[Mb-civic] Schiavo debate is back but life's moved on - Ellen Goodman - Boston Globe Op-Ed

[William Swiggard]

  Schiavo debate is back but life's moved on

By Ellen Goodman  |  March 31, 2006  |  The Boston Globe

WHOEVER THOUGHT that Terri Schiavo would rest in peace? A year after her 
death, her parents and husband are back in the spotlight with ''his" and 
''theirs" books. A year and two weeks after her feeding tube was 
removed, they are making dueling appearances on television. Sixteen 
years after she fell into a persistent vegetative state, they have 
opposing organizations launched in her memory.

This post-mortem battle has suggested a national civil war waged in blue 
and red. Indeed since Schiavo's death, conservative groups have filed 49 
bills in 23 state legislatures seeking laws that would leave any patient 
without a living will -- such as Terri -- on life support.

But what if they gave a culture war and nobody came?

Here's the surprising fact. Those bills have stalled or been watered 
down. Public opinion has not changed an iota. A year ago, 63 percent 
thought Terri's tube should be removed. Today, they feel the same way. 
End-of-life issues have simply not become a divisive political flash 
point for the vast majority of Americans.

If you can see this in the Schiavo case, you can also see it in the 
issue of doctor-assisted suicide. Not long ago, former Attorney General 
John Ashcroft tried to upend Oregon's Death with Dignity Act by 
threatening doctors who prescribed lethal doses of drugs under the state 
law. But in January, the Supreme Court rapped the federal government 
hard on the knuckles.

Most politically savvy folks predicted proponents would rush to bring 
Oregon's law to other states and opponents would push Congress to alter 
the Controlled Substances Act. But that hasn't happened either.

The low-key response may be testimony to where we are now in the long, 
intimate, difficult discussions about the end of life, about death with 
dignity and mercy.

We've learned a few things since Florida became the site of the Schiavo 
crossfire. We've also learned a few things since Oregon became the only 
state to permit doctors to prescribe lethal drugs.

In the first seven years, only 208 terminally ill Oregonians chose that 
way of dying. That's one in a thousand. Doctor-assisted suicide frames 
the issue, as bioethicist Thomas Murray of the Hastings Center says, in 
starkly legalistic and individual terms when most of us make these 
decisions with our families, not our lawyers; together, not alone.

If the ultimate goal is to improve end of life for the 2.4 million 
Americans who die every year, we have to think about more than one-tenth 
of 1 percent.

So, as a country, we have simply moved on. Despite the Terri Schiavo 
fiasco, despite the Oregon law, Americans have actually come to 
something of a consensus. It's a stark, shared view of what we fear and 
a nuanced view of what we want for ourselves and others.

The fearful fantasy began 30 years ago with the icon of Karen Ann 
Quinlan breathing on a respirator. We fear medicine will take over. We 
fear pain. We fear dying in isolation. What we want, as Murray recounts, 
is ''better treatment of pain, some assurance we won't get caught up by 
the medical machine and we want a chance to die the way we live -- in 
networks of relationships."

This shared consensus doesn't mean that we have solved the problem. In 
the past decade there has been real improvement. More hospice patients 
die at home in Oregon than in any other state. More people have also 
signed advance directives since they saw Terri Schiavo's family locked 
in primal prime-time battle over her fate.

But we still don't treat pain aggressively enough. Doctors who 
specialize in such treatment are sometimes treated as suspected drug 
peddlers. Advance directives don't always work. Half of all cases 
involving end-of-life decisions include a conflict within the family or 
between family and professionals.

Surely, we need to resist the laws that would give the state control 
over Terri's feeding tube. Surely, doctors should be allowed to 
prescribe lethal drugs in those rare and controlled cases outlined in 
Oregon. But for the sake of 99.9 percent of Americans, we are shifting 
from a legal agenda to a personal agenda.

In a Hastings Center report last fall, Murray and co-author Bruce 
Jennings said, ''We must talk about what we dare not name, and look at 
what we dare not see. We shall never get end-of-life care 'right' 
because death is not a puzzle to be solved. Death is an inevitable 
aspect of the human condition."

This is the way we move from the culture wars to the kitchen table, from 
the high-decibel yell of politics to the quiet conversation of worried 
families.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/03/31/schiavo_debate_is_back_but_lifes_moved_on/
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