Circa 2005
Dear Readers,
The difficulties in figuring out what Terri Schiavo wanted for herself broke the hearts of two families and embroiled a nation in moral debate. I don’t presume to have any greater wisdom that any other American, certainly not more than the legal scholars and ethicists who have commented or the families whose personal struggles have been debated so publicly.
But when I saw Congress spring into action to pass the bill for federal review of Mrs. Schiavo’s case, I was troubled by some nagging inconsistencies with the rest of our health policy. I know their debate was supposed to be about Terri Schiavo, but I kept thinking about another patient, one of my patients. She is 63, is fully conscious, lives alone in her own apartment and has kidney problems causing high potassium levels in her blood. Her internist tells me that Medicaid, which many legislators have wanted to cut by $20 billion this year, will not pay for the medication that would remove the excess potassium from her system unless she gets sick enough to go into the hospital. However, high potassium levels put her at continual risk of very serious abnormal heart rhythms (just as low potassium caused a heart attack in Terry Schiavo’s case), and her fear that she may die early as a result of this cardiac risk leaves her hopeless and depressed. As our nation considered whether Terri Schiavo would have wanted to remain alive, I thought about my patient, who very much wants to remain alive. Where is the consistency in a Congress that will rush back from its Easter break for a vote to potentially help preserve the life of one individual, yet seems to have no problem with program cuts that may shorten the lives of many others?
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In the wake of the special congressional bill for federal court review of what one woman with a very specific type of injury would have wanted for her care, I thought also of the Medicaid Community Attendant Services and Supports Act (MiCASSA), no version of which has yet to pass in Congress. This legislation addresses the preferences for care for a quarter of a million Americans who would like to live in their own homes or apartments, but in order to have their health care covered through Medicaid are now unnecessarily institutionalized and deprived of the option to live with autonomy and independence. Terri Schiavo, however, did get her care paid for by Medicaid, as well as by proceeds from a malpractice litigation suit—the same type of suit that some on Capitol Hill would seek to limit.
My point is not to begrudge Mrs. Schiavo any of the care she received. I hope, as does the nation, that in the end our legal system was able to come as close to her wishes as possible. The point is that it is far too easy when hearing the rhetoric about budgets and block grants and turning Medicaid over to the states to forget we are really talking about people and lives and moral imperatives and personal freedoms, the same things that captured the nation so passionately in Mrs. Schiavo’s dilemma. Medicaid cuts and MiCASSA ought to stir us as much as the Terry Schiavo case. Shame on us if we don’t take them just as seriously.
Sincerely,
Gillian Friedman, MD
Managing Health Editor
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