Natural life not an option for Schiavo

I sympathize with social conservatives who want Terri Schiavo to live but their anguish is of their own making, and misdirected. It is not an issue of choosing life over death -- that choice was made 15 years ago. The real issue now is when and how to let her die.

When Schiavo suffered severe brain damage 15 years ago, her family and doctors used artificial means to prevent her death. It is correct, I believe, to "err on the side of life" when the outcome is unknown and recovery is possible.

But, and few people understand this, the decision to prolong Schiavo's life was also a decision not to let her die naturally but to let her die later and in a different way. In the case of brain damage, when we first choose (correctly) not to let life end naturally, it means that if the patient does not recover and needs medical life support, someone else must decide when and how she should be allowed to die.

The hard price to pay for the decision to block natural dying is what we are dealing with now. To allow her to die, the family and doctors must "act" by stopping nutrition and hydration. And this is what disturbs many people -- letting her die seems like "killing" or "taking away her right to live." To some social conservatives it seems as though Schiavo's husband, her physicians and the courts are choosing death rather than life.

But it is not a matter of choosing life or death. The family and doctors correctly chose life when the outcome was not known. Now, neither Schiavo's parents nor her husband can choose natural life. The choice is whether to allow her to die now, as would be her choice based on the best evidence, or to wait and let her die years later, as her parents wish. Either way it is a decision someone has to make.

When recovery is virtually impossible, to "err always on the side of life rather than death" means extending the wait until death -- already 15 years for Schiavo. Since she is still young, if she were kept alive indefinitely with artificial feedings it would probably be decades more before she would die of heart disease or some other fatal disease. I don't think anyone questions the love of Schiavo's parents for their daughter, but, unfortunately, their choice to keep her body alive after her brain has long ceased to function would condemn her to perhaps decades of a kind of life she would not want. Is this a morally correct decision? Does it serve God's will?

At least half of Americans who die now could be kept alive for a few hours, days, months or even years longer by using further medical therapy. But loved ones are making decisions to stop treatments and let them die instead of extending "life" to the limits of modern technology. This is not killing. It is the other end of the deal by which life is first prolonged by medical management but must then be allowed to end sometime later, under medical management. Once natural death is overcome medically, someone must make the decision about how and when to allow death to proceed. It's not a choice between life and death but a decision about when to allow death. It's the same for Terri Schiavo, and it is not morally wrong.

The goal should not be sanctity of all life for as long as possible, no matter the condition of the patient. Rather, the goal should be to give a person a chance for the sort of life that is natural or desirable. After having prolonged life through medical means until the chance of recovery is nil, the true issue is when to let go and to allow the patient to die. Keeping a body alive indefinitely after the mind has died can wreak great harm to the concept of sanctity of life.

Social conservatives bring unnecessary anguish upon themselves by avoiding the hard decision of how and when to let a patient die and by mistakenly framing the issue as choosing life or death. In cases such as this, we fulfill our moral duty by preventing natural death in the hope of recovery. Later, the question is when to let go of the unnatural life we have produced.

Tom Preston, M.D., was a professor of medicine at the University of Washington before he retired. He wrote "Final Victory, Taking Charge of the Last Stages of Life," published in 2000.

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