To Live or Not To Live: The Terri Schiavo Debate - Case Study Example

To Live or Not To Live: The Terri Schiavo Debate Terri Schiavo became a household in the debates over right to die, as well as human rights. The fight was between her husband and her parents. Her husband wanted to remove his wife’s feeding tube, after years of her lying in a vegetative state. Her parents disagreed. Terri’s parents would have to go to court, because, legally, her husband was her next of kin and he had the ultimate say. The fight went well beyond this. Before it ended, it became a war between bioethics and law. Ultimately, the law won out. Yet, was this really the right choice? Many argue that it might have been, but then there were many arguments in this case. Not all of them were ethical or logical, and not all of them played out in court. The story of Terri Schiavo is so much more tragic than people stop to realize. When a situation is so easily preventable, how does it get so terribly out of hand, and how are even the most basic decisions of care handled? The bottom line, Terri Schiavo should have been alive today, and possibly even alive and well. Terri Schiavo suffered a cardiac arrest due to an eating disorder on February 25th, 1990. She was without oxygen for several minutes and then lapsed into a coma. Her coma then evolved into a Permanent Vegetative State. For fifteen years, she remained in that state, until her feeding tube was finally removed for the last time on March 18th, 2005. She died thirteen days later, ending a fifteen year battle with so many players, and yet so few concrete, satisfactory, answers (Quill, 2005). Terri Schiavo was in a Permanently Vegetative State, also known as PVS. While experts tried to argue that she was in a Minimally Conscious State (MCS), at her autopsy, it was confirmed that she had been in a PVS. The difference between the two conditions is slight. Those patients who are in a PVS are unaware of self and environment; they may make gestures, sounds, and eye movements. These behavior, however are involuntary. People in a MCS are aware of self and environment, but can only express it so much. They cannot speak, but their gestures, eye movements, and vocalizations are a deliberate attempt to communicate with those around them (Winslade, 2007). While Schiavo’s state was considered irreversible, there is much more that may have been learned from her had she survived. Studies have shown that some patients in a PVS can regain some level of consciousness. Some may live for decades in a PVS and begin to recover some consciousness. Simply put, it really is impossible to say that Mrs. Schiavo would never regain any level of consciousness. Whenever the debate of end of life issues arises, religion will play a role. The Schiavo case was no different. Religious leaders said that removing Schiavo’s feeding tube made a clear statement that “a life can be meaningless”. They called it “murder” (Anonymous, 2006). However unethical religious leaders and Mrs. Schiavo’s parents, who are deeply Catholic, felt this decision was, the courts could not intercede on the basis of religious sentiment. However, this was one of the many reasons that should have supported the choice to keep Terri Schiavo alive. Religion aside, the message that a life can be meaningless should never be conveyed. Terri Schiavo’s parents, the Schindlers, were also deeply Catholic. They argued that their daughter, also Catholic, would like to live, and that if she were going to die, it should be on God’s terms, not the state’s. Sadly, separation of church and state, a basic constitutional right, made it impossible for any decisions to be based on church doctrine, just as church doctrine is not based on contemporary legal precedence. This point brings another point into play. What would Terri Schiavo have wanted? The law states that if a person is incapable of making decisions about their care, and there is no advanced directive, their next of kin can make the decisions for them. In Terri’s case, her next of kin was her husband. Florida Circuit Court Judge Greer heard arguments from both sides concerning what Terri’s wishes were. Judge Greer evaluated the testimony of five people. The judge ruled that her statements were a clear view of what she would have wanted, and that they were legally convincing evidence of her desires. This ruling was made on February 11th, 2000 (Schwartz, 2006). However, had Terri left in writing her desires should she ever be unable to make choices about her medical and physical well – being, this would not have been at issue. No one truly knows if these statements were an accurate reflection of the wishes of a young, twenty-something woman. Terri’s wishes may not have been carried out. She may have been denied her desire to live. Sadly, only Terri knew what her wishes were. Cases like this call for stricter regulations to determine what an incapacitated person may want when lifesaving, and life sustaining, measures, are called into question. Then there was the case of Terri’s Law. This law was intended to keep Terri’s feeding tube in place. It was ruled as unethical and invalid by the courts (Thompson, 2005). However, the courts make decisions every day that determine the lives of those who cannot decide for themselves, including, but not limited to, children and the disabled. The law was designed to have the courts review the Schiavo case. However, the courts did not. They also did not order a PET scan on Mrs. Schiavo, which would have showed the state of her brain. This scan would have shown the functional state of her brain, and whether or not the damage could be repaired. Add to this that the way in which Terri would die, without food and water, can take quite a long time, and can be painful. Essentially, Terri’s case was immoral, because medical tests weren’t ordered, and the method of death was less than easy for the patient, as well as the people who had to watch her slowly slip into nothingness (Calabresi, 2006). There is no avoiding the right to die debate when talking about the Schiavo case. The topic has always been heated since it began with Karen Quinlan in the 1970’s. Many patients suffering from terminal illness support the right to die. The ends of their illnesses are often very painful with slow deterioration, and suffering. These patients wish to end their lives rather than deal with death on such terrible terms. However, this is their choice, and not someone else’s (Bloche, 2005). Of course, this returns to the idea of advanced directives. Terri Schiavo was trapped in her own mind. There was no way for her to speak her mind. She is not a representative of the right to die debate, but she was still used as a symbol, which was unfair to all parties involved. Going hand in hand with the right to die debate is the idea that there should be a standard of guidelines when discussing the issue. The case of Terri Schiavo sparked the topic, as there was no standard of rules. There were no laws to guide the courts, and no real standards to guide the medical community. No one knew if the decision was really accurate, because there was no set protocol (Dresser, 2005). Both legal and medical experts must get together to develop an objective standard, which must work for both sectors. This set of guidelines could prevent another Terri Schiavo case. Were these guidelines in place when she was alive, the controversy over Terri Schiavo would never have occurred. It may have even saved her life. The other saddening outcome of this case is that it tore a family apart. Michael Schiavo and Terri’s parents, the Schindlers, had always been very close. At the start of Terri’s illness, her family had a very tight-knit bond with Michael. However, as time went on, and their difference of opinion on her treatment became apparent, eventually this bond was eventually dissolved (Klugman, 2006). The issues suffered by both families went far beyond just personal disagreements. The lives of the Schiavos and the Schindlers were no longer personal. Every decision the families made, every move, trip to the grocery store. Their private lives were no longer private. This case turned two families upside down and had them living in a virtual fishbowl. When people think of the Schiavo case, rarely do they think of how it destroyed the lives of both families. Another interesting thought to ponder is, were the civil rights of Terri Schiavo, as a disabled person, violated? Terri Schiavo did not have a terminal illness. By the standards of many disability rights organizations, she was a disabled woman who relied on a feeding tube to help her deal with her disability. It was the brain injury, they contended, that disabled her (Johnson, 2006). Further, many of these organizations felt that calling things like feeding tubes and ventilators “medical equipment” was incorrect. They felt that these devices were assistive technology, like a cane for a blind person, or TTY for the deaf. The question arose, was this about to die, or violating the civil rights of a disabled woman? This muddied the waters further on the legal ramifications on the decision to allow the removal of her feeding tube. If this was a right to die case, then the decision could have been fair and ethical. If it was a violation of Terri Schiavo’s rights, then the removal of the feeding tube was murder. If you take a cane from a blind person, and force them to cross Fifth Avenue during rush hour, you would be responsible for the outcome. The courts would be responsible for violating a law that they have upheld countless times before on countless cases. This could change the climate for disabled people everywhere. This thought is a very frightening one for disabled Americans. Then there are the Schindlers’ videotapes that must be examined. These tapes show Terri Schiavo, smiling and laughing, seeming to communicate with her parents and those around her. Could she communicate? Were all those test results wrong? The Schindlers seemed to think so (Cranford, 2005). The Terri they shared with the world may have had a chance. The video tapes called many medical opinions of Terri’s brain function into question. Was she smiling at her mother? Was that hand wave just an involuntary reaction brought on by her nerves and brain? It was possible for some in the PVS to regain even small amounts of consciousness. There is no way to say that Terri would not have been one of those people. She may have been able to regain some capability. Even if it was just a little, to the Schindlers, this was worth the world. It meant that all of the fighting for Terri meant something more. It meant someday getting their daughter back. The incident that put Terri in this predicament also must be called into question. Terri Schiavo’s condition was caused by a cardiac arrest. The condition that caused the cardiac arrest is known as a hypokalemia, and this was brought on by an eating disorder. People feel that Terri didn’t receive adequate care after her condition began, and this is true. She should have received treatment for her eating disorder (Quill, 2005). Her brain injury didn’t come from a car accident; it came from a highly treatable illness. Bulimia. Terri Schiavo would purge, meaning that she would eat great amounts of food, and then regurgitate. Her parents and her husband should have known of this condition. Her eating habits were far from normal, and sometimes Terri’s “diets” would mean that she would refuse to consume any food at all. At one point, the only thing that she would put, and keep, in her body was iced tea. This should have been a red flag to everyone who knew her that Mrs. Schiavo needed help. That something had to be done before she hurt herself. Something was bound to happen, and it did. Had she received adequate medical and therapeutic treatment for this illness, she would never have been the subject of such international tragedy. The people responsible for denying her the much needed treatment are the same people who fought over her in court. Everyone pointed fingers, but no one stood up and took responsibility. Responsibility is the big issue with the Schiavo case. Terri was everyone else’s responsibility. Everyone fought about how her care should be managed, and no one bothered to step up and take steps to see things through. Each person or group involved also felt that each other person or group was ultimately responsible for Terri’s death. Michael was responsible because he was in love. The Schindlers were responsible because they didn’t fight hard enough. The doctors were responsible because they didn’t do enough before or after the cardiac arrest. Everybody had an opinion on whose fault it was. In the middle of it all was a woman trapped inside of her own mind. She had no rights, she had no choice, and she had no say. The medical and judicial system were under fire for failing her, her husband was under fire for failing her, her parents were under fire for failing her. No one stopped to consider who Terri may have thought failed her. She may have even failed herself, by taking such poor care of herself. Still, there were so many times that her life could have been saved. She could have been a normal mother, friend, wife, and sister. She could still have been alive today. Everyone failed Terri, and no one claims responsibility for it. That makes this case even more tragic. Ultimately, it was all preventable. References Anonymous, “Shattering the Consensus on End of Life Care: Was the Schiavo Case Palliative Medicine’s Humpty Dumpty?” Palliative and Supportive Care ~2006. M. Gregg Bloche, “Managing Conflict at the End of Life”, the New England Journal of Medicine, Boston, June 9th, 2005. Steven G. Calabresi, “the Terri Schiavo Case: In Defense of the Special Law Enacted by Congress and President Bush”, Northwestern University Law Review, Chicago 2006. Ronald Cranford: “Facts, Lies, and Videotapes: the Permanent Vegetative State and the Sad Case of Terri Schiavo”, the Journal of Law, Medicine, and Ethics, summer 2005. Rebecca Dresser, “the Need for an Objective Standard”, the Hastings Center Report, May/June 2005. Mary Johnson; “Terri Schiavo, a Disability Rights Case”, Death Studies 30: 163–176, 2006 Copyright # Taylor & Francis Group, LLC Craig M. Klugman: “Reframing Terri Schiavo: One Familys Story of Morality, Ethics, & Politics”. The Internet Journal of Law, Healthcare and Ethics. 2006. Volume 4 Number 1. Judith Schwartz, R.N., PH.D, “Can We Know What Terri Schiavo Would Have Wanted?” Palliative and Supportive Care ~2006. Robert E. Thompson, “The Terri Schiavo Dilemma: An Ethics Report with a Few Surprises”, Physician Executive, September/October 2005. Timothy E. Quill, “Terri Schiavo – a Tragedy Compounded”, the New England Journal of Medicine, Boston, April 21st, 2005. William J. Winslade, “Severe Brain Injury: Recognizing the Limits of Treatment and Exploring the Frontiers of Research”, Cambridge Quarterly of Healthcare Ethics (2007), 16, 161–168 Read More