On February 25, 1990, Terri Schiavo suffered from severe brain injury. She could no longer do anything for herself and was without an attorney. Her husband named Michael Schiavo was her legal guardian. Due to brain damage, Ms. Schiavo did not have the ability to swallow and was feed through a feeding tube. During that same year, she entered into a persistent vegetative state (PVS). As years passed, Mr. Schiavo, along with physical therapists, attempted to rehabilitate Ms. Schiavo but was unsuccessful. Tired of seeing his wife in such a condition, Mr. Schiavo thought that it would be in everyone's best interest, including his wife's, to unplug all life support devices and let her die. The parents of Ms. Schiavo disagreed with Mr. Schiavo's proposal; this created much hostility that was viewed by the public (Perry, Churchill, & Kirshner, 2005). This case has been the focus of medical controversy nationwide. This paper discusses the following: the ethical importance of the case and its impact on future practice, the legal ramifications of the case, the ethical principles violated in the case, and its impact on the standards of practice.
The ethical importance of this case includes issues regarding the sanctity of life, discrimination experienced by the disabled community, and the moral character of individuals empowered to make decisions about their live and well-being. Many people view this case as a struggle between the sanctity of life vs. quality of life. The main question in the Schiavo case is who decides what is right in the eye of the public. The law must preserve and support the rights to act according to one's personal morality. With that being said, living wills and durable powers of the attorney are the blatant driving forces of autonomy. By removing the issues of autonomy and liberty from the equation, the courts are the only entities left to make decisions in the best interest of the individual according to their own values, even if they no longer have the ability to communicate for themselves (Perry, Churchill, & Kirshner, 2005).
Removing Ms. Schiavo's artificial nutrition and hydration resulted in an ethical dilemma. There was much concern over the potential cascading effect that would result if people who are disabled may be perceived to have a poor quality of life and felt disregarded. While there is no general policy for what should be done to and for people living in a persistent vegetative state, the notion of liberty ought to be stressed as the fundamental issue involved, that all individuals will be able to choose for themselves and that their living wills, if in existence, will be honored (Perry, Churchill, & Kirshner, 2005).
Another ethical issue is whether or not Michael Schiavo should have had a voice in the decisions made for his wife. It was argued that he should not have had a say concerning decisions made for her because over the fifteen-year period of caring for her, he developed a relationship with another woman. Regardless of his romantic life after Ms. Schiavo's injury, his aggressive attempts to rehabilitate her cannot be ignored. Yet attempts were made to take the focus off of the decision itself and discredit the individual making the decision (Perry, Churchill, & Kirshner, 2005).
It is important to be familiar with 3 complicated terms in the Terri Schiavo case. The first is persistent vegetative state (PSV) occurs after a coma; a patient loses cognition and can only perform certain, involuntary actions on his or her own. While some describe those in a persistent vegetative state as "brain dead," in fact, the lower brain stem in PVS patients retains some reflexes and the ability to breath. "Whole brain death" is the second term. This means to have no brain activity at all. "Higher brain death" is the last term. Higher brain death occurs when the parts of the brain that is responsible for consciousness and higher reasoning stops functioning. Terri Schiavo suffered from higher brain death (Wijdicks, 2001).
Ms. Schiavo's brain was severely damaged due to lack of oxygen. She demonstrated few gross motor skills and could breathe on her own, indicating some signs of brain stem activity. Having residual reflexes provides one with the ability to open their eyes on breathe on their own. As a result, many argued that she had brain function. The definition of brain death is absolute unresponsiveness to stimuli, the absence of spontaneous muscle activity that includes respiration. Brain death is also known as cerebral death and irreversible coma (Fritz, 2005). According to traditional standards of whole-brain death, Terri was still fully "alive" and thus should not have her feeding tube removed. Terri Schiavo suffered from a "higher brain injury. Primal responses did not vanish, resulting in the quality of life issues.
The Schiavo case involved repeated appeals, motions, petitions, and hearings in the courts at all levels. The media worsened the problem by exploiting individuals using the case as a platform for religious, political, and cultural purposes. Activism began to rise from pro-life and disability rights groups and both sides bellowed their beliefs. The case was reviewed both by state and federal courts, and numerous judges examined the issues surrounding the question of whether a severely brain damaged woman's feeding tube ought to be removed. The question is not about what the husband, parents, congress or the President of the United States wants. The legal question is not even about what Terri Shiavo wanted. It is about whether due process was denied and whether the courts gave due consideration to all of the issues in this case (Dresser & Kirby, 2005).
The law did not fail Terri Schiavo. This case is historic in the United States because it has provided excellent evidence, legal scrutiny, and judicial attention. Ms. Schiavo was in a persistent vegetative state since 1990 diagnosis which was verified by numerous doctors. After eight years of rehabilitation Terri's husband petitions to have Terri Schiavo's feeding tube removed. The first attempt to remove the feeding tube was in February of 2000. Terri Schiavo's parents win a motion to resume tube feedings. On October 15, 2003, the legal system in the state of Florida ruled for the second time the removal of the feeding tube. Five days later the Florida Legislature enacted an action allowing Florida Governor Jeb Bush to override withholding nutrition and hydration from a patient. This was later ruled unconstitutional and Mr. Schiavo challenged this and the court ruled in his favor (Dresser & Kirby, 2005).
Judge George Greer ordered the removal of the feeding tube on March 18, 2005. The Supreme Court refused to hear the case which caused the third removal of the feeding tube. There were numerous attempts by Ms. Schiavo's parents to feed Terri, which were denied by Judge Greer. As a result of not being fed, Terri died (Dresser & Kirby, 2005).
This case is a convincing example of the decisions that the government makes that can lead to dire social consequences. Therefore, it is more desirable to obtain a statement or legal document stating the individual's wishes. A living will dictates what the individual's wishes are if they become incapacitated. The individual will be given a peace of mind, knowing that their family members will not be placed in such circumstances (Dresser & Kirby, 2005).
Healthcare professionals use ethical principles and ethical theories to guide clinical practice. Examples of ethical principles include autonomy, beneficence, veracity, fidelity, paternalism, justice, and respect for others. Although these principles are important to understand and strive to meet in daily practice nurses need to have a deeper basis to help them guide their practice. (Guido, 2010).
Several ethical principals were violated during this case. By not granting her wish of not wanting to live in a PVS, the courts and members of her family violated her autonomy. Terri Schiavo's wishes expressed to her family and friends before her injury were not respected. Beneficence was another principal that was violated because instead of doing her any good, they harmed her by not respecting her wishes and keeping her alive with no quality of life, putting her at risk for bed sores, infections, and contractures. Paternalism was also violated when the courts ruled for her instead of allowing her husband and legal guardian to make medical decisions for her (Guido, 2010). Ethical theories and principles are used on a daily bases in the medical industry. It is important to understand these principles as they assist in decision making when dealing with ethical dilemmas. Nurses are often the mediator between the family members and the rest of the healthcare team, when it comes to making the best decision for the patient's needs (Guido, 2010).
This case mirrored a perfect example of conflicts arising from end of life decision-making. The effects of the case include hospitals continuing to rely on clinical ethicists, ethics committees, or mediators to help in the resolution of conflicts between family members or health care providers. When conflicts arise such as…