What’s Wrong with the World

The men signed of the cross of Christ go gaily in the dark.


What’s Wrong with the World is dedicated to the defense of what remains of Christendom, the civilization made by the men of the Cross of Christ. Athwart two hostile Powers we stand: the Jihad and Liberalism...read more

Choice devours itself: Husband in Oregon wants to stop his wife's spoon feeding

Readers may remember the case of Margot Bentley in Canada. Margot had been an activist in favor of euthanasia and suicide and had explicitly stated that she wanted to be dehydrated to death rather than being kept alive if she became incompetent. However, when she became very elderly and was suffering from dementia, she was accepting spoon feeding at the nursing home where she lived. The nursing home didn't want to stop feeding her, despite the fact that her children wanted to force them to stop. The case went to court, and the judge ruled that, since Margot was accepting the spoon feeding, it should be allowed to continue.

In Oregon a very similar case is playing out. Once again, the court and nursing home have made the right decision to continue to spoon feed the patient, but there are disturbing indications that this would not happen if the statutory laws were even slightly different or if the woman were not in a nursing home.

The legal situation is pretty straightforward. The woman, Nora Harris, is not dying, and she is accepting spoon feeding. In fact, she was feeding herself with her hands by eating a sandwich before the spoon feeding was started. Her dementia has progressed to the point that she has trouble using utensils. Oregon law expressly says (rightly) that patients in nursing homes must be offered a certain number of meals a day and must be offered assistance with eating if they have trouble using utensils.

The state ombudsman's representative, responsible for preventing abuse and neglect of people in nursing homes, noticed the sandwich eating and told the nursing home that they should give Nora help eating the hot, cooked meal that was available. I find it mildly interesting that in all the talk of what Nora would or wouldn't want, nobody is saying whether she's been handed a sandwich recently. My guess is that the ombudsman thought she would get better quality food and more enjoyable food by being offered assistance with the cooked food and felt that the nursing home was shirking by just handing her a sandwich. Now, spoon feeding her has become the norm, and her husband and everyone else is quite clear that she would simply be left to starve to death if not spoon fed. I guess that means her husband also doesn't want her to be handed a sandwich!

Anyway, since the statutory law is so clear, the nursing home has to help her to eat, the ombudsman and her court-appointed guardian ad litem insist that she should be spoon fed, and the judge ordered accordingly when her husband, Bill Harris, sued to force the nursing home to stop feeding her.

So, one might say, a victory for the good guys. But it is disturbing to see that in all of this, person after person who is doing the right thing is acting as though this isn't unequivocally the right thing to do but is merely required by statutory law. Listen to the judge talking:

In issuing her decision, Jackson County Circuit Judge Patricia Crain said she could not order the nursing home to stop spoon-feeding Nora because the state ombudsman's office says not helping her eat would be a violation of state law.

"It's not a happy decision for me," Crain told Bill and his daughter during the July 13 court hearing. "From what you describe of your wife and your mom, she would hate this. She would hate it."

Although food isn't being shoved in Nora's mouth, Crain said in some ways Nora is being forced to eat because if she were still competent she would not want the spoon-feeding intervention.

Aw, poor judge. She's so unhappy to have to order that Nora not be starved to death. Because she's sure that she "would hate this." Notice that the judge speaks of Nora almost as if she is already dead. Never mind the fact that she doesn't seem to hate being spoon fed, that she is right now accepting the food. Judge Cain speaks of what she "would have hated" as if the only "Nora" whose feelings matter is a "Nora" who is no more--the fully conscious, talking Nora who, the judge believes, would have wanted to starve to death.

I note this particularly, because it is relevant to any attempt to make "choice" sufficient to protect people in Nora's situation. I say again: No it isn't. Because to a certain mindset (namely, the mindset of the people who actually make the decisions in these scenarios), the only choices that count are the choices made while you were still fully cognizant. Anything else is entirely unreal. It doesn't count as a choice, a request, or willingness. Hence, when Marjorie Nighbert explicitly asked for food, she was denied it and dehydrated to death because she had asked for it after a judge deemed her no longer mentally competent.

So the judge is completely sympathetic to the pro-death position, but her hands are (shucks) tied by positive law.

How about the nursing home? According to Nora's husband's lawyer, they're not terribly enthusiastic about having to feed Nora, either:

"Fern Gardens would have continued to follow Bill's directions, but they had their hands tied. The facility didn't want to clash with the state ombudsman's office," Broesder says.

The only people who are showing some faint grain of sense are the ombudsman's office and the guardian ad litem, who are actually (shocker) doing their job.

Eric Foster, an attorney appointed by the court to represent Nora, argued in court documents that Oregon law requires Fern Gardens to assist Nora with eating.

He noted her advance directive did not explicitly say she did not want help eating, plus it stated her husband could decide to withhold only artificial nutrition and hydration on her behalf.

"Since Mrs. Harris did not include specific instruction that she not be helped with eating, the evidence is not yet clear and convincing Fern Gardens should not help Mrs. Harris eat," Foster wrote.

Foster also argued, "The best evidence of whether Mrs. Harris should be provided with food assistance is her current desire to eat. Mrs. Harris could consistently refuse to eat, if that was her desire. If she refuses meals in the future, Fern Gardens will not pressure her to eat."

He wrote Nora should be given the chance to satisfy her hunger through assisted eating, and should not be deprived of the comfort and social interaction that help with eating provides.

Bill Harris complains that, God forbid, Foster is "representing the state ombudsman's view." Um, yes, perhaps that's because he agrees with it, both as a matter of legality and as a matter of morals. It hardly follows that, as Bill alleges, he is "not looking out for her best interests"!

Nonetheless, here's a disturbing quote from the ombudsman's office itself:

Fred Steele, agency director of the state Office of the Long-Term Care Ombudsman, says his office's mission is to make sure people in long-term care are treated with respect and their rights are protected.

"This is an extraordinarily difficult situation," Steele says of Nora's case. "This case highlights the difficulties of how we advocate for residents who can't communicate for themselves."

Steele says there is a legal question about whether advance directives can be used to express a wish not to be assisted with regular feeding.

"Advance directives don't usually address regular food. The advance directive form only speaks to artificial nutrition," he says. "This case is not dealing with artificial nutrition and that's the complication. It's an open legal question that might have to play out with the courts or the Legislature."

No, it's not an open legal question. It's an open-and-shut legal question, and the ombudsman's own office has pressed for the law to be followed. What Steele really seems to be doing here is inviting, almost asking, the Oregon legislature to change the law so that family members can tell nursing homes to stop spoon feeding patients because they are sure they would have wanted to starve to death!

The words of a lawyer who came in to testify as an "expert witness" on the side of Nora's husband are rather telling, though unintentionally so:

Cheri Sperber, owner of the Ashland-based aging issues company Gray Matters Consulting, says she has prepared thousands of advance directives for clients, but the issue of assistance with regular eating hasn't come up until now.

"That's something I'm going to discuss now with my clients," she says. "That's something most people don't think about."

Sperber served as an expert witness for Bill in his attempt to stop the spoon-feeding of his wife.

She says Oregon Administrative Rules that require nursing facilities to provide patients with eating assistance are meant to prevent abuse and neglect.

"They get help so they're not just sitting there starving," Sperber says.

Please tell me, Cheri, if Fern Gardens had stopped spoon feeding Nora as Bill wants them to, how she would not just be "sitting there starving." How would that not be abuse and neglect? Isn't it sort of the whole point that Bill wants her to be sitting there starving instead of being fed?

Let's parse this out: What Cheri Sperber and Bill Harris and others on their side want to say here is that there would be some kind of postmodern distinction between mere neglect, in which Nora is simply forgotten, and deliberate neglect, in which Nora is deliberately left starving because everyone has sat and pondered and decided that she "would have wanted" to be starved to death. (Question: Is she sipping water from a straw or what? What about hydration? This isn't mentioned in the article, but I have a sinking feeling, given all that Bill Harris is saying, that he would have ordered hydration stopped as well.)

Oh, well, that would make it fine, right? Deliberate neglect is non-neglect, by the waving of a magic ethical wand.

Oh, and maybe she'd be doped up, too, so that's presumably again supposed to be why she wouldn't have just been "sitting there starving."

Bill says with palliative care to ease any suffering, his wife could have passed away by now in a relatively peaceful way — if not for the spoon-feeding.

"Palliative care to ease any suffering," aka drugs.

So: Being doped up after the nursing home and your relatives decide that you would want to die of starvation and/or dehydration and then sitting there starving isn't really just sitting there starving. Got it. Thanks for clearing that up for us, Cheri.

It will be interesting to see which state is the first to change legislation to legalize this explicitly. So far, it hasn't happened, though people are in fact dehydrated to death all the time, all over the country, if it is deemed that they would otherwise need artificial nutrition and hydration. A different nursing home and a different ombudsman might have simply gone along with Bill Harris by reasoning that there is a faint risk of choking to Nora from the spoon feeding. Hence, she "needs" artificial hydration and nutrition. But her advance directive expressly rejects artificial nutrition and hydration. Voila! A legal argument for not giving her nutrition and hydration at all. All taken care of. Indeed, as time goes on, if she has even a single coughing or choking incident with the spoon feeding, that will in all probability actually happen.

But for the moment, she's being fed. A small victory, and one with a dark cloud hanging over it, but a real one.

Be sure you write up your own desire for food and water very explicitly.

Comments (17)

Starving people to death is, really, the compassion of Hell.

The Chicken

But it is disturbing to see that in all of this, person after person who is doing the right thing is acting as though this isn't unequivocally the right thing to do but is merely required by statutory law.

Legal positivism.

Yeah, I know, but people don't talk that explicitly like legal positivists unless they are either a) being smart-alecks who really want to do what the law says but are sorta pretending that they are being forced to do it or b) looking for a way out of it.

Unfortunately I'm betting that the people talking that way here fall under category b.

... looking for a way out of it.

Advance directives were made to define a way out. The way out was attempting to represent people's autonomous choices at a given moment, which they can't. But even if they could the way out was enshrining the autonomous choice as right or just or sacred, depending on your choice of language.

We shouldn't be surprised that people talk like dazed lawyers after being faced with the shock that not only do directives on such things solve nothing in the end, but that there isn't even a way to construct a laws that fulfill their promise (even if it weren't wrong) without contradiction. We could posit designated mind-readers I guess.

There isn't a way to simultaneously have laws that require feeding to avoid neglect based on older laws while allowing for spoon feeding (assisted!) in some circumstances and not others as specified by some future law. Likewise, it isn't possible to conceive of laws to allow bathroom attendance in school based on arbitrary self-perceived gender identity without contradicting current laws designed to protect against predators. Catch-22.

There isn't a way to simultaneously have laws that require feeding to avoid neglect based on older laws while allowing for spoon feeding (assisted!) in some circumstances and not others as specified by some future law.

Yes, well put.

The people trying to make "choice" do all the work refuse resolutely to acknowledge that right and wrong are even relevant or that life and death are any different from anything else. You can't treat, "Do you want to be killed?" like "Do you want a manicure?" or "Do you want coffee or tea?" or even "To whom do you want the little antique desk to go after you die?"

The obsession with "choice" faux dignity.

>>The people trying to make "choice" do all the work refuse resolutely to acknowledge that right and wrong are even relevant are even relevant or that life and death are any different from anything else.

I'm currently graduate school and my professor said that morality is a social construct immediately after he said that the class can debate the existence of God till the wee hours of the morning. This was a research class.

immediately after he said that the class can debate the existence of God till the wee hours of the morning.

Was that supposed to be an expression of open-mindedness--I will allow you to debate the existence of God for a long time and take any position, on any side--or a statement alleging the impossibility of discovering whether or not God exists?

@ Lydia: Probably the latter. The topic for the day was research validity and it came upon social issues (alcoholism, domestic violence, homelessness, legalization of marijuana etc.). Since there is no way to measure the morality of, say, abortion or gay marriage, that morality should not be taken into account - it's strictly a non-factor, neither good nor bad. That's what I got from his somewhat cryptic statement in the way it was laid out; you can debate about God all you want but morality is a social construct, period.

I personally don’t think such things are about “choice” or disbelief in moral absolutes. Sure sometimes people just want to be rid of those who are a burden, or to be done with an uncomfortable situation. But I think a far larger factor is about a vision of a good life, or it’s twin in the rejection of a perceived bad one. It’s about an idealized and higher vision, false though it is, that is enshrined in that choice. Is the problem as simple as that people are morally abdicating or are they active participants in these shared ideal visions?

It’s not the choice, it’s what the choice represents. It’s what autonomy represents in an advance directive. I think people are deadly serious about such things. We’re too cynical. On this view the authentic choice was the one made when the patient was healthy. That was the authentic vision. I’m less concerned about the professor denying moral absolutes than I am about the apparent lack of understanding of human nature in those who affirm them.

You watch any public tragedy and you’ll see everyone from the chief of police to the mayor to the coroner to the man on the street telling us how they understand its significance in terms of identification with somebody they're close to that's recognizably similar to the victims. Without any special reason why it should be so, one after another they'll all run through this formulaic declaration of how their experience is such that they can grasp the true depth of what the loss really means. As if just being a human being itself isn’t enough to grasp the tragedy of another human beings unfortunate death. It's not now seen as verifiably authentic or genuine. But I thought that was the whole point of being a human.

I was listening to the radio after the San Bernardino shooting and to my utter disbelief a conservative commentator I like a lot kept repeating how awful it was for the families to lose them so close to the Christmas season. After the fourth time I couldn’t take it any more and just switched it off. Unbelievable.

This stuff is pervasive in public expression of all types, and I believe it's fairly recent. It seems to me something is going on here well beyond moral relativism.

Mark, I do think that we are getting a certain kind of revived but perverse moral absolutism. And I think the idea that it's somehow absolutely or objectively *bad* to be alive with dementia (for example) is one such example. Hence people say, "I wouldn't want to live that way" and so forth. And the husband probably believes it is objectively *wrong* for the nursing home to keep feeding Nora Harris.

But I would add that people are indeed very illogical and inconsistent. So they will toss out one set of absolutes and sometimes even use moral relativism to do so while embracing another set with (as you say) great fervor. If one tried to talk to the husband about the intrinsic value of human life, it wouldn't surprise me much if he came back with, "That's just your opinion" or even "That's just your religious opinion" (meaning thereby that it is subjective and arational).

To give an analogy: The transgender agenda is thoroughly postmodern. At one time they will say that being innately a woman is absolute and fixed, so that a person who is "born a woman in a man's body" is suffering terribly from this fate and will never been free until he has been able to "live as a woman." It's fixed. It's unchangeable. At another time they will declare gender identity mutable and fluid, so that the reason that a person born in a man's body can become a woman is because of this fluidity. Totally inconsistent, but it doesn't stop them from declaring with fervor that you are _absolutely_ wicked, ignorant, and wrong if you don't go along with their demands.

So relativism and fanatical absolutism interact in truly bizarre ways right now.

Let me add too that this definitely _is_ "about choice." (Though I suppose we can argue all day about so vague a question as, "What is this really about?")

What I mean by that is this: There is a fixed idea in American culture that all sorts of things that would otherwise be wrong are somehow washed and made clean if the person you do those things to chooses them. Examples: Killing someone. Beating someone up.

If you just go out there and kill someone who didn't want to die, some old lady in a nursing home, then that would _usually_ be wrong, but it's supposed to be okay if she _wanted_ to die. If you beat a girl up, that would usually be wrong. But if she _agreed_ to be beaten up for pay to make a p*rn video, then it's supposed to make it okay.

Many more examples could be given.

The point of my "choice devours itself" series is that this sort of distinction never works out in practice, because these things are evil even when they really are chosen. And in the end, it pretty much inevitably happens that the idea of choice becomes fudged. So now it isn't necessary that the old lady in the nursing home is choosing to die *right now*. The most important thing is that she *would have* chosen to die if her previous, cognizant self could look forward and "see" her current self with dementia. So if her husband had his way, she'd be starved to death despite the fact that she's happily eating by mouth, while all the time the husband would be claiming that this was her "chosen" fate.

It's this very bizarre way that choice ends up undermining itself when it is applied in these extreme ways (you can choose anything, and that makes it all right) especially in the areas of sex and death, self-harm, etc.

This stuff is pervasive in public expression of all types, and I believe it's fairly recent. It seems to me something is going on here well beyond moral relativism.

Mark, perhaps part of what we are seeing is the moral relativism coming into conflict with its own self. As with complete truth relativism (i.e. absolute skepticism), complete moral relativism is incoherent of its own self, and nobody can _actually_ operate on its basis throughout their lives. So you get people being schizoid in their own behavior and internal justifications, and eventually it pops out in various deformities like the one you mentioned.

Frankly, I don't know why we put up with reporters - especially TV reporters - who ask absolutely inane and bizarre questions immediately after these tragedies. I wish more people would slug them, or hand them a shovel and sand bag and tell them "get the hell out of here, or help". It's as if being a "reporter" means you get to stop being human (in order to be "objective") or something.

Sorry, I’ve been preoccupied. Well Lydia recently made the claim that there was an idea out there that Christians now tended to think all sins are equal. And I agree with her without reservation. Why? Plenty of evidence. I hear it in people’s words all the time. Recently. Painfully. I could name names. People I know, face to face; how authentic is that? I hear it implicitly and at least much if not most (I wonder if all?) of the time I hear it argued explicitly. Now I know and I suspect Lydia might agree that this is a form of moral relativism at least on certain questions driven by bad Christian theology.

But I think in the context of this thread where people have actually thought about such issues, as they generally have however superficially, isn't a similar thing. I don’t hear an implicit (and certainly not explicit) relativism in their words, and I don’t see it in their actions. I see a clash of ideals. I can judge that their bad reasoning may, will, and has led to what I’d think relativism in certain or even many or most circumstances. But I don’t tend to confuse causes for effects, at least I hope.

Ultimately I don’t agree with the idea that it’s explanatory in any significant way to say “relativism and fanatical absolutism interact in truly bizarre ways right now”. “Truly bizarre.” Hmn. “postmodernism”. Hmn. “… a certain kind of revived but perverse moral absolutism”. Hmn. “… people being schizoid in their own behavior and internal justifications” (Tony). Hmn. Well it's explanatory on a certain view, but I’m not going to go there. I’m no fool, despite certain rather biased opinions. The aforementioned statements form a highly interesting mix. I could put a name on it; I’ll refrain. I’m never one to depreciate online discussions, and I think people dismiss the significance of such social interactions (I know right? Insert_joke_here) too easily. But folks, even I’m not damnfool enough to enter into this supremely complicated discussion online. If I could sit across a table and discuss this I wouldn’t mind, iff the conditions were auspicious. But that’s not the case, so I’m bowing out. I hope you all have a good weekend.

You can't consent to sex so that at a future time, say, when you are drunk or otherwise in a mentally reduced state no indication that you want to stop has to be listened too; that is, you can't consent to have sex so that even if you want to stop they don't have to. However, it seems that they think that you can consent to have care withheld that you either desire or produces benefits outweighing the harms involved or both before you are in need of that care. Sure you might have better mental functions over all before, but isn't the same true in the sex example? It seems that there are number of plausible reasons why the example in regard to sex is true, and I think that perhaps one of those reasons could just as well apply to the life-or-death example as well.

Sean, you make an interesting analogy. What your analogy shows is that we have to decide which things we will treat as _requiring current consent_. Now, your analogy shows that generally we require that sex is deemed to require current consent, and rightly so. You can't rightly say, "Hey, later on if I'm in a total coma, I consent to having sex with so-and-so" and have that treated as binding.

Now, these sorts of decisions will never be neutral. It will never be the case that *everything* requires current consent, or else we could never care for babies or the mentally incompetent. They would just starve to death or die of neglect, because by definition they couldn't give current, mature consent to each of the things we would need to do in order to care for them--feed them, clothe and bathe them, etc.

So again, quite rightly, the idea has been that _feeding_ someone isn't something you have to get _current_ consent for.

What has happened, bizarrely, is that this has been reversed. Now, a person can consent *ahead of time* to be killed, and then at that time, feeding him ends up being treated like sex! "Oh, this poor woman can't possibly give current, mature consent to being spoon fed. How terrible. They are feeding her without consent!"

As if feeding her is akin to raping her!

Your analogy is a legitimate one, but what it does is to raise the interesting question: What do we treat as analogous to sex, and what do we treat as disanalogous to sex?

Of course, I'm not going to agree that even killing someone who _does_ give present consent should be allowed, but how much crazier it is when getting killed is something you can "consent to" ahead of time, while sex isn't, and getting fed is something you have to consent to *at* the time, as if getting fed were like having sex!

Hopefully this makes some sense:

Perhaps their belief that dying with dignity is basically dying in the way and at the time that one chooses before being in such a situation makes them view feeding a person who previously, it seems (to them, anyway), might not have wanted such action taken as wrong, as an affront to their dignity, like having sex while they are in a mentally reduced state. It's still odd reasoning, since she does presently want to eat and isn't obviously in unbearable pain. She presently has a desire to live, and isn't that all the rage these days for accounting for rights, desires, that is?

Of course, one could (should) challenge that conception of dying with dignity.

About those involved in the case of this particular woman, or with other cases in general I wonder if they are more worried that she is being pressured to eat than they are that she is being pressured to not eat. Yet, we don't convict people unless their guilt is ascertained beyond a reasonable doubt; we'd rather let a guilty person go, if there is reason to doubt their guilt. Well, wouldn't the fact that she does want to eat count as reasonable doubt to the permissibility of withdrawing aid that seems to help her? Of course! And Foster was right for saying, "The best evidence of whether Mrs. Harris should be provided with food assistance is her current desire to eat. Mrs. Harris could consistently refuse to eat, if that was her desire. If she refuses meals in the future, Fern Gardens will not pressure her to eat." If she is aware of this fact, then her continuing to eat is all the more reason to doubt the permissibility of letting her die. So do they show even the same concern for those who might be pressured not to eat or accept treatment which they might benefit from, despite what harm might come as they do to those they worry are being pressured to eat or take possibly beneficial (or event futile) treatment? I guess my point is that we are (and I think ought to be) more concerned about not harming the innocent than we are about punishing the guilty. So, shouldn't they be more concerned about not killing or letting die those who do not really want to be killed or let die than they are about killing or letting die those who want to be killed or let die?

Post a comment

Bold Italic Underline Quote

Note: In order to limit duplicate comments, please submit a comment only once. A comment may take a few minutes to appear beneath the article.

Although this site does not actively hold comments for moderation, some comments are automatically held by the blog system. For best results, limit the number of links (including links in your signature line to your own website) to under 3 per comment as all comments with a large number of links will be automatically held. If your comment is held for any reason, please be patient and an author or administrator will approve it. Do not resubmit the same comment as subsequent submissions of the same comment will be held as well.