Medical Ethics Theresa Schiavo Unit

Medical ethics

MedicalEthics Theresa Schiavo

Unit

Thecase of Theresa Schiavo is most memorable for the legal and ethicaldebates it elicited in America and all over the world. The issue ofwhether to remove her from a feeding and hydration system was highlycontested by the legal guardian of Theresa, her husband, and herparents. With the husband keen to end the suffering of his wife, herparents were still insistent that Theresa was conscious and she hadchances of recovery. The issue led to the legislation of news laws onthe use of anesthesia and triggered heated debates on the ethicalposition of such a situation from a religious and medicalperspective. The case also took the shape of pro-life and right todie debate with activists on either side of the debate and the mediaproviding the fuel and momentum.

Thestory started when Theresa Schiavo, then aged 26 years, collapsed athome in Florida after a full cardiac arrest on February 25th1990. She was rushed to hospital where she was diagnosed withhypoklemia which is usually caused by excessive intake of fluids thatleads the body to lose important minerals such as potassium. Sheremained in a coma for two and half months after which the doctorsdeclared her to be in a perennial vegetative state. For the next twoyears, Theresa was moved from one hospital to the other in search ofspecialist care. A wide range of treatments were employed in anattempt to arouse her unsuccessfully. This included speech andphysical therapy. After these treatments failed, her husband, MichaelSchiavo filed for a court order to have her removed from the feedingand hydration system to which her parents opposed by a seeking acourt injunction. Schiavo’s husband assumed he had the legalbacking as the guardian and the moral backing as a husband todetermine whether she was to remain as she was or she was to beremoved from the system (Lynne 2005). For healthcare professionals,such a case also presents ethical dilemma.

Overthe period of her hospitalization and case, Mrs. Schiavo wasdescribed by many terminologies including brain dead, vegetative,minimally conscious, locked in, and disabled. Such misuse of thesemutually exclusive terms by the media and politicians engaged in thedebate fuelled emotions unnecessarily. By being medically declared tobe in a persistent vegetative state, the doctors implied that Schiavowas in “eyes-opened unconsciousness” caused by disassociationbetween wakefulness and awareness caused by lack of integrationbetween the upper brain and the midbrain to function with rest of thebody or the brain stem (Fine 2005). This is very different from beingbrain dead which is defined as irreversible loss of the clinicalfunction of the whole brain.

Thetwo sides of the debate contested on the state and diagnosis of Mrs.Schiavo. On one hand, the parents were convinced that Mrs. Schiavowas conscious and was even making attempts to talk and smile to them.On the other hand, Michael Schiavo was convinced that Mrs. Schiavowould never recover. He shared the perception expoused by Tollefsen(2011) that the self is different from body and that death is theseparation fo the two. This was also supported by court appointeddoctors and Schiavo’s long time doctors that there was no hope forrehabilitation. This diagnosis of her brain dead was later confirmedby an autopsy carried out after death which showed that her brainweighed half that of a normal human brain. Doctors further reiteratedthat there was no way her body could recover such lost brain mass.

Thestate law of Florida then, provided guidance on handling vegetativestate. The state law then recognized vegetative state “as absenceof voluntary action&quot and an &quotinability to communicate orinteract purposefully.” Based on this, Michael filed for removal ofSchiavo PEG tube. Such a decision would mean that she would die in7-14 days. Parents filed for an injunction and the court ruled intheir favor that saw the reintroduction of the PEG tube based on theclaim that it did not amount to prolonging life but rather feedingand hydrating the patient based on her inability to swallow food andfluids( Lynne 2005). For pro-life views, the ethical question thatarises, does a legal guardian have the right to make such a decision?Does being in a persistent vegetative state amount to deathtechnically?

Froman ethical religious point of view and specifically Catholicism, theremoval of the feeding tube was morally justified. Reverend McBrien(2005) wrote that the Catholic Church teaches that death is necessaryfor individuals to be prepared for the next life and judgment day.Death for these believers is a passage into another world. As anatural process, extending life by extraordinary means isdiscouraged. The use of the feeding tube according to McBrienamounted to use of extraordinary means to extend life which could bestopped. Hupert (2006) however disagrees with McBrien and views useof feeding tube as provision of sustenance as part f human basiccare. Quinden (2005) opined that the discussion of whether to retainthe feeding Tube in Schiavos case of to remove it should not bematter of medical professionals or legislators but a private matterbetween loved ones. The author does not address the disagreementbetween the so called loved ones on whether to remove or retain thefeeding tube. As loved ones, the Schindlers, Mrs. Schiova’’sparents, and her husband should have agreed on the way forward as afamily without involvement of the courts.

TheSchiavo case no clear ethical bearing. Any side take in the issuedepends on the ethical perspective taken. Under benevolence, medicalprofessionals owed Mrs. Schiavo the right to end her suffering bywhatever means. As a person who had reached a point of “never goingback” as revealed by the post mortem, the decision to remove thefeeding tube was right. On the other hand, under non-maleficence, theaction to remove the feeding tube was inherently wrong andunprofessional (Tollefsen 2011). This reveals that the issue on theright to end the life of another is highly contextual. The law alsogoes back and forth on the issue and is often distorted andinterpreted differently to suit prevailing arguments. Medicalprofessionals face an unclear path on the issue with the two mainethical principles in healthcare being contradictory. It cantherefore be concluded that the ethical soundness of the decision toremove the feeding tube in the case of Schiavo is a personal issue.It is the parties pertinent to the issue in this case her family andhusband to iron out the issue amongst them in a manner acceptable bythe law.

References

Ersk,M. (2004). The Continuing Challenge of Assisted Death. Journalof Hospice and Palliative

Nursing.6(1).Retrieved online on 10thSept 2014 from, http://www.medscape.com/viewarticle/468566_4

Fine,D. (2005). From Quinlan to Schiavo: medical, ethical, and legalissues in severe brain

injury. ProcBayle Univ Med Cent18(4): 303–310.

HubertJ., &quotFr. Richard McBrien and others mislead catholic public:allege Schiavo feeding tube

removalOK CatholicOnline:Mar. 8, 2006. Retrieved online on 10thSept 2014 from, http://www.catholic.org/featured/headline.php?ID=3066

Lynne,D. (2005). Thewhole Terri Schiavo story.Retrieved online on 10thSept 2014 from,

The whole Terri Schiavo story

Quindlen,A. (2005). &quotThe Culture of Each Life,&quot Newsweek(AtlanticEdition) 145(14),37-52.

Tollefsen,C. (2011). Bioethicswith liberty and justice: themes in the work ofJosephM. Boyle.

NewYork: Springer.