[Paleopsych] NYT: States Taking a New Look at End-of-Life Legislation

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The New York Times > National > States Taking a New Look at End-of-Life
March 31, 2005


    ATLANTA, March 30 - As Terri Schiavo lies dying in a Florida hospice,
    the fierce debate over end-of-life decisions has moved into
    statehouses across the country, bringing new scrutiny to who should
    make the decision to stop life support.

    Some legislative proposals are drawn straight from the battle between
    Terri Schiavo's parents and her husband. Among them is the Alabama
    Starvation and Dehydration Prevention Act, which would forbid the
    removal of a feeding tube without express written instructions from
    the patient. And a legislator in Michigan is writing a bill that would
    bar adulterers from making decisions for an incapacitated spouse.

    In other cases, state lawmakers want to make living wills more widely
    available or simply to clarify the laws that govern the fate of
    someone in Ms. Schiavo's position. She left no written instructions.

    New end-of-life legislation has been introduced in at least 10 states.
    But once the emotion surrounding the Schiavo case subsides, how many
    of the proposals will become law is an open question.

    Polls indicating broad public opposition to government involvement in
    the Schiavo case may be giving some politicians second thoughts. With
    many legislatures approaching the end of their sessions, some bills,
    including those in Hawaii, Kansas and Kentucky, have already stalled.

    Yet last-minute efforts by Congress and Gov. Jeb Bush of Florida have
    changed the rules of legislative intervention, some experts said.

    "What legislatures in Tallahassee and Washington have done in the last
    weeks has broken all of our crystal balls," said Kenneth W. Goodman,
    an ethics professor at the University of Miami and a co-director of
    the Florida Bioethics Network, a group of ethicists who consult with
    hospitals on end-of-life care. "In fact, this had been a settled area
    in medicine, law, ethics and across the faith traditions - that it's
    O.K. to say no to the use of a machine that's keeping you alive."

    All 50 states already have laws that allow people to write an advance
    directive, or a living will, that specifies their health care
    preferences if they are incapacitated, designates a health care proxy
    to make decisions for them, or both. The new proposals primarily
    address situations in which, like Ms Schiavo, the incapacitated person
    has not done so.

    Social conservatives are pushing for laws that put a premium on
    preserving life, raising protests from those who have fought for
    right-to-die laws, the most far-reaching of which is Oregon's law
    permitting doctor-assisted suicide. Those advocates say the Schiavo
    case threatens to wipe out their three decades of effort to give
    weight to patient choice and quality-of-life considerations.

    In Kansas, a proposal that passed the House by a large margin last
    week would require a guardian to get court approval before ending life
    support. The bill is championed by abortion opponents as well as by
    advocates for the rights of the disabled, who say that Kansas law does
    not require guardians to consider their wards' intentions or wishes.

    "The Schiavo case, when it made the headlines, gave us the urgency in
    the Legislature - made it real to people," said Representative Mary
    Pilcher-Cook, a Republican and one of the proposal's supporters. "They
    could see that our most vulnerable people were really at risk."

    Kansas' legislative session is expected to end this week, however, and
    the bill's supporters say that the Republican-led Senate has indicated
    it will not bring the measure to the floor.

    In Michigan, Representative Joel Sheltrown, the author of a proposal
    to strip people who are having extramarital affairs of their right to
    make decisions for an incapacitated spouse, is a Democrat, meaning he
    may have an uphill battle in the Republican-dominated Legislature.

    But Mr. Sheltrown was not the only one to entertain such a notion.
    Last week Ken Connor, a legal adviser to Governor Bush on the Schiavo
    case, said Florida should have such a law. Opponents of Ms. Schiavo's
    husband, Michael Schiavo, say he should not be allowed to make medical
    decisions for his wife because he is living with another woman.

    Other bills seek to draw a line between a feeding tube and other
    life-sustaining measures. In Louisiana and Alabama, Republicans have
    introduced bills that would assume, in the absence of a written
    directive, that a patient wanted food and water. In Louisiana, the
    bill would require that a feeding tube remain in place until any
    litigation over its removal was resolved. In Alabama, Representative
    Dick Brewbaker, the bill's Republican sponsor, said he would probably
    make the law apply only in the event of a family dispute.

    Although doctors say Ms. Schiavo is not in pain, the notion of a
    patient's starving to death strikes emotional chords.

    "That's a horrible way to die," said State Senator James David Cain,
    the Republican who is the sponsor of the Louisiana bill. "Your tongue
    swells up, your lips become all swollen up and chapped."

    Mr. Cain said he was reminded of his sister, who died of leukemia
    years ago. "I remember her asking my daddy to wet her lips," he said.

    Yet most states, including Florida, regard artificial nutrition and
    hydration as a medical intervention like using dialysis or keeping a
    patient on a ventilator.

    Florida's 15-year-old Death With Dignity law, one of the few to say
    outright that oral declarations of a patient's wishes are valid, had
    been considered a model before the Schiavo case. Senator James King
    Jr., the Republican who sponsored the law after watching his father
    die of cancer, said he felt strongly about the oral-declaration

    "I recognized after we started on this that just demanding a written
    declaration wasn't going to do it," Mr. King said. Because people do
    not like to think about death, he said, "most people would shy away
    from exercising their given right."

    Until the Schiavo case, the statute worked smoothly, he said. But in
    2003, Mr. King, then president of the Senate, bowed to intense
    pressure to take legislative action that he now says violated the
    principles of the earlier statute. With his help, the Legislature
    pushed through Terri's Law, which restored Ms. Schiavo's feeding tube
    despite court orders and was later ruled unconstitutional.

    Mr. King now offers that as a cautionary tale. "I had said then
    publicly and many times since: that was probably the worst vote I ever
    made in my years of being a legislator," he said.

    Last week, Mr. King was one of nine Republicans to vote against a bill
    called Terri's Law II.

    Ariel Hart contributed reporting from Atlanta for this article, and
    Carolyn Marshall from San Francisco.

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