Editor’s note: The following article is by Diana Lynne, author of a
powerful, comprehensive book on Terri Schiavo’s life and death, entitled “Terri’s Story: The
Court-Ordered Death of an American Woman.” This latest WND Books
release is now available at WorldNetDaily’s online store.
In Part I of this two-part series, “Will you be the next Terri?” Lynne
reported how the advance-directive statutes across the country are subject
to interpretation and leave the door open for future familial
life-versus-death court disputes.
Amid the ongoing cultural war over the sanctity of life versus the
promotion of death demonstrated in the Terri Schiavo case, a WND analysis of
state advance-directive laws reveals how you will be treated should you
become incapacitated depends on where you live.
Judging by the language used in the living wills in nearly half the
states, they appear solely created for the pro-death purpose of refusing or
withdrawing medical care and treatment. Both North and South Carolina
entitled their living wills as a “Declaration of a Desire for a Natural
Death.” Other states like Illinois, Iowa, New York, Rhode Island, Virginia
and Washington articulate an aversion to “prolonging the death process”
without requiring the patient actually be dying.
New Jersey distinguishes itself by offering competent adults the ability
to define death for themselves as either “whole brain death” or the
“cessation of a heartbeat and breathing.”
Missouri throws in a disclaimer: “It is not my intent to authorize
affirmative or deliberate acts or omissions to shorten my life, rather only
to permit the natural process of dying.”
And while some states list the treatments that can be refused or
removed – CPR, electric shock, artificial breathing, drugs, blood, blood
transfusions, surgery, antibiotics, artificial nutrition and hydration and
IV fluids – more often, the definition of “life-sustaining procedures” is
left open and subject to interpretation. Many states simply reference
“treatments that merely serve to prolong the dying process.”
Contrarily, the living wills in 20 states provide the pro-life
opportunity to request life-sustaining procedures be utilized, not avoided.
Ironically, the only state in the country with legalized assisted suicide,
Oregon, represents one of a handful of states that list the pro-life
checkoff request such as, “I do want CPR,” before the pro-death
checkoff, “I do not want CPR.” The other states are Delaware, Idaho,
Washington and Wisconsin.
“Oklahoma has the strongest law” in terms of erring on the side of life,
according to attorney Burke Balch, director of the Robert Powell Center for
Medical Ethics with the National Right to Life Committee. “Though it’s not
As WND reported yesterday, disparity in the state
living-will statutes in part stems from the medical conditions chosen by
legislators to serve as triggers for the execution of advance directives. In
addition to the variously defined term “terminal condition,” 18 states allow
life-sustaining procedures to be refused by or removed from patients who
are “permanently unconscious” or in an “irreversible coma.”
Fourteen of these specify persistent vegetative state, or PVS, the
diagnosis attached to 41-year-old Terri Schiavo by a probate judge.
Pinellas-Pasco County Circuit Court Judge George Greer arrived at his
ruling over the course of two court proceedings on the basis of testimony by
three expert witnesses solicited by Michael Schiavo, who sought the removal
of his wife’s feeding tube, and one independent, court-appointed medical
Subsequently, scores of neurologists, speech pathologists, rehabilitative
therapists and a brain surgeon filed affidavits with the court suggesting a
more accurate diagnosis might be MCS, or minimally conscious state. In its
statute, New York casts a wider net to apply its removal-of-treatment
criteria by including patients diagnosed in MCS.
Terri’s brother, Bobby Schindler, recently reflected upon the usefulness
of labels such as PVS and MCS in an interview with WND.
“Why don’t we just say someone is brain-damaged? Why do we have to
diagnose someone as PVS?” he queried. “It seems to me the diagnosis was
created for one reason, and one reason only: to set up a criterion so the
law can come in and say a person can be killed.”
“These terms are all meant to devalue the value of a patient as a person
and to make it easier to ‘let them go,'” agreed hospice watchdog Ron
Panzer, with the Hospice Patients Alliance. “The phrase ‘let them go’ is no
longer letting them go, it’s pushing them over into death through hundreds
of different means – by depriving them of ordinary medical treatment or
dehydrating them to death or overdosing them.” While stressing all hospice
facilities aren’t corrupt, Panzer, a former nurse within hospice, says he
receives dozens of complaints from families across the country about
relatives “being killed” in hospice.
Through the non-profit foundation the Schindlers set up during their
battle to keep Terri alive, the Terri
Schindler-Schiavo Foundation, the family hopes to get states to rethink
the inclusion of PVS in their living-will statutes.
Quality of life
Much of the debate over Terri Schiavo stemmed from this notion of quality
of life. Many argued that because she lacked awareness — a court
determination that was widely disputed by medical experts — her life lost
its value. Some argued Terri Schiavo ceased to be a person.
A handful of states wade into this quality-of-life debate, covertly or
overtly, in their living-will statutes. Maryland and New Jersey specify the
advance-directive also applies to non-terminal conditions that cause “severe
deterioration.” Arizona and South Carolina go so far as to list “severe
brain damage” and “dementia” as reasons to choose death.
Tennessee spells it out: “I want my doctors to help me maintain an
acceptable quality of life … ”
Feeding tubes as extraordinary means
The Terri Schiavo case also sparked controversy over defining a feeding
tube as life-sustaining medical care versus basic, humane care. WND’s
state-by-state survey indicates it’s a matter of time before another case
reignites that controversy. No state excludes feeding tubes from their
definition of life -sustaining procedures that can be removed per advance
However, a majority of the states – 28, to be exact – differentiate
between artificially provided nutrition and hydration, and other forms of
life-sustaining treatment by providing a separate checkoff or space for
instructions regarding this. These are Alabama, Alaska, Arizona, Colorado,
Delaware, Georgia, Hawaii, Idaho, Indiana, Kentucky, Maine, Maryland,
Minnesota, Mississippi, Nevada, New Hampshire, New Mexico, North Dakota,
North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, South Dakota, Tennessee, Washington and Wisconsin.
Idaho offers the most declarative, pro-life statement that speaks to the
Terri Schiavo case: “Nutrition and hydration, whether artificial or
nonartificial, shall not be withheld or withdrawn from me if I would likely
die primarily from malnutrition or dehydration rather than from my injury,
disease, illness or condition.”
WND’s survey of state laws finds two straddle the pro-death versus
pro-life debate. The living wills offered to Minnesota and North Dakota
residents primarily pose open-ended questions and leave ample blank space
for individuals to tailor the documents to their needs. Other states offer
the ability to cross out sections, with which the signers don’t agree and
blank space to indicate special instructions.
Should you find yourself living in a state whose advance-directive form
doesn’t jive with your values, several non-governmental forms are available
that either emphasize the preservation of life, such as the Will to
Live distributed by the National Right to Life Committee, or facilitate
what’s considered a natural death without medical intervention, such as the Five Wishes
created by the Florida Commission on Aging with Dignity.
Both of these organizations have worked to ensure the forms comply with
the varying state statutes. However, 11 states are “mandatory form”
states, according to the American Bar Association, and require health care
powers of attorney or other advance directives to be substantially in the
form contained in the statute. These are Alabama, Kansas, Kentucky, Nevada,
New Hampshire, Ohio, Oklahoma, Oregon, South Carolina, Texas and Utah.
Experts recommend you read the fine print very carefully. As the writers of South Dakota’s living will warn, “This document can control whether you live or die.”
Diana Lynne’s powerful, comprehensive book on Terri Schiavo’s life and death, entitled “Terri’s Story: The
Court-Ordered Death of an American Woman.” is now available at
WorldNetDaily’s online store.