The Terri Schiavo Case: Ethics, Law, and End-of-Life Care

Introduction to the Terri Schiavo Case

Ten years after Terri Schiavo died, the debates her case ignited continue to resonate. She passed away shortly after her feeding tube was removed, following her husband's request that she be allowed to die. Terri was 41 years old at the time. She had spent nearly half of her life in an immobile vegetative state following a cardiac arrest in 1990, which caused a severe lack of oxygen to her brain and resulted in extensive brain damage.

There was — and still is — considerable debate surrounding the legal case that arose from her husband's request. The controversy reached all the way to the U.S. Supreme Court. Terri's husband, Michael Schiavo, had begun requesting that doctors allow Terri to die in 1995, after it became apparent that she would not recover from her condition. Like Michael, every physician who examined Terri concluded that she had no realistic chance of returning to normal life. Michael did not want to see Terri remain in a permanent vegetative state and believed she would not have wished to live in that condition.

Terri's family, however, did not share this view. They argued that Terri would have chosen to remain on the feeding tube and hope for recovery. They claimed they were unfairly ignored in their effort to preserve her life. The dispute escalated from a private matter in Florida circuit courts all the way to the U.S. Supreme Court.

Legal Battles and Political Intervention

When President George W. Bush attempted to intervene and override the Florida courts' rulings, he nearly provoked a constitutional crisis. The Florida courts had consistently backed Michael Schiavo's position. The Vatican also entered the debate, challenging U.S. law that permitted doctors to facilitate death in special cases following consultation with the patient's family. According to the Vatican, it was wrong to discontinue food and water for a patient in a vegetative state.

This position created significant confusion. Many Catholics in the United States and Catholic healthcare institutions were uncertain how to respond to requests to allow a patient to die by discontinuing tube feeding. The facts of the case ultimately worked against Terri's family and the position of the Catholic Church. Terri's family had claimed she was not in a permanent coma, but an autopsy settled that dispute in Michael's favor. It was evident that Terri's brain had been extensively damaged — it was atrophied and weighed less than half of what a healthy brain should. No available treatment could have remedied her condition, and none exists today.

Terri's ambiguous state — somewhere between life and death — was the most difficult aspect of the case. She displayed some characteristics associated with being alive: she could appear to cry, laugh, or smile. At the same time, she showed signs consistent with someone near death, as she was entirely unable to feed herself. Both sides used this liminal state to support their respective positions, illustrating the powerful role that labeling and classification play in high-stakes medical and legal disputes. The courts ultimately sided with Michael, authorizing the removal of the feeding tubes.

The Rehabilitation Counselor's Perspective

Persistent vegetative state involves two distinct dimensions of possible recovery: recovery of function and recovery of consciousness. Recovery of consciousness can be evidenced by a patient's demonstrated awareness of their surroundings, consistent and reliable responses to auditory and visual stimuli, and general interaction with others. Functional recovery, by contrast, is demonstrated through communication, the ability to learn new information, movement, self-care, participation in social or vocational activities, and the performance of adaptive tasks (Medical Aspects of the Persistent Vegetative State, 1994).

It is possible to achieve recovery of consciousness without achieving functional recovery, but functional recovery cannot occur without prior recovery of consciousness. In some patients, external signs of recovering consciousness may not be immediately apparent, making it important to monitor the consistency and reliability of recovery indicators carefully.

The cost of caring for patients in a vegetative state is another critical factor. While it is difficult to estimate the total cost of long-term care for someone in a persistent vegetative state, research has indicated that estimated hospital care for the initial three months stands at approximately $149,200. Long-term placement in a skilled medical care facility is estimated to range from $350 per day (or over $126,000 per year) to $500 per day (or approximately $180,000 per year). For children cared for at home, estimates stand at approximately $129,000 per year for the first year and $97,000 for subsequent years (Medical Aspects of the Persistent Vegetative State, 1994). Rough estimates for the total cost of persistent vegetative state care for both adults and children in the United States range from one billion to seven billion dollars annually. The cost of therapy alone is substantial.

References

Medical Aspects of the Persistent Vegetative State. (1994). The New England Journal of Medicine, 330.

Ten Years After Terri Schiavo, Death Debates Still Divide Us: Bioethicist. (2015). NBC News. Retrieved October 26, 2016.

Sanburn. (2015). Terri Schiavo Impact on Right to Die Movement. TIME. Retrieved October 26, 2016.