Category: Old Dish

She’s now in the hands of her creator. It seems to me any more political talk should cease for a while. The moral questions linger, however. And it has been argued that there is only one authentic Catholic position on the Schiavo case, and that it is that the feeding tube should have been kept in indefinitely, regardless of the wishes of the legal husband. Anything else is murder. But that is far too crude an assessment of the Catholic position. This pope recently declared that feeding tubes are not “extraordinary” or disproportionate methods of prolonging the life of the terminally ill. But this is not official Church doctrine – yet. The long tradition has been a balancing of various goods and evils. Here’s the money quote from the 1980 document that is most relevant here:

However, is it necessary in all circumstances to have recourse to all possible remedies?

In the past, moralists replied that one is never obliged to use “extraordinary” means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of “proportionate” and “disproportionate” means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.

In order to facilitate the application of these general principles, the following clarifications can be added:

If there are no other sufficient remedies, it is permitted, with the patient’s consent, to have recourse to the means provided by the most advanced medical techniques, even if these means are still at the experimental stage and are not without a certain risk. By accepting them, the patient can even show generosity in the service of humanity.

It is also permitted, with the patient’s consent, to interrupt these means, where the results fall short of expectations. But for such a decision to be made, account will have to be taken of the reasonable wishes of the patient and the patient’s family, as also of the advice of the doctors who are specially competent in the matter. The latter may in particular judge that the investment in instruments and personnel is disproportionate to the results foreseen; they may also judge that the techniques applied impose on the patient strain or suffering out of proportion with the benefits which he or she may gain from such techniques.

It is also permissible to make do with the normal means that medicine can offer. Therefore one cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community.

When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.

You can argue both sides of this in the Schiavo case. A constantly infected feeding tube that has resulted in no tangible progress of any kind for over a decade? Is that “burdensome”? But what can “burdensome” mean for someone unable to feel or think? Notice that the church even allows for discontinuing “disproportionate” means of life-preservation on the grounds of expense alone. And you can see why: if the rule is that all persistently vegetative patients must be attached to feeding tubes indefinitely, then the costs to society would be stratospheric. At some point we could have as many not-dead-yet human beings suspended unconsciously in semi-life as we have in embryo factories at the other end of the human spectrum. My point is not that this case has been easy in Catholic moral terms. My point is precisely that it is not easy. Fifteen years with no brain waves at all? Keeping her in that state would have been just ordinary care? And at what point do we “accept the human condition” in the Church’s words? That’s the question. We can say, however, that Michael Schiavo’s record is certainly within the scope of the Church’s historical understanding of what the moral obligations toward his wife are. What we are seeing is how far this Pope has shifted the debate toward an absolutist position on life and death. He is the innovator. But he does not have a monopoly on what the Church as a whole believes. It’s a church; not a personal cult. Not yet, anyway.

The New York Times’ story today about the alleged new strain of HIV tells us a few things. No other person has been found with an identical strain; the patient is responding to anti-retroviral treatment; the bulk of his sexual contacts were already HIV-positive. So we had five days of hysterical coverage from the NYT for … this? The new story – tellingly – does not include the context that was provided in previous stories, i.e. that this new strain comes “as a growing number of gay men become infected despite warnings about unsafe sex.” Maybe that’s because the New York City Health Department has no statistics to support that claim; and, in fact, has data that refute it (data unknown to the reporters at the NYT). Is New York City alone in marking a decline in HIV infection rates? Nope. We were told a couple of years ago that Seattle was having a huge new increase. The Seattle Weekly recalls that “[King County’s] top AIDS official, Dr. Bob Wood, called the situation ‘frightening,’ ‘astounding,’ and ‘the most dramatic increase since the beginning of the epidemic.'” Hard data two years later show a stable rate of infections, despite a growing number of people living with HIV. Or a state like Virginia? A state-wide drop of 20 percent between 2003 and 2004. In Charlottesville, they saw a 67 percent drop. San Francisco? The same hype only a few years ago – “sub-Saharan levels” of infection, according to the head of the city’s public health department. The latest data show infection rates completely stable, along with a dramatic rise in the number of people getting tested. I’m waiting for evidence that will show that this “new” strain is new, that there is a resurgence of HIV infection among gay men in America, and that the New York Times is not a megaphone for whichever AIDS hysteric comes along next. As I said, I’m waiting.

Adam Moss’s revamped New York magazine continues to impress. The latest smart piece is by John Heilemann on Karl Rove. John (an old friend) is smart enough to criticize Rove while not under-estimating him. I almost look forward to Rove running Bill Frist for president next time around. But this paragraph is the most interesting:

Not long ago, I had a chance to see Rove speak to an audience of conservative activists down in Washington. The speech was as revealing for what it left out as for what it included. Not once did Rove proclaim the importance of reducing the size and sphere of Washington’s purview. Not once did he echo Ronald Reagan’s famous line – which codified a fundamental verity of modern Republicanism – that “government isn’t the solution to our problems; government is our problem.” Instead, Rove rejected the party’s “reactionary” and “pessimistic” past, in which it stood idly by while “liberals were setting the pace of change and had the visionary goals.” Now, he went on, the GOP has seized the “mantle of idealism,” dedicating itself to “putting government on the side of progress and reform, modernization and greater freedom.”

Greater freedom? Abroad, sure. At home, we have seen a clear decrease in tangible freedoms, some reasonable, others far less so. The only time this president speaks warmly of freedom is when he’s referring to foreigners. Heilemann correctly diagnoses the Bismarckian first term agenda of Rove: “tax cuts for the rich; subsidies for farmers, tariffs for the steel, shrimp, and lumber industries; the gargantuan Medicare prescription-drug entitlement for the drug companies and the elderly.” Big government goodies for everyone. Larded over with a Kulturkampf. Just like Bismarck.

TORY SUICIDE – AGAIN: Just when they looked as if they were gaining traction for the coming election, Britain’s Tories return to their favorite activity: attacking each other. Depressing.

EMAIL OF THE DAY: “This May 8th will be the first year of my mother’s death. The publicity surrounding Terry Schiavo has brought up a whole lot of feeling for me, possibly even producing shades of PTSD. My Mom had pancreatic cancer and was hospitalized for about 2 weeks when my father, sister and I took her off IV fluids. The physician said there is nothing more we can do except to prolong her suffering and we all felt strongly my mother had suffered enough. My mother had been hospitalized about 2 years prior, 9 month in Intensive Care because a surgeon punctured her bowel while removing a benign tumor. During that time and for several months later at home, my mother was in a highly agitated state of consciousness, in and out of delirium. Afterward she expressed gratitude for not remembering.

I remember about 2AM, the night we took her off fluids waking up in anguish and horror, thinking that I was killing my mother. Hysterical, I attempted to speak with someone at the hospital about our decision. I think they thought I was crazy. Early that morning, my Dad and I went to the hospital and I was able to talk to a physician who said we made the right decision. If there had been any chance at all that my mother could have lived, we would have taken it, no matter the odds. The decision was agonizing and to this day I am haunted by it.

My sister-in-law is a devout Catholic, a Republican, and she watches Pat Robertson’s 700 Club almost religiously. She phoned the hospital that moring and spoke with me, disagreeing with the decision we made. When I asked why, she said, ‘You never know.’ ‘You never know what?’ I pleaded. ‘You never know, miracles can happen.’ I restated to her the physician’s words to us. ‘I still don’t believe you are making the right decision,’ and went on to describe several miracles she said she knew of. I asked her if her words were supposed to be comforting to us. She didn’t understand my question.

Andrew, I do not understand. My mother was a good Catholic and as far as I know, Christians believe that good Christians go to heaven. I just don’t understand the need of so many devout Christians in prolonging the suffering of another human being who is in the end stage of disease and with no hope for remission. And they do it with a conviction that is rude, intrusive and without compassion or regard for those of us who have to make an anguishing decision.”

I don’t buy everything that GayPatriot writes; and his rhetoric can be a little much at times. But it’s a shame he has been intimidated by the gay far-left into ending his blogging. A shame but unsurprising. If the gay “outers” spent a fraction of the time they spend attacking other gay people actually making the case for equality to straight people, the world would be a better place.

REALITY CHECK: Here’s Larry Kudlow on the Schiavo case:

Inexplicably, the U.S. court system is determined to take Schiavo’s life. I say inexplicably because the courts have chosen to disregard the morality of life, the religious belief in life, the culture of life. Inexplicable because all Americans of faith believe that in situations like this we should, as President Bush has said, err on the side of life.

In fact, of course, majorities of “people of faith” disagree with Kudlow and with the notion that removing life-support (and a sophisticated feeding tube is life support) after fifteen years of being completely incapacitated is certainly not an easy call. Even people inclined to be “pro-life” see that this case may be one in which allowing a human being to die is the morally preferable thing to do. But Kudlow doesn’t see this diversity of religious view – even now. That’s how hermetically sealed the far right is. Until now, most people haven’t seen the theocratic tendencies in today’s GOP. The religious right has focused on abortion (which affects a small minority) and gays (ditto). But the right to die affects everyone. Suddenly the willingness of the far right to use the full weight of government to impose their views comes to light. Now many people get a taste of how gays feel. And a chill up their spine.

“The Republicans are no longer the party of small, limited government, fiscal sanity, states and individual rights, and the Constitution. In their own way, they have become as bloated, hypocritical, invasive, and spendthrift as much of the worst the Democrats have to offer.” – Bill Quick, DailyPundit. I’m basically with Bill, although we disagree about a few particulars.

SCHIAVO AND CONSERVATISM: My thoughts on this trial in the life of a vegetative woman and her family. It’s been striking lately how the rhetoric of some conservatives has morphed into revolutionary tones. Bill Kristol, at heart an ally of religious radicalism, calls for a revolution against the independent judiciary we now have. Fox News’ John Gibson has argued that “the temple of the law is not so sacrosanct that an occasional chief executive cannot flaunt it once in a while.” Bill Bennett has said that the courts are not the ultimate means to interpret law and the constitution, that the people, with rights vested in the Declaration of Independence, have a right to over-turn the courts if judges violate natural law precepts such as the right to life. Beneath all this is a struggle between conservatives who place their faith in the formalities of constitutionalism and those who place their literal faith in the God-revealed truths they believe are enshrined in the Declaration, truths that alone give meaning, in their eyes, to America as a political project. Here’s an interesting essay on the divide among Straussians on this point, particularly between Harry Jaffa and Harvey Mansfield Jr.

Ashley Smith, Brian Nichols and the miracle before Holy Week. My latest Time essay.

EMAIL OF THE DAY: “As I read through yesterday’s emails, I am struck by the possible fruitfulness of moderate Republican conservatives joining forces with similar folks in the Democratic Party. Perhaps if we leave the extremists of both parties out on their respective limbs and offer a strong ideology of fiscal responsibility, “gentle” hawks only responding in war when clear need is identified, protecting our own public financially from being sold out abroad, protecting our borders (even at the expense of some very wealthy businesspeople) — promising personal rights of privacy in the pew and the bedroom and on the deathbed — I think a strong, pragmatic, sensible, workable “party” could emerge. We MUST ditch religious zealotry ASAP — it is killing real moral values!!”

CASTLE ON SONTAG: A brutal and often funny memoir of the favorite intellectual of the American left.

“I’m quite astonished to hear people who call themselves conservatives arguing, in effect, that Congress and the federal courts have a free-ranging charter to correct any injustice, anywhere, regardless of the Constitution. And yet my email runneth over with just those kinds of comments. And arguing that “it’s okay because liberals do it too” doesn’t undercut my point that conservatives are acting like liberals here. It makes it.” – Glenn Reynolds, coming to terms with what the religious right is doing to conservative principles. The important point is that religious zealotry cannot be incorporated into conservatism. It is the nemesis of conservatism. And it has to be purged in order for conservatism to be revived.

With less regular postings, many of you have asked me to add an RSS feature to let you know of new posts when they occur. Your wish is, er, Robert’s command. You can click on the RSS link at the bottom of the page. The feed URL is http://feeds.feedburner.com/andrewsullivan/rApM. You just put this into your RSS reader application.

You will recall how Richard Cohen of the Washington Post wrote recently of an “apparent upsurge” of HIV infections among gay men. He was seconded in this by one Charles Kaiser who cited his own anecdotal evidence of rising numbers of gay men contracting HIV in New York City. As it happens, we do have some hard data on this now because since 2002, New York City has required all new HIV diagnoses to be reported. Michael Petrelis lays out the latest data on his blog today. It’s quite striking. New diagnoses of HIV have declined each year. The most comprehensive data is for first quarters of each year (they haven’t gotten past reporting the first quarter of 2004 yet). So look at this: in the first quarter of 2002, we have 1403 new diagnoses; in Q1 2003, we have 1288; in Q1 2004, we have 908. So we have a 35 percent decrease in HIV diagnoses in New York City in three years. That’s not AIDS diagnoses (although they’re down too). This is HIV infection data. When the infections are broken down into subcategories, the numbers in the first quarters of 2002, 2003 and 2004 of HIV infections among men who have sex with men declines from 327 in 2002 to 344 in 2003 to 277 in 2004: an annual decline from 2003 to 2004 of almost 20 percent. Maybe the “apparent upsurge” has taken place since the beginning of 2004. But I see no reason why this big decline would suddenly reverse itself. More importantly, Cohen has no and had no evidence to write what he did, and using it to, in his words, “condemn” gay men in New York City whom he holds responsible for a new epidemic. Cohen needs to write a correction and an apology for non-existent reporting. Petrelis also sends an email to the NYT suggesting they run a story on this great news – especially since their science writer, Lawrence Altman has been writing scare stories for five years. If the NYT can run five consecutive scare stories on a not-new strain of HIV, they can surely run some actual facts about the subject.

SCHIAVO EMAILS: Here are three diverse ones making different points:

Why not consider the current debate within conservatism on the Shavio case as an indication of vitality rather than imminent demise? Conservatism has been “cracking up” for years now, along the libertarian/conservative divide, along the paleo/neo divide, along the religious/secular divide. Look at The Corner: reasoned arguments on either side of a topic that I think we can all admit is at least morally difficult. Do you see the same thing going on at DU? Or at The Nation?

I consider this a strength of American conservatism: we tend to be much more accommodating of ideological differences than the left. I know that statement will draw scoffs from many of your readers, and possibly from you. But consider: abortion. Who has a more diverse spectrum of opinions? Similarly Affirmative Action. Immigration? As counter-intuitive as it seems, I think conservatives in America can claim to be more accepting of diversity of opinions on each of these topics. Hell, even gay marriage. Some are for, some are against. It’s all a glorious mess, and hopefully we’ll muddle through and do some good along the way.

I take the point, and I do think the right is far more intellectually alive than what’s left of the left. But the strains are getting intense. As this reader indicates:

For over 30 years I have been a conservative on fiscal issues and a bit of a moderate on social ones. So Republicans were my party of choice. This episode with the Schiavo case has left me in despair for the party. If this continues, it may have the same effect that Radical Republicans had on the South after the Civil War, only this time it will be the urban areas that will resent this attack. For the past few years I thought that I could live with the religious right. No more. Who ever is closest to the center will get my vote.

That’s what happened to me at the last election. Take national security away, and I’m much closer to moderate Democrats than 90 percent of the big spending, moralizing Republicans. One more:

“We are looking directly at the real face of contemporary Republicanism. Sane, moderate, thoughtful people are watching this circus and will not soon forget it.” I couldn’t agree with you more. I’m what one might call a moderate “swing voter.” I came of age politically as a Democrat in the 90’s, very supportive of Clinton’s centrist policies and somewhat hardened as a partisan by what I regarded as the outrageous excesses of Republicans during the impeachment and preceding investigations. Having said that, I’ve always been a hawk on defense and have some fundamentally libertarian sensibilities that guide my views on domestic policy. I regard the traditional “liberal” worldview as one that can manifest itself in malignantly foolish ways at home and dangerously naive ways abroad.

After 9-11 I came to vigorously support the administration in the war against Islamist terrorism and supported the Iraq war as well. These two issues led me to seriously consider voting for President Bush. Particularly in the run-up to the Iraq war, my hostility to the far left element of the Democratic party and its apparently increasing prominence (see Michael Moore and his ilk) led me to really wonder whether someone like myself would be a better fit in the Republican party. As Howard Dean’s campaign took off I came to view myself as a likely Bush voter. Ultimately, two things happened to change that vote. First, as evidence of the administration’s inexcusable incompetence in carrying out regime change in Iraq mounted, I came to the conclusion that President Bush didn’t deserve reelection as a matter of fundamental accountability. Second, the Democrats (for the 4th cycle in a row) wound up nominating an essentially moderate candidate. After concluding that Kerry was an acceptable alternative to Bush–specifically that a Kerry administration could be trusted with national security–I voted for him.

While I didn’t regret my vote, in the months after the election my continuing aversion to some tenets of contemporary liberal thought (see the Larry Summers “controversy”) led me to occasionally flirt with the idea of switching my allegiance, such as it is, to the Republican party. The Terri Schiavo fiasco has put an end to all that. This disgraceful episode has crystallized for me why I am much more a Democrat then a Republican. The reality simply is that moderates like me have much more influence in and, accordingly, are more at home in, the Democratic party. The Leftists couldn’t even muster a majority of congressional Democrats to oppose the Iraq war–all but one Representative voted for the Afghan war. Yet the Theocons of the Republican right are able to call the Congress into a special session, pass an emergency bill and wake the President up in the middle of the night to sign it–all in the name of exalting an extremist religious belief over traditionally Republican principles of federalism, governmental restraint and family rights. All of this with only five, count them, five Republicans voting “No.”

As a centrist Democrat friend of mine once said, “the extremists in my party make me laugh, the extremists in the Republican party make me cry.”

I think they have jumped the shark. But we’ll see.