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Terri Schiavo suffered an acute brain injury that left her in a persistent vegetative state, with almost no chance of recovery. Eight years later, after numerous efforts to rehabilitate her, her husband, Michael Schiavo petitioned the Florida court to remove her feeding tube, thus allowing her die. Although he was her legal guardian, Terri Schiavo's parents, Robert and Mary Schindler, argued that she was still conscious and that letting her die would be akin to murder. Examining the case of Terri Schiavo and the altogether embarrassing public carnival it generated will serve to demonstrate that is necessary for ethical and moral norms to acknowledge that when science suggests that a patient in a persistent vegetative state (PVS) has no chance of recovery, medical opinions and the expressed desires on the individual and his or her guardians should take precedence over moralizing conversations.
Before discussing the moral, ethical, and medical perspectives regarding the case of Terri Schiavo, it will be useful to briefly recount the events which led to her PVS and the subsequent media uproar surrounding the decision to remove her feeding tube. In 1990, Mrs. Schiavo suffered a severe cerebral anoxic injury, likely as a result of complications from (at the time) undiagnosed bulimia (Kaplan 96). She entered a coma, which was eventually upgraded to a PVS. Her husband, Michael Schiavo, was her legal guardian and while he initially "battled for her care and support," after eight years of Mrs. Schiavo's treatment in a hospice center with no signs that Mrs. Schiavo was recovering from her PVS, Mr. Schiavo opted to let her die and "successfully petitioned the Florida state courts for an order directing the withdrawal of her feeding and hydration tube" (Kaplan 96, Calabresi 151). Mrs. Schiavo's parents disagreed, and so they sued to keep her feeding and hydration tubes in, claiming that Mrs. Schiavo would have wanted to be kept alive indefinitely.
Robert and Mary Schindler, Mrs. Schiavo's parents, were devout Catholics, and so they viewed the question of whether or not to remove her feeding tube as a moral issue, rather than a medical one (Calabresi 151). This is based on an assumption regarding the perceived "sanctity of life," a perspective that has no basis in objective reality but which stems solely from a belief in the supernatural, and an assumption that human life has some inherent worth beyond its value as a conscious being capable of expressing a desire to continue living. From a moral perspective, "stopping feeding tubes is murder," because in general, allowing someone to die is de facto immoral, in the same way that suicide is considered inherently immoral (Bloche 2372). This is largely the approach taken the Schindlers and the "cultural conservatives and others who rallied to the side of Schiavo's parents," as well as the predominantly Christian members of the Florida and United States legislatures, who passed two different laws "for Mrs. Schiavo's relief;" the Florida law allowed the governor to issue a stay preventing the removal of the feeding tube, and the federal law "was designed to encourage the federal courts to rehear de novo" the Schindler's claims regarding Mrs. Schiavo's wishes (Calabresi 151-152).
Most interesting in the case of Terri Schiavo, however, is the fact that the Catholic church actually makes distinctions between when it is acceptable to let someone die, generally depending on how expensive it is to keep them alive, how likely they are to stay alive, and what will ultimately cause their death. "The most definitive statement to date on obligatory and nonobligatory life supports in the Vatican Declaration on Euthanasia," which condemns euthanasia but allows for "the refusal or withdrawal of treatment 'if the investment in instruments and personnel is disproportionate to the results foreseen" (Cahill 124). The Vatican claims that "such a decision is not suicide or euthanasia, but 'acceptance of the human condition'" (Cahill 124). In 2004, the pope "delivered an 'allocution' removing ANH [artificial nutrition and hydration] from the category of 'medical procedure,' as mentioned in the Declaration, thus excluding it from estimates of proportionality" (Cahill 125). The pope's decision was based on the fact that cessation of ANH results in "death by starvation or dehydration," and even though death by starvation or dehydration is not fundamentally different from death by heart, kidney, or lung failure for someone in a PVS, the idea of starvation and dehydration makes people much more squeamish, likely because they seem like such simple threats to avoid (Cahill 125). Thus, while in general the moral view of death is that letting anyone die is inherently wrong, the Catholic view (which may or may not have been held by the Schindler's, depending on their commitment to the dictates of the Pope) allows for some cessation of treatment, but not the particular form of treatment Terri Schiavo was undergoing.
Considering the ethical perspective on the Terri Schiavo case is somewhat more difficult than discussing the moral perspective, because where morals are based on arbitrary prohibitions against certain behaviors, often recorded in a text purported to have magical authority granted by an all-knowing, supernatural creature, ethics are based in reality, and as such must take into account an individual's capacity for thought and the ability to feel pain. For example, while suicide is often considered immoral because certain magically-inspired books say so, it is not unethical, because the only person with the authority to decide whether to continue living or not is the individual. In Terri Schiavo's case, she was both unresponsive, and thus unable to express her wishes, and immobile, and thus unable to take care of herself, or alternately, kill herself. Situations like this, where the ethical answer (let her decide) is unfeasible, is precisely the reason laws have been codified governing who has the right to make decisions for people incapable of deciding for themselves. In this case, the Florida courts granted Michael Schiavo guardianship over his wife, and he subsequently acted in a way that he imagined was most in line with his wife's wishes, which, in a difficult situation such as this, is the closest to ethical one can hope to be. However, there is one more thing in favor of an ethical perspective, rather than a moral one, and that is the fact that ethics, unlike morals, are careful to include the best available information when determining a course of action. Here, at least, Terri Schiavo's case represents an ideal case in which to investigate the intersection of ethics, morality, and medicine, because the unprecedented public attention granted to her case meant that aside from the obvious media attention, Mrs. Schiavo received a generally unheard of amount of medical attention, meaning that more so than in many other instances of PVS, Mr. Schiavo and the courts could be relatively certain that there was no hope for recovery.
Mrs. Schiavo's parents attempted to claim that Mrs. Schiavo was not in fact in a PVS, and that she could actually respond to them. They even found medical professionals willing to claim as much, but it is important to consider the details of their claims, and the extent to which Mrs. Schiavo's PVS was confirmed, before jumping to conclusions that Mrs. Schiavo may have been misdiagnosed. In particular, one may note that "Schiavo was unprecedentedly examined by no fewer than 7 board-certified neurologists, all of whom diagnosed her condition as PVS," demonstrating a certainty not usually present in similar cases (Wijdicks 1157). The confirmed diagnosis that Mrs. Schiavo was in a PVS meant that "she could never have recovered to an independently functioning human being, able to care for herself" or communicate in any meaningful way (Wijdicks 1157). This was clear well before the Schindlers decided to file suit against Michael Schiavo, but it seems likely that, if they truly believed that they could actually communicate with her, as they claimed, they did not believe the diagnosis no matter how many different neurologists confirmed it.
Although "there are strong opinions to the contrary" provided by "others who did not actually examine Schiavo by instead watched videotapes of her examinations or edited videotapes provided by the parents," these opinions have little bearing on the reality of Mrs. Schiavo's diagnosis (Wijdicks 1157). The reality is that "PVS is the result of a brain that is badly, and chronically, injured, and meaningful clinical recovery from PVS is possible only in the hopes and dreams of patient's loved ones and supporters" (Wijdicks 1158). Thus, the medical perspective on Terri Schiavo's case is that her brain was irretrievably damaged, and that there was no chance of recovery.
It is important to note that the medical perspective itself does not suggest what to do in the event that a patient, like Terri Schiavo, is in a PVS. The role of medical professionals is to provide the most accurate information, so that those in a position to decide what to are able to do so safe in the knowledge that they have the best information. In this case, that person was Michael…[continue]
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They do not show what people perceive, and, in the end, this is what consciousness is (18). According to Steinberg, PET studies of vegetative patients have indicated "that the primary sensory cortices respond to pain and sounds, but that higher-order associative cortices do not. For minimally and fully conscious people, in contrast, sounds activate associative areas as well" (18). A study of minimally conscious patients exposed patients to recorded narratives. Similar