Executive Director - Euthanasia Prevention Coalition
There is no problem with respecting a person's informed and free wish to refuse unwanted medical treatment (medical treatment in the traditional sense). But in the cases of Rivera and Schiavo, the issue is not withholding or withdrawing medical Treatment but rather the withdrawing of hydration (fluids) and nutrition (food) from a person who is not otherwise dying.
The case of Rivera is further nuanced because her family is united in their opposition to dehydrate her to death. The decision was made by an appointed guardian.
The problem is that bioethicists have defined fluids and food as medical treatment.
When someone is cognitively disabled, such as Rivera, they often need to be given fluids and food via a PEG or feeding tube.
It is a simple and minimally invasive procedure to put a PEG into a person who is unable to eat without assistance. Once the PEG is in place the only requirement is to keep the person clean and to regularly provide fluids and food through the PEG.
Providing fluids and food to someone through a PEG is not a difficult act can be done by family in their home without problems.
To deny fluids and food from someone who is not otherwise dying will cause the person to die from dehydration in usually 10 to 14 days. Terri Schiavo died of dehydration 13 days after all fluids and food were withheld.
To withdraw fluids and food from someone who is dying and nearing death and who is unable to effectively assimilate fluids and food or in the rare circumstance where its provision causes physical suffering, is not causing the person's death but rather recognizing the limits of life and letting the person die.
The real question: Is the witholding or withdrawing of fluids and food from a person with a cognitive disability and who is not otherwise dying an act of killing or is this simply an act of letting a person die?
Since the person is not otherwise dying, the cause of death is not their underlying disease or condition.
One may say that Terri Schiavo died because her condition caused her to be incapable of eating or drinking without assistance. If this were the case, then everyone who requires assistance to eat and drink could also be denied this basic necessity of life. Many people with disabilities and very young children are dependant on assisted feeding.
A side-effect of having a cognitive disability is not the inability to assimilate fluids and food. Therefore you cannot say that death by dehydration is simply an act of letting a person die.
There is a difference between killing and letting die. If this difference is completely negated by post-modern bioethics, then we should all be concerned. Many people, who are not dying, need assisted feeding for long periods or time.
The concern is not respecting a persons right to refuse unwanted medical treatment. If a person dies as a result of legitimately refusing medical treatment, their death is the result of their disease or condition. In other words they died a natural death.
The concern is with intentionally and directly causing death.
Clearly to withhold fluids and food from a person who is not otherwise dying, such as Rivera, will intentionally and directly cause her to death from dehydration and not her underlying disease or condition.
This is an intentionally caused death and not simply letting a person die.
This is ethically the same as euthanasia.