Monday, March 28, 2005

Congress Ready to Again Debate End-of-Life Issues

The New York Times
March 28, 2005
Congress Ready to Again Debate End-of-Life Issues

WASHINGTON, March 27 - After a string of fruitless legal and legislative efforts, the central question in the Terri Schiavo case - Who makes end-of-life decisions when the patient's wishes are disputed? - is headed back to Capitol Hill, where debate over broader legislation has already begun.

On Sunday, lawmakers of both parties agreed that Congress has a role to play in such cases and should contemplate legislation that would give added legal recourse to patients like Ms. Schiavo. While it is difficult to predict whether such a measure could pass, the Schiavo case has clearly pushed thorny questions about end-of-life care to the fore on Capitol Hill, as well as in state legislatures around the nation.

The Republican-controlled House already passed a bill that would allow the federal courts to review cases like Ms. Schiavo's, in which the patient has left no written instructions, the family is at odds and state courts have ordered a feeding tube to be withdrawn. That bill evolved into one that was narrowly tailored to Ms. Schiavo.

Now some Democrats, prodded by advocates for the disabled, say Congress should consider whether such a law is needed.

"I think we should look into this and very possibly legislate it," said Representative Barney Frank, Democrat of Massachusetts, who opposed Congressional action in the Schiavo case. Mr. Frank was speaking on Sunday on the ABC News program "This Week With George Stephanopoulos." Mr. Frank added: "I think Congress needs to do more. Because I've spoken with a lot of disability groups who are concerned that, even where a choice is made to terminate life, it might be coerced by circumstances."

In the Senate, Tom Harkin, Democrat of Iowa, has also been consulting with advocates for disability rights and is preparing to introduce legislation along the lines of the bill that the House passed, a spokeswoman said. Senator Harkin, an author of the Americans With Disabilities Act, was one of the few Democrats in the Senate who spoke in favor of the so-called private relief measure that allowed a federal court to review Ms. Schiavo's case.

The question of Ms. Schiavo, who has lingered in what doctors describe as a "persistent vegetative state" for 15 years, has been characterized by the news media and politicians as a "right to life issue," fueled by Christian conservatives and opponents of abortion. But advocates for the disabled are also playing a strong role, enlisting Democratic lawmakers like Mr. Harkin.

"We very much wish that Congress would intervene on a broader level and create meaningful protections for people who are in guardianship," said Diane Coleman, president of Not Dead Yet, a disability rights group that is focused exclusively on end-of-life issues. "It's not a simple right and left issue, in spite of how it's being portrayed."

Ms. Coleman called the measure that was passed by the House "a step in the right direction."

Yet it is unclear whether Christian conservatives and disability rights advocates can agree on what action Congress should take. Tony Perkins, president of the Family Research Council, a Christian conservative group, said on Sunday that his organization was working with states to urge them to pass measures that would prevent the withdrawal of nutrition from patients like Ms. Schiavo.

Mr. Perkins said state action was "the preferred route," adding, "In certain circumstances there may need to be some federal action, but I would not advocate a broad brush stroke of the federal government to try to prevent this from happening again."

In pressing for the broader House bill, Representative Dave Weldon, Republican of Florida, who is the measure's chief author, has likened Ms. Schiavo to a death row inmate. Such inmates are automatically accorded a federal court review; so, too, he has said, should patients like Ms. Schiavo be.

Speaking on ABC opposite Mr. Frank on Sunday, Representative Weldon said, "I had some of the most liberal members of the House of Representatives tell me they were glad I brought this bill forward."

Mr. Frank, however, disagreed with the death penalty analogy. But when asked if he would like to see legislation in the area, he said: "Oh, yes, I think - but I would like it to be with hearings. I wouldn't like it rushed through without any chance to debate it."

He went on to say that one thing Congress could do would be to "stop cutting Medicaid and stop cutting housing for the people who are disabled and stop cutting back on disabled people, so that they don't feel the kind of economic pressures that disability groups tell me they sometimes feel."

As to Mr. Weldon's measure, whether it could pass in Congress is unclear; the bill attracted opposition in the Senate, which is why Congress passed the narrower bill. Senator Ron Wyden, Democrat of Oregon, objected, in part because he feared the Weldon measure would interfere with an assisted-suicide law in his state.

In an interview last week, Mr. Wyden said he did not like the idea of "Congress playing medical czar" and added, "What I'm hoping for is that Congress will step back a little bit and let the passions cool."

Already, the Senate health committee has scheduled a hearing next week to debate the Schiavo case and discuss "the urgent need for Congress to examine current health care practices used in the care of non-ambulatory individuals," according to a statement by the chairman, Senator Michael B. Enzi, Republican of Wyoming.

The hearing was initially scheduled for Monday; in a fruitless effort to keep Ms. Schiavo's feeding tube from being withdrawn, Mr. Enzi called Ms. Schiavo and her husband, Michael, as witnesses, noting pointedly that it was a federal crime for anyone to impede their testimony. Later, when Ms. Schiavo's feeding tube was withdrawn, Mr. Enzi postponed the hearing until April 6.