Congress may focus on end of life issues

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When Congress passed extraordinary legislation in the case of a brain-damaged Florida woman, it also paved the way for broader congressional debate on end-of-life issues and the rights of incapacitated people.

Some legal experts and medical ethicists, however, believe that Congress should not expand the federal role in an area that has been the realm of state lawmakers and state courts.

“We’ve had a framework for 30 years and this case hasn’t changed it,” said Jonathan Moreno, a biomedical ethicist at the University of Virginia. “There’s nothing unique about the case ethically, medically or legally except it’s become a political cause celebre.”

Alta Charo, an ethicist at the University of Wisconsin, said courts have already determined that there is a “constitutional right to personal autonomy, including to control the manner of your death...That’s been in American national law for decades.”

An ABC News poll showed that most Americans disapprove of Congress’s intervention. Two thirds said they thought lawmakers were using the case of Terri Schiavo for political gain, and 70 percent deemed the congressional action inappropriate, according to the poll published on Monday.

Now 41, Terri Schiavo’s heart stopped briefly and cut off oxygen to her brain in 1990. Her feeding tube was removed last Friday.

Two congressional committees intend to hold hearings related to the case in the next week and several lawmakers—mostly Republicans but also some Democrats—have urged Congress to scrutinize the care of the disabled and the potential role of the federal judiciary.

“Every precaution should be taken to learn and respect their (incapacitated people) desires regarding the removal of life support,” Sen. Tom Harkin, an Iowa Democrat, said this weekend.

Other lawmakers, including Florida Democrat Sen. Bill Nelson and Indiana Republican Sen. Richard Lugar, have introduced legislation to encourage more Americans to sign advanced medical directives or living wills. Their legislation would allow Medicare to pay for elderly people to consult with their doctors in advance about end-of-life care. It would not affect how states deal with cases like that of Terri Schiavo.

Studies have found that relatively few people draw up living wills and sometimes they are vague. Ethicists and lawyers say that living wills do reduce but do not eliminate family or legal conflict.

“The whole idea that you can have everyone make advanced directives and reduce this kind of conflict is illusory,” said Rebecca Dresser, a Washington University legal expert.

Dresser said that neither states nor the legal and medical professions have yet adequately figured out how to avoid or resolve cases where relatives are bitterly at odds. “I’m not sure that Congress can address that better than anyone else.”

Charo, for one, isn’t taking any chances. “I’m going home and rewriting my advanced directive tonight,” she said. “It’s now going to include that I not want my case brought to federal courts, President Bush, members of Congress or the governor of my state in the case of any dispute.”

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