Terri Schiavo’s legacy

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The case of Terri Schiavo made it clear that there are no easy answers when dealing with brain-damaged patients who have not previously put in writing whether they would want to live or die in their compromised state.

Now, some state lawmakers are scrambling to find solutions.

Just as members of Congress and President Bush intervened in the final weeks of Mrs. Schiavo’s life, lawmakers in at least eight states have proposed bills designed to avoid a recurrence of the seven-year end-of-life dispute among family members of the brain-damaged Florida woman, who died March 31.

“Lots of legislation has been proposed that would make it more difficult to withdraw nutrition and fluids from an incapacitated patient unless a patient has provided a written directive to that effect,” said Alan Meisel, professor of law and bioethics at the University of Pittsburgh, who opposes such proposals.

It’s uncertain whether any of the proposals will be enacted this year, because some state legislative sessions already are over and others end this month.

But lawmakers agree the issue will not go away anytime soon.

“Although Terri Schiavo very dramatically brought these issues to the attention of the nation, their importance did not fade or diminish with her loss,” said Sen. Michael B. Enzi, Wyoming Republican and chairman of the Senate Health, Education, Labor and Pensions Committee.

The committee held a hearing last week on hospice care, legal tools for the disabled and whether any legislation might be warranted in the aftermath of Congress’ Palm Sunday vote intended to clear the way to reinsert Mrs. Schiavo’s feeding tube.

Dr. Michael Gauderer of Greenville, S.C., co-developer of the feeding-tube system in use today, estimates that about 279,000 Americans receive life-sustaining nourishment each year. The Brain Injury Association of America estimates that between 30,000 and 45,000 patients are attached to feeding tubes at any given time.

On the state level, a Michigan legislator is sponsoring a bill that would prohibit a married person involved in an adulterous relationship from denying food, fluids or medical treatment necessary to sustain the life of an incapacitated spouse.

Michigan Rep. Joel Sheltrown, a Democrat, said his proposal was sparked by the Schiavo case, in which Mrs. Schiavo’s husband and guardian, Michael, led the fight to remove her feeding tube. Mr. Schiavo said his wife had made it clear several times before she suffered brain damage in 1990 that she would not want to be kept alive using artificial means.

Mr. Schiavo battled his wife’s parents, Bob and Mary Schindler, who denied their daughter could not recover and sought to keep her alive. The Schindlers pointed out that Mr. Schiavo waited seven years to disclose his wife’s purported end-of-life preference and did so only after becoming involved with another woman. He now has two children with the woman.

“While people in happier times may trust their spouse to make future medical decisions for them, situations change. People are not angels,” Mr. Sheltrown said. “No one should be deprived of the right to life in a medical situation in which they cannot defend themselves.”

Because Michigan law already prohibits the denial of life-sustaining treatment unless the patient has requested it, opponents and some in the press have accused Mr. Sheltrown of political grandstanding.

His measure faces an uphill battle, but Mr. Sheltrown doesn’t have to worry about time constraints, as the Michigan Legislature is in session year-round.

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