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Practically speaking, can we determine that the patient's advanced SDAT condition was
similar to or at least approached that of Daniel Fiori's vegetative state?
SDAT is a degenerative disease that in the early and middle stages presents much
like a disability, but near the end exhibits the ravages of end-stage terminal illness. At
first it is characterized by "forgetfulness, incontinence, restlessness, sleeplessness, and
wandering...[that] devastate the individuals with the disease" (Davis 1989, 15). It will
eventually leave a patient unable to speak or ambulate and will ultimately result in death.
It "takes away everything, ... by erasing the person you once knew" (Rosenblatt, "The
Disease That Takes Your Breath Away," Time, April 30, 2001, 86). Like Daniel's
permanent vegetative state, it is irreversible.
Perhaps the totality principle (above) offers some help on this matter. In order to
decide the question we need to take notice that advanced SDAT eventually takes away
cognition and spiritual capacities, leaving only the lower biological functions, in a way
similar to a PVS that lasts twelve months or longer. In light of this evidence can we say
that the court decision is justified, based on the totality principle that "the whole person
... is sacred and has rights?" In our view the biggest challenge is in determining when
the SDAT patient's condition has reached end-stage.
In the final analysis, the Fiori and Goldman decisions have to do with issues
related to "medical futility." These issues are characterized by concerns about the high
cost of care, frustration on the part of the medical community, and family members'
confusion with respect to decision-making. Wisdom is needed to deal with life and
death issues and to arrive at a conclusion with some measure of assurance.