Essay by Dr. Michael Degnan

The plight of Terri Schiavo and her family is tragic. Still more tragic is the situation escalating into a national sensation involving the President, Congress and the Federal Courts.

Food and water to a human being who is not dying and who can be benefited from this sustenance are basic needs to which each member of our community is entitled. In the first court case where Michael Schiavo first sought to remove his wife's water and feeding tubes two doctors testified that after spending 45 minutes to an hour with her, they believed that she was aware of the people around her. She responded differently to her parents speaking to her than to strangers speaking to her. She broke into a wide smile and calmed after her mother spoke with her which was unlike any pattern of unconscious responses these doctors had seen in unconscious patients. Nurses who worked with Terri also reported such differences. The doctors who judged her to be unconscious and in an irreversible persistent vegetative state spent 15 minutes observing Terri. Even if the diagnosis of persistent vegetative state is correct, the criteria for this diagnosis fail to exclude the possibility of consciousness in the patient. The criteria do not allow for the possibility of consciousness of one's own mental state, for consciousness is defined as awareness of the external world. On that criteria none of us are conscious while dreaming. Neither do they allow for a more basic awareness of pain and pleasure that does not require the activation of the cortical areas damaged in Terri's brain. It is reasonable to believe that Terri has some level of consciousness.

Michael's memory that his wife told him she would not want to continue to live in this state did not come to him until after Terri had won close to a million dollars in a malpractice suit that Michael filed on his wife's behalf. In fact in that suit Michael sought the money to be used for care for his wife. Her medical situation prior to that suit and after that suit had not changed significantly. Yet after the money was banked, he reportedly refused to have his wife receive the physical therapy she had received prior to the malpractice award. Only after the malpractice award did Michael use that money to hire lawyers and doctors to make the case for removal of the water and food tube for his wife. While Michael's lawyer claims that Terri has a constitutional right to refuse food and water, there are good reasons for not believing her husband's recollection. In addition, the responsiveness Terri showed to physical therapy in the early years following her brain injury and that she still has shown recently belie the claim that she wants to die by starvation and dehydration.

The Catholic Church has consistently taught that extraordinary means, treatments and procedures that offer little or no hope of reasonable benefit for an individual, may be removed or not begun without intending the death of the individual. In these cases the patient's death is foreseen, but not necessarily intended. The intention is to remove or not initiate a treatment that offers little or no benefit for the patient. However, if the treatment or procedure offers reasonable hope of benefit, then the physician or family are obligated to give it to the patient. Refusal to give the individual such ordinary means is tantamount to intending the individual's death. For example, if parents of a Down syndrome child discover that their child has an intestinal obstruction whose removal offers an excellent likelihood of benefit and the parents refuse to have the child undergo the surgery, then it is reasonable to conclude that the parents intend the death of their child.

By contrast, parents who fail to order food for their newborn who lacks a digestive system are not necessarily intending their child's death for in this case the food does not offer a reasonable hope of benefiting the child. In Terri Schiavo's case the food and water offer her reasonable benefit: they keep her alive, able to receive the benefits of physical therapy and avoid the likely deep thalamic-based conscious experience of pain associated with starvation and dehydration.

The legislation passed by the Congress and signed by the President had support from both Democrats and Republicans. In addition to support from conservatives and pro-life citizens, the disability rights communities and some civil rights organizations supported the legislation. Federal oversight of state courts that failed to protect the civil rights of African Americans in the late 1950's is the precedent for this Congressional action.

In the end, the federal courts may not rule in Terri's favor for they may be precluded from reconsidering the legitimacy of Michael Schiavo's claim that removal of the means of food and water are what Terri would have wanted. The Congressional act that directed the Federal courts to consider the case may be deemed unconstitutional. If so, our legal system will have followed its course. But justice for Terri Schiavo and her family will not have been realized.

Dr. Michael Degnan

NCPD Board member and

Professor of Philosophy

University of St. Thomas , St. Paul , MN