Terri Schiavo was a coma victim whose plight came to national attention early in the Bush Administration. The legal issues split the country as much as the abortion issue.
Schiavo (Dec. 3, 1963 – Mar. 31, 2005) was diagnosed by physicians as being brain-damaged after her husband reported that she had collapsed in their home early in the morning. [Terri had been suffering from anorexia; her Potassium levels were very low (2.0). She was in a Persistent Vegitative State (PVS)…which she stayed in until her death. 10 Years]
[Michael, her husband, eventually desired to have her feeding tube removed,] and Her husband and her parents became locked in a lengthy legal battle over whether to keep her alive.
Florida Governor Jeb Bush and his brother President Bush sided with the parents, who believed their daughter was responsive. Despite a special law passed to prevent her death, courts finally decided to [cap her feeding tube, which ended any attempts by anyone, medical or not, to feed her. This occurred] on March 18, 2005, and she died of starvation and dehydration within two weeks.
A judge ordered her death despite objections by everyone in Terri’s own family and several medical professionals. [Though, there were many medical professionals who sided with the state…that she was in a PVS and had no hope of recovery to any type of recognizable life.] His order not only required removal of Terri’s feeding tube, but ordered the arrest of people who peacefully attempted to give drinking water to Terri rather than let her die of dehydration.
One of Terri’s nurses stated that Terri frequently spoke (saying “help me” and “Mommy”) and recognized familiar people. Yet she was forced to die by dehydration over the objections of her parents, her brother and sister, her church, and millions of Americans.
The State and Schiavo’s estranged husband refused to allow an independent autopsy, and Schiavo was cremated after her death. (conservapedia.com)
Of course, there are two sides to every story. The Mayo Clinic has a detailed report on this case which seems to show Terri’s husband wanting her to live for the first 5 or so years, and then upon Terri’s parents recommendation, to not be so intent on this but to instead live his life, and even ‘date’. When Terri’s husband one a few lawsuits dealing with ‘malpractice’, totaling close to a million dollars, the attitude of the parents seemed to change, and then they began complaining about the importance of their daughter’s life and that her husband, and the state, were trying to end her life. It is a difficult case to wade through.
(The following are excerpts from an article entitled ‘The Terri Schiavo Saga’ on www.mayoclinicproceedings.com)
- Is it ethically and legally permissible to withdraw or withhold ‘Life Sustaining Treatments’ (LSTs)?
The ethical principle of respect for patient autonomy (particularly the right to maintain bodily integrity and to be left alone) underlies the right of patients to refuse, or request the withdrawal of, unwanted medical interventions. Patients may decline interventions that they previously consented to if their health care values and goals have changed. Regardless of intent, physicians should not impose treatments on patients that patients do not want because doing so constitutes battery.
Indeed, from a legal standpoint, patients in the U.S. have a constitutionally recognized right to refuse any and all forms of medical intervention, whether or not they are terminal and whether or not such refusal may lead to their death. This acknowledged and protected freedom is the culmination of decades of cases, beginning in the 1960s with the recognition that Jehovah’s Witnesses could refuse blood products, even if such refusal would lead to their death.
In reference to the Terri Schiavo case and addressing the issue of the right to refuse treatment, 55 bioethicists stated [in a brief] to the Florida Supreme Court: “The implicated bioethical issue is not whether elderly or disabled persons can be deprived of wanted treatment, but how to implement their fundamental right to decline life-prolonging measures they would abhor. It is certainly true, as the Governor observes, that ‘the State has a compelling interest in ensuring that people with disabilities are not deprived of basic human rights’…but among those basic human rights is the right to refuse medical treatment. The Governor wants to deprive Terri Schiavo of that right, which the judicial process has determined she would want to exercise.”
- Who speaks for the patient when the patient cannot speak?
Physicians frequently care for patients who lack decision-making capacity and cannot speak on their own behalf. In these situations, physicians must rely on surrogates to make decisions for the patient. If the patient has an advance directive that names a surrogate, that choice should be respected. Unfortunately, most adult Americans, like Terri Schiavo, do not have an advance directive. In these situations, physicians must identify a legally authorized surrogate. Some states have statutes that specify a hierarchy of surrogates…[in Florida the hierarchy is as follows]: 1. Judicially appointed surrogate; 2. Spouse; 3. Adult child, or the majority of adult children; 4. Parent; 5. Adult sibling, or the majority of adult siblings; 6. Adult relative; 7. Close friend.
In the Schiavo case, Michael was both her court-appointed guardian and her husband, the 2 highest ranking positions for selecting a surrogate.
- What are the duties of a surrogate decision maker or proxy?
First and foremost, a health care surrogate or proxy has the moral obligation to follow the explicit directives of the patient, as articulated formally in an advance directive or by complying with the patient’s previously expressed wishes. In the absence of explicit instructions, surrogates must use ‘substituted judgment’, that is, knowing the worldview, values, goals, and fears of the patient and making decisions as closely as possible to those the patient would make if capable. Often, these decisions are difficult. Families may not discuss end-of-life and similar issues, and as a result, surrogates may genuinely not know how the patient would decide. In these situations, the surrogate should follow the ‘best interest’ standard, that is, given the medical facts and prognosis, make decisions that would be in the best interests of the patient.
Consequently, when the Schindlers (Terri’s parents) testified in their depositions that, if they were to act as Terri’s surrogate decision maker, they would insist on maintaining the feeding tube and all life support even if Terri had left written instructions to the contrary, they disqualified themselves from ever being appointed as proxies.
- Is Artificially Supplied Food and Nutrition (AFN) a medical treatment or mandatory comfort care?
Throughout the history of medical ethics, questions about what should be considered mandatory care have surfaced; therefore, we submit an approach to the question, “What is a medical intervention?” that can be used not only for AFN but also for other interventions. We call this test the “Little House on the Prairie Test.” This test simply asks that one envision being with Dr Hiram Baker in Walnut Grove, Minn, in the 1880s and confronted with a patient similar to Terri Schiavo. If the patient has a pathologic condition such that Dr Baker could not maintain the patient’s life with the available treatments (which were little more than comfort care measures), then the patient had a life-threatening illness or lethal pathologic condition beyond the efficacy of humane care. Terri had a life-threatening pathologic condition that rendered her unable to hydrate and nourish herself even by hand-feeding or using a baby’s bottle. Instead, Terri needed a PEG tube, which required endoscopy or a surgical procedure to insert. Notably, the skills and technology required to place a PEG tube have been available for only several decades, and the pre-prepared nutritional formulas infused via the tube require the oversight of an experienced nutritionist. Therefore, that which was required to sustain her was beyond the level of humane or comfort care; it was a medical intervention. Using the Little House on the Prairie Test, Terri’s feeding tube is a medical treatment that she had the right to refuse, either directly or through a surrogate.
Terri was not in a room where she was prohibited from accessing food; she had a pathologic condition (severe cerebral injury and atrophy) that would inevitably cause her to die without medical intervention. Artificially supplied fluid and nutrition is no different than dialysis, mechanical ventilation, pacemakers, and other medical treatments that bypass lesions and other pathologic conditions that prevent normal physiological and anatomical functions. Artificially supplied fluid and nutrition, or any medical treatment, can be withheld and/or withdrawn when it is determined to be unwanted by the patient or incapable of leading to the desired goals of medical treatment in general, such as the restoration of function and independent living.
Medical interventions are foreign to the human body, they are not an intrinsic part of it, as evidenced by the fact that most people get along well without a physician’s assistance until they have an illness or injury. It is presumptuous and a disservice to our patients and profession when we insist that our interventions be seen as mandatory.
- Does the patient’s diagnosis make a difference in the decision to withdraw or withhold medical treatments?
The media paid substantial attention to Terri’s diagnosis (eg, PVS vs minimally conscious state). In reality, diagnosis in and of itself is irrelevant. It was universally confirmed, at least by physicians who did not have a proprietary conflict of interest, that the chances of Terri’s level of consciousness improving to a point at which she could be considered capable and competent to provide additional views on continuing or discontinuing the feeding tube were nil, opinions corroborated by the autopsy findings. However, making efforts to better establish a diagnosis would be relevant if in doing so the patient might be able to better communicate his or her wishes.
- Is withholding or withdrawing AFN the same as Euthanasia?
Another claim made during the Schiavo controversy was that Michael and the State of Florida were overtly killing Terri as an act of euthanasia by withdrawing the feeding tube. Her underlying pathologic condition, which prevented her from hydrating and nourishing herself without the assistance of an external medical intervention, was the cause of her death. The decision to limit LSTs may lead to death, but it is a different kind of choice from euthanasia. Refusing LSTs is a request to be left alone, the goal of which is to be free of burdensome and unwanted medical treatments and to allow nature to take its course. Euthanasia is a deliberate act, the goal of which is to kill the patient. In euthanasia, a human being, not a disease, is the final arbiter of death.
We hope that it is clear that the courts were not making judgments on the value of Terri’s life, but rather doing their best to honor her life by trying to seek out and comply with her previously expressed wishes. Terri’s life was indeed precious, no matter how debilitated, and her “worth” was not in question. The unfortunate reality for each of us is that we are mortal, subject to injury, and, ultimately, pathology and death will rule the day. Each of us must face this reality and determine the appropriate levels of medical intervention that each is willing to undergo in forestalling the inevitable. We live in a time when medical knowledge and power can prolong life in a variety of disease states that cause severe debilitation, and our technical abilities often challenge our wisdom about appropriate implementation.
(end MayoClinic quotes)
And now, a more Bible-centerred view:
Natural death does not require that extraordinary means be used to artificially prolong someone’s life. Thus, in situations where a patient’s vital processes have ceased their spontaneous functions, and where no hope of recovery remains for the patient, “life support” machines are not a requirement. Refusal of “heroic means” to sustain life is quite different than initiating procedures that cause death, for example by lethal injection. (FaithFacts.org)
Food and water are considered “ordinary” care necessary to sustain life, along with comforting the patient as best as possible. Nutrition and hydration are not “medical treatments.” Administering food and fluids is not considered “extraordinary means” and withdrawing them, which by itself would cause death, [should be considered an act of murder]. (FaithFacts.org)
God has designed death to ‘generally’ follow a normal, natural cycle; it is not designed to be brought about by unnatural means.
Ecc 3:1-2 To every thing there is a season, and a time to every purpose under the heaven: A time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted;
As our society progresses toward a culture of death, the so-called “right-to-die” will become an obligation-to-die, for example, for anyone who believes that they are a burden to someone else—either financially or otherwise. And by what rationale would the trend be confined even to that? The ramifications are terrifying, but totally logical. (FaithFacts.org) For example, what would stop society from supporting the euthanizing of a 66 year old sweet Grandmother who fell and fractured her pelvis and now is confined to a Nursing Home for continued care; she has no money and her family all lives in Germany. Or, a 4 year old girl who has severe deformities; her parents have given her over to the State; the medical treatment costs are about $1 million per year. Or, your eyes are not blue, your hair is not blonde, you don’t stand over 6 ft tall, you are not in perfect health, and you do not say Hial Hitler!
How would you vote on these?
- In 1985, a Virginia woman who killed her cancer-ridden husband with an ice pick was sentenced merely to two years’ probation and psychiatric treatment.
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A U.S. District Court in Rhode Island ruled in 1988 that the feeding tube could be removed from a 49-year-old woman. The woman was in a coma as a result of a brain hemorrhage, and since she could not swallow, she received nourishment and liquids through a feeding tube. Her family had sued in court to compel the hospital to terminate her food and water. The medical workers who were caring for the woman were unanimous in opposing the action, but the court ordered them to remove the tubes so the woman would starve to death.
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A man severely crippled by a 1985 motorcycle accident went to court in an attempt to gain the “right” to kill himself. In 1989, the Georgia Supreme Court unanimously ruled that he could kill himself by shutting off the breathing apparatus that kept him alive.
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In March 1996, a 62-year-old New York man was sentenced to just six months in jail (he was expected to serve only four) for killing his wife with a mixture of honey and an antidepressant. He claimed it was assisted suicide, and a note left by the wife said she drank the potion “freely and without reservations”; but prosecutors also discovered that he had kept a diary indicating he was tired of caring for his sick wife, who had multiple sclerosis, and was eager for her death. (David W. Cloud)
**Your great uncle gave you his will that stated if he should be placed into a nursing home that he wanted no artificial means to be done to him to keep him alive (i.e. no medicines, fluids, machines, etc.; food and water were allowable)
**Your child was hurt in a fall 3 years ago and is ‘brain dead’ and on a ventilator since; he has had no signs of any improvement; the medical care is costing you $150,000 per year, after Insurance; you are now in debt close to a half a million dollars!
**Your Grandmother is a Jehovah’s Witness; you both are very close; she takes a fall and fractures her pelvis and is suffering from internal bleeding; she is not coherent; the doctors want to give her blood resuscitation; her JW beliefs, though, forbid that; you are the only family member left alive.
**Your friend is 47 years old and is a few months pregnant and just finds out through amniocentesis that the baby is a Down’s Syndrome baby and is severely deformed and not expected to live more than a few weeks after birth; your friend is not wanting to go through the trauma of seeing her newborn baby suffer and die a tragic death; she asks you if you thought it would be ok to have an abortion.
Why would anyone want to die before their time? God has a plan for them! Maybe they might get saved!
Ecc 7:17 Be not over much wicked, neither be thou foolish: why shouldest thou die before thy time?
Is it not always possible, as long as euthanasia is rejected, that one’s eternal destiny might be changed by more time in this world? In light of the seriousness of life and salvation, it is an awful responsibility to decide that a loved one’s life will be prematurely snuffed out and his opportunity for salvation forever erased. (David W. Cloud)
It is the responsibility for family members to care for their loved one, not kill them!
1 Ti 5:8 But if any provide not for his own, and specially for those of his own house, he hath denied the faith, and is worse than an infidel.
Be careful how you treat your family….
Consider the testimony of Dr. Michael Miller, professor of medicine at New York Medical College and the medical director at a White Plains nursing home:
“Ninety-five percent of the patients come in [to his nursing home] with families already distanced. … They have had diminished contact, constant struggles, are constantly attacking the nursing home staff, and make demands for premature death. … It’s not the dementia or the sickness that causes family problems. Family problems began long, long ago and reemerge when the person gets old and sick. And the major way that family ‘pathology’ can get expressed, he said, is to tell the doctors, ‘don’t feed her,’ or ‘don’t treat the pneumonia,’ or, if the parent needs to walk to remain mobile, ‘that will only disturb her. Leave her alone.’ That’s all a way for the family to say, ‘We’ve had enough.’ … (David W. Cloud)
Let a person’s physical body be the determinant of when it will die, not one’s emotions or rationalizing.
Ps 90:10 The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away.
Maybe there is enough ‘strength’ left for another year, maybe two, maybe 22!
As a Christian, you may want to die…and that is very understandable
Phil 1:21 For to me to live is Christ, and to die is gain.
But, let Christ decide on this, not you, a relative, or the State.
Until then, live for Christ…
John 9:4 I must work the works of him that sent me, while it is day: the night cometh, when no man can work.
Eccl 9:10 Whatsoever thy hand findeth to do, do it with thy might; for there is no work, nor device, nor knowledge, nor wisdom, in the grave, whither thou goest.
