, the Bush administration defended the action amid public opinion polls showing strong opposition to federal intervention. Spokesmen said there were special circumstances warranting the legislation narrowly written to apply only to Terri Schiavo.

Bush, in Tucson, Ariz., told reporters that the legislation he flew back to Washington to sign gives Schiavo's parents "another opportunity to save their daughter's life."

"This is a complex case," Bush said. "But in extraordinary circumstances like this, it is always wise to err on the side of life."

Some hospice advocates said they saw little in the Schiavo case that seemed unusual, other than the depth of the family's division. They said such end-of-life decisions are made so routinely in hospitals that there are standards and protocols for multiple layers of medical and ethics review.

"Terri Schiavo unfortunately is not the only person in the United States in this situation," said Les Morgan, president of Growth House, an arm of the Inter-Institutional Collaborating Network on End of Life Care. "Everyday, families struggle with this." Terri Schiavo has been in what doctors call a "persistent vegetative state" for 15 years after her heart stopped beating when she was 26, apparently because of a chemical imbalance caused by an eating disorder. Her heartbeat was restored but by then her brain had been severely damaged.

Her husband, Michael, and other family members testified that she had said she would never want to be kept alive artificially. But the woman's wishes were never formally written down and her parents disputed that she would ever say such a thing.

Her parents, Bob and Mary Schindler, praised the new law, and immediately sought to reverse the verdict of the state courts. Their case has been championed by right-to-life organizations that also oppose abortion.

Before the federal case reached Whittemore, Michael Schiavo's efforts to remove her feeding tube had resulted in nearly two dozen hearings in front of nearly as many different judges, and a federal appeal had previously been turned down for review by the U.S. Supreme Court. The federal law orders another federal court review.

Republican leaders hailed the action as a triumph for what Bush describes as a "culture of life." House Majority Leader Tom DeLay of Texas called the legislation a "Palm Sunday compromise."

Although 53 Democrats opposed the measure in voting early Monday, their criticism was muted in recognition of the fact that nearly as many Democrats (47) voted for the measure.

In stepping into the dispute on behalf of the woman's parents and against the court-recognized wishes of Terri Schiavo, University of California, Davis Medical School bio-ethicist Ben Rich is among those who see the politics creeping back into what had been a settled issue.

"I feel like we've gotten into a time warp," said Rich. "We're rolling back the clock to pre-Cruzan days where we didn't accept situations where there was a fate worse than death."

Nancy Cruzan was the brain-dead woman whose case produced the landmark 1990 U.S. Supreme Court decision upholding the constitutionality of Missouri's legal standards for terminating life support.

Hospice organizations that provide comfort to the dying were hoping that if any good came from the intense public spotlight on the Schiavo case, it would be that the people better understand the imperative of having living wills or similar such declarations in place so that their own end-of-life wishes don't become fodder for midnight votes in the Congress.

"Her situation is a terrible tragedy for everyone," said Margaret Clausen, executive director of the California Hospice and Palliative Care Association. "I think this is a really is a family matter and a judicial matter and I am disappointed to see the executive branch and the legislative branch getting involved.

"But the greatest lesson is for people to communicate with those who care about you about how you want your end-of-life to be when you can't speak for yourself," she said. "If you want your wishes honored - whatever your wishes are - they need to be written down."

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