M4 Ethics Midterm Assignment: Terri Schiavo's Case
M4 Ethics Midterm Assignment – Terri Schiavo
HSC312
Kristina A. Paxton (Shaarda)
Excelsior College
1. Briefly outline the relevant medical facts contributing to Ms. Schiavo’s condition
Terri Schiavo was home one evening and collapsed, causing severe hypoxia. The cause of the collapse was determined to be a heart attack, which it was theorized by her physicians to have been caused by a potassium deficiency. Because of the lack of oxygen during her collapse, she was left with severe brain damage. Her brain damage eventually left her in what is known as a persistent vegetative state (PVS). A permanent vegetative state is caused by a damaged cerebral hemisphere. That damage results in a loss of decision making and thinking ability. While Terri Schiavo was able to breathe on her own, she was unable to make any intentional movements, or see, even though her eyes were open.
2. Provide a brief summary of the legal history specific to Ms. Schiavo’s case. Include a discussion of the major past cases which influenced the issues in the case, focusing primarily on an individual’s right to refuse medical care. …show more content…
Terri Schiavo’s case went through a number of legal issues and battles, just to decide who had the right to decide whether she remained on life sustain support or not.
The first time the case went to court was to resolve the dispute over her neurologic devastation and how her parents and her husband were interpreting her wishes regarding life support. The courts ruled in her husband’s favor, that Terri would not want continued life support and the decision was made to withdraw life sustaining treatment. Her parents appealed the decision to remove treatment and won, because their physicians stated that Terri was not in a permanent vegetative state. Her husband and parents again went to court regarding PVS, and once again her husband was granted the right to remove
treatment.
At this point I believe the legal system failed Terri Schiavo. I think that after going back and forth between PVS and not, the court system should have stopped allowing appeals, granted either her parents guardianship or her husband guardianship. Due to the fact that the courts allowed arguing between parents and spouse to continue, the appeals continued eventually involving the Governor of Florida, who attempted and passed an unconstitutional law called Terri’s Law. Once the Florida Supreme Court declared Terri’s Law unconstitutional, Terri Schiavo was finally allowed to have all life sustaining treatment removed, and died on 13 March 2005, fifteen years after she went into a coma.
3. Based on your readings and discussions in Module 4, discuss some of the legal considerations of relevance in Ms. Schiavo’s case.
One of the most important considerations that was brought up in many of the articles regarding Terri Schiavo was the importance of advanced directives, living wills, and do not resuscitate orders. Even though those documents can be interpreted in a manner suiting live or die. It is still important to have them. Those documents let someone know that you have given thought to what you want to happen with your body, and how you want to end or not end your life as the case may be. There were many people that felt that if Terri Schiavo had had one or more of those documents the trials would never have had to happen, and the decision that her husband made to terminate care would have been respected much more readily. Having those documents would have also prevented the long drawn out trials both her husband and her parents had to have.
Another important factor in this case was protecting those that have lost competence. Once Terri Schiavo was declared PVS, her husband was appointed to be her guardian. His ‘job’ was to make decision for Terri that were in her best interests, since she was no longer able to make those decision on her own. Most people go into a hospital knowing that they will be treated with respect, by competent nurses and doctors, and given the best care possible. People that are in a PVS state do not have that reassurance, they are depending on the people that they love to make sure that they are treated in that manner, as well as getting the treatment they would choose for themselves.
4. Discuss the contextual motivations potentially influencing the following stakeholders (those directly or indirectly affected by the case), and the ethical or moral justifications for their positions: Ms. Schiavo’s parents, her husband, the Governor of Florida as a representative of a state’s interest, taxpayers and the disabled community.
Terri Schiavo’s Parents – Their decision to keep their daughter on life sustaining treatment had more to do with what they wanted, than what would be best for their daughter. The Schindler family even said “even if Theresa had told them of her intention to have artificial nutrition withdrawn, they would not do it” (Ditto, 2006, p. 139). Having their daughter alive, and in a hospital where they could see and touch her was more important to them than making a decision to terminate the life sustaining treatment, which ultimately was what was better for her. “Terri’s parents said they desperately wanted to keep her alive, so stopping treatment and allowing her to die would have hurt them deeply” (Preston & Kelly, 2006, p. 128).
Michael Schiavo (husband) – His decision to remove life sustaining treatment, and to continue to fight for the right to do so came from a desire to do what he felt his wife wanted. This decision came through discussions he had with Terri, giving him more of an insight to exactly what she wanted done in a situation where life sustaining treatment was needed. He was attempting to honor his wife’s wishes.
Florida Governor (Jeb Bush) – Gov. Bush felt that as a representative of the residents of Florida he had a duty to protect the disabled and vulnerable population; those who were unable to protect themselves. His desire to protect Terri Schiavo from being ‘killed’ by her husband and the hospital/hospice staff was the driving force behind Terri’s Law. The Gov. felt that Terri’s Law would protect those unable to make life sustaining treatment decisions for themselves. However, Terri’s Law was tailored specifically to Terri Schiavo, so he was effectively assisting only one person in his state as opposed to everyone in her situation. His desire to protect the taxpayers of Florida, especially the disable and vulnerable while honorable, had absolutely no effect on anyone except Terri Schiavo.
5. Based on what you have learned so far in this course, state your ethical position relative to the issue--what would you do? Remember to justify your position.
My position would be to remove the feeding tube, and all other life sustaining care. Her doctors and neurologists had already declared that she was in a permanent vegetative state, and there was no chance of recovery. She was not aware of herself, others or her surroundings. She was incapable of thinking, or intentional movement (Munson, 2012, p. 559). So, even though she was breathing, she wasn’t really alive in the sense of being able to do anything for herself. It would be better, I think, to remember a person as a vivacious human being, rather than remembering them as a husk of the person you once knew, lying in a hospital bed connected to machines and tubes. Withdrawing the feeding tube would be the humane thing to do, because Terri Schiavo had lost ‘what made her a person” (Munson, 2012, p. 561), when she was determined to be in a permanent vegetative state.
6. Discuss at least one of the health policy considerations that are present in this case.
• In developing your response, keep in mind that public policy seeks to protect and benefit the welfare, safety and interests of society while balancing the rights of individuals. Health policy considerations are issues that can and/or should be discussed, and changed in order to avoid scenarios such as what happened with Terri Schiavo.
If there is no hope for a person’s recovery, should end of life care be continued?
Theoretically the simplest way to resolve this issue would be to have a DNR (do not resuscitate), a living will, or a fairly detailed advanced directive. However, simply having one of those documents may not be enough as the textbook and the readings for the Terri Schiavo case have explained. Each one of those documents can be interpreted in a manner contradictory to how they were originally intended. I believe in many cases continued care for someone with no hope of recovery is not for them so much as it is for the living. Making the conscious choice to let someone you love “die” is not a decision anyone wants to make, or live with.
End of life care for someone with no hope of recovery is also a serious drain on resources. The hospital/hospice has to maintain a room, monitor the person, keep up with medications, feeding, bathing, grooming and provide whatever treatment is required to sustain life. For part of the cost of this care, insurance will bear the brunt of the cost. But, when the insurance runs out, or a family is unable to pay their portion of the bills, then the cost becomes an issue for the city/county/state to fund. Once it becomes the burden of the government, the taxpayers of that area are not responsible in part, to pay for a total stranger’s life sustaining care. I don’t believe the burden of the cost of care for someone with no chance of recovery should belong to anyone except the family or spouse of the person requiring the care. If that person has no family or friends that can care for them, I believe that responsibility should fall on the hospital/hospice to make the decision on whether or not to terminate all life sustaining care.
7. Briefly discuss what you have learned from your exploration of the Terri Schiavo case. Has the case influenced your view of advanced directives? Presuming you have not already, are you now considering completing your own advance directives? Why or Why Not?
One of the most important things I think I have learned from this case is that there is not right or wrong when it comes to decisions about end of life care. Someone is always going to be offended by a decision that is made, and nothing can be done to change that. I also don’t think that there can truly be any real right or wrong when it comes to ethics in decision making. Anything can be seen as moral to one person while another person views it as completely immoral. I think decision making in health care, whether for yourself or for someone else are always going to be criticized even if there are laws to protect the decision and the decision maker.
In regards to advanced directives, shortly after I joined the Army I made sure all my bases were covered with a do not resuscitate order, an advanced directive and a living will. After my husband I married, I made him sign a statement saying he understood what my wishes were in regards to living in a vegetative state. I believe it is very important to ensure that not only your spouse, but your family and other loved ones are completely aware, and understand exactly what your wishes are regarding end of life care, or care in the case of a PVS state.
References
Cyranoski, D. (2012). The mind reader. Nature, 486(7402), 178-180. Retrieved from www.nature.com
Ditto, P. H. (2006). What would Terri want? On the psychological challenges of surrogate decision making. Death Studies, 30, 135-148. doi:10.1080/07481180500455624
Fins, J. J. (2008). Brain Injury: The vegetative and minimally conscious states. In From birth to death and bench to clinic: The Hastings Center bioethics briefing book for journalists, policymakers, and campaigns (pp. 15-19). Garrison, NY: The Hastings Center.
Mathes, M. (2005). Terri Schiavo and end-of-life decisions: can law help us out? MEDSURG Nursing, 14(3), 200-202. Retrieved from http://ehis.ebscohost.com.vlib.excelsior.edu
Munson, R. (2012). Chapter 7: Euthanasia and assisted suicide. In Intervention and reflection: Basic issues in bioethics (9th ed., pp. 565-570). Boston, MA: Wadsworth, Cengage Learning.
Perry, J. E., Churchill, L. R., & Kirchner, H. S. (2005). The Terri Schiavo case: Legal, ethical and medical perspectives. Annals of Internal Medicine, 143(10), 744-748. Retrieved from http://ehis.ebscohost.vlib.excelsior.edu
Preston, T., & Kelly, M. (2006). A medical ethics assessment to the case of Terri Schiavo. Death Studies, 30, 121-133. doi:10.1080/0/481180500455608
HSC312
Kristina A. Paxton (Shaarda)
Excelsior College
1. Briefly outline the relevant medical facts contributing to Ms. Schiavo’s condition
Terri Schiavo was home one evening and collapsed, causing severe hypoxia. The cause of the collapse was determined to be a heart attack, which it was theorized by her physicians to have been caused by a potassium deficiency. Because of the lack of oxygen during her collapse, she was left with severe brain damage. Her brain damage eventually left her in what is known as a persistent vegetative state (PVS). A permanent vegetative state is caused by a damaged cerebral hemisphere. That damage results in a loss of decision making and thinking ability. While Terri Schiavo was able to breathe on her own, she was unable to make any intentional movements, or see, even though her eyes were open.
2. Provide a brief summary of the legal history specific to Ms. Schiavo’s case. Include a discussion of the major past cases which influenced the issues in the case, focusing primarily on an individual’s right to refuse medical care. …show more content…
Terri Schiavo’s case went through a number of legal issues and battles, just to decide who had the right to decide whether she remained on life sustain support or not.
The first time the case went to court was to resolve the dispute over her neurologic devastation and how her parents and her husband were interpreting her wishes regarding life support. The courts ruled in her husband’s favor, that Terri would not want continued life support and the decision was made to withdraw life sustaining treatment. Her parents appealed the decision to remove treatment and won, because their physicians stated that Terri was not in a permanent vegetative state. Her husband and parents again went to court regarding PVS, and once again her husband was granted the right to remove
treatment.
At this point I believe the legal system failed Terri Schiavo. I think that after going back and forth between PVS and not, the court system should have stopped allowing appeals, granted either her parents guardianship or her husband guardianship. Due to the fact that the courts allowed arguing between parents and spouse to continue, the appeals continued eventually involving the Governor of Florida, who attempted and passed an unconstitutional law called Terri’s Law. Once the Florida Supreme Court declared Terri’s Law unconstitutional, Terri Schiavo was finally allowed to have all life sustaining treatment removed, and died on 13 March 2005, fifteen years after she went into a coma.
3. Based on your readings and discussions in Module 4, discuss some of the legal considerations of relevance in Ms. Schiavo’s case.
One of the most important considerations that was brought up in many of the articles regarding Terri Schiavo was the importance of advanced directives, living wills, and do not resuscitate orders. Even though those documents can be interpreted in a manner suiting live or die. It is still important to have them. Those documents let someone know that you have given thought to what you want to happen with your body, and how you want to end or not end your life as the case may be. There were many people that felt that if Terri Schiavo had had one or more of those documents the trials would never have had to happen, and the decision that her husband made to terminate care would have been respected much more readily. Having those documents would have also prevented the long drawn out trials both her husband and her parents had to have.
Another important factor in this case was protecting those that have lost competence. Once Terri Schiavo was declared PVS, her husband was appointed to be her guardian. His ‘job’ was to make decision for Terri that were in her best interests, since she was no longer able to make those decision on her own. Most people go into a hospital knowing that they will be treated with respect, by competent nurses and doctors, and given the best care possible. People that are in a PVS state do not have that reassurance, they are depending on the people that they love to make sure that they are treated in that manner, as well as getting the treatment they would choose for themselves.
4. Discuss the contextual motivations potentially influencing the following stakeholders (those directly or indirectly affected by the case), and the ethical or moral justifications for their positions: Ms. Schiavo’s parents, her husband, the Governor of Florida as a representative of a state’s interest, taxpayers and the disabled community.
Terri Schiavo’s Parents – Their decision to keep their daughter on life sustaining treatment had more to do with what they wanted, than what would be best for their daughter. The Schindler family even said “even if Theresa had told them of her intention to have artificial nutrition withdrawn, they would not do it” (Ditto, 2006, p. 139). Having their daughter alive, and in a hospital where they could see and touch her was more important to them than making a decision to terminate the life sustaining treatment, which ultimately was what was better for her. “Terri’s parents said they desperately wanted to keep her alive, so stopping treatment and allowing her to die would have hurt them deeply” (Preston & Kelly, 2006, p. 128).
Michael Schiavo (husband) – His decision to remove life sustaining treatment, and to continue to fight for the right to do so came from a desire to do what he felt his wife wanted. This decision came through discussions he had with Terri, giving him more of an insight to exactly what she wanted done in a situation where life sustaining treatment was needed. He was attempting to honor his wife’s wishes.
Florida Governor (Jeb Bush) – Gov. Bush felt that as a representative of the residents of Florida he had a duty to protect the disabled and vulnerable population; those who were unable to protect themselves. His desire to protect Terri Schiavo from being ‘killed’ by her husband and the hospital/hospice staff was the driving force behind Terri’s Law. The Gov. felt that Terri’s Law would protect those unable to make life sustaining treatment decisions for themselves. However, Terri’s Law was tailored specifically to Terri Schiavo, so he was effectively assisting only one person in his state as opposed to everyone in her situation. His desire to protect the taxpayers of Florida, especially the disable and vulnerable while honorable, had absolutely no effect on anyone except Terri Schiavo.
5. Based on what you have learned so far in this course, state your ethical position relative to the issue--what would you do? Remember to justify your position.
My position would be to remove the feeding tube, and all other life sustaining care. Her doctors and neurologists had already declared that she was in a permanent vegetative state, and there was no chance of recovery. She was not aware of herself, others or her surroundings. She was incapable of thinking, or intentional movement (Munson, 2012, p. 559). So, even though she was breathing, she wasn’t really alive in the sense of being able to do anything for herself. It would be better, I think, to remember a person as a vivacious human being, rather than remembering them as a husk of the person you once knew, lying in a hospital bed connected to machines and tubes. Withdrawing the feeding tube would be the humane thing to do, because Terri Schiavo had lost ‘what made her a person” (Munson, 2012, p. 561), when she was determined to be in a permanent vegetative state.
6. Discuss at least one of the health policy considerations that are present in this case.
• In developing your response, keep in mind that public policy seeks to protect and benefit the welfare, safety and interests of society while balancing the rights of individuals. Health policy considerations are issues that can and/or should be discussed, and changed in order to avoid scenarios such as what happened with Terri Schiavo.
If there is no hope for a person’s recovery, should end of life care be continued?
Theoretically the simplest way to resolve this issue would be to have a DNR (do not resuscitate), a living will, or a fairly detailed advanced directive. However, simply having one of those documents may not be enough as the textbook and the readings for the Terri Schiavo case have explained. Each one of those documents can be interpreted in a manner contradictory to how they were originally intended. I believe in many cases continued care for someone with no hope of recovery is not for them so much as it is for the living. Making the conscious choice to let someone you love “die” is not a decision anyone wants to make, or live with.
End of life care for someone with no hope of recovery is also a serious drain on resources. The hospital/hospice has to maintain a room, monitor the person, keep up with medications, feeding, bathing, grooming and provide whatever treatment is required to sustain life. For part of the cost of this care, insurance will bear the brunt of the cost. But, when the insurance runs out, or a family is unable to pay their portion of the bills, then the cost becomes an issue for the city/county/state to fund. Once it becomes the burden of the government, the taxpayers of that area are not responsible in part, to pay for a total stranger’s life sustaining care. I don’t believe the burden of the cost of care for someone with no chance of recovery should belong to anyone except the family or spouse of the person requiring the care. If that person has no family or friends that can care for them, I believe that responsibility should fall on the hospital/hospice to make the decision on whether or not to terminate all life sustaining care.
7. Briefly discuss what you have learned from your exploration of the Terri Schiavo case. Has the case influenced your view of advanced directives? Presuming you have not already, are you now considering completing your own advance directives? Why or Why Not?
One of the most important things I think I have learned from this case is that there is not right or wrong when it comes to decisions about end of life care. Someone is always going to be offended by a decision that is made, and nothing can be done to change that. I also don’t think that there can truly be any real right or wrong when it comes to ethics in decision making. Anything can be seen as moral to one person while another person views it as completely immoral. I think decision making in health care, whether for yourself or for someone else are always going to be criticized even if there are laws to protect the decision and the decision maker.
In regards to advanced directives, shortly after I joined the Army I made sure all my bases were covered with a do not resuscitate order, an advanced directive and a living will. After my husband I married, I made him sign a statement saying he understood what my wishes were in regards to living in a vegetative state. I believe it is very important to ensure that not only your spouse, but your family and other loved ones are completely aware, and understand exactly what your wishes are regarding end of life care, or care in the case of a PVS state.
References
Cyranoski, D. (2012). The mind reader. Nature, 486(7402), 178-180. Retrieved from www.nature.com
Ditto, P. H. (2006). What would Terri want? On the psychological challenges of surrogate decision making. Death Studies, 30, 135-148. doi:10.1080/07481180500455624
Fins, J. J. (2008). Brain Injury: The vegetative and minimally conscious states. In From birth to death and bench to clinic: The Hastings Center bioethics briefing book for journalists, policymakers, and campaigns (pp. 15-19). Garrison, NY: The Hastings Center.
Mathes, M. (2005). Terri Schiavo and end-of-life decisions: can law help us out? MEDSURG Nursing, 14(3), 200-202. Retrieved from http://ehis.ebscohost.com.vlib.excelsior.edu
Munson, R. (2012). Chapter 7: Euthanasia and assisted suicide. In Intervention and reflection: Basic issues in bioethics (9th ed., pp. 565-570). Boston, MA: Wadsworth, Cengage Learning.
Perry, J. E., Churchill, L. R., & Kirchner, H. S. (2005). The Terri Schiavo case: Legal, ethical and medical perspectives. Annals of Internal Medicine, 143(10), 744-748. Retrieved from http://ehis.ebscohost.vlib.excelsior.edu
Preston, T., & Kelly, M. (2006). A medical ethics assessment to the case of Terri Schiavo. Death Studies, 30, 121-133. doi:10.1080/0/481180500455608