Module 2 Case study

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Tiffany Simnick 24 JAN 24 PHI 230 Module 2 – Case Studies 2-3: The Case of Terri Schiavo 1. Summarize key information and events in the case. Think about the information that would be needed by an ethics committee reviewing this case. Clearly list the specific ethical issues involved in her case. Terri Schiavo was born on December 3, 1963 and died at age 41 on March 31, 2005. On February 25, 1990 she was found unconscious in her apartment by her husband of 5 years, Michael. Michael called EMS but did not perform CPR. Terri was resuscitated but did not regain consciousness. She was found to have suffered from a cardiac arrest and was anoxic until EMS arrived. The hospital found that she was hypokalemic but was unable to determine the cause of her cardiac arrest. The hospital placed a PEG tube for nourishment. Weeks after the incident she was sent to a skilled care and rehabilitation facility. In June of 1990, her husband was appointed her legal guardian. Michael took Terri to California for experimental thalamic stimulator implant treatment, which failed. Neurological evaluation showed that she only had reflexive behaviors consistent with PVS. She had multiple swallow studies that showed she had severe oropharyngeal dysphagia. In 1994, Michael no longer believed that Terri would recover. He elected to no treat a UTI and requested that Terri’s status be changed to DNR. The facility Terri was staying in challenged the request and Michael then withdrew his request and transferred her to another facility. In July 1993, Terri’s parents, the Schindler’s, petitioned the court to remove Michael as her guardian. The petition was dismissed. In May 1998, Michael petitioned the court to authorize the removal of Terri’s PEG tube. The Schindler’s were against the removal of Terri’s PEG tube. The petitioned the court numerous times over many years against the removal. In 2001, the Second District Court of Appeal ordered five physicians to examine Terri to determine whether her condition could improve. In October 2002, the five physicians conducted their examinations and majority concurred with previous medical evaluations. In 2003, the Advocacy Center for Persons with Disabilities filed a federal lawsuit claiming that the cessation of AFN was abuse and neglect. The Florida House of Representatives passed “Terri’s Law”, which was a brief statement authorizing a onetime stay for the specific prevention of withholding or withdrawing nutrition and hydration in a patient whose circumstances fit Terri’s circumstances. Michael joined by the American Civil Liberties Union filed a state court lawsuit asserting that Terri’s Law was unconstitutional. September 23, 2004, The Florida Supreme Court ruled that Terri’s Law was unconstitutional. On March 18, 2005, Terri’s PEG tube was removed. All petitions from the Schindler’s were denied. Terri’s autopsy showed that she sustained severe and irreversible brain damage. Her brain weighed less than half of what a 41-year-olds brain should weigh. Hook, C., & Mueller, P. (2005, November). The Terri Schiavo Saga: The Making of a Tragedy and Lessons Learned . Mayo Clinic Proceedings. https://www.mayoclinicproceedings.org/article/S0025-6196(11)61439-0/fulltext
Tiffany Simnick 24 JAN 24 PHI 230 Module 2 – Case Studies Ethical issues involved in Terri’s case: Who should get guardianship? AFN cessation is it ethical? Advance directives/hearsay 2. Imagine you are a member of an ethics committee consulted for a decision about whether Terri’s feeding tube should be removed. As a member of the ethics committee, analyze the case using the Four Topics Method. Some of the questions may require more discussion than others because of their direct relationship to the Schiavo case. Do your best to comprehensively answer the questions. Medical Indications: She was diagnosed as having PVS. Her neurological examination showed only reflexive behavior. Her condition is chronic and irreversible. Physicians were not able to show any source of factual and successful treatment for improvement of condition. Patient preferences: She had no advance directives. She does not have the capacity to present her wishes. Should her husband be the one making the decisions? Did he move on? If so should her parents be the ones to now make determinations on her care? Quality of life: Terri’s condition is unable to improve. She requires AFN via a PEG tube to help maintain her nutrition to keep her alive. She is bedridden. She is unable to communicate or move other than reflexive behavior. Contextual features: Michael sued and was awarded money related to Terri’s condition. Some of the money was in a trust for Terri’s care. Michael stated that her parents wanted a share of the money. Did the money run out from the trust and Michael no longer have the money to care for Terri? 3. Removal of Terri’s feeding tube is unethical. It is neglectful to hold nutrition. Michael should not be Terri’s guardian. Guardianship should have reverted to the parents. He cared for her for four years and then gave up. Terri did not have her end-of-life wishes dictated. It was only known hearsay from family and friends mostly who was close with Michael. The allegations that Terri did not want to live like this was only made known after Michael requested Terri’s status be changed to DNR. I don’t believe it is ethical to keep her alive for 15 years while in PVS when her condition per physicians will never improve. That is no quality of life; It is not even life. She may be alive, but she is not living.
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