Letters to the Editor

What about life?
While four Calvin professors offered "perspective" on the Schiavo case (Summer 2005), it left one wondering: What is the biblical perspective? What is the Reformed perspective? The articles addressed the biomedical perspective, the economic perspective, the legal perspective and then some much needed "resources for Advanced Care Planning," which were especially needed in light of the previous articles. However, while one article quoted Planned Parenthood to support its perspective, not a single reference was made to scripture. Shouldn't the author of life be consulted in matters pertaining to life?

Deutoronomy 30:19 sets before us this choice: "This day I call heaven and earth as witnesses against you that I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live." This is the lesson that we should learn from the Terri Schiavo case. Life is the only godly choice. This is the biblical and Reformed perspective. When will we learn it?

Daryl Kats '89
Boise, Idaho

More on Schiavo
I thought the feature "Lessons from the Schiavo Case" (Summer 2005) was very helpful and well balanced.

However, there were two issues that were not mentioned as particulars in the Schiavo situation, and it would have been interesting to see comment on them.

First, Michael Schiavo has been living with another woman with whom he has had two children. It seems to me that neither the courts nor the press has taken this into account in establishing if he still has his wife's interest foremost when acting as her proxy. I am unclear when all this began, but it certainly seems to complicate matters. Has he abrogated his role by his new allegiance? I would be interested in both the legal as well as the appropriate moral perspective on this situation.

Second, from a medical and moral perspective it seems grossly inhumane to kill someone by deprivation of food and water. While Terri Schiavo was declared technically to be in a "persistent vegetative state," there were indications by various observers in the media that she had feelings of pain and discomfort. We don't kill animals that way, so why do we kill people that way? It may be legal, but is it right? If the right thing to do is to end life in this situation, would it be better to do it by appropriate medication? What is the proper Christian approach to ending life in such a situation?

Gordon Hassing '64
Cincinnati, Ohio

Questioning Schiavo
Although I am grateful to Calvin and the Spark for trying to help students and alumni learn lessons from the distressing Terri Schiavo case from Calvin experts, I was more than a little disappointed in the assessments of the two experts who directly addressed the Case - Professors Bouma and Tatum. I think there are good moral reasons to be concerned about the outcome of the case as well as better legal reasons for concern than Professor Tatum would have us believe.

Granted that Schiavo was in and had been in a persistent vegetative state - and I am a little less sanguine than Bouma about the ease and certainty of making this diagnosis - we still have good grounds to challenge Bouma's assertion (and Tatum's agreement) that sound medical, moral and legal principles were employed in "upholding Ms. Schiavo's wishes." The fact is that we are pretty clueless about her wishes.

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During the first three years of Terri's treatment Michael Schiavo made no claims to know what her wishes were with respect to care, should she be incapacitated. The claims to know about Terri's wishes begin to surface in 1997 after more than three years of acrimony between Michael Schiavo and Terri's parents, the Schindlers, about medical treatment for Terri. And although Tatum is right that Judge Greer found the evidence "clear and convincing" and that no appellate court overruled this judgment of Greer - which is not quite the same thing as an appellate court itself finding the evidence clear and convincing - he fails to mention that the first court-appointed guardian ad litem , Richard Pearse, did not find the evidence clear and convincing, and that the second guardian ad litem , although reporting the findings, does not give his own assessment of whether he believed that Michael Schiavo's report of Terri's wishes met the high standard of "clear and convincing evidence."

What evidence do we have that Terri Schiavo had expressed the wish that she not continue to receive food and water should she ever be incapacitated? The testimony of Michael Schiavo, and that of his brother and his brother's wife - testimony of conversations that were remembered, apparently, not during the first three years of her treatment but seven or more years later, after numerous failed attempts to withdraw artificial nutrition and hydration, and after more than three years of fighting between Michael Schiavo and Terri's parents. If ceasing to provide Terri Schiavo food and water was the morally sound thing to do, it's not because we have adequate reason to believe that this is what Terri would have wanted.

Bouma indicates that although Christians may forego and withdraw medical treatments, we may "not arrange an act intending our death." And this is what puzzles me about his claim that removing the tubes that were used to provide Terri with food and water was morally sound. Terri Schiavo was not brain dead, and she was not dying. But she could not continue to live with the food and water tubes removed. Given that it was a certainty that the removal of the tubes would result in her death by dehydration, what else could the removal of the tubes be but an act intending Terri's death? If it is wrong to intend our own deaths or to intend the deaths of others, then it was not morally sound to remove the tubes that provided food and drink to Terri.

Bouma finds several positive outcomes from the case (no doubt this is his cheerful Dutch Calvinism, whereas my dour Scottish Calvinism can find little to rejoice in). He thinks we need to talk more about what care we would want if we were rendered incompetent - and with that I agree - and that we need to make sure we have an advance directive in which we express our wishes about care and who we want to make the decisions for us should we be incapacitated. I believe there are good reasons, theological and moral, for not thinking that my judgment today about how I should be cared for should I become incapacitated should be binding at some later time. I'll be different then; I don't know what I should want then. Let those who love me figure out what's best for me (and I'll do the same for them, if need be).

I shall say little about Professor Tatum's claims other than to say that the judicial branch of government is no less worthy of the suspicion that Calvin folks are willing to apply to the executive branch. In other words, a little less deference to the wisdom of the Florida court - a court which at times, contrary to state law, itself acted as the guardian of Terri Schiavo rather than entrust her welfare to a guardian ad litem - seems to me to be in order.

The question is, "What should we do with patients in a persistent vegetative state?" as Tatum concludes, or better said, "What do we owe those who cannot speak for themselves?" I am less troubled than Bouma about a legislative and executive branch that is interested in protecting the lives of the voiceless and less certain than Tatum that the Schiavo case can be dismissed as more of a matter of "social movement activism" than an appropriate concern on the part of those committed to the protection of the weak and the voiceless.

Thomas D. Kennedy '75
Valparaiso , Ind.

Schiavo case response
Michael Schiavo's cohabitation is a significant confounding factor in this case, but not a necessary or sufficient reason to disqualify him as surrogate decision-maker. Michael (then Terri's husband of five years) asked to be legally appointed, consistent with Florida law, and the Schindlers raised no objections. Only one of the three guardian ad litems expressed concern that his judgment might be affected by the sizeable malpractice settlement that he would inherit should she die (there likely was little left when she died). Wolfsen, the guardian ad litem appointed under Florida 's "Terri's Law," noted that Michael began dating other women with the encouragement of the Schindlers before they had their falling out. He also noted that during more than 13 years of caring for Terri, Michael had been very attentive to her needs - she never had a bedsore. So the courts took note but concluded that he was acting sufficiently responsibly. Morally, Michael should have respected the covenant of marriage, pursuing a community of fellowship that did not involve sexual relations. But if Terri had expressed to him on several occasions that she did not want her life sustained on technology, then he was honoring her wish and his promise. It was an awkward position for the courts; it also was awkward for Christians to call for divorce or not honoring her wish.

Over the last several decades in the U.S., medicine, medical ethics and the law have come to recognize that withholding or withdrawing medical treatments, even when they are highly likely to result in a person's death, are allowing a person to die rather than killing him or her. This is the significant moral difference from both physician-assisted suicide and voluntary euthanasia that intend the death of the person. Individuals in a persistent vegetative state lack environmental awareness and are unable to perceive pain and suffering of hunger and dehydration other than perhaps reflexively, though Terri's loved ones and many of us empathetically agonized on her behalf and with her families. Good palliative care monitors the patient, and if there are reflexive indications of discomfort, addresses it with analgesics or morphine (Terri received acetaminophen and two low doses of morphine a week apart). From a Christian perspective, we can acknowledge God's sovereignty over life and death by not dictating an act that directly results in death. As Christians, we must be prepared to offer hydration and nutrition to individuals, but we may be refused. Honoring one's wishes honors the freedom God has entrusted us with and our bodily integrity. While we foresee that removing artificial hydration and nutrition is likely to result in the individual's death - a death that would have occurred earlier by natural means had technological intervention not been instituted - we also can and should pray that if it be our Creator's will, God would intervene miraculously, but "not our will, but your will be done." I hope the members of Terri's families and all Christians were able to voice such prayers on her behalf throughout this tragedy.

Hessel Bouma
Calvin biology professor

John Calvin, megachurch pastor
The megachurch idea is not new. John Calvin was a megachurch pastor. The Institutes of the Christian Religion were a theological primer for hundreds, if not thousands, of church planters throughout the French-speaking world. John Calvin kept up with many of these workers through his extensive personal correspondence, of which over 4,200 personal letters are still in existence today. The Belgic Confession, with its lack of a strong authority structure beyond the church council, was a document to bring so many of these self standing megachurches together and give them a common voice in response to the Catholic Church.

John Van Farowe '94
Allendale , Mich.

Abortion or birth control?
Heather Hiemstra Gemmen is herself a "startling beauty" for having survived sexual violence - the healing power of God's grace is apparent in her words ("From Shattered Heart to Startling Beauty," Summer 2005). Sexual violence is a physical, psychological as well as spiritual violation, and condemning sexual violence means support for survivors and accountability to its offenders within both religious and secular communities.

I am confused, however, by a phrase that the writer uses in her article about Ms. Gemmen. Ms. Anderson writes that Ms. Gemmen struggled as a Christian "with taking an (ultimately ineffective) post-rape abortifacient." To what method is Ms. Anderson referring? Frequently, emergency contraception is offered to women who have been raped to prevent pregnancy. But emergency contraceptives consist of the same hormones found in ordinary birth control pills and prevents pregnancy in the same way as other hormonal contraceptive methods: by delaying or inhibiting ovulation, inhibiting fertilization or inhibiting implantation of a fertilized egg, depending on when during the menstrual cycle a woman initiates the method. (According to the National Institutes of Health, the Food and Drug Administration and the American College of Obstetricians and Gynecologists, pregnancy begins when a fertilized egg implants in the lining of the uterus.) Thus, emergency contraception is no more a "post-rape abortifacient" than are regular birth control pills; it has no effect once a pregnancy has been established.

Heather Boonstra ex'87
Washington , D.C.

Heather Gemmen spends several pages in her book reflecting on her decision to take Ovral, the drug offered by her doctor. While Gemmen struggles with her decision from a moral perspective, Ms. Boonstra's description of the pill's effect is correct, and the pill should have been described as " emergency contraception." — Editor