The Terri Schiavo case was an unusual incident where a person who should have been removed from life support long ago was sustained due to federal and public intervention. The case instigates moral and ethical questions of decision to end life as well as the limits of autonomy in surrogate decision making. Torke et al. (2008) argue that guardian judgment is often used as decision-making when a patient lacks the cognitive abilities to decide treatment for herself. Surrogate decision-making, however, has its own flaws and should be replaced by something more rational. Using the Terri Schiavo case as base, the following essay argues that the decision whether or not to prolong a patient's life (or indeed any decision revolving on an incumbent or cognitively disabled patient) should focus on the patient's dignity and individuality rather than on his or her autonomy.
The Terri Schiavo Case: background
The Terri Schiavo case lasted between 1998 to 2005 and involved the country and the government into the question of whether Theresa Marie "Terri" Schiavo should be sustained on life support despite repeated medical evidence that showed her brain to have atrophied and her to be in a consistent medical vegetative state. Her husband, Michael, wished her life support to be removed in 1998. Her family (specifically, her parents, Robert and Mary Schindler), disability rights groups, pro-Lifers, and the federal government (under Governor Bush) interfered insisting that there was potential for consciousness. Repeated tests were conducted on Terri all of which showed that Terri was clinically dead. Nonetheless, public furor and political intervention prevented Terri from being formally buried. In the end, in 2005, under orders from Judge Greer who was prepared to reinforce them with force, Terri's life support was formally removed on March 18, 2005, and Teri died on March 31, 2005.
Autopsy revealed that Terri's brain had been thoroughly dehydrated. In fact, her brain weighed only 615 g (21.7 oz.), only half the weight expected for a female of her age, height, and weight, due to the loss of neurons. Cause of her death was diagnosed as "indeterminate'.
The moral/ethical issues present in the case
The primary ethical issue is whether to sustain Terri's life by keeping her on life-support or terminate it due to the fact that medical evidence indicates the complete loss of functioning of her brain. The moral issues include the fact that sustaining Terri and treating her in the state that she is may be a violation of patient dignity and contrapositive to her will which may be simply to be buried once she has died.
Other moral issues involve the ongoing economic expense that drains taxpayer's money in attempts to restore a patient to consciousness despite all medial evidence showing futility of such attempts. Terri's maintenance on life support and perseverance of her family and others in treating her prevent both her family and her husband from continuing with their normal lives.
Your ethical position relative to the issue -- what would you do!
I would certainly have decided that Terri be removed from life support as soon as she was deemed to be in a vegetative state. Scientific evidence was clear that Terri's brain had completely deceased. Six hours of video demonstration also showed Terri to be clearly in a comatose state.
Basic ethical principles demand dignity for the patient (Tong, 2007). As long as the patient is cognitively aware, the patient can render her own decision regarding the care of her body and health. When no longer cognitively aware, care is passed on to a guardian. But, at all times, it is the patient's dignity that should be considered most of all. Terri's dignity was flagrantly violated in this case by interventions that insisted on feeding her despite medical evidence that showed that she could no longer swallow. Terri was also forced to undergo experimental therapy, and her body was violated by the intermittent insertion and removal of life support as well as her being wheeled back and forth from hospice. More so, Terri's body was being manipulated for political agendas. Her consent, in this case, had not ben requisitioned.
In short, as Mathes (2005) argues, all end-of-life care should be directed around the dignity of the patient and allowing the patient to die in as comfortable and painless a manner for her. Resuscitation and interventions to prolong the patient's life should not be attempted if the patient does not will it, if attempts seem only to be giving the patient pain and will produce little hope, and if interventions are for concerns other than the patient. Given this reasoning, Terri should have been removed from life support a long time ago.
**Defend your stated ethical position by using the theories you learned about in the first Module to validate your response.
Care-based ethics necessitates that the nurse orbit her practice around the patient. Jane Watson's model for instance, calls for greater motivation and vigor in nurse's practice by using a spiritual approach where nurses see patients as per a holistic whole and that the whole of nursing be done with the patient as the center, considering the patient's need in exclusion to that of anyone else. Terri was, certainly, not always at the center. It was, rather, religion and politics, as well as other selfish human concerns that played a part.
Deontology, meanwhile, judge s the consequences of the action based on the action's correspondence to a certain rule or principle. In other words, a normative principle may be 'to care for others as you would yourself." Theoretically, most people would not want themselves to be 'bandied' around after they are dead and used as experimental play thing or treated in the, occasionally, undignified manner that Terri was.
Utilitarianism, meanwhile, advocates doing the maximum good for the greatest amount of people. Burying Terri would not only relieve millions of citizens of continuing to pay money for her upkeep but would also enable families to move on with their lives and relieve medical practitioners of a useless burden.
Finally, modern medical ethics asserts that the patient has the right to refuse or choose her treatment; a practitioner should act in the best interest of the patient; and the first imperative is to do no harm. The first two have been discussed in this essay. The last: burying Terri would arguably commit the least harm particularly since repeated tests have shown that it would literally take a miracle for her to regain consciousness.
Explain how each of the significant parties (i.e. Terri, her husband, her parents, the medical staff, taxpayers, etc.) would be impacted by your ethical position. Discuss a party that would have supported your ethical position, and why, and another that would have condemned your ethical position, and why
Terri Schiavo's case was unique in its complications. When the patient is no longer able to independently make decisions regarding her life, the resultant decision-making can be psychologically strenuous on her guardians. Analysis of the Terri Schiavo case highlights the three core points of psychological conflict: (1) guardians may be divided as to the appropriate standards by which medical decisions for the patient should be rendered, (2) there was debate about Terri's wishes regarding being maintained on life-sustaining technology, (3) there was debate regarding the true extent of Terri's disability and hopes for her recovery (Ditto, 2006).
Terri's husband insisted that Terri would wish to be removed from life support and to die in peace. Her parents insisted that Terri, devout Catholic, would wish to be sustained. They and Pro-lifer groups maintained that Terri still retained a certain modicum of ability and that there was hope for improvement. The medical staff was divided on this issue according to their political and religious beliefs. Some saw the work as frustrating and aimless and, therefore, may have readily treated her with less dignity and in a robotic discouraging manner. Others perceived her, however, as someone who provided hope for experimental research and they may have, consequently, approached her with greater care. Taxpayers would have largely been frustrated with circumstances where they have to pay large amounts of money to keep an individual, clinically proved dead, alive due to political shenanigans.
My decision to remove her from life support would disturb her parents -- although be psychologically healthy for them in that it would allow them to move on. It would be a relief to Michael Schiavo by allowing him to move on with his life and would certainly be healthy to his second marriage and to the child that he fathered from that marriage. The decision would irk pro-Lifers who argue the sanctity and maintenance of life. On the other hand, it would have affirmed the position of anti-prolife groups as well as supporters of rights for individuals with disabilities.
Discuss the health policy considerations that are present in this case.
The health care policy considerations in this case include issues of government intervention in medical affairs.