Terri Shiavo Case Study

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)

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.

Does a written document such as a living will decide when someone should die or should the verbal wishes of the incapacitated person be followed if known? Such as the controversy over when life begins, we now face the ultimate question of when does life end. In 1990, Terri Schiavo, a young Florida woman suffered a heart attack caused by bulimia leaving her brain without oxygen for six minutes. According to medical opinions, she has limited involuntary physical movement. She has remained in a persistent vegetative state ever since. Terri did not have a living will or medical directive in place at the time of her heart attack.

It is very important that each individual, if possible has a say in his or her own dying and death. Facing death is hard for everyone and there are specific issues to be talked about in advance. A living will or a Physician Order for Life-Sustaining Treatment (POLST) is extremely useful. The POLST is designed for people with serious or life-threatening illnesses. “This is a standardized form that describes a patient’s wishes and is signed by his or her physician, providing both summary of an individual’s advance directive decision and the physician’s order. It can be used to inform emergency personnel about a patient’s wishes for life sustaining procedures, such as CPR. “

The fight between Mr. Schiavo and the Schindler family began in 1993 which is three years after Terri’s diagnoses. The fight continued between the parents and husband, Terri’s feeding tube was removed in 2001, put back in, removed again in 2003 and a third time on March 18, 2005 (Quill, 2005). Congress then passed an “emergency measure” that was signed by the president in an effort to force federal courts to review this case and create a legal mandate for her feeding tube to be reinserted yet again (Quill, 2005). The district court of Florida denied the emergency request and this decision was upheld on appeal, multiple appeals were denied and Ms. Schiavo died March 31, 2005 (Quill, 2005). Therefore, Terri was on a ventilator in a persistent vegetative state for 15 years.

The case of Terri Schiavo is a landmark case that involved a fifteen year battle over whether or not to provide life support for Terri Schiavo who was 26 years old when she collapsed in her bedroom in February of 1990. According to Munson (2012), Terri Schiavo’s husband Michael Schiavo, claimed to have woken to the sound of a thud at approximately four a.m. and found Terri unconscious on the floor. He called 911, but Terri had suffered cardiac arrest and by the time she was resuscitated she had suffered irreversible brain damage.

One’s body and life are one’s own to dispose as one sees fit. Everyone is entitled to the right to die concept, in that they can decline or accept life-sustaining treatments. However, this was a dispute in the case of Terri Schiavo where all three branches of government were involved to decide on whether they should keep her on life-prolonging measures or discontinue after she was left in a comatose state. After no sign of improvement for over two months, her diagnosis was changed to a persistent vegetative state leaving her life decisions in the hands of her husband, Michael. Michael argued that his wife would not have wanted the prolonged life support and even went as far as starting a petition to remove her feeding tube, which her parents

The Terri Schaivo case made headline news as her husband and parents fought a battle over Terri’s right to live or die. In 1990, 26-year-old Terri Schaivo was found in her home unconscious and without oxygen to her brain for several minutes, which left Terri in a vegetative state. According to a Schiavo timeline on the Miami University website, “Ms. Schiavo suffers cardiac arrest, apparently caused by a potassium imbalance and leading to brain damage due to lack of oxygen.” (Cerminara & Goodman, 2003).

In the early months of 2005, Terri Schiavo’s life story, involving her persistent vegetative state (PVS) captured the worldwide spotlight and brought up controversial issues surrounding guardian care of the patient, as well as the overall decisions made by Congress. The government involvement in her case impeded any decisions the family and spouse could properly address for the well being of Schiavo (Montero 166). The governmental court system in Terri Schiavo’s case behaved immorally in regard to the eventual removal of her feeding tube.

In reference to the article “Alzheimer, Dementia and the Living Will: A Proposal” by Claudia Burla, Guilhermina Rego, and Rui Nunes, a living will is “…a written document available in paper or in the health care system intranet…” (Burla, Rego, & Nunes, 2014). Essentially, this written document allows an independent person to make choices with respect to their desires for the future when it comes to their health and the care they receive. A good example of when a living will would be useful is one from the “Alzheimer, Dementia and the Living Will: A Proposal” article, the authors propose that for patients with Alzheimer’s, “…the living will can be presented to the patient in the early days of their geriatric care…when the person is still in full enjoyment of cognitive ability…” (Burla, Rego, & Nunes, 2014). If a person were slowly experiencing the early signs of a mental disease, yet still had the capabilities to be autonomous, the person would be successful in writing a living will before the disease completely took over. As a result of having this prewritten document, the burden of decision making would be

However, the hastily passed laws both the state of Florida and the federal government are eventually deemed unconstitutional by the courts. The feeding tube is removed on March 18, 2005 despite frantic appeals of the Schindlers and organizations that support them. On March 31, 2005, at 9:05am, Terri Schiavo died a “calm, peaceful, and gentle death” according to Michael’s attorney (China Daily). The eventual autopsy found that, “The damage was irreversible,” and that “No amount of therapy or treatment could have regenerated the massive loss of neurons” (University of Miami).

According to the publication Dying in America, “More than one-quarter of all adults, including those aged 75 and older, have given little or no thought to their end-of-life wishes, and even fewer have captured these wishes in writing or through conversation.” (pg 18)

Remember that living wills only become active when the patient becomes terminally ill – when death is imminent and the patient can no longer communicate his/her wishes to their physician, spouse, or family. Living will DO NOT become active immediately after you sign them.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.

The advance directive, or living will, is one way of circumventing the ethical dilemma of Quinlan, as it is essentially a set of choices by the competent patient if faced with different hypothetical circumstances. Patients can thus feel comfortable knowing that their competent wishes have been documented and can be easily interpreted in case of catastrophe. However, the authority of advance directives is a topic hotly debated amongst medical ethicists (see Advance Directive Authority). Arguments against directives state that not all factors are considered by the person creating the advance order. Also, in some cases of severe dementia, it is argued that the personal identity of the author is no longer intact and therefore has no authority over the treatment of the “new” person. The debate on this topic is extremely complex, but many of today’s cases are decided on an individual basis, with the directive often being upheld.