"[E]ven the Divine Image"

My good friend, Wesley Smith, debated Florida bioethicist Bill Allen on Court TV on March 24, 2005, as Terri Schiavo lay dying in a Florida hospice.

He then wrote about that exchange five days later in the National Review Online, and had everyone, including Rush Limbaugh, who read his article on the air, buzzing. Wesley effectively “outted” Mr. Allen and his ascription to “personhood theory.”

Notably, Ronald Cranford, M.D., “Dr. Death” himself, wrote about this back in 1987 and recanted his theory on the witness stand during the 1997 Conservatorship of Wendland trial in the San Joaquin County Superior Court. But now the concept has again reared its ugly head:

Wesley Smith: Bill, do you think Terri is a person?

Bill Allen: No, I do not. I think having awareness is an essential criterion for personhood. Even minimal awareness would support some criterion of personhood, but I don’t think complete absence of awareness does.

So that same night, I was asked to appear on Scarborough Country on MSNBC to “debate” Mr. Allen. Overall, it wasn’t much of a debate. Our airtime was brief, even as planned, but became more abbreviated in the wake of Jesse Jackson’s surprise appearance in Pinellas Park, Florida, that day. Still, our short on-air exchange was very educational — and horrifying.

(Aternate site at which to watch the video.)

Here’s the transcript:

Now, for 12 days, Terri has been denied food and water, as she is starving to death and she is also being dehydrated. Now, starvation is obviously a crime in Florida under any other circumstance. It’s even a crime to starve an animal to death. So, why is removing a feeding tube an acceptable way to end a life?

With me now is Bill Allen. He’s the director of the program in bioethics,law and medical professionalism at the University of Florida College of Medicine. We also have attorney Janie Siess. She argued a 2001 California case that set a precedent on
this matter.

Let me begin with you, Bill. You heard Jesse Jackson talk about how this was immoral, how it was unacceptable. Obviously, emotions are running high. A lot of Americans, myself included, don’t understand why it’s ethically OK to deny food and water to this woman. Explain it to us, if you will, from a medical bioethics argument. Why is this the most humane thing to do?

BILL ALLEN, BIOETHICIST: Well, because if Terri doesn’t, if Mrs. Schiavo doesn’t want this, then her wishes should prevail. And it’s not food and water. It’s an invasive procedure that requires an operation to give her fluids and nutrition, that she can’t swallow. And it shouldn’t be called starvation. It’s wrong to call it starvation. If this were withdrawal of a ventilator, you wouldn’t call it suffocation if it’s an appropriate withdrawal.

SCARBOROUGH: Would you put on the same level keeping nutrients, keeping food and water or whatever you want to call it from a patient the same thing as a ventilator or a respirator, where you have got a machine plugged in that is basically doing the work of lungs or other organs?

ALLEN: Yes, because it’s not the complexity of the medical procedure that matters. It’s whether the person finds it to be more of a burden than a benefit. And many people find feeding tubes to be that way.

My own grandmother, the nurses said you could hear her screaming all over two floors when they put the feeding tubes down her nose. And then she sat up and pulled them out when they left the room. So, they came in and tied her wrists down. She sat up and reached down to her wrist with her nose and pulled them out again.

I think that’s humane. If somebody regards it as something that they don’t want, that is what is inhumane. So, it doesn’t matter whether it’s feeding tubes or dialysis or a ventilator or even aggressive antibiotics. If it’s a form of treatment where the person believes that the benefits aren’t – are outweighed by the burdens of the treatment, they should be able to refuse it.

SCARBOROUGH: Janie Siess, let me ask you your response to his statements and also response to a lot of articles I have been reading talking about how humane it is, what a gentle death starvation is. “The New York Times,” in fact, had that in a headline just last week. Is starvation, is the deprivation of nutrients, of water a peaceful way to die, as some are claiming?

JANIE SIESS, ATTORNEY: Well, I am not a doctor, but Ronald Cranford, the same neurologist who is involved in this case, testified in my case in California.

And he described graphically, the process of death, and it was anything but calm or peaceful. It was gruesome. It was horrific. And it involved pain. Now, the other thing that we need to remember here is that we are not talking about a ventilator for Terri Schiavo, and we are not talking about ending her life in a matter of a few minutes when you remove that ventilator. we are talking about a woman now who is in the 12th day of a gruesome, prolonged death.

You are hearing reports that she is being given morphine. That’s for a reason. It’s because of pain. You are hearing that her eyes are sunken in. You are hearing that her skin is dry. Her tongue was too dry for them to give her the communion wafer, and she could only tolerate one drop of communion wine. That is because this woman is suffering. This is inhumane because there’s precious little evidence of what Terri would have wanted, and there is no evidence that she would have consented to this type of death. And that’s the real question. Does the person say to someone, “I don’t want to live in a disabled state?” But then the second part of that equation is, do they understand that to release them from that disabled state might sentence
them to this kind of death? And that’s the point that I hear so many bioethicists, including Mr. Allen, missing.

SCARBOROUGH: All right, Mr. Allen, I will give you the last word.

ALLEN: Well, I am not missing that point. I know plenty of people who have said, “if I have bone cancer and I am dying of bone cancer and the pain can’t be relieved adequately with narcotics, I want to refuse all kinds of artificial treatment.” It doesn’t matter what kind it is, whether it’s feeding tube or ventilator or any other kind.

SCARBOROUGH: Bill Allen, do you think she is a person still?

ALLEN: Well, I think she has lost the distinguishing feature, or she has lost the physiological ability for awareness, self-awareness, which is the distinguishing feature of human being or, if you will, even the divine image.

SCARBOROUGH: So, she is not a person anymore because she doesn’t have awareness?

ALLEN: If she doesn’t have awareness, which is the case in persistent vegetative state, yes.

SIESS: She is a person, and she has a substituted decision-maker, a guardian, her husband, who is subject to the highest possible fiduciary duty. And it is his job to see that her rights are protected, and that’s what has not happened in this case.

SCARBOROUGH: All right, Janie Siess, Bill Allen, thanks so much for being with me. I appreciate it.

So Allen’s remarks on Scarborough Country were even more shocking and dangerous than during his debate with Wesley.

Allen doesn’t claim merely that disabled persons such as Terri Schiavo lose their 14th Amendment rights because they can no longer independently exercise them, which was the gist of Cranford’s proposition.

Allen actually takes the argument a couple of steps further. He contends that Terri Schiavo, after becoming disabled, ceased to be a person.

Worse, Allen stated that it was perfectly acceptable to kill Terri Schiavo because she had lost “the distinguishing feature of being human or, if you will, even the divine image.”

“[E]ven the divine image.”

It took awhile for me to process what Allen said. And then I had to check the transcript — more than a couple of times — to be sure.

Why? Well, because the idea he was conveying is so shocking, so outside the bounds of reason for most people, and so abhorrent, I had to force myself to process the information.

But there it is in all of its stark, harsh, ugly reality: Bill Allen believes that because she was purportedly in a persistent vegetative state, unable to care or speak up for herself, Terri Schiavo “lost the distinguishing feature of being human” — she ceased to be a child of God, created in His own image.

And that is the proverbial bottom line of the death culture.

The concept is so deceptively and diabolically simple that the human mind instinctively overlooks or rejects it. If Terri Schiavo, Robert Wendland, and other disabled persons who are unable to independently exercise their rights are no longer children of the heavenly Father, created in His likeness, they are utterly expendable! From such a vantage point, there is no need to afford such disabled individuals due process or assure that their rights are judiciously protected. There is no need to wait until they actually die to begin harvesting their organs for donation.

And lest you think that Bill Allen is simply a fanatic on the fringe of current trends in bioethics, think again. Mr. Allen, who holds a law degree, as well as a Master’s degree in Divinity, is an Associate Professor of Ethics and the Director of the Program In Bioethics, Law & Medical Professionalism at the University of Florida.