As someone who still remembers the Karen Ann Quinlan case, I feel obligated to address a troubling moral issue which seems to have gotten its foot in the door as a result of the Terri Schiavo debate.

Bear in mind that I think the removal of the feeding tube was wrong based on the totality of the circumstances as I see them. But that does not mean that I would want a feeding tube under similar circumstances, or that I think there's anything morally wrong about refusing a feeding tube.

Others disagree, and their support for Terri Schiavo is not limited to persons in her position, but if I am reading them correctly, they maintain there is no right of anyone, anywhere, to remove -- or refuse -- a feeding tube:

VATICAN CITY (CNS) -- Removing the feeding tube from Terri Schindler Schiavo, a brain-damaged Florida woman, or other patients in a similar condition amounts to "direct euthanasia," a "cruel way of killing someone," said the Vatican's top bioethicist. (Emphasis added.)

Does this mean that a decision not to insert a feeding tube is also "euthanasia"?

If so, then there are a lot of people committing euthanasia without knowing it.

Years ago, I accompanied my father on his medical rounds, and I remember one senile patient who had no idea what was going on. Dull eyes, repeating things that made no sense, no idea where she was, the whole thing.

My father remarked to me, "Eric, if she was a dog we'd take her out and shoot her."

Not that he supported euthanasia; he was just remarking on the irony to a small boy (who happened to be both horrified and intrigued).

The irony in the Schiavo case is that if you had a dog in the same position and let it starve, people would say you were being cruel.

On that point, at least, everyone seems to agree.

No one would treat a dog the way Terri Schiavo is being treated.

From there the debate gets fuzzy. I can't settle these issues for other people, and if I've learned anything from this case, it's the importance of making your wishes known clearly, specifically, and in writing -- before the time comes when it won't be possible to communicate them. People think it could never happen. I think it could never happen. It's the nature of life. Yet just a few weeks ago I stopped for a red light and BLAM! I was rearended -- really hard. Had it been an 18 wheeler instead of a van, I could have been killed -- or put in Terri Schiavo's position.

And who would take my case? It would be a bit arrogant for other people to say that if I was mostly brainless, and unable to communicate or eat, that I'd have a "challenge to overcome," because there'd be no me there. I wouldn't be capable of wanting tubes to keep the physical body hydrated or fed, or not wanting them.

But a point which must be acknowledged is that some people would want the tubes. Most of us would not have wanted to live like Christopher Reeve. Yet few of us would deny that shutting off his respirator would have been murder.

These aren't easy issues, and I don't have easy answers. But it strikes me that they are personal decisions -- which must be made personally.

Are there people out there (perhaps readers of this blog) who don't think I have the right to refuse a feeding tube? Why? Is my personal business theirs? Again, why?

Perhaps I am worrying over nothing. As one conservative blogger puts it,

This is also not a "right to die" case, as the media are calling it. That Terri has a right to refuse a feeding tube is not in question. What is in question is what happens when one person is making that decision for another, and when there is a great deal of circumstantial evidence that the guardian and even the doctors are acting in bad faith.

I hope it isn't. And I don't think religion could settle it one way or another; there's even a religious right to refuse treatment:

In addition to the Cruzan federal case, there have been 30 state-court decisions affirming the right to disconnect feeding tubes alone, said Arthur Caplan, chair of the Department of Medical Ethics at the University of Pennsylvania.

Ironically, the issue began in the 1950s when Jehovah's Witnesses wanted to reject medication, he said. "The right to say no to treatment comes from religious reasons."

But if religion isn't personal, what is?

UPDATE: (10:30 a.m.) The U.S. Supreme Court has refused to hear the Schindlers' appeal.

MORE: William F. Buckley Jr. weighs in on the value of "Nazi" hyperbole in some of the arguments by Terri Schiavo's supporters:

It was unseemly for critics to compare her end with that of victims of the Nazi regime. There was never a more industrious inquiry, than in the Schiavo case, into the matter of rights formal and inchoate. It is simply wrong, whatever is felt about the eventual abandonment of her by her husband, to use the killing language. She was kept alive for fifteen years, underwent a hundred medical ministrations, all of them in service of an abstraction, which was that she wanted to stay alive. There are laws against force-feeding, and no one will know whether, if she had had the means to convey her will in the matter, she too would have said, Enough.

Some of this may be a product of the phenomenon known as "preaching to the choir." Unfortunately, one man's "choir" may be another man's mob. When I studied Rhetoric, I was taught that one of the most critical aspects to the science of persuasion was understanding the nature of the audience. A speech which might persuade a group of law professors might fall flat with a group of truck drivers -- or vice versa.

With blogging, the audience tends to be a mystery.

(Maddening, of course....)

AND MORE: Such hyperbole is not limited to the right. Here's a Daily Kos commenter who believes that anyone discussing the Schiavo case is an insane drug addict:

Almost all Americans are TV addicts, and this plague is destroying our nation. This week you will hear the hordes of these drug-induced insanity-suffering addicts talking about a brain dead woman name Terri Schiavo and her personal family matters, which affect none of us in any way. Realize, anyone you hear taking time to discuss this case is a drug addict, has allowed the media to control their brain to talk about something that affects them in no way; absolute mind control. When you hear the talk, realize, they are very, very sick and in need of help.

To help them out, don't respond with any input to the story - to do that is to be a part of the problem. Instead, trying asking them if they know that on Friday, $1 billion dollars was cut from police funding, community hunger programs were completely eliminated, numerous education programs were slashed, and firefighter funding was slashed, while another $134 million in tax cuts was passed in the middle of a war and record deficits. And then just walk away, knowing there is no helping addicts until they can see the problem themselves - and by not participating in their insanity but, instead, helping to point out how insane they are being, you have taken an important step in reclaiming our nation from the drug-induced malaise it is in.

CORRECTION: While the above was posted at Daily Kos, the author, one Thomas J. Bico, is not the Daily Kos commenter, but a Google-approved official journalist who writes for an outfit called the Moderate Independent.

Which makes him an expert on drug addiction and insanity.*

*Among other things, Mr. Bico (who happens to be the Moderate Independent's "editor-in-chief") has diagnosed Alan Greenspan as suffering from "psychotic schizophrenia." (No wonder the Kos-o-philes like him.)

Why blog? Isn't it easier to just be a Google news site?

UPDATE: More on Google in the the previous post. Why be a blogger when you can just call yourself a news site?

FEEDING TUBE UPDATE (03/29/05): Are Living Wills going to be subjected to new attacks? In today's Philadelphia Inquirer there's a story of a terminally ill man whose living will specifically stated that he did not want a feeding tube, but whose wife wants to insert one:

Mariann Judith Clunk of Hatboro filed suit against her father's doctors and health-care facilities last week when she learned that her mother had asked for a feeding tube. His living will clearly says he did not want one, Clunk said.

Her father, John P. King Jr., 72, a patient at the Delaware Valley Veterans Home in Philadelphia, signed an advance health-care declaration in 1998 stating that if he were "in a terminal condition or in a state of permanent unconsciousness" he would "not want tube feeding or any other artificial invasive form of nutrition (food) or hydration (water)."

Judge David W. Heckler may issue an order in the case today.

John King named his wife, Ann King of Philadelphia, as his surrogate to make health-care decisions for him in the event that he could not.

Ann King did not attend the hearing in Doylestown yesterday, and did not send an attorney to represent her. Attorneys for the doctors called no witnesses.

Clunk and the two doctors named as defendants all testified that John King was at the end stages of Alzheimer's disease and was no longer able to function.

Clunk, who is an operating room nurse at Fox Chase Cancer Center, told the court that her father could no longer walk, feed himself, or control his bladder or bowels. She said his speech had been reduced to "almost nothing."

Clunk said the question of inserting a feeding tube had come up in conversations with her mother several times throughout the nine years of her father's illness.

"Dad said that he didn't want this," Clunk said. "I was told that this wasn't my decision."

Gregory J. Lynch, medical director of the Delaware Valley Veterans' Home and a defendant in the case, testified that John King is at the end stages of Alzheimer's disease and "totally dependent on others."

Lynch called Ann King "a devoted wife" who "was very faithful to him and doted over him."

In meetings with doctors about her husband's disease, Ann King refused to discuss the life expectancy of end-stage Alzheimer's patients, Lynch said. "When we approached this with Mrs. King, she was not interested, and asked us to put our papers away," he said.

Lynch said he did not understand why Ann King wanted doctors to use a feeding tube against her husband's wishes.

Howard Bronstein, John King's family physician, testified that he "has an incurable, irrevocable medical condition" and probably has less than a year to live. He said it concerned him that Ann King was asking doctors for medical treatments that her husband specifically said he did not want.

"I thought that he had clearly laid out the circumstances by which he wanted to die," Bronstein said.