The national divide over Terri Schiavo’s court-ordered starvation is really a debate about socialized medicine. Markets coordinate private decision-making in a socially efficient way. Under socialism, private decision-making becomes dysfunctional because there is no private incentive to make efficient choices. That means that socialism will never work very well, but it also means that for socialism to work AT ALL, individual choice must be excised. In particular, if socialized medicine is to work, government must be able to dictate when people die.

Through Medicare and Medicaid, most medical care for the elderly has already been socialized in this country. We have destroyed the incentives that, under a system of liberty, would keep people from spending an inordinate amount of money on dying. If old people had to pay for terminal care out of their own pockets (more specifically, if they had to decide what private insurance coverage was worth paying for out of their own pockets), they would think twice about spending a half million dollars on dying (and reducing the amount they pass on to their children by that same amount).

People generally want to make a contribution with their lives and one of the main contributions that people can make is to pass on a prosperous family tree. Faced with the choice, most people will not want their deaths to take a huge bite out of what they have lived for. They will opt instead to buy insurance that does not pay for expensive terminal care, but lets them die when there is nothing left but dying. Liberty, by empowering moral choice, will control the cost of dying, if we let it.

With socialized medicine, this moral choice never takes place. Socialism passes the cost of dying on to everyone else’s children. Each family sees its own medical choices as costless, and everyone ends up paying for everyone else’s unchecked spending. Indeed, if the dying are allowed to make their own choices in a system of socialized medicine, they can spend far more than their own savings. As life sustaining technologies expand, there is no limit to the amount that can be spent on dying. If we forge ahead in this direction, sustaining life without regard to whether the quality of the life preserved is worth the cost, it could consume our entire national wealth.

The contrast is stark. In a socialist system, letting people choose for themselves is national suicide. In a market system, the costs and benefits of heroic measures are both weighed by the person whose life is at stake, making for a decision that is both moral and efficient. These opposite implications of individual choice cause socialists and non-socialists to see the Terri Schiavo case in opposite ways. Democrats, for whom socialized medicine is a holy grail, are faced with the requirement of trying to make socialized medicine work. Expenditures have to be rationed rationally, on the basis of medical benefit per dollar spent, and care for Terri Schiavo would fall near the bottom of any such scale.

Terri’s quality of life was not the zero that the State of Florida claimed when it wrongly declared her to be a vegetable, but it was very low, with no chance of substantial improvement. If a socialist system can’t let Terri Schiavo die, it can’t let anyone die, and we are doomed to either spend all of our national wealth on dying, or to abandon the Democrat dream of socialized medicine. The socialist objection to keeping Terri alive was nicely expressed by Deborah Rhode, director of the Stanford Center on Ethics: “We’re spending millions of dollars of health and legal expenses on one woman at a time when millions of Americans can’t get care for life-threatening illnesses.”1 This statement is perfectly accurate, and for those who look at whatever money is being spent as society’s money, it is a call for action. Don’t keep that brain damaged girl alive. Spend the money where it can do some good!

Non-socialists see the case in completely different terms. There is no reason for a non-socialist to worry about the economic rationality of keeping Terri alive because, under a system of liberty, economic and moral rationality take care of themselves. Letting individuals face the costs and benefits of their own decisions leads to the most rational decision-making possible. The only concern is to make sure that moral agency is empowered, turning the case into purely a question of individual right.

Here the State of Florida failed completely. Florida Judge George Greer violated any minimum standard of due process when, in the absence of any criminal investigation, he awarded sole guardianship over Terri to her husband Michael. The day of Terri’s injury, Michael had flown into a rage over money she spent at the hairdresser. He was the only one present when her injuries occurred. She was documented to have arrived at the hospital with an “extraordinarily rigid neck,” a condition that a reviewing doctor said was consistent only with strangulation.2 How can Michael be a better choice for guardian than Terri’s parents, who were under no cloud of suspicion? That is insane.

The competent Terri left no instruction how she would want to be treated if she were rendered incompetent. Why, in the absence of such a “living will,” was Michael Schiavo’s highly contested testimony about what the competent Terri would have wanted given absolute precedence over what the damaged Terri seemed to want (which was to live)? Why, in the absence of a living will, were the wishes of her parents to take care of her given no consideration? Why were several affidavits alleging a wide variety of conscious behavior by the damaged Terri, along with evidence of abuse by her husband, all dismissed by the Florida courts? Why didn’t Michael’s refusal to allow neurologists to test Terri cause the Florida courts reconsider their finding that she was a vegetable, or that Michael should have sole guardianship?

The extreme bias of the Florida courts in Michael Schiavo’s favor is intolerable. This was an estranged husband who, if Terri had died at the time of her injuries, would have been a murder suspect. Where is the feminist outrage? How can the Democrats as a whole not be outraged? Everyone has federal due process rights under the Fourteenth Amendment that a state must satisfy before it can deprive one of its citizens of life, liberty or property. The grotesque lapses in Florida’s handling of the Schiavo case could easily constitute a failure to meet minimum necessary due process standards. Conservatives and the Republican-led Congress wanted those rights reviewed, but not Democrats. Why?

For those who dream of socialized medicine, questions of individual blame and justice do not matter. Terri needed to die in any case, because socialized medicine is untenable unless society can determine that people like Terri must die, regardless of who is to blame for their condition or whether they want to live. In a socialist system, people cannot be allowed to follow their own wishes because, not facing correct incentives, they will not make efficient choices. A socialist system can only work at all if government sets a standard based on efficiency and forces all to abide by it no matter what.

Judge Greer made remarks consistent with this mindset at a hearing where Terri’s parents (the Shindlers) were contesting the fitness of Michael Schiavo to have sole guardianship. They noted how Terri’s original medical report documented bruising to her neck and they tried to introduce testimony from Terri’s friends that Michael had been a violent abuser before Terri suffered brain damage. Judge Greer’s response, according to the Shindlers: “It would be interesting to know what happened,” but it is “irrelevant to this case.”

Whether Michael throttled Terri is irrelevant to whether he should be her guardian? Only to an ideological socialist, for whom individual right and individual choice are irrelevant. If Michael nine-tenths of the way murdered Terri, the efficient thing to do now is to let him finish the job! Maybe you can think of another explanation for thinking that evidence of attempted murder is irrelevant to guardianship, but a majority of members of Congress were disturbed enough by the facts of the case to want it looked into. In accordance with their Fourteenth Amendment obligation to guarantee due process, they ordered a due process review, and pertinent to that review, they wanted her brought before them so that they could see for themselves whether she was actually a vegetable.

Democrats misrepresented this defense of individual rights as an attack on individual rights. “Dem’s new message: the party of less intrusive government” touted a San Francisco Chronicle headline about the Schiavo case.4 David Magnus, director of the Stanford Center for Biomedical Ethics, pretended that the case is a right to die case: “I’m surprised about the tenor this has taken on. We wouldn’t deny a Jehova’s Witness the right to refuse blood or the right of a Christian Scientist to refuse surgery.”5 Pure disinformation. What people were protesting was an egregious legal process that claimed Terri wanted to die when all the evidence said the opposite.

It is bad enough that the Democrats give their socialist dreams priority over individual right. It is even worse when they pretend at the same time to be the ones who are defending individual choice against overweening government. The threat to liberty comes entirely from socialized medicine. We need medical decision-making to be efficient and we need it to be moral. Liberty, enforced by the protection of individual rights, achieves both. Socialism achieves neither.