The Ethics Bazaar


March 12, 1991|By ELLEN GOODMAN

BOSTON. — There is a father in Missouri who wants to take his daughter shopping. The trip he has in mind is a grim one. He wants to find a doctor and a state that might allow her to die.

The father is Peter Busalacchi. The daughter is Christine, the second most-famous patient in the place where Nancy Cruzan once lay. It took a Supreme Court decision and then some, before Nancy Cruzan won the ''right to die.'' The feeding tube was removed only after her family proved that the young woman had left ''clear and convincing evidence'' that she wouldn't want to live in a persistent vegetative state.

Christine left no such evidence before the car crash that severely damaged her brain at age 17. So last fall her father decided to move her from the strict and highly charged atmosphere of Missouri to a doctor he trusted in Minnesota.

Now the Missouri Court of Appeals has said that Mr. Busalacchi doesn't have that right. Last week, the judges ruled that a lower court must look into the father's motives and the daughter's condition before they decide whether to let this unhappy pair out of the state's borders.

Christine Busalacchi has become a ward -- or is it a prisoner? -- of the state of Missouri. Mr. Busalacchi, who could take his child to any doctor anywhere if she were competent, has lost that chance because she is not. And the state of Missouri has determined that it doesn't trust the morality of the state of Minnesota.

As Judge Gerald M. Smith wrote in a harsh dissent, ''There is a parochial arrogance in suggesting, as the state does, that only in Missouri can Christine's medical, physical and legal well-being be protected.''

The dilemma that faces this Missouri father was set up by the Supreme Court's decision. The justices left the life-or-death fate of people like Christine -- those who never stated their wishes -- to the ''laboratory of the states.'' As a result, they insured that we would go shopping through these laboratories for a full selection of our rights.

Indeed, this is now part of the process for ''consumers of health care'' and their families. At either end of the life cycle and often in between, Americans are learning to be comparison shoppers. We go across the border from one ethical marketplace to the next.

Back in the 1970s, families traveled with brain-dead children to a state that would recognize their death. Today a couple in search of a surrogate mother will find one state open for business and another closed. A teen-ager can find an abortion in one state without her parents knowing, but not in another.

Last summer, an Oregon woman went to Michigan to use the suicide machine, because there was no law against assisting suicide there. If Roe v. Wade is overturned, abortion would be the next right that became a mere matter of geography.

When you talk about ending treatment and ending life, you have entered a Middle-Eastern bazaar of medical ethics. It is as if every state carried a different message on its license plate.

Not only do states have different laws and guidelines, so do counties, hospitals, even doctors. In some places, a family can walk down a hospital hallway and find a second and third contradictory opinion. As Arthur Caplan at the University of Minnesota says, ''if consistency is a fundamental prerequisite of ethics then it is taking a long holiday with respect to the termination of treatment.''

Few of us are comfortable with the idea of ethical border-crossing in this case. Some say 20-year-old Christine Busalacchi smiles and feels. Others say that her responses are just reflexes. If she is in an irreversible vegetative state, Missouri would keep her alive forever. Minnesota has no such blanket law.

How can it be right to remove a feeding tube in one place and not in another? How can it be right to stop treatment here and continue it there?

If the states are to be the ''laboratories'' in which we experiment during a time of uncertainty, if these labs reflect the range of our moral debate, then we cannot be forbidden access. In the end there is something worse than the difficult, disturbing, free-ranging ethical marketplace. What is worse is a ban against shopping for medical rights.

Ellen Goodman is a syndicated columnist.

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