The Consequences of Casual Conversations

One evening, during the second term of President Ronald Reagan, Terri Schiavo and her husband Michael decided to watch a television movie about Karen Ann Quinlan. Quinlan, as most readers know, had a tragic life. After overdosing on a combination of drugs and alcohol, she fell into unconsciousness and never awakened. Her parents won a lawsuit in the New Jersey Supreme Court allowing them to disconnect her ventilator. Karen didn’t die immediately—she lived on for 10 more years before finally expiring from pneumonia.

While discussing the movie, Michael claims that Terri stated she would not want to live hooked up to a “machine” (she’s not), or be a “burden” (her parents don’t consider her a burden and want to care for her). Michael’s brother, Scott, backs up his claim, while his sister-in-law, Joan, told the court that Terri had approved of pulling the life support from the dying baby of a mutual friend and said that if she ever wrote a “will” she would say that she didn’t want “tubes.”

Little did Terri know that these purported statements, uttered under very casual circumstances, would become the justification used by her husband in his six-year drive to remove her feeding tube and end her life. Indeed, based on these casual statements, Judge George Greer of the Sixth Judicial Circuit in Clearwater, Florida ruled that Michael had established “by clear and convincing evidence”—the highest evidentiary standard in civil law—that Terri would rather dehydrate to death over a period of 10-14 days than live on food and water supplied by a feeding tube.

This aspect of Terri’s case deserves far more attention that it is receiving. Most of us have undoubtedly made similar casual statements in response to the death of a relative or the emotions generated by a movie. But shouldn’t much more be required to justify the intentional ending of a human life? At the very least, shouldn’t we demand a well thought out, informed, and preferably written statement that not only indicates what is desired, but also shows that reasonable alternatives have been fully considered?

For example, if Terri did say she didn’t want tubes, did she know that it would include a feeding tube and that it could mean a dying process that involved seizures, heaving, nose bleeding, cracked lips, parched tongue, and the extremities becoming cold and mottled? If she did, would that have made a difference to her? And would her opinion have changed if she knew that the statements made to her husband and in-laws would be stretched by Judge Greer to refuse her parents’ reasonable request that before being dehydrated, she be allowed access to rehabilitation that many medical experts believe might permit her to be weaned from the feeding tube altogether?

And what does the statement, “I don’t want tubes,” mean anyway? Perhaps Terri was thinking about the stark atmosphere of a neonatal intensive care unit in which babies may be kept alive by battalions of beeping and buzzing medical machines. But she isn’t in that condition. Or, if she was thinking of Karen Quinlan’s circumstance, she might have conceived of herself spending years on a respirator, which was the treatment at issue in her case. But Terri isn’t on a respirator. The only life support she needs is food and water.

Many dehydration cases have involved such casual statements. The most disturbing of these was that of Marjorie Nighbert, which, ironically, also occurred in Florida. Marjorie was a successful Ohio businesswoman who was visiting her family in Alabama when she was felled by a stroke that left her disabled but not terminally ill. After being stabilized, she was moved to a nursing home in Florida where, it was hoped, she could be rehabilitated to relearn how to chew and swallow without danger of aspiration. To ensure she was nourished, she was provided a feeding tube.

This presented an excruciating quandary for her brother Maynard, who had a general power of attorney from Marjorie (not power of attorney for health care), as a consequence of which he became her surrogate medical decision-maker. Marjorie had once told her brother that she didn’t want a feeding tube if she were terminally ill. Despite the fact that she was not dying, however, Maynard believed that if she were unable to be weaned off the tube, she would have wanted to die rather than live using the tube for nourishment. When she did not improve, he ordered the tube removed.

As she was slowly dehydrating to death, Marjorie began to ask the staff for food and water. In response to her pleas, members of the nursing staff surreptitiously gave her small amounts. One distraught staffer eventually blew the whistle, leading to a state investigation and a temporary restraining order requiring that Marjorie be nourished

Circuit Court Judge Jere Tolton received the case and appointed attorney William F. Stone to represent Nighbert and to conduct a 24-hour inquiry, the sole issue being whether Marjorie was competent to rescind her power of attorney and make her own decisions. After the rushed investigation, Stone was forced to report to the judge that she was not competent at that time. She had, after all been intentionally malnourished for several weeks. Stone particularly noted that he had been unable to determine whether she was competent when the dehydration commenced.

With Stone’s report in hand, the judge ruled that the dehydration should be completed, apparently on the theory that Marjorie did not have the competence to request the medical treatment of food and water. Before an appalled Stone could appeal, Nighbert died on April 6, 1995.

Society’s approach to the so-called “right to die” has become far too casual. None of us should be made to die because of statements made in casual conversations or due to misconstrued oral directives. The time has come for the best legal minds in the country to draft model legislation that will tighten existing laws so as to give every reasonable legal benefit of the doubt to life rather than, as too often happens now, to slow death by dehydration.

Author Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide. He is the author of “Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder.”