The story of Terris husband’s pursuit of the right to remove his wife feeding tube sparked dispute across the country of the United State of America, in particular, the State of Florida. There were a lot of individual introspection on the withdrawal of artificial nutrition in patients with persistent vegetative state, however before choosing sides, it is important to first have an understanding of not just the history of the case and the fact that Terri was involuntarily starved to death, but also understand the medical terms that were used by medical professionals in Terris diagnoses.
This to ascertain a clearer understanding of the diagnostic criteria that lends itself to the outcome ten years, after suffering from a cardio-respiratory arrest. Terri initially had a cardiac arrest, according to the American Heart Association, cardiac arrest is the abrupt loss of heart function in a person who may or may not has been diagnosed with heart disease. It can come on suddenly, or in the wake of other symptoms.
Cardiac arrest is often fatal if appropriate steps are not taken immediately. She was later diagnosed to be in a persistent vegetative state.
The New England Journal of medicine defines a persistent vegetative state as a condition in which a medical patient is completely unresponsive to psychological and physical stimuli and displays no sign of higher brain function, and is kept alive only by medical intervention.
The diagnosis criteria for persistent vegetative state are: no evidence of awareness of self or environment; no interaction with others, no evidence of sustained, reproducible, purposeful or voluntary behavioural responses to visual, auditory, tactile or noxious stimuli, no evidence of language comprehension or expression, return of sleep-wake cycles, arousal, even smiling, frowning, yawning. They can, however, open their eyes., they have relatively regular sleeping and waking patterns but not necessarily related to day and night, they can breathe, and appear to smile or frown). Sufficient hypothalamic and brainstem autonomic functions to survive if given medical or nursing care bowel and bladder incontinence variably preserved cranial nerve and spinal reflexes.
The US National Journal of Library defines coma as follows: it is a deep state of unconsciousness. An individual in a coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or because of injuries, such as a brain injury. Coma, brain death, vegetative state are separate and distinct conditions, although a patient may pass from some of these states to another. For example, a patient may present in a coma, then pass through the vegetative state to the minimally conscious state, and then return to a state of normalcy. In some cases, this transition may be so rapid as to make the individual states barely noticeable, as if the patient went from coma to normal all at once, while in other cases there may be slow progress or no progress at all as in the case of Terry Schiavo who remain in a persistent vegetative state for ten years.
What are the ethical/moral issues that emerge from this case?
Ethics is a systematic endeavour to understand moral concepts and justify moral principles and theories. It undertakes to analyse concepts as right, wrong, permissible, good and evil in their moral contexts. There are various ethical issues raised in this case, one substantive What is best for Terri and one procedural, Who should make that determination? What is best for Terri, the continuation of artificial nutrition and hydration or respecting her autonomy and following her surrogate decision-makers determination of her desire to forego life-prolonging treatments. The answer to the question of what is best for Schiavo raises a number of intertwined substantive ethical issues. Can an incapacitated patient refuse life-sustaining treatment? What if the treatment is a basic essential of life food and water as opposed to an extraordinary medical treatment “Must all patients, regardless of their wishes, be required to submit to life-sustaining treatment in the absence of imminent death?
Does physicians have the right to refuse to treat patients when the treatments will not provide any benefit to the patient other than prolonging the death of the patient. If a physician refuses to provide life-sustaining treatment to a patient is it euthanasia?
Ethical questions to ask are, were the decisions made by all parties involved in the best interest of the patient? Did her husband had the tube removed because that was what Terri would have wanted, or was it for his own personal advancement, as alleged by Terris parents and critiques, was it because he started a new family, because he wants the insurance money or because he wanted to remarry. (Keep in mind that the decision of the husband to remove the feeding tube is making the moral decision for his wife who is not able to make the decision for herself.)
Was Terris parents thinking about Terris condition and how it was affecting Terri and what Terri would have wanted, are was it just a case of hurting parents who love their child and dont want their child to be taken away from them regardless of the state Terri was in. Did religion played a part in the opposing of the husband decision to remove Terris feeding tube. Who had the right to decide what happens to Terri? Who decided whether Terri lives or die, the state, her parents or her husband?
Dr Linda Ganzini, a geriatric psychiatrist noted, that a patients legal right to autonomy is measured by the patients decision-making capacity, or ability to understand and appreciate the nature and consequences of health care treatment decisions, including risks, benefits, and alternatives. In other words, if decision-making capacity is deemed absent, then a surrogate, who might be a health care agent with a durable power of attorney, a legal guardian, or the patients next of kin, is appointed to make end-of-life decisions based on an advance directive. As such Terri was not able to make such a decision, as to the right to live or die. In such a case Terris husband by law had to make all decision for her.
The ethical distinction between allowing-to-die and euthanasia depends, for the most part, on the medical condition of the patient. Some observers, including Terris parents, argued that Terri was merely impaired, and that physical function could be restored if she were given the proper therapy, or was allowed to stay longer on the feeding tube. There were widely accepted criteria for discerning the medical condition of people in a prolonged state of coma or unconsciousness, however, the thorough autopsy after her death belied any thought that she would have recovered, given the debilitated state of her brain, especially the cerebral cortex. According to Terris husband
and other witnesses, who testified that his wife would not have wanted to remain alive in a permanent vegetative state. He says he loves his wife and will do whatever it takes to end an
existence that he believes she would not want to endure. He thinks that she would want her feeding tube stopped and that she would wish to die rather than remain bed-bound in a permanent
vegetative state for the rest of her days. Was he speaking on behalf of his wife or himself?
Nonmaleficence states that caregiver should act in ways that do not inflict or cause harm to others. They should not cause intentional harm. For a specific patient may be difficult to balance
in the absence of patient guidance. Terri was said to be conscious, and while there were contradict- ting evidence from different Medical personal about the state that Terri was in, her parents were content to her being alive and would have taken care of her themselves. Terri’s Husband, on the other hand, felt removing the tube was what was best for Terri.
Terri was diagnosed as being in a vegetative state, however, there was uncertainty about her consciousness and what she can feel or not feel. Sean Morrison, MD, Professor of Geriatrics and Palliative Care at Mount Sinai School of Medicine in New York, in an interview with The New York Times, stated that neither ‘starvation’ nor suffering applies to Schiavo, he explained that a person in a vegetative state does not experience burdens or benefits. They show no signs of joy or sadness, there is no evidence that patients in a persistent vegetative state experience
hunger, thirst, or physical pain. Suffering is a conscious experience and persistent vegetative patients lack consciousness. With this said, many persons were appalled that the removal of the feeding tube cause Terri to starve to death. Base on the current research one can say ok, no harm came to Terri.
There was no true way to assess for psychological, suffering in patients in a persistent vegetative state, but the best medical science available suggests that they do not experience these dimensions of suffering. However, other medical research has shown that a person in a persistent vegetative state can experience pain, feel hunger and thirst, depending on the stage of the illness. If this research is empirical, it puts a different spin on the outcome of the case, and removing the tube was a violation of an ethical principle.
In summary ethical issues are: Should ones quality of life be deemed more important than preserving life, does autonomy override the sanctity of life in the case of Terri. Terri death brought sadness to her parent a satisfaction her husband.
How were Terri Schiavo rights violated if any?
One can only ascertain the violation of Terris right if it was known without a shadow of a doubt what Terri wanted, whether she wanted to live in the vegetative state or otherwise. Although the Florida Court found sufficient evidence that Schiavos decision would be to discontinue the life-sustaining treatment, the State legislature and governor promulgated
and enforced legislation allowing the governor to override the courts order allowing the discontinuance of treatment for Schiavo. However, looking at it from a life and death situation, I believe her right to life was violated, starving her to death was inhumane, with the fact that she was unable to express whether or not she was being affected physically by the withdrawal of food to her body. Many believe that removing a feeding tube from a profoundly cognitively disabled person results in a painless and gentle ending. But is this really true? After all, it would be agonizing for me if I was deprived of food and water for any length of period. So, why should I believe that cognitively disabled patients experience the deprivation differently simply because they receive nourishment through a feeding tube instead of by mouth?
How her husbands demands were justified and were they rightly so justified?
Expressed as an ethical principle, the central focus in this case, is respect for autonomy. Many have argued, however, that the proper moral framework is not autonomy at all, but rather sanctity of life. Examining these alternative frameworks is important, both to discern why respect for autonomy is the key ethical feature of this case and to display the weaknesses of the alternatives. Several commentators argued that the central question of the Terri Schiavo case is a struggle
between the sanctity of life versus quality of life.
As guardian, Terris husband had the full power and authority to order the withdrawal of life-prolonging procedures. It was said that in the initial stage he took care of Terri, working alongside Terris parents. He sought at least some modest restoration of her self-awareness. He promised that he would care for Terri for the rest of her life, during a malpractice lawsuit, that he was going to learn how to become a better caregiver for Terri. However, it all changed a few years into her sickness. What had prompted the change in Michael decision a few years later, was it hopelessness, a realization that his wife will never be normal again, that she will remain in a vegetative state for the rest of her life or was it for his personal gains. Why did he decide that it was now time for Terri to die? One will never truly know, what is known, however, is that the courts agreed with his rationale to remove his wife feeding tube and let her die. He was able to convince the court that, that was what his wife would have wanted, via a conversation that he had with her in the past.
How would you have resolved this issue?
When I first read this case (for assignment) I was immediately in support of the removal of Terris feeding tube, thinking that no one would really want to live that way and that being in a vegetative state for the rest of ones life is not living, but just existing. I empathize and understand with Terris parents immovable desire to keep their daughter alive, and also the willingness of Terris husband to let her go after years of no improvement in her condition. Parental love and spousal love take shape in fundamentally different ways. Parents first know their children as helpless beings, totally dependent on their care. Husbands first know their wives as attractive, autonomous beings who both give and receive love, and who enter into marriage as willing partners, and so, I thought why didnt Terris husband just signed over guardianship to her parents, this way, all parties won, her mother would have her daughter to take care of and the husband can go and start his new life, and I didnt see the reason why the court had to get involved.
Upon on further research into the case however, I realized that it was more than just signing over legal guardianship or just removing the tube. Like most bystanders, I did not have knowledge of the intricacy of the case, what each party really stand to lose, or what the diagnosis meant. Also, the fact that Terri was breathing on her own, made a lot of difference to me, she was not on life support machine that you could say ok, she was basically dead already and it was the just the machine that was aiding her breathing. Even though she was diagnosed as in a vegetative state she was alive, breathing on her own, and only need the feeding tube to feed her food, all she needed was food (liquid) to keep her alive, like any normal human being.
With this knowledge I would have sat with both parties and have both parties state what is it they wanted for Terri, putting aside their own emotions and needs (wanting their daughter, estate, money, to remarry etc) I would have pointed out that for ten years God had keep Terri and it must be for a reason, and that reason is not for her to suffer, God could have caused her to die but he didnt and as such it means that there is purpose in her living, regardless of the state that she is currently in as that too can change. Where there is life they is hope, where there is no life there is no hope, and God has a way to work things out in his way and his timing.
I would encourage both parties to signed a contract where the husband give sole guardianship to Terris parent with the understanding that the estate and any money that they both invest in he will get them as well as he can file for divorce, and go and start his new life. If it is a case that the want to start life with someone else. This way both party win, and the state would not
have any need to get involve and to make wrong moral decision due to political grandstand/ influence. In the intern rim I would also provide counselling for both parties.
The question as to the ulterior motive of both Terris parent and husband is not to make this case ethically or humanly easy. Terris parent has to decide to continue feeding an adult in a profoundly incapacitated state, and understand that it will not be easy and it will become tiring.
One would ask if ensuring years or decades with a feeding tube, with no self-control, and with virtually no possibility of improvement is not loved but torture, and not respect for life but forced degradation, however, for me the obligation to feed should win out, because the living humanity of the disabled person is undeniably real.
Nobody knew what Terri Schiavo would have wanted. She left no advance directive (will) and in its absence her husband says one thing and her parents another. Similarly, we do not know her husband spoke sincerely on his wife behalf, never do we know with absolute certainty Terri cognitive status, was she minimally conscious or permanently unconscious? In either case we also do not know to an absolute certainty whether or not she sensed any discomfort from dehydration and starvation, or anything else. What I do know however, intentionally taking the life of an innocent human being is unethical and immoral, even if a person is deemed conscious, in a vegetative state, regardless of the end it accomplishes. Such an act is dehumanizing because it treats human being which has intrinsic value and is an end in itself has a mere thing which merely has instrumental value and is a means to an end.
In examining the ethics of withdrawing Schiavos tubes even under sanctity of life, I recognize that no amount of reasons may be able to overcome blind faith. The sanctity of life principle is supported by both religious and non-religious group. Religious theories are often based on natural moral law which states that there are certain objectively that true moral principles are unchanging and universal. If life is said to be sacred because humans are made in the image of God or that persons have intrinsic value simply by being human and thus are ends in themselves, then active euthanasia in appropriately treats a person as a means to an end, a painless state of death. Even if we grant that a painless state is a good end, it is immoral to accomplish even a good end by an evil means.