Terry Schiavo Brought to Light

¶ … Terry Schiavo brought to light the deep divisions in American society regarding medical ethics. As Terry Schiavo rested in a persistent vegetative state (PVS), her family fought over what her future -- and theirs -- should look like. Terry's husband Michael Schiavo argued that his wife would not have wanted to be kept alive artificially through feeding tubes and wished that Terry would be able to die with dignity. Michael Schiavo and others like him believed that Terry was but a "living corpse," (Caplan, McCartney, & Sisti p. 426). Keeping Terry alive was both an affront to her personal dignity and also to her civil liberties, according to her husband and his supporters. However, Terry's parents disagreed. The Schindlers and other religious Americans believed that Terry should be kept alive via artificial nutrition and hydration (Caplan et al. p. 426). Their views seem to contradict the notion that human beings should not interfere with the natural course of life, but the Schindlers claimed that Terry would have wanted to live as long as possible. The same argument against physician-assisted suicide was occasionally invoked in the Schiavo case (Caplan et al.). The debate centers on several distinct issues, including patients' rights, medical ethics, religious morality, and legal jurisdiction.

Laura Crow's brother Josh died three years "to the day" before Terry Schiavo passed away. Based on her personal experience, Crow claims, "Beneath my anger at the media and my government, I felt deeply empathetic toward Terri's husband and parents. I understood both sides because I had explored them within myself," (p. 185). In the end, Crow singled out two main reasons why she sympathized more with Michael Schiavo than with Terry's parents. Crow mentions several reasons why she agreed with removing Terry Schiavo's life support.

First, Crow deplored the government intervention and media hype that characterized the Terry Schiavo case. She believes, as many do, that the decision to remove or keep life support is a personal one and that state intervention should be minimal. Second, Crow notes the crucial difference between quality of life and quantity. President Bush and Governor Jeb Bush both believed it to be immoral to remove Terry Schiavo's feeding tube. However, Crow claims, "When president Bush declared that, in the face of uncertainty we must err on the side of life, I think he missed a key element of humanity," (p. 186). That "key element of humanity" is "how a person lives," or "quality of life," (Crow p. 186). Third, Crow interjects the word "freedom" to conclude her essay "Extreme Measures: A Personal Story of Letting Go," (p. 186). Freedom is one of the reasons given to support the decision in favor of removing artificial life supports. Finally, the author claims "Had my family been refused the option to withdraw life support, Josh would have succumbed eventually, but it would not have been a good death," (Crow p. 186).

The same basic themes form the basis of arguments for or against the removal of life support for a person in a persistent vegetative state. Crow suggests that privacy and individual freedoms are major issues in medical ethics. Although privacy is invoked strongly by the side supporting the right to terminate life support, the concept of privacy is itself debatable. Goldberg claims that the idea of individual privacy is relatively new. Throughout most of human history, individuals were viewed as parts of a collective whole with "broader obligations" society that transcend their own needs (Goldberg p. 31).

With regards to individual rights and freedoms, Goldberg claims that mental competence is the key. Like many who supported Terry Schiavo's parents, Goldberg claims that individuals in a persistent vegetative state are unable to express how they feel about life support or life extension. Their inability to communicate or lack of mental competence means that they should be kept on life support. Removing Terry's life support without her express consent would be infringing on her personal rights and freedoms. Goldberg also notes that if Terry had created a living will with orders to terminate her life in such a condition, she might have wanted to change her mind at the last minute. Thus, even the concepts of freedom and privacy can be defined in different ways. Goldberg does point out that the "family's rights to emotional stability and financial security" should also be taken into account in the decision-making process (p. 32). If Terry Schiavo's parents agreed with the husband, then the government would not have intervened. In Terry Schiavo's case, her family was deeply divided over how to proceed and called upon the law to help.

Goldberg also disagrees that quality of life is always more important than quantity. Governor Bush and President Bush, along with the religious groups that supported Terry Schiavo's parents, believed that life is always sacred regardless of whether or not an individual is suffering. According to Goldberg, evaluating the quality of life is objectively impossible because there are no clear standards with which to use. Keeping Terry Schiavo on life support can be viewed as the moral decision when coming from a religious perspective. As Caplan et al. point out, the Catholic Church and other religious organizations became especially vocal during the Schiavo case because their moral code differed from that of Michael Schiavo. The religious parents of Terry and their supporters believe that extending life is inherently a moral choice, whereas terminating life is immoral.

Unfortunately, when two radically different worldviews collide it is impossible to find a true common ground. Michael Schiavo believed firmly that quality of life trumps quantity, but the Schindlers believed equally as firmly that quantity of life is also important. Moreover, the Schindlers claimed that Terry "professed her Catholic faith" and would not have chosen to die but rather to live (Caplan et al. p. 423). Yet Caplan et al. also note that even within the Catholic church there is a lack of consensus over how far human beings should go to extend life: "when it comes to categorizing artificial nutrition and hydration as one or the other, statements from various Catholic authorities included in the book demonstrate that consensus is lacking," (p. 424).

Another major issue raised in the case of Terry Schiavo is that terminating life support is often framed as a type of euthanasia. Withdrawing life support is a type of euthanasia. Goldberg refers to the withdrawing of life support as "passive euthanasia" because no one is administering a lethal drug to hasten death (p. 33). Rather, the patient dies naturally because the body cannot sustain itself. Goldberg also mentions that some philosophers do not view a moral distinction between passive and active euthanasia. Some posit that withdrawing life support can in many cases "cause more suffering" than active killing because of the length of time it takes to die (Goldberg p. 33). In the Schiavo case, though, the "cerebral cortex had largely been replaced by cerebrospinal fluid," and the patient felt no pain (Caplan et al. 425). If medical recovery were possible, then withdrawing life support would be immoral but in the case of patients with PVS, recovery is often impossible. Thus, the quality of life vs. quantity of life debate remains unresolved.

Similarly, it is difficult to resolve the dilemma over whether extending life is natural or unnatural. To the religious person who views life as being sacred, removing life support would seem to be the appropriate and moral decision. All living things die and so artificially extending life would be like "playing God." Ironically, though, those most vocal about life extension base their opinions on religious points-of-view. Artificial life extension is viewed as natural even though the organism cannot survive on its own. Those who denounce the right to die most likely base their views on a fear of death. Those who champion the right to die most likely base their views on a fear of a bad life -- or a bad death.

Both sides of the argument agree that autonomy and freedom as well as privacy are important. However, the sides disagree on how to define autonomy, freedom, and privacy. If a person is in a persistent vegetative state and cannot voice an opinion, then who has the right to choose whether or not to continue life support? If the patient signed a living will in favor of or against life support, how can anyone be sure that the individual would not changed his or her mind when faced with the prospect of dying suddenly? Patients in a persistent vegetative state do not feel pain and therefore might not experience suffering. On the other hand, persons in a persistent vegetative state might suffer mentally if their consciousness were engaged. The quality of life is a subjective decision, too. Because Terry Schiavo could not vocalize her thoughts, it is impossible to know for sure whether she wanted to live or die at the moment her feeding tube was removed. Definitions of quality of life differ, and definitions about the quality of death differ.