Friday, January 7, 2011

Killing the vulnerable by dehydration.

Recently an Italian newspaper, Avvenire, interviewed bioethicist Wesley Smith about the deaths of Terri Schiavo and Eluana Englaro,. Schiavo and Englaro had similar cognitive disabilities and both of them were directly and intentionally dehydrated to death.

Last fall, Canada had a similar case when Pastor Joshua Mayandi, who had a cognitive disability, but who was not otherwise dying, was dehydrated to death.

The comments by Wesley Smith were particularly insightful and worth reading. The english translation is as follows:

What is the importance of cases like Eluana and Terri Schiavo, what is the public's reaction to them?

The country (USA) is generally unaware of the Eluana Englaro case. Ever since the Terri Schiavo media circus, I think that the attention to these issues has waned, especially if they are overseas stories --perhaps because the media think the issue has been settled.

From a legal point of view, what are the repercussions of the Schiavo case in the United States?

After Terri's death, there have been a few attempts to make it more difficult to dehydrate people with cognitive disabilities. But politicians were scared off by the media outcry against Terri's family and the "religious right", ignoring the fact that disability rights activists were also part of the movement to save her life.

The issue of artificial nutrition as a medical treatment is of very topical interest in Italy. What do American doctors think about it?

I don't think that doctors behaved differently after the Terri Schiavo case. Food and water are pulled almost as a matter of routine. Most doctors think of it as just part of the practice of medicine. It is only when families disagree that these cases go to court or make news.

What are the consequences of these definitions?

Because the tube requires a minor surgical procedure and the sustenance is specially prepared to have a proper balance of nutrients, in the United States it is defined as a medical treatment. But if it means that it can be refused as you can refuse an aspirin, then there are ethical problems, because refusing food and water will have only one possible outcome: death. So I think artificial nutrition and hydration should be in a category of its own and not so easily withheld or withdrawn.

Society needs to protect vulnerable people by recognizing that the provision of hydration and nutrition, for people who are not otherwise dying, is very different than other cases of withholding or withdrawing medical treatment.

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