Right to stay alive: Who decides?

In the past, courts and ethicists have largely agreed that tube feeding is a medical treatment, and that removing it does not cause suffering. Thus it could be stopped with the consent of patients or their proxies. But Schiavo's parents and many advocacy groups argue that tube feeding constitutes basic humanitarian care that would be cruel to end. Leaders from many religious denominations, such as the Lutheran Church-Missouri Synod, and antiabortion groups agree.

"Everything in medical science advances," says Jim Sedlak, vice president of the American Life League, an anti- abortion group in Washington. "Today providing a feeding tube is a normal type of thing, it is not an extraordinary type of thing. She is alive. She is a live human being, and we have an obligation to provide any live human being with food and water."

Relatives sometimes see patients diagnosed as in PVS blink, move their eyes, or make other movements that suggest they are responding to their surroundings. Doctors say this is misleading and that no thought process is taking place.

PVS is like seeing snow on your TV set, says Arthur Caplan, chairman of the medical-ethics department at the University of Pennsylvania. "It's on, but there's no signal at all." While the case troubles some advocates for the disabled, Dr. Caplan doesn't agree. "When you get to Terri Schiavo's situation, calling her 'disabled' starts to stretch the concept because she's pretty much in-abled or un-abled," he says.

"[Schiavo] is what some people may call a 'nondead, nonperson,' " says D. Dixon Sutherland, a bioethicist, theologian, and director of the Institute of Christian Ethics at Stetson University in DeLand, Fla. "Her personhood is gone, but by medical definition, she's still alive."

Schiavo is a Roman Catholic, but even within that religious denomination opinions vary toward patients in her condition. Last year, Pope John Paul II said that patients "in a vegetative state had the right to basic sanitary assistance - food, water, and hygiene," even if there is "scarce hope of recovery." But Paris says that declaration stands "wholly against 400 years of consistent Catholic moral analysis of these issues." While bishops in states such as Massachusetts, New York, New Jersey, and Pennsylvania have embraced the pope's position, others in Washington, Oregon, Florida, Iowa, and Rhode Island have not actively taken up the cause, he says.

Right-to-life groups feel they have "a kind of religious mandate [to show] that human life on any terms is sacred and has to be preserved," says Dr. Sutherland, a biblical scholar. But he doesn't see any precedent in the Judeo-Christian tradition. "The Christian tradition has never focused on the preservation of life for life's sake in this kind of radical way," he says. "There is no mandate that we keep human bodies alive as long as medically possible, technologically possible. That is not what our obligation is as human beings to ... loved ones. And it's not our goal in life or purpose in life as Christians."

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