We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.
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For an excellent overview of the Schiavo case, written by someone with a better work ethic than me (she links to her sources, I just kind of remember their gist), go to Majikthise.
Out of the morass of purely case-specific issues in this case, perhaps the most legitimate policy argument raised by the Schiavo trainwreck has to do with the withdrawal of food and water.
Let’s be clear on Schiavo’s condition and treatment here: she is being fed and hydrated through a tube in her stomach. She is not feeding herself, and is presumably not capable of taking food and water orally, or the tube would never have been inserted. This kind of feeding and hydration is just as much a medical treatment as having a glucose or saline IV inserted into your arm.
No one attempts to deny that Terri (or anyone else) would be permitted to refuse this treatment for themselves; a law mandating that you receive a given medical treatment against your will would be widely regarded as an abomination.
Similarly, no one seems to be seriously arguing that if Terri were on a ventilator or some other form of artificial “life support”, that her guardian should be permitted to withdraw the life support, even though there is no written evidence of what Terri’s wishes were in that regard.
This leaves many of the folks who are now arguing for federal intervention into Terri Schiavo’s medical treatment in the rather uncomfortable position admitting that (a) she could refuse to consent to being fed through a tube in her stomach, and (b) that her guardian could withdraw other forms of life support, but nonetheless that (c) her guardian cannot refuse consent to her being fed through a tube in her stomach.
Thus, the policy question being posed by this case seems to be whether a surrogate decisionmaker should be compelled by law to “consent” to their ward being fed through a tube in her stomach, unless he can produce written evidence that is what the patient would have wanted.
The case against such a legal mandate boils down to the argument that denying the right to consent or refuse consent to the surrogate is the same as denying it to the patient herself. Of course, the surrogate is not, in fact, the patient, and there may be legitimate boundaries placed on the decisions the guardian can make on behalf of their ward. The question is whether withdrawal of nutrition and hydration is outside of those boundaries, and if so why.
The case for a legal mandate that nutrition and hydration be given over the objections of the legal guardian rests comes down to the argument that, where there is any doubt as to what the patient would want, we should err on the side of keeping them alive. This argument, however, founders on a couple of points. Logically, it cannot be limited to nutrition and hydration, and thus requires that we keep all life support, no matter how extraordinary, in place. Further, it begs the question of how much certainty is enough. Even where a written living will exists, the question can be raised about whether the patient changed her mind.
Because we cold-hearted libertarians care about such things, Terri Schiavo’s care is being paid for by taxpayer money through the Medicaid program. Even though her parents have noisily pledged to take all financial responsibility for her care, they have not yet done so, even though the trust fund established out of the proceeds of her malpractice case to pay for her care is nearly exhausted. The annual cost is probably around $80,000 per year.
Various precincts of the US body politic are obsessed with Terri Schiavo, a young woman who has been at the center of an ongoing familial, legal, and now, sadly, political dogfight.
In very broad terms, Terri Schiavo is unable to make decisions for herself. She is apparently brain damaged, and has been in some degree of coma or “persistent vegetative state” for years. Her husband wants to withdraw artificial life support and let nature take its course. Her parents want her kept on life support indefinitely in the hopes that some day she will make some degree of recovery. As ever, you can find a medical expert to present just about any side of this that you want. This situation is, sadly, all too common.
The uproar around Terri Schiavo illustrates rather nicely the key distinction between libertarians and, well, everyone else. For libertarians, the critical question is “who decides?”, based on their belief that you should be able to make your own decisions in life. Most other folks, it seems, don’t care “who decides” nearly as much as they care about “what decision is made,” and particularly, “whatever decision is made, it damn will better be one I approve of.”
In Terri’s case, this means that all sorts of folks who you think would know better than to invite the state to participate in medical decision-making are doing exactly that, because Terri’s husband has made a decision that they do not approve of.
So, not only have we been treated the spectacle of the Governor of Florida, Jeb Bush, trying to elbow his way to Terri’s bedside so he can dictate what care she will receive, we also have various Florida legislators trying to insert the State of Florida into the mix. Now the US Congress, apparently not satisfied with embarrassing itself* in its ongoing investigation into steroid use in major league baseball, is preparing to abuse its subpoena power to block the decision made by Terri’s husband.
A fundamental principle of health care law, and one dear to the hearts of libertarians, is that you must give informed consent to any treatment before it is administered to you (with an exception in cases of emergency when you are unable to communicate, in which case the caregivers are allowed to assume you want life-saving treatment). A doctor who treats you without your consent has committed assault and battery. It is your right to refuse any treatment at all, even if it will mean your death, and so long as you are a competent adult no court or legislature can intervene to force treatment on you.
When the patient is not a decisional adult, someone who will make decisions on their behalf must be located. You can appoint your own surrogate decision-maker, via a health care power of attorney (which I strongly recommend). Some states have lists of “deemed” surrogate decision-makers on the statute books, such as spouses, parents, siblings, etc., in rank order so everyone knows who has authority in a given case. As a last resort, a court will appoint a guardian.
The whole process is focused on the proper issue of identifying “who will decide.” Once the decision-maker is identified/appointed, they stand in the shoes of the patient. The state retains (or should retain) only the most limited role, to ensure that the decision-maker does not abuse their power. Clearly, the decision to withdraw life support is a decision that Terri Schiavo could make for herself. Indeed, my wife has told me that if she were in Terri’s position, that is exactly what she would want. Her husband’s decision to make it in her stead is by no means an abuse of his power as her surrogate decision-maker – such decisions are made routinely, every single day, across the country by people charged with the heavy burden of making health care decisions for someone else.
What we have in the Schaivo case, then, is the legally appointed and recognized decision-maker making a choice that is well within his purview. Multiple court reviews have concluded that he is the right person to make the call, and his decision should be honored. To this libertarian, that is the end of the matter, because the very essence of being a libertarian is respecting the decisions of others even when you might decide otherwise. To a broad spectrum of conservatives, however, the fact that medical decision-making should be private is of no concern when the decisions made are decisions they disagree with.
*While at the gym yesterday, I caught a few minutes of the steroid hearings. It was painfully embarassing to see the solons of American governance earnestly seeking noted idiot Jose Canseco’s advice on public policy. A quick survey of the fellows in the locker room revealed that this latest Congressional exercise in nannying competent adults and chasing headlines is not being well-received by the public. The universal sentiment was, “Don’t they have anything better to do?”
P J O’Rourke weighs in with a modest proposal on public transit in the Wall Street Journal. A choice tidbit:
The Heritage Foundation says, “There isn’t a single light rail transit system in America in which fares paid by the passengers cover the cost of their own rides.” Heritage cites the Minneapolis “Hiawatha” light rail line, soon to be completed with $107 million from the transportation bill. Heritage estimates that the total expense for each ride on the Hiawatha will be $19. Commuting to work will cost $8,550 a year. If the commuter is earning minimum wage, this leaves about $1,000 a year for food, shelter and clothing. Or, if the city picks up the tab, it could have leased a BMW X-5 SUV for the commuter at about the same price.
That, my friends, is a sound bite that can stop a light rail train (proposal) in its tracks if it gets in front of the voters before the referendum passes. Of course, as we all know, these kinds of facts emerge only after the horses have left the barn, so to speak, because of the bare-faced lying that always accompanies the run-up to large public works projects.
Irony, or hypocrisy? You decide.
In one of those events that barely even raises an eyebrow anymore, one of the leaders of the “Million Mom March” in favor of (even more) gun control, was arrested on firearms violations.
A Springfield woman who began lobbying against gun violence after her son was shot to death in 2002 was arrested last week when police allegedly found an illegal gun and drugs in her home.
First, lets be clear – she wasn’t lobbying against gun violence, she was lobbying against gun ownership. The Million Mom March was all about driving guns out of everyone’s hands, regardless of criminality.
So just what was she busted for? Having a gun with a scratched-off serial number, and not having firearms owner ID card (required by Illinois). Two classic gun-grabber laws, here being applied to someone who admits that she had the gun in question.
In other words, she admits violating the laws in question. One wonders if she will plead guilty and volunteer for jail time, as her beliefs would seem to require. Well, one wonders only if one is terminally naive – she is fighting the case, apparently unwilling to live with the consequences of the restrictions she wants to impose on others.
Michael Barone is truly the dean of American political analysis. Throughout last year’s election, his analysis was spot-on, and his recent post mortem continues in the same vein.
I have long thought that the way to win elections in the US was not to chase the apathetic and uninformed “undecided” voters, but rather to “motivate your base”, that is, to give people who care about goverance and who lean your way philosophically a reason to vote for you. I was particularly gratified to have a strategy that is generally dismissed by the American commentariat ratified by Michael Barone:
But polling in late 2003 and for most of 2004 indicated a very close presidential race. Bush strategist Karl Rove keeps a card in his pocket showing that the percentage of voters who were behaviorally “independent” declined from 15 percent in 1988 to 7 percent in 2002. The strategy that Rove designed and that Bush-Cheney ’04 campaign manager Ken Mehlman executed was geared not to persuading the undecided and weakly committed voters, but to turning out the maximum number of Republicans. The Kerry campaign and other Democrats likewise saw their main task as turning out the party faithful.
Rove won the turnout war (although not for lack of, erm, “creative” attempts by the Democrats to get the Deceased-American and Fictional-American communities to the polls in critical precincts), and the rest is history.
The Dems achieved impressive turnout gains, Barone notes, using their old, command-and-control, industrial-era model. They were, however, buried by Republicans using a new networked model for campaign organization. As a result, the Republicans under George W. Bush may well have turned the Democrat’s flank , inaugurating an era of Republican dominance.
The 2004 election has also reshaped the American electorate, in part through the invention of new political techniques. It is too early to say that it produced a natural majority for the winning party. But it has laid the groundwork.
In this article, Barone shows how it is done, using historical perspective and current data to put forth a predictive and testable thesis. If you get all wonky over American politics, read the whole thing. Peddling its insights at cocktail parties will make you seem smarter than you are, and isn’t that the ultimate payoff for all the blogs you read?
We interrupt your browsing for this bulletin:
Mark Steyn is back on-line.
That is all.
We all knew that, of course. But when the Manolo puts the evil eye on you, well, time to update your will, launder your cash, gas up the Lear, and oil the hinges on the back door.
Beautiful shoes for everyone! Death to the tyrant who would deny the peoples the beautiful shoes! This it is the political philosophy of the Manolo.
The Cuban embargo should be lifted, not for ideological libertarian reasons, but for pragmatic ones. Doing so will unleash a tide of cash and goods into Cuba, not to mention Americans, and nothing could be more corrosive of the tyrannical regime there.
Much as I love cigars, I won’t buy Cuban cigars, because that is a state-controlled industry and I choose not to do business with the Cuban state. (Plus, I think they are overrated). I would go to Cuba, though, after the embargo is lifted because doing so would allow me to circumvent the state, meet real Cubans, and undermine a Stalinist bastard in my own small way.
Freedom of speech makes it much easier to spot the idiots.
– Jay Lessig, quoted in the Wall Street Journal’s Best of the Web.
The first Iraqi election, which I gather was to elect delegates to their constitutional convention, went off better than expected, and plenty good enough to go forward. The number being bandied about for turnout nationwide is 60% – higher in the Kurdish north and the Shiite south, lower in the Sunni triangle. This would make it higher than in any US election in recent memory.
At first, I thought the practice of requiring voters to be indelibly marked with purple ink was a major error, as it would target them for terrorist retaliation. As it happened, though, the purple finger has become a symbol of defiance against the killers and hope for the future. The illusion that the various terrorist gangs that roam a few neighborhoods in Iraq have the power to influence the course of this nation may have taken a mortal wound. Terrorism in Iraq has always lacked a popular base to speak of, existing mostly on foreign lifelines from Iran, Syria, and the Western media, but now the isolation of the terrorists from the Iraqis has been vividly displayed.
We don’t know who won, of course, but the fact that the Iraqis turned out to elect delegates to a constitutional convention is an enormous positive. Now, I know some find it fashionable to affect a certain ennui toward such bourgeois artifacts as elections and written constitutions, but I regard elections as a necessary, but not sufficient, condition for a free society, and a written constitution as damn useful sand in the gears of the seemingly inevitable expansion of the state. The Iraqis have taken their first step down the road. Lets hope they make it all the way.
One of the current controversies around the war on terror is how to treat the prisoners. Dale Franks at the excellent Questions and Observations blog gets it pretty much right, I think.
My preferred method of dealing with these terror prisoners would be to get two captains and a major together as a tribunal, declare them to be unlawful combatants, and put them in front of a firing squad. Now, maybe, because we’re nice guys, we could let them know that if any of them give us verifiable, useful information, then we’ll commute their sentences, and won’t shoot them. Otherwise, however, it’s a blindfold and a last cigarette for the lot of ’em.
The difference of course, is that doing so would be legal. It would be part of the accepted customs of warfare that have been generally agreed upon for over a century. Torturing or beating them to death, without even the convenient fiction of legality, is not.
I found very little to quibble with in his excellent essay on the subject.
Nothing gets the political class to lying their faces off like the chance to spend your money on their legacy.
I saw it in Madison, Wisconsin when the new Frank Lloyd Wright convention center was being pushed through. The lies included (a) we will not build a new hotel next to this facility (it was built a year or two later (b) this facility will not block views/access to the lake it is built on (it does, in spades), and (c) this facility will not be a drain on the public purse (it requires a taxpayer subsidy ad infinitum.
I am seeing it again in Dallas, where the legacy project revolves around the Trinity River that runs through downtown Dallas. Jim Schutze, the excellent political writer for Dallas’ alternative newsweekly (the one with the sex ads) details the lies now on offer from the City of Dallas and its allies and puppets.
For example, recently arrived on my desk is the slickly produced special D magazine Trinity River edition, just out, called “The Trinity: How the river will change Dallas forever.” This magazine–a collection of preposterous whoppers, fibs, prevarications, exaggerations, subterfuge, propaganda and Orwellian doublespeak–is an omen of things just ahead.
The D magazine special edition goes on and on about the recreational amenities the Trinity River project will create: “…the Trinity River will accommodate small sailboats and paddle boats,” the magazine tells its readers. “More interestingly, a reverse-flow lake is planned with a 17-foot drop where it curves back to the river, creating rapids and a perfect whitewater course for winter kayaking competitions…
“But the most visible benefit will be on the Oak Cliff side, which will have easy access to downtown, great views and–most important of all–along the levee, direct entry into the country’s largest urban park.”
All of this is a lie.
Read it and weep.
They’ve been getting plenty of mad props from all over the ‘sphere, and rightly so: no one bashes the UN better than Diplomad. Every self-absorbed, self-interested, counterproductive flaw you ever imagined the UN had, has been on display in response to the tsunami, and Diplomad has the goods.
This Embassy has been running 24/7 since the December 26 earthquake and tsunami. Along with my colleagues, I’ve spent the past several days dealing non-stop with various aspects of the relief effort in this tsunami-affected country. That work, unfortunately, has brought ever-increasing contact with the growing UN presence in this capital; in fact, we’ve found that to avoid running into the UN, we must go out to where the quake and tsunami actually hit. As we come up on two weeks since the disaster struck, the UN is still not to be seen where it counts — except when holding well-staged press events. Ah, yes, but the luxury hotels are full of UN assessment teams and visiting big shots from New York, Geneva, and Vienna. The city sees a steady procession of UN Mercedes sedans and top-of-the-line SUV’s — a fully decked out Toyota Landcruiser is the UN vehicle of choice; it doesn’t seem that concerns about “global warming” and preserving your tax dollars run too deep among the UNocrats.
We can never get too much UN-bashing here at the Rancho Dean. Add ’em to your blogroll, sez R. C.
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