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PERSPECTIVES:
Terri Schiavo and End-of-Life Care
March 25, 2005    Episode no. 830
Read This Week's November 7, 2008
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BOB ABERNETHY, anchor: A conversation now about the Terri Schiavo case, which has drawn national attention to the moral arguments about whether a person in a persistent vegetative state should be allowed to die. We want to go through the questions families ask, and should ask, with John Harvey, a medical doctor and a Catholic theologian who chairs the bioethics committee at Georgetown University Hospital in Washington.

Dr. Harvey, welcome.

Dr. JOHN HARVEY (Chair, Bioethics Committee, Georgetown University): Thank you.

ABERNETHY: How many people around the country, roughly, are in a vegetative state?

Dr. HARVEY: About 19,000.

ABERNETHY: And exactly what is a persistent vegetative state?

Photo of JOHN HARVEY Dr. HARVEY: It's a permanent coma that lasts and lasts and lasts. It's caused by two things. The upper part of the brain can either be dead because of lack of oxygen due to the fact that the patient has suffered some sort of accident and the heart has stopped beating, or the individual can be poisoned or be traumatized, and the cells of the upper part of the brain are not dead but are discombobulated and don't function right.

ABERNETHY: Can you, as a physician -- can you know for sure that there's no possibility of recovery?

Dr. HARVEY: You can after you've observed the patient over a period of time, and that's why I always, in dealing with this, treat such a patient for a year. And then I can look and see whether the brain, the upper part of the brain, has disappeared -- dead, gone, nothing there and the cells can never grow back -- or the brain is still there, and the cells are still there but they're not functioning correctly.

ABERNETHY: Okay. You're convinced it's a persistent vegetative state. There's no durable power of attorney, no message from the patient.

Dr. HARVEY: That's a problem for patients.

Photo of Harvey and Abernethy ABERNETHY: A year has passed. There's been no change. Then what do you tell a family?

Dr. HARVEY: I will bring it up with the family, the fact that I have come to the conclusion with the proof that the brain is dead -- not just discombobulated, but dead. I would bring up the fact that it is time to think about whether we want to continue to treat this patient, because it's futile, and it is not really in the best interest of everybody to continue the treatment.

ABERNETHY: Now the pope said, just a year ago, that in that situation, when somebody is being fed food and water, that it would be akin to euthanasia, to killing them ...

Dr. HARVEY: Right.

ABERNETHY: ... to remove the tube.

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Dr. HARVEY: I was at that conference, took part, and gave a paper there, and it's important to understand that the words of the Holy Father were interpreted in many different ways, so that it's hard to really come to the conclusion of what exactly he said to everyone. He talked very carefully and said in principle, food and water is ordinary treatment. It's not a medical treatment, and therefore it's part of comfort care and must always be used -- but in principle, which means there are conditions and times when it can be omitted.

ABERNETHY: You would counsel a family, then, that they should consider other things ...

Dr. HARVEY: Oh yes, I do that.

ABERNETHY: ... in addition to what many people feel is the absolute value of preserving life?

Dr. HARVEY: Right. And life has great value, of course, but it's not the final value of human life. The final value of human life is life with God in heaven, and when we keep that from happening by treating a futile situation, we're blocking the final "telos" -- as the Greeks say -- of human life.

ABERNETHY: Now what are the calculations?

Photo of Harvey Dr. HARVEY: Burdens and benefits is the way we look at this. What are the burdens upon the patient, the family, and the community? What are the benefits of the continued treatment?

ABERNETHY: And you would counsel a family that if the costs, for instance, the money -- $80,000 a year?

Dr. HARVEY: Yes, it's about $80,000 a year. Costs can be included in the calculation of burdens. The Holy Father did say that costs should not be considered, but he was thinking in terms of every country in the world has a national health program that pays for this -- except America. We don't have such a program.

The counsel to the family is [a] very carefully considered, sympathetic review of everything that's going on, and the recommendation that we stop giving food and fluid because we know the patient will die of dehydration and starvation. But the patient is dying because of the illness that he or she has, the physiological change of not being able to eat.

ABERNETHY: If in this situation the feeding tube is removed, does the patient suffer?

Dr. HARVEY: Not at all. The patient has no feeling. The patient doesn't hear. The patient doesn't see. The patient doesn't think. All the patient exhibits are what we call reflex actions.

ABERNETHY: Dr. Harvey, many thanks.

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