After Piergiorgio Welby….
Here’s another one. Thank heavens we live in Malta, where these decisions are left up to the next of kin, and respected.
I should point out that Piergiorgio Welby’s case was much worse, because he was conscious, able to communicate, and refusing life support himself, yet having that life support foisted on him against his will because he was too weak to pull out the plug. What cruelty. What lack of respect for life. If you can’t force somebody who is suffering from cancer to receive treatment, then you can’t force somebody to stay on life support.
We do not have the right to refuse medical treatment on behalf of our minor children, but we have the right to refuse it for ourselves. I know of a man who died of gangrene in Malta some years ago because he refused to allow doctors to amputate his toe (he was diabetic). The gangrene spread and he occupied a hospital bed in agony for many weeks, but doctors respected his decision. When his children begged them to amputate his toe – and later his leg – regardless of his wishes, they refused. That’s the way it should be.
The Times, 3 February
Italian man defies government in right-to-die case
The father of an Italian woman who has been in a coma for 17 years defied the Vatican and Italy’s centre-right government today, moving her to a private clinic where a feeding tube keeping her alive will be removed.Eluana Englaro, 38, has been in a vegetative state since a 1992 car crash. Italy’s top court ruled last year that she can be allowed to die but the decision was contested by politicians and prelates and split public opinion in this Catholic country.
In the early hours today the woman was taken by ambulance to a hospice in the northern city of Udine, the only one in Italy that has agreed to stop feeding and hydrating her. Anti-euthanasia activists carrying bread and water — which have become the symbol of the protest against removing the tube — tried to prevent the vehicle from leaving. “In a few days Italy will execute its first death sentence since 1948,” said Alfredo Mantovano, an Interior Ministry undersecretary.The government says that removing the feeding tube amounts to euthanasia, which is illegal in Italy.
Cardinal Javier Lozano Barragan, the Vatican’s equivalent of a health minister, said in an interview with La Repubblica daily: “To withdraw food and water from her means only one thing, and that is deliberately killing her.” Eluana’s father, Beppino Englaro, has battled his way through Italy’s courts for more than 10 years to allow his daughter to die.
Last November, the country’s top court ruled in his favour, rejecting an appeal against a previous ruling by a lower tribunal in Milan which — for the first time in mainly Catholic Italy — had allowed him to disconnect the feeding tube.
The Milan court said it had been proved that Englaro’s coma was irreversible and that before the accident she had stated her preference to die rather than be kept alive artificially. “I feel that I can now free the most splendid creature I have ever known,” Beppino Englaro, who rarely speaks in public, said after that ruling. But Maurizio Sacconi, health minister in Prime Minister Silvio Berlusconi’s centre-right government, issued an order barring all state and private clinics from withdrawing nutrition from comatose patients.
Critics say the order has no legal value because it cannot overrule the decision by the top court. Still, several clinics contacted by Englaro’s father turned him down, saying they feared retaliation from the government. Eluana has been called “Italy’s Terri Schiavo” — the American who spent 15 years in a vegetative state and was allowed to die in 2005 after a long court battle.
Medical experts say it could take around two weeks for Eluana to die after the feeding tube is removed but that she would feel no pain. Doctors at the Udine clinic said on Tuesday she will stop being fed in three days’ time and that she will be sedated to avoid any possible discomfort.
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Can someone tell me if the man who refused treatment for his gangrene toe was committing suicide? This is because if treatment was carried out, he would have been cured and his life saved.
Neither case (Englaro’s or Welby’s) involved anything which can be described as “medical treatment”. I can think of no other description of what is being done to Englaro than “being slowly starved to death”.
Excellent article. Watch out for the Gift of Life brigade!
I wonder what their take on this would be?
When they say that God is ‘democratic’ because he lets us decide how we want to live our lives, all I think is how ‘undemocratic’ it was for God to give us life without ‘asking’ us if we want to be part of ‘his’ creation.
Some believe that this decision is the thin end of the wedge. However there comes a time where quality of life surpasses quantity. Each case has to be seen on its own merits. Science has advanced so much that doctors know that certain comas are irreversible. Clinging on is painful just as much as letting go but sometimes the latter is the right and logical decision.
Fausto Majistral: Let’s split a hair: medical treatment does not necessarily inolve the use of what we normally think of as drugs. If rehydration through the use of a saline drip qualifies as medical treatment, then so does the use of a feeding tube and the removal of that tube would then amount to the withdrawal of medical treatment.
On a related note, I wonder how many of those who hold their breath in shock when reading of such cases happening elsewhere know how often similar situations are dealt with quietly and routinely in Malta.
I agree with most of what you say – but to tell you the truth I’m a little fearful too. We live in a world where ‘dying with dignity’ is advocated as the right thing to do but I can’t help but feel that behind the dignity thing are a lot of fed up or greedy relatives who want to snuff out their granny so they can get their hands on the house before the inheritance is all gone in medical bills and paying for the old folks home. Add to that the organ donation industry – get admitted to hospital and I’m quite sure they’re measuring up your kidneys and corneas and doing a cost benefit analysis – you or your heart – which is worth more? Before telling you that what the planet needs is less people not more so best you do the right thing and curl up in a corner and wait for the grim reaper to do his thing. Too cynical ? Perhaps.
@ASP
I was told ‘God is almighty’, that seems to be quite the opposite of ‘God is democratic’.
ASP
“When they say that God is ‘democratic’ because he lets us decide how we want to live our lives, . . . .”
You have the wrong idea of what democratic means.
All I can say is that if I ever fall in a coma with no hope whatsoever of regaining consciousness, then I would rather die than be a burden to my family. On the other hand, it would be difficult for me to take a decision like Eluana’s father. He must have agonized over it.
I used ‘democratic’ because I don’t know what word to use and thought it would fit most.
@Andrea… ‘god is almighty’ was what i was told but it doesn’t mean it’s true
Let’s say I’m angry with the situation(s) around me…. was this life worth the hassle? Nobody asked to be born …it was all decided by the parents. I’d rather adopt than bringing another human being to life.
There is a world of difference between the Pier Giorgio Welby case and those of Terri Schiavo and Eluana Englaro. For firsts, Welby was conscious and could take the decision for himself, whilst Schiavo and Englaro could/can not (I am not prone to believe declarations in the sense that these people would have liked to be allowed to die because they had said so in the past, unless they are written down on paper and signed).
Schiavo and Engalaro, although not brain dead, were/ is in an irreversible coma and being kept alive through a feeding tube, through which got their sustenance – water and food. Water and food are NOT medication. They are something which we all need to stay alive. In this sense, the feeding of water and food to patients in coma cannot be said to constitute the employment of “extraordinary means” to keep one alive. The withdrawal of a feeding tube in these cases is tantamount to killing the person, in a very slow and prolonged way, of hunger and of thirst.
Being attached to a ventilator for the rest of one’s life, on the other hand, can be classified as an extraordinary means of treatment. Here is a person, who besides having to be given sustenance (which is not treatment), must have a machine breathing for him every second of the day. If he wishes (and is lucid enough to take such a decision) to have this treatment withdrawn, I don’t see any reason why not. In this case death is brought about by the withdrawal of treatment rather than by the withdrawal of food and water. In my opinion this makes a difference.
Some people may make a difference between the withdrawal of treatment and not giving treatment in the first place (the gentleman with the gangrenous toe who eventually died of septicaemia). Not treating (and so prolonging miserable life unnecessarily) seems to be more acceptable, all in all, than withdrawing a form of treatment that is already being administered – in which case both Welby’s, Schiavo’s and Englaro’s cases can be considered to be similar, the only difference being WHO took the ultimate decision.
Berlusconi rules:
http://www.france24.com/en/20090206-government-seeks-stop-euthanasia-comatose-woman-
Andrea
Euthanasia is banned in all EU countries except the Benelux so stop picking on Berlusconi and pretending to be scandalised because his government seeks to prevent it. In this he is no different from Zapatero, Merkel, Brown, Sarkozy and all the other European leaders.
It might not have occurred to you but, for the state, euthanasia is much cheaper than keeping a keeping alive a patient who is in a coma or terminally-ill. From a selfish point of view, therefore, it makes better economic sense to allow mercy killings and all politicans who oppose the practice do it because of their convictions, which you should learn to respect, even if you do not share them.
Incidentally, Berlusconi does not rule Italy but heads the government because the electorate overwhelmingly wanted him to. Perhaps you are more intelligent and have better judgement than millions of Italians but that’s not how democracy works. Contrary to what people like you and Norman Lowell think, it’s not the ‘elite’ which counts but the majority of common people, including ‘Ċetta ta’ Bubaqra’.
[Daphne – Antoine, feeding tubes and life support machinery are removed here in Malta quietly all the time, with no greater requirement than the consent of the next of kin. I hope it stays that way. Of course, it isn’t always the ideal, because the next of kin are not necessarily the best-placed to make these decisions, especially when the decision to give the go-ahead to remove feeding tubes/life support machinery/intravenous drips may leave them with feelings of guilt, and so they avoid taking that decision. I know of a case in which a dying man of almost 90 was left hooked up to an artificial feeding system for three weeks, prolonging his inevitable death and his extreme discomfort. The consultant couldn’t give the go-ahead for the removal of ‘feeding’ without the wife’s permission, and the elderly wife believed that by giving this permission she would be ‘killing’ her husband. Hence the prolonged torture.]
@Antoine Vella
That was a remarkable lecture. People like me and Norman Lowell? Never would have dreamed of being mentioned in one sentence with that lunatic.
@ASP
Hey, cheer up a bit!
-‘Euthanasia is illegal in predominantly Catholic Italy, but patients have the right to refuse care’-
http://www.france24.com/en/20090206-italian-pm-president-locked-battle-over-euthanasia-case
Berlusconi’s act is unconstitutional?
Wouldn’t be the first time.
Hey Antoine!
Get a life! No pun intended!
Daphne
“..feeding tubes and life support machinery are removed here in Malta quietly all the time, with no greater requirement than the consent of the next of kin.”
I’m sure it happens in Italy too. Englaro’s father could have had her quietly transferred to another hospital where this would have been carried out. Instead he chose to go to court and make a spectacle of himself and his daughter. Whatever he might claim, he seems to be enjoying his five minutes of notoriety and is not shying away from any publicity coming his way. I’ve no idea why the court sided with him but wouldn’t be surprised if there were partisan considerations – Italian courts are like that.
Once the case became public, it was transformed into a political game which involved also the ex-communist president. It is noteworthy that, quite correctly, neither the Italian government nor ‘Berlusconi’s’ media have criticised the president, in spite of the latter’s refusal to cooperate. I can only imagine what would be the media reaction if Abela ever refused to sign a decree in Malta.
Relatives of patients have to take agonising decisions but these affect only their loved ones. Politicians, on the other hand, enact laws which affect everybody and therefore cannot afford to be swayed by emotions. As long as there is no widespread consensus for euthanasia in Europe, it is likely to remain illegal in principle in most countries. Authorities can pretend not to be aware of individual cases which occur discreetly but cannot close an eye on a court decision which would have effectively legalised euthanasia.
[Daphne – I very much doubt that Mr Englaro was driven by exhibitionism. In the US and UK reports I have read about the case, he is invariably described as having won the respect of the Italian public with his dignity and his quiet, well-spoken approach. There are many possible reasons why he did not have his daughter moved to a private clinic before now, and I rather suspect that the most obvious explanation is the correct one (as it invariably seems to be): he didn’t have the financial means to do it. So why did he move her to a private clinic now? Again, the most obvious explanation is probably the correct one: that the blizzard of publicity about his plight (he has been fighting his case for 17 years, but the public did not know about it until now) brought forward an anonymous donor, as this sort of situation so often does. That donor might even have been the private clinic itself. I would imagine that if it is prepared to take the risk of giving a reverse salute to Berlusconi’s decree, then it is also doing it free of charge.]
Antoine,
….and Cetta ta’ Bubaqra is so intelligent, humane and religious that she would rather have her mother/husband/wife/daughter spend years in totally useless agony (even months for all that matters) for no purpose whatsoever except so that her relatives can turn round and say, ”Miskina kemm kella tbaghti”. What absolute Middle Ages nonsense.
[Daphne – Except that it isn’t Middle Ages nonsense, but nonsense made possible by advanced medical technology. And am I the only one to find Silvio Berlusconi’s reference to her supposed ability to conceive and bear a child, in that vegetative state, appallingly distasteful? Trust him to think of that, of all things.]
http://www.guardian.co.uk/world/2009/feb/08/englaro-italy-vatican
Only shows the delusion of Berlusconi. His motivation to “save” Englaro’s life (amongst others, admittedly) was that she is still “in the condition to have babies”.
Daphne, I somehow think that you are leaving a very important factor out in your last comment. Life support machines and feeding tubes are removed quietly in Malta WHEN THE PATIENT IS BRAIN DEAD. Neither Terry Schiavo nor Englaro were/ are brain dead (coma does not necessarily mean brain death) and Welby most obviously was not.
[Daphne – I beg to differ on that one, Moggy, even though I you are a doctor. I know – as distinct from knowing of – somebody who was asked at St Luke’s for the go-ahead for her father’s life-support machine to be switched off. He had suffered a severe stroke and was not brain dead but had no chance of ever regaining consciousness. The case of the 90-year-old man who was kept hooked up to an intravenous drip for three weeks when he was dying – thereby prolonging his death as opposed to prolonging his life – is one I know through direct experience. The consultant was willing to have it removed but only with the express consent of the next of kin – in this case, his elderly wife who couldn’t cope with the trauma of that decision.]
“Human dignity is inviolable.”
Berlusconi manages to violate the poor woman’s dignity in reducing her to a kind of a ‘silent birthing machine’ and proves his pejorative perception of women, just once more.
[Daphne – Hideously distasteful: the image springs to mind unbidden of some man copulating with this comatose body; not quite a necrophiliac, but almost. If there isn’t a word for this kind of perversion, I’m quite sure Berlusconi is capable of coining one.]
Antoine, let me comment on this point:
‘I can only imagine what would be the media reaction if Abela ever refused to sign a decree in Malta.’
The government of Malta does not issue decrees. Our president cannot refuse to sign a bill passed by parliament, or refuse to act on the advice of the prime minister in those cases specified by the Constitution.
Presumably there will be calls for Abela to do just that the first time the government puts through a controversial law (the new rent law, perhaps?), but only by misinformed people.
I would like to make some points regarding this discussion. First of all, the notion that euthanasia is unacceptable is not some extravagant Berlusconi foible but the predominant view all over the western world. It does not stem directly from religious dogma but from the value given to human life by society and is not a medieval concept – in the Middle Ages people were abandoned and left to die. Berlusconi is only doing what any other PM would have done, faced with a court decision which goes against his convictions (and the law) on such a sensitive issue.
It would be shameful if the Udine clinic had really agreed to let Englaro die just to spite Berlusconi. By the same token, if he had been in favour of euthanasia they would have forced her to live at all costs. It would be clearly malicious for a hospital to undertake a procedure of any kind solely to spite a political opponent and no doctor worthy of the name would harm a patient to make a political statement. If this really was the case, it would be an example of the single-minded hostility that the Italian government has to face from its official and unofficial opposition.
As far as I know, none of the persons who have come out of a coma have ever spoken of having been in agony or extreme discomfort though I stand to be corrected on this. I suspect that the agony is actually a projection of what the relatives themselves feel and when we speak of euthanasia being a humane and kind solution, we mean that it is kind to the relatives (in the case of patients in coma). At any rate, the method of euthanasia being proposed in the case under discussion is anything but humane as the patient will slowly die of thirst. At that point, if they decide she should die it would be quicker and kinder (and more intellectually honest) to kill her with an injection, like vets do with sick pets.
Finally, Berlusconi claiming that a comatose person can give birth is an obvious reference to the various cases – admittedly few but notable – where women in coma gave birth to healthy babies. Such occurrences are invariably welcomed as wondrous events and proof that a person in coma is not a corpse but a live and functioning human being capable of, for example, sustaining the long and complex physiological process that pregnancy is.
Antoine Vella
I really hope those women were already pregnant when they fell into a coma.
To Italy’s credit, not everything is getting censored:
http://observers.france24.com/en/content/20090203-you-like-that-huh-relish-advertising-campaign-milan-sexual-abuse
Eluana passed on to a better life – let us hope that there is one for her – at 20.10 today. To all those who put in their comments about this tragic story may I suggest reading “La lunga vicenda di Eluana Lungaro” just put on Corriere della Sera online tonight.
Antoine Vella –
Berlusconi’s act was just a pandering ploy to the win the Catholic vote. This is a divorced man who preaches the sanctity of marriage just to ingratiate himself with the Roman Catholic Church and poach the millions of Italian voters who are still conditioned by the preaching of the Vatican. His comment that comatose persons can still give birth was crass and callous to say the least.
Andrea
“I really hope those women were already pregnant when they fell into a coma.”
Usually they were but unfortunately there have been at least three cases of women, raped while in coma, who conceived and gave birth.
http://www.encyclopedia.com/doc/1G1-54724747.html
http://query.nytimes.com/gst/fullpage.html?sec=health&res=9805E1D91239F931A35757C0A960958260
http://www.bookrags.com/highbeam/baby-for-coma-mum-raped-in-nursing-20010408-hb/
Ray Borg
“Berlusconi’s act was just a pandering ploy to the win the Catholic vote.”
You are not well-informed. If this case were to influence voters, Berlusconi knows that he stands to lose more than he gains since most polls show that the majority of Italians are in favour of letting Eluana die. Anti-Berlusconi Catholics approve his efforts to save her but would not, for this reason, vote for him so your summary judgement of Berlusconi’s intentions is clearly incorrect.
You are also incorrect in considering resistance to euthanasia as exclusive to Catholics; there is not one christian denomination which does not oppose the principle, as do many non-religious movements.
Antoine Vella
Too much information!
[Daphne – I beg to differ on that one, Moggy, even though you are a doctor. I know – as distinct from knowing of – somebody who was asked at St Luke’s for the go-ahead for her father’s life-support machine to be switched off. He had suffered a severe stroke and was not brain dead but had no chance of ever regaining consciousness. The case of the 90-year-old man who was kept hooked up to an intravenous drip for three weeks when he was dying – thereby prolonging his death as opposed to prolonging his life – is one I know through direct experience. The consultant was willing to have it removed but only with the express consent of the next of kin – in this case, his elderly wife who couldn’t cope with the trauma of that decision.]
I did, in fact, forget to mention one detail myself, in my last post – and this is that one is not obliged to use extraordinary measures to keep someone alive (even though the person is evidently dying). The first case you mention falls under this set of circumstances, and I would agree completely with the withdrawal of such persons from a ventilator (as I have already said that I agree with the outcome in the Welby case). Withdrawing hydration/ nutrition is not the same thing. Hydration and nutrition are not extraordinary means of treatment, and just the basics of nursing care. What we doctors refer to as TLC is basically keeping the patient comfortable and hydrated, even though treatment is not being given, whereby death will eventually come. Extreme dehydration in itself can cause discomfort, so I see no virtue in bringing it about.
@Antoine vella
Can you please climb down from your high horse? I think I am as well informed as you are, if not better, on this matter. First of all your reading of the opinion polls is incorrect. Just have a look at “L’Osservatorio di Renato Mannheimer Il sì e il no al 47% Italia divisa in due” published in last Sunday’s Corriere Della Sera and get yourself updated. There you can read that public opinion was equally divided. Berlusconi is not worried by Veltroni’s divided and disarrayed PD (Partito Democratico. He is more concerned about losing the vote of the Conservative right – read Casini and Buttiglione- and this is why he chose to appease the fundamentalist Catholic vote.
Your defence of his crass and callous comment about comatose women giving birth when he was defending his position on the Eluana tragedy is pathetic and distasteful.
Berlusconi’s delusions of grandeur seem to rub off on his admirer.