re: Maureen Dowd – DeLay, Deny and Demagogue; or
Politicans and the awful case of the living-dead Terri Schiavo
New York Times, Thursday, March 23, 2005

http://www.nytimes.com/2005/03/24/opinion/24dowd.html

From my colleague Bob Roberts, sent to me March 24, 2005:

This is what makes me so angry. I know we disagree on the basic issue; I think Michael Schiavo is a liar, and I don't believe he knew, has proof or can prove that Terri wanted to die and personally believe he should be charged with murder if she does. (I'm really suspicious of anyone who has a wife in this state AND another long-term relationship [elsewhere] with kids [involved]. I'm sorry. The vows said "for better or for worse." Perhaps it's my personal experience that drives that, but I find it difficult to believe he's been "there for her" when he goes home to someone else each night.) But I know we agree on one thing ... that the actions of the more-sanctimonious-than-thou group who claim to be in Terri's corner really drive us nuts. For me, it's not so much what they've done but why they're doing it.

I believe, as Dowd does, that none of them care a whit about Terri Schiavo at all and I REALLY object to them loading all of their baggage onto her back. Their overall agenda creeps me out, and this is just more confirmation. I have a right in this country to believe as I see fit and should not have one group's version of The Truth, or whatever you want to call it, shoved down my throat. It's what many of our ancestors came here to avoid, even if most of them weren't particularly tolerant of others' religions.

If the public reaction to the federal attempt at intervention is to build a groundswell against DeLay and Co., I say great, even if I disagree with the majority on this issue. DeLay is evil. Flat out. Something has to stop him.

As for the law, all the more reason to spell out everything in writing ahead of time. I really don't think other people should be forced to "play God" and decide what others might want. My druthers are to err on the side of life because if you guess wrong with the alternative, it's too late. I don't know how you go about prompting people to spell out their end-of-life desires ahead of time. Let's face it ... many people don't even have wills, let alone "living wills." But it's the only way to be certain, and we owe those we love and cherish nothing less.

This bunch is so tax-break happy. Maybe the government should offer a one-time tax break to anyone who can prove they have a living will. To save the controversy and heartbreak, it would be money well spent.

 
From policywonk, sent to Bob March 25, 2005:

Of course we agree about the demagogues and their true reasons and agendas. I'm not so sure that we disagree about erring on the side of life — but my real problem is what we mean by that. Absolutely, people should have living wills — and mine, oddly enough, would stipulate that for as long as I have functioning the part of my brain that actually does the thinking, judging and remembering (NOT just the part that controls autonomic functions like breathing, digesting food, regulating hormones, etc.), I'd want to be kept not only alive but otherwise physically healthy. Gimme those vitamins and antioxidants, please, in a daily parenteral cocktail!! And don't spare the physical therapy until I'm brain dead. But if that thinking part of my brain's gone, never to return, well, I've checked out, folks, and I've got an organ donor signature on the back of my driver's license for the rest.

To me, it's that part of the brain where human consciousness resides that is the deciding factor: if it's working, great, but if it's not and can never again be made to work, that person's dead regardless that the heart's still pumping and lungs are still breathing on their own. Death means the permanent, irretrievable loss of consciousness, i.e. mind, the defining characteristic of our humanity; I'm not referring just to the ability of a person to be awake and alert but to the existence of mind on a human level.

Mere coma means that the physical capacity for consciousness/mind is still there and retrievable. Brain death, of course, means that brain function is gone completely. But there is still that ill-defined in between wherein what physicians currently refer to as a persistent vegetative state may or may not mean that the part of the brain that thinks, reasons and communicates is still working.

There are a few such children born every year (or stillborn, more likely) with part of the physical structure of the brain missing; if they live at all, it's only for hours, days at most. More often, such fetuses are miscarried: nature discards many kinds of genetic failures during pregnancy as mistakes that aren't worth the investment of the mother's physical resources. This is an evolutionary phenomenon that persists over generations, a result of natural selection.

Mind is the product of brain, so where there's an inadequate structure to produce mind, there isn't a person there, merely an incomplete attempt at a person. Clearly, the result is human in origin and yet falls short of meeting the definition of a human being — because the part that is the key defining characteristic, the human mind with its capacity for sophisticated reasoning, was never there. Its presence is wholly dependent on adequate physical structure, which never developed. We dignify such stillborn or short-lived offspring by calling them persons, but that is a matter of traditional consensus, not fact. Out of custom, we call any human fetus that is born dead or alive a human being, because lacking data we still have to draw the line somewhere, and for those born live, it’s a pretty good yardstick. But the presence or absence of mind is where we ought to draw the line.

Once the part of the brain's structure that produces mind stops working, that's it: we know of no way to get it back, because it's like a hard disk that has been not only wiped but physically damaged so that it can't be reprogrammed. Mind is not retrievable at that point — which means the person is gone for good. My understanding of Ms. Schiavo's condition is that her physicians have long agreed that that has been the case almost from the time she first went into a persistent vegetative state. Years, in short. [note to me: at least one blog claims that the cerebral cortex of the brain has liquefied, but I don’t know that to be true; if it is, that would sure explain the consensus among her physicians. This would be verifiable by autopsy.] The brain stem still works, apparently, but that controls only autonomic functions and organs. If the amygdala, the old lizard part of the brain located underneath the two lobes and connected to the brain stem, is still working, there might still be a brain wave — but that's not what produces human consciousness, either, although the amygdala does influence consciousness once it's there.

We don't know a lot about the human brain yet, but we do know that much. And it's enough to know that the person who was Terri Schiavo has been gone for years. She's not coming back, folks. All that's left is the carrying case for the person who used to be there. No amount of wishful thinking or desperate efforts by parents who don't want to survive their own children will change that. It's a bloody awful situation, but one in which the medical judgment of experts who have actually examined Schiavo's body and monitored its condition for years should have prevailed. And everyone else should butt out of the decisionmaking, most particularly the politicians at all levels.

Maintaining the body that used to be Ms. Schiavo is not erring on the side of life — it's kidding yourself at the expense of not only her family but the state and the society about when life ends. And it's expense for care that would be better spent on, for example, proper prenatal care and nutrition for impoverished or uninsured mothers and their living children — you know, the people Medicaid was intended for? — not the desperate and outrageously expensive end-of-life care because-we-don't-want-to-face-death cases, the ones that waste the precious and shrinking budgets we do have to maintain the unraveling safety net. More than three-quarters of what we spend on Medicaid annually is spent on the elderly and disabled, mostly nursing home costs, and much of that is for end-of-life care. I'm not saying that all of it is inappropriate care or badly spent, merely that we're not spending that money for the purpose originally intended, and someone else is getting shafted because we won't face end-of-life issues head on as a society and instead let the right-to-lifers bully us.

I predict that at some point — one would hope sooner rather than later, but I really doubt that — we will discuss at what point life begins in terms of at what stage a fetus has a brain sufficiently developed structurally to produce and support a human level of mind or consciousness. It isn't enough to have the equivalent of a cat brain or a rat brain or a lizard brain, or even an ape brain: there may be only a slight difference between our genome and that of chimpanzees, and yet the capacity for mind is orders of magnitudes different. Otherwise, they'd be working out Fermat's theorem and splitting the atom, too, instead of just us doing that. I don't even care how many apes you can teach sign language to — there's still a vast difference in consciousness, and evolution doesn't work so fast that they'll be catching up to us any time soon.

And the only benchmark we currently have to use is the brain structure and level of consciousness of a healthy, full-term human newborn. I suspect that the necessary brain structure for that level of consciousness isn't there until late in the third trimester; it certainly isn't there at 24 or 26 or 28 weeks, even though we can keep fetuses delivered at that stage alive with enormous investment of medical resources — but what is there at that point is the real possibility that, assuming the newborn survives, the necessary brain structure to support the mind will develop, barring catastrophe. At the end of life, as in Ms Schiavo's case, it's a different story: the structure to support mind had been there before but is now damaged irreparably, and mind has departed permanently. There's no possibility of reversing that.

We are back to what it means to be a human being, and theology is factually flawed as a guide for that. Theology insists that there is something called a soul, never demonstrated to be fact and with no evidence produced to support such a vague but convenient allegation, that is somehow different from mind. Theology insists, also conveniently, that this soul isn't tied to a specific physical location of the body — and yet it is present from the very moment of conception. Bullshit. If theology said otherwise, of course, it would be forced to contend with established realities in the physical world. Why anybody still gives theology credence over fact, I'll never know.

What I do know is that whenever religion attempts to make statements or predictions about the physical world — ranging from physical forces such as wind or rain being gods, to the Catholic Church's insistence that Earth is the center of the universe and the sun revolves around us rather than the reverse, with a lot of other nonsense in between — whenever we do this, Nature laughs and disproves it. We eventually learn better, and each time we do, religion has to give ground to fact. At some point, religion and its proponents resent that.

Only foolish people would give theology precedence over fact. But some of those fools have money and clout and can deliver votes — which is the only practical reason that the Republicans suck up to the religious far right. The true irony here is that in mindlessly following theology over fact, these people willingly surrender the single most defining characteristic of our humanity, the capacity for reason that is the human mind: not that soul that nobody can demonstrate exists, but the overwhelmingly demonstrable ability to have and process sophisticated, rational thought — something that they can choose to give up not because they have these alleged souls, but precisely because they have human minds. Human consciousness, not animal.

And that's my epistle to the unbelievers for this sabbath.