Terri Schiavo Case Summary

When a patient is unable to make decisions for himself or herself, their caregivers and those who know them are appointed to make the decisions based on what the patient would have wanted. This is called surrogate decision making. According to the article Terri Schiavo and End-of-Life Decisions “when surrogate decision makers and caregivers cannot agree upon what that choice would have been, they may turn to the courts to determine either what the now-incapacitated patient would have chosen or who is best suited to choose as the patient would have” (Mathes, 2005)

The practically speaking, the case of Nancy Cruzan highlights the fact that an individual cannot rely only on telling his would be decision maker what type of care is desired should that individual become incompetent. Such evidence may not be viewed as sufficient to refuse medical treatment as happened with Nancy Cruzan. It thereby becomes important to record exactly what type of treatment should be accepted or refused if one’s decision making capacity is lost. The most common way to do this is in the form of an advance directive. Such a document would declare not only who the patient wants a surrogate decision maker, but also relates the degree of treatment desired by the patient. The presence of an advance directive makes caring for incompetent patients much easier because confusion over the patient’s wishes is avoided. Had Nancy Cruzan made an advance directive, withdrawing the artificial nutrition

In society today, we often have to make decisions. Some of these decisions may mean the life or death of a loved one. The decision of whether or not to administer artificial nutrition and hydration as a form of life support is one decision that some people have to make. I feel that tube feedings, while okay for short term use are fine, but they should not be used as a form of long term care because the risks outweigh the benefits of having a feeding tube.

A patient barrier might include having limited knowledge surrounding life-support systems and treatment options, thereby hindering their ability to fully comprehend or demand certain interventions. Good counseling is therefore essential to overcoming this barrier in implementing the patient’s true and best wishes (Kroning, 2014, p. 222). Another barrier in implementing advance directives concerns the role and influence of family members and the patient. There may be discordance between the desires of the patient and family, which can result in serious debate and tension if not addressed and taken into consideration. Physicians still may have reservations, as certain demands made by the patient may raise ethical concerns in the future, if the provider feels the interventions being done are no longer medically appropriate.

An example of this Act is the very popular Nancy Cruzan Case. Although Nancy was left in a vegetative state resulting from a car accident, her parents were able to make the decision to have her removed from feeding tubes because Nancy expressed before the accident that she never wanted to be kept alive from breathing or feeding tubes. This Act really promotes Advanced Directives and hospitals, clinics and other providers that receive Medicare or Medicaid funds to provide patients with written information about their right and the information must clearly state the institutions policies on withholding or withdrawing life-sustaining treatment.

Compare the situations surrounding Diane and Debbie in terms of the physicians’ actions and morality surrounding those actions leading to their deaths. How are the cases similar? How are they different? What was the situation surrounding Terri Schiavo? How does her situation compare to the Diane and Debbie cases? What are the major ethical issues involved in each of these three cases? How are their cases similar? What are the ethically relevant, salient differences between them? What do you personally take away as the “moral of the story” for these three cases?

An 89 year old patient came to the emergency room from a nursing home. Per the nursing home staff, the patient had a “floppy leg” and grimaced when that leg was moved. The patient’s advance directive paperwork was provided. The patient is non-verbal. An advance directive is a document composed by competent patient’s that ensure the right of self-determination: the right of every person to make their own decisions about their medical treatment, including the right to refuse treatment (Martin, 2013).

The Superior Court of Los Angeles County became a pivotal case in a patient’s right to refuse treatment. In the initial case Ms. Bouvia and her legal team sought a court order to have the NGT removed and to stop all medical treatments she did not consent to. She argued that this treatment would not be a cure for her condition and would not improve her quality of life. The hospital staff argued the interest of the state prevailed over a patient’s right to refuse treatment. They noted that the state and healthcare teams viable interests include: “(1) preserving life, (2) preventing suicide, (3) protecting innocent third parties, and (4) maintaining the ethical standards of the medical profession, including supporting the right of physicians to effectively render necessary and appropriate medical services” (Liang & Lin, 2005). Additionally they sighted Ms. Bouvia’s failed previous attempt to “starve herself to death” in 1983 with the assistance of her medical team. The court denied her request citing these key interests and the fact that medical professionals felt that Ms. Bouvia could live 15-20 additional years with supplemental nutrition justified the state’s interest in preserving her life. The court also stated that any other decision would be condoning a medical team to aid and abet suicide.

That other factor is removing one from life support. This issue is brought up in both the case of Karen Ann Quinlan and in the case of Cruzan v. Missouri. It is illegal to remove a patient from life support without

In the year of 1990 on February 25, a presumably healthy young women by the name of Theresa Marie Schiavo better known as Terri suffered a massive heart attack in her Florida home which left her with serve brain damage. At the age of 26 she found herself unable to speak, or move, and unfortunately without a living will in place. How can she have told them what she really wanted if unable to talk in a vegetative state? Terri, although able to breathe on her own, found herself unable to eat or use the bathroom without the aid of a machine or person she was literally a prisoner in her own body. By law her husband Michael Schiavo was in charge of making treatment decisions for her , and after two years of therapy he wanted to disconnect the feeding tubes that helped keep her alive.

The ethical principles for nurses to practice with beneficence and no maleficence. This legal battle between Terri Schiavo’s husband and her family was an ethical debate between continuing artificial life or remove her feeding tube by the request of her husband. Using the theories of utilitarianism and deontology can be applied or considered in making the most ethically correct resolution. The cases are very complex and raise many moral and ethical issues. The cases have brought awareness to society of “the importance of discussing end-of-life issues with family members and underscores how an advance directive, a living will and/or durable power of attorney for health care, are a healthcare proxy clarifies and provides evidence of the wishes of an individual regarding end-of-life decisions. Terri Schiavo should impress upon laypersons and professionals alike the uncertainty of the context in which issues of continuation and termination are argued ethically. Nobody knows what Mrs. Schiavo would have wanted. She left no advance directive and in its absence her husband says one thing and her parents

This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like

Terri Schiavo was 26 years old when she collapsed in her home and suffered acute hypoxia for several minutes. Slightly shy of a year after her injury, it was clinically determined that she was in a persistent vegetative state (Perry, Churchill, & Kirshner, 2005). There were no legal documents, such as an advance directive or living will, specifying the wishes for care under such circumstances. Her husband, Michael Schiavo, was designated as her legal guardian. The Schiavo case caught the public’s attention when her husband elected to remove her feeding tube in the mid 1900’s. He understood that there has never been a case of recovery after a year of being in a persistent vegetative state. One of the moral issues surrounding the case centered on the appropriateness of removing the life-sustaining feeding tube or maintaining it. Throughout the case, there has

This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brain hemispheres which has left her unconscious and unable to make medical decisions for herself. She only has some brain stem reflexes and requires a ventilator for life support. Mrs. Smith did not set up an advanced directive, which is defined by Miracle (2011) “mechanism by which individuals make known how they want medical treatment decisions made when they can no longer make them for themselves” (p.229). Without an advanced directive, medical decisions will fall to Mrs. Smith’s children, Sara and Frank. Each of which have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life with continued medical intervention, as Sara would like to do, or stop all treatments and care, as Frank

The case of Karen Ann Quinlan led to four basic approaches to this ethical problem; advance directives or other clear evidence of the patients wishes while competent, surrogate decision making (power of attorney), and action in the patients best interest. Each solution has deficiencies both in theory and practice, but there can be no debate that their application has changed the landscape of medical ethics.