Terri Schindler-Schiavo And The Nature Of Personhood

While my husband and I were talking the other night, I told him that, if he ever were in the situation that Terri Schindler is in, I didn't think that I could have his feeding tube removed. He was silent for a while, and then he said that he didn't think he could do it either. "Why?" I asked. After some thought, he said, with a small note of stress in his voice, that he would always have some hope, even a small amount. I thought about that. Would I have the same kind of hope? Being a clinical psychologist, my answer is yes and no.

I am aware that we do not fully understand where the seat of consciousness lies in the brain. Most psychologists really don't even talk about consciousness much, preferring to study "cognitive functioning" and other kinds of mental constructs that  we believe we can measure and interpret with some degree of empirical precision.

We also can describe personality and identify features of it in people's behavior and beliefs. We can even, to a certain extent, empirically study unconscious processing. However, we cannot identify and measure consciousness directly. We don't know where it is, only that it "works" and that we can see its products, mediated, of course, by motor output. We can't even directly measure the intentionality of motor output without inferring based on various types of external data and subjective reports.

We typically identify cognitive functioning, planfulness, and reasoning with the cerebral cortex, although we are more than aware that projections exist between the cortex and deeper areas of the brain and that processes like axonal sprouting can occur after brain injuries such as stroke. We cannot with certainty say that no shred of conscious processing exists if deeper areas of the brain remain intact after damage to the cerebral cortex. The reality is that we cannot prove where, whether, or how consciousness exists. We can detect it if a person is capable of expressing themselves through motor behavior. However, we cannot prove it doesn't exist if a person becomes locked-in or unable to communicate.

If the person is conscious but locked-in, not only can we not know whether the person is lucid; we also do not know whether the person is suffering. We would, of course, want to alleviate any suffering of the person if we knew it was present. On the other hand, should unnatural death be seen as the vehicle by which a person's suffering should end? Suicide, historically, has been taboo. So have assisted suicide and euthanasia. Perhaps these were taboo in the past because of moral predilections; however, times have changed, and bureaucracies now operate with secular law as their only moral framework. This is good because it allows a plurality of beliefs to exist in society; however, it also means we must be very careful about what kinds of laws we make.

What should we do, in society, about a suffering person? The answer to this question is a moral and ethical one. How we view suffering depends to a great extent upon our own beliefs. The only framework we have for understanding Terri's suffering, if she is suffering, is her faith -- Catholicism -- in which suffering is seen as a cross that one must bear with the help of God. While some people might not accept Terri and her family's belief system, we are called to respect it.

Michael Schiavo also should respect Terri's choice of morality. While he claims to speak for Terri's wishes and best interests, one can hardly understand how this would include, for example, reportedly denying her last rites or visitation from her pastor. Even if Terri strayed from her faith, as well all are wont to do, we have no other framework by which to understand her morality than by the very faith she maintained until she became incapacitated, that being Catholicism.

Nobody has the benefit of a living will from Terri, and the only people who seem to be respecting Terri's former way of life are her parents and siblings. Should a person be able to change their faith or wishes after they become incapacitated? Yes, of course, although we might never know that they did it. Therefore, we try to follow their wishes as best we can based on how they were before they became incapacitated. This is also why we bury people according to their last wishes. The problem, in Terri's case is that, while Michael Schiavo purports to speak for her, he does not appear to respect her faith, nor their marital vows.

Setting all of this aside, however, I would like to pose an entirely different question. What if Terri isn't suffering? What if we could demonstrate without a shred of doubt that she has no cognitive functioning, only a reptilian brain which enables her to breath and metabolize energy. What if Terri's body, midbrain, and lower brain live, but Terri's higher brain,all of her consciousness, and all of her personality could be shown to have been wiped out? Some would be tempted to say that Terri would then be alive but not a person. They might argue that what distinguishes people from animals and plants is higher brain function, reponsive cognition, or consciousness.  Not being a person, Terri would then cease to be our moral and social responsibility.

The problem then becomes how we define a person. However, the frustration is that the question of personhood cannot be answered with a dichotomous true or false. We can try to distinguish conscious from comatose, unconscious, or vegetative states; however, which of these states constitutes personhood?

This is the same kind of question, of course, that becomes intensely debated when people discuss issues such as partial-birth abortion: just when does that child become a person, or perhaps the child was never not a person? Some answer that birth is what makes each child a person, but we cannot use that definition for an older child, teen, or adult because they already have been born.

Therefore, we fall to the question of consciousness and brain function, which belies our definition of personhood for fetuses and infants, because they have demonstrable cognition, motor activity, perception, and sensation. Anencephalic infants do not typically live long even if cared for and fed, unlike Terri, who continues to live. Thus, we are thrust back into our original problem of what is a person.

Perhaps we might start with one simple assumption, which is that people are entitled to live. While the state has authority to take a life in situations in which a person is a danger to others, because people have the right to live, the state should not have the authority to take a life arbitrarily outside the natural course of life and death. This is where the concept of euthanasia can be separated from that of abortion because we can decide that people are entitled to live once they are living outside of another person. What happens when a person is still inside another person is a distinctly different matter because, in that situation, two people's lives are intertwined, and one of them must make a moral choice to let the other live or die.

We can, however, still make the argument that Terri is not in a normal state of life because she cannot feed or care for herself. However, infants cannot feed or care for themselves either, and we certainly do not see that state of affairs as cause for euthansia. While we might argue that infants will progress to be able to care for themselves, this is not always the case either. We must be careful not to design a program of eugenics in our quest to keep only self-sufficient people alive. Besides, shut down all the major trucking routes and utility grids, and we will all find out, very rapidly, just how self-sufficient we really are. In fact, we are here to help each other, and that is why we live in a society.

So, going back to my original point that, should I be in the position of contemplating whether to pull a feeding tube out of a loved one, would I still have hope? I said my answer was yes and no. Now, I will tell you why. I would have hope for recovery because medical science is constantly progressing. I would have hope for recovery because new technologies are constantly being developed that can tell us more about how to help each other when we become infirm. If new technologies presently are available, they should be applied in the interests of assisting the person in need without delay.

However, I would not have hope if those technologies did not exist or were so far off in the future as to be unrealized in our generation. Furthermore, even if we could regenerate a cortex, I would have no hope that the same person would be regenerated. All science fiction aside, if a person has no cerebral cortex, there isn't much hope for motor, memory, and personality return with our present state of scientific knowledge. Then again, I also know God can do anything.

Knowing, however, that a person's hope for recovery were slim to none, I still could not pull out the feeding tube. Two people in my life have been in this situation before. The first one starved to death, hopelessly and cruelly, right before his family's eyes. The second lived with a feeding tube, greatly incapacitated, until she died on her own. Her only movement involved blinking, moving her head and arm, and fiddling with her rosary. She couldn't pray aloud, and we never knew if she was actually praying, be she did what she did and could when she did and could do it. Was it a life? Perhaps not for some, but it was her life, nonetheless.

After following Terri's situation for over a year, I have realized that I am not comfortable with the state setting down definitions for degrees or categories of personhood. If a person can live and breathe, then we should care for them, and feeding is in no way an unnatural means of supporting a person's life. We all have a right to live, and a right to die, but not a right to take each other's lives if we are not a threat to anyone. Terri is hardly a threat, except to various parties' financial resources, whether that be individuals, families, or the state. To be a burden on someone is not to be a threat. I feel we have no choice but to respect the life of persons in all their forms, even if they are unproductive, disabled, or a burden. We cannot budget based on the value of something priceless, a human life.

If Terry could speak or indicate her will to us, if she could rip out her own feeding tube or even hurl herself to the floor, we would have a better indication of what she wanted. She then could, in many ways, dictate her own treatment and care, or lack of it. However, she cannot, so our only response, then, is to respect her as a person in accordance with the moral framework in which she chose to live her life. Terri's situation touches on a number of issues of major importance to me both personally and professionally, and her life, for me, has come to represent the dividing line between love and indifference, mercy and callousness, as well as hope and despair on so many levels. Besides anything else that she might have been or will ever be, Terri Schindler-Schiavo is a person, and that is what we must never forget.