The Right To Die * Terri Schiavo – by Dr. Richard B. Fife

I mentioned two landmark cases in my previous blog – Karen Ann Quinlan and Nancy Cruzan. The ethical question for Quinlan involved not only the principle of autonomy but also beneficence and nonmaleficence. The Quinlans believed that the ventilator was intrusive and harmful to Karen (“do no harm”). Likewise, they believed that the thing most beneficial for Karen was not her death but removal of the ventilator. If death were to come because of that action, they were reconciled to it. That it was not really a right-to-die case became apparent because even after her parents won the right to remove the ventilator, Karen did not die as expected. Indeed, Karen continued to live for more than a decade.

The third landmark case was that of Terri Schiavo. In 1990, Terri Schiavo, a 26 year old, previously healthy woman, suffered a cardiac arrhythmia resulting in cardiac arrest. In 2003, she was 39 years old , had been on a hospice program for three years, and had remained for 13 years in a persistent vegetative state. Neurologists had certified that she was indeed in a PVS and very unlikely to recover. Terri’s husband claimed that before the cardiac arrest, she had commented on the Quinlan case and said that she would never want to be kept alive in a persistent vegetative state. Terri’s parents claimed that she never made such statements. They also claimed that Terri showed some evidence of cognition and they disagreed with the diagnosis of PVS. Therefore, acting on the principles of beneficence and nonmaleficence, they opposed the removal of the feeding tube. An ethics committee discussing this case would be faced with further complications, such as the following: the parents had been showing a video claiming that Terri was able to follow movement in a conscious way with her eyes, indicating cognition. However, there were other claims that the tape was made several years previous over a long period of time and spliced together. In addition, there were claims that Terri’s husband had ulterior motives because of the presence of a girlfriend with his child and significant amounts of money won in a malpractice suit. There were also questions relating to the faith body of the persons involved. A huge complication was that the governor and the state legislators intervened and tried to craft a law to stop Terri’s husband. It was called “Terri’s Law” but it was very narrow and pertained only to the Schiavo case. If the courts had not ruled this law unconstitutional, as they did, all terminally all persons in Florida would be affected if they were in dementia and had no living will.

Aside from all of this, there were a number of ethical dilemmas in this volatile case. How do we deal with a person in a persistent vegetative state in the absence of a living will? How is the right of self-determination decided? Who decides whether the situation is futile or not? In terms of beneficence, who would get to decide what was most beneficial for Terri? Eventually, the courts would side with Terri’s husband, allow the tube to be remove, and allow Terri to die. It is interesting that in spite of all the ethical dilemmas involved, the case of Terri Schiavo was never taken before the hospice ethics committee or any other clinical ethics committee that might have had legitimate involvement in the case.

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