The Terri Schiavo conflict and ethical dilemmas in end-of-life care

Terri Schiavo- a Case of Life-Ethics

Mercy Killing, euthanasia, life support, brain damage are some of the hotly debated issues today in medical and legal circles. When is a person really dead? Why should life support system be provided? When can it be removed? Under what circumstances a person can be killed by the medical staff? There questions, as disturbing as they may be, are high pertinent to the case of Theresa Schiavo, the 41-year-old woman who died on March 31st, this year after her feeding tube was removed. (BBC News)

Terri Schiavo, as she is popularly known now, suffered a serious brain injury in a cardiac arrest in 1990 which may have been triggered by her suspected bulimia. She was then married to Michael Schiavo and apparently living a happy life. Terri's parents, Robert and Mary Schindler, wanted to keep her alive with the use of a feeding tube. Michael Schiavo agreed to this initially. In 1992, Michael sued Terri's doctors for malpractice and won $750,000 for her and $300,000 for himself. The money won for Terri was placed in her trust that paid for her healthcare and medical treatment. The trust contained $50,000 at the time of her death. Michael was made Terri's guardian-s something that was disapproved by her parents in 1993 when they filed a suit to have him removed from this position. The court rejected the case and Michael remained sole guardian of Terri. A year later in 1994, Michael ordered do-not-resuscitate order in case of a heart attack after consulting with Terri's doctors. It was found Terri's brain had suffered immensely and she might not recover. In 1998, things went sour when Michael ordered removal of feeding tube that had been keeping Terri alive for last eight years. In 2000, the state court of Florida ruled in favor of Michael's order but Schindler were allowed to appeal. A seething legal battle ensued which went all the way to U.S. Congress where it was decided in 2003 that Terri must live. The law was challenged by Michael and in 2004, the court again ruled in favor of Michael who felt that law was unconstitutional. In 2005, the battle came to a grim end when U.S. Supreme Court rejected Schindler' appeal and Terri's feeding tube was removed in March this year. Exactly 13 days later, Terri died resulting in an uproar from activists on both sides of euthanasia debate. Pro-life quarters complained that Terri was not brain dead and could respond while the pro-choice quarter felt her vegetative state had reached a point from where it was impossible for her to come back.

Those who supported the Schindler felt that Terri was not brain dead and with proper treatment, she could come back to life. They were of the view that Michael Schiavo had some vested interest in Terri's death and there had been some signs of recovery. "Nat Hentoff of the Village Voice, not exactly a conservative newspaper, claims the media have gotten this story wrong. Although Schiavo is not able to talk, she's not in a permanent vegetative state, claims Hentoff. He says he has talked with some neurologists who believe that, with appropriate therapy, she could learn to feed herself and be more responsive. Further, there is no proof that she ever rejected the use of unusual measures to stay alive. And her husband may have his own reasons for wanting her dead. Keeping her alive is eating away at the $750,000 malpractice payment he received." (Christian Century, 2003)

On the other hand, supporters of Michael Schiavo argued that Terri's life had become meaningless since she was completely depended on feeding tube. Her brain had suffered immense damage and there was no way she could recover. They felt that keeping her alive on a feeding tube was only prolonging the inevitable. "Schiavo's parents' belief that their daughter shows signs of consciousness is simply wishful thinking, according to physicians quoted in a September 23 Washington Post story on the subject. Though the parents' ease was bolstered by videotapes of her seeming to smile and look at visitors, such signs are natural instincts of someone in a vegetative state, say many medical experts. "The CAT scan shows massive atrophy of the brain," said Ronald Cranford, a neurologist who testified for Michael Schiavo in the trial. "What Terri Schiavo manifests is a classic vegetative state," he said to the Post. "It looks like she's looking at you, but really she's not. It looks like she's grinning at you, but she's really not." Cranford added that she does not show key signs of consciousness -- the ability to "track" with her eyes." (Marus, 2003)

Euthanasia or physician-assisted suicide is a contentious issue. But Terri's case was an exception when it came to discussing it in the context of euthanasia. In mercy killing, it's usually the patient himself deciding his fate but in Terri's case it was her guardian choosing how she died. Thus we need to understand that Terri's case was not an ordinary euthanasia case. The government has always maintained a pro-life stance. The Church also doesn't allow mercy killing in any form or shape. Terri's death was also termed a murder by the Vatican. There have been many euthanasia cases in the past that may help us understand the Terri case better.

In Washington vs. Glucksberg case of 1997, Supreme Court made it clear that a complete ban on doctor-assisted suicide doesn't violate the provisions of Fourteenth Amendment. The Court explicitly rejected the plaintiffs' claim that right of liberty extends to use of suicide by terminally ill people. In this case, doctors filed a petition objecting to Washington's ban on physician-assisted suicide. The Supreme Court studied the case from various angles and came to the conclusion that suicide itself is a pervasive problem in the country and it would thus be senseless to allow physician-assisted suicide to people suffering from chronic illnesses.

The Supreme Court gave some very logical arguments in favor of its decision to uphold the ban. Washington Post (1997) printed excerpts of this important court decision and wrote, "[The Court stated] First, Washington has an "unqualified interest in the preservation of human life . . . The State has an interest in preventing suicide, and in studying, identifying, and treating its causes . . .. Research indicates, however, that many people who request physician-assisted suicide withdraw that request if their depression and pain are treated . ... Next, the State has an interest in protecting vulnerable groups -- including the poor, the elderly, and disabled persons -- from abuse, neglect, and mistakes . ... If physician-assisted suicide were permitted, many might resort to it to spare their families the substantial financial burden of end of life health care costs "