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Debate continues in Missouri over end-of-life issues

May 02, 2005
By: Elizabeth Baird
State Capital Bureau
Links: HB 905, SB 517, SB 547

JEFFERSON CITY - Over a month after the death of Terri Schiavo, at least three Missouri lawmakers are trying to sort out where the state should stand on end-of-life issues.

Every state, including Missouri, allows patients to control their own fate through advance directives.

Missouri is one of eleven states where legislation has been filed to address the question of whether to sustain life if no such directive exists.

None of those bills has become law. With less than two weeks left in Missouri's legislative session, the three bills pending in Missouri have almost no chance of passage.

Schiavo died March 31 in Florida after 13 days without food or water. Although Schiavo's parents appealed to the federal courts to have her feeding and hydration tubes reinserted, those courts upheld the decision made by Florida courts to allow Schiavo's husband, Michael, to decide her fate. Her death came amid a great deal of national protest.

In Missouri, two bills that relate to the issues of the Schiavo case have been filed in the Senate and one in the House. All three address end-of-life decisions for incapacitated patients who lack living wills or advance directives.

The Senate bills were filed March two weeks before Schiavo's death. The House bill was filed the day Schiavo died.

Although not directly related to Schiavo's case, Senate Majority Leader Charlie Shields, R-St. Joseph, has filed a bill that he said would establish a "pecking order" for who should make health-care decisions for incapacitated patients without durable power of attorney. The bill would provide that no health care decisions made by an attorney or surrogate if that decision is contrary to the provider's religious beliefs or institutional religious-based policy.

"This is designed to resolve some of the issues that arise when caring for someone who is unable to speak for him or herself," Shields said. "This is really just a safety net."

Another Senate bill would allow a court to grant custody of a vegetative patient to any relative willing to continue care if a dispute over his or her life arises.

"Civilized society should be on the side of life," said the bill's sponsor, Sen. John Loudon, R-St. Louis County, "Deciding to end someone's life should not be left up to one person."

Legislation that deals directly with nutrition and hydration was heard by the House Health Committee in late April. The bill would prohibit the withholding or withdrawal of nutrition or hydration for patients without written powers of attorney granting the authority to do so, violations would warrant a felony charge.

One senator said that is the approach that needs to be taken. Sen. Gary Nodler, R-Joplin, said the Senate bills don't go far enough.

"I think it wouldn't hurt to have a law that makes it clear that hydration and nutrition are not to be considered life support," Nodler said. "When you remove nutrition and hydration, you're not letting someone die, you're killing them."

Lana Jacobs of Columbia, who was arrested in Florida after trying to bring water to Schiavo, said the bigger issue is defending life under every circumstance.

"Missouri has a long way to go," Jacobs said, "We've killed 62 people on death row; we kill poor people everyday with Medicaid cuts."

In 1990, Missouri faced a similar situation with the case of Nancy Cruzan, who suffered brain damage as the result of a 1983 car crash. Cruzan was fed by artificial means for years. Controversy arose when Cruzan's parents expressed a desire to remove her feeding tube. The U.S. Supreme Court ruled in their favor and Cruzan died Dec. 26, 1990.

Reg Turnbull, a Jefferson City attorney specializing in elderly and end-of-life issues, said that while these cases have involved young persons, it's older Missourians who seek advance directives.

"Older people contact me to get these documents done and oftentimes the younger people and middle aged people still don't get around to doing them," Turnbull said, "It's ironic that something happens to the younger people and its usually the older people that flock into see me."

The Missouri Catholic Conference has been extensively involved with issues of life at the Capitol. Director Larry Weber said that while the legislators filed the bills on their own, his group will work with them to ensure the value of human life is preserved.

Opponents of the legislation, however, say the General Assembly should not intervene in life-and-death situations.

Denise Lieberman, legal director for the Eastern Missouri Civil Liberties Union, said the measures would impede patients' rights.

"People's wishes should not be ignored because they haven't taken specific steps to have them recognized," Liberman said. "The legislature should not be in the business of shackling the hand of individuals and tying the hands of the court."

Sen. Chuck Graham, D-Columbia, also opposes the bills.

"As someone who has had to make the decision to remove support from my mom, the last thing I want is Senator Loudon or any other government official getting in the middle of a private family decision," Graham said.

While opinions vary on the necessity of the legislation, various activists in Missouri say the debate the Schiavo case has generated has been beneficial.

"The lesson is people need to take steps to ensure that their health care wishes are respected by others and be able to communicate what their personal values are," Weber said.

Weber also said opponents who see end-of-life issues as private family matters misunderstand the intent of government.

"The government has an obligation to ensure the wellbeing of an incapacitated person," Weber said. "That's their purpose."

But Turnbull offers a different perspective.

"We are a country of individuals, what people need to decide is what is right for them, no law can decide that," Turnbull said.

Wait and see was the approach recommended by Jim Pierce, governmental affairs chairman for Missouri Hospice.

"I'm leery of jumping on the Schiavo case without time for more consideration and thought," Pierce said. "This seems to be an extremely quick response to something we may regret."

For now, it seems Missouri's legislature is taking the Pierce approach -- stalling action on all three end-of-life bills.

But in the closing days of a legislative session, it is not uncommon for amendments to be tacked onto nearly unrelated bills.