Medical Ethic’s Assignment

Terri Schiavo Case

Refer to the project guidelines in the grading module. The final paper should be
written in Q&A format. Each question will be worth 5 points, be certain that your
answer contains 5 relevant points regarding the case for full credit.

After viewing the video on the Schiavo story, reading the reference articles in the
medical ethics module, and doing your own research, please answer the following
questions regarding this case. There are no right or wrong answers for some of these
questions; you will be graded on how well you defend your answers. You should be
prepared for a class discussion.

1. Define persistent vegetative state and brain death. What is the difference?

Brain death is defined as the “irreversible cessation of circulatory and respiratory

functions, or irreversible cessation of all functions of the entire brain, including the
brainstem, is dead. A determination of death must be made with the accepted medical
standards” (Sullivan 1999). A persistent vegetative state (PVS) is a vegetative state that
lasts four or more weeks, when a “person is able to be awake, but is totally unaware. A
person in a PVS can no longer ‘think,’ reason, relate meaningfully with his/her
environment, recognize the presence of loved ones, or ‘feel’ emotions or discomfort.”
The difference between brain death, or what is sometime referred to as a coma, and a
persistent vegetative state, is that during brain death, the patient is completely
unresponsive, whereas when a person is in a PVS, they have periods of being awake
and asleep, where these individuals can cough, sneeze, scratch, cry, or smile, which
loved ones often misinterpret as the person with PVS is aware of their surroundings
and condition (Arenella 2016).

2. Discuss which bioethical principles from class are involved in this case and
why?

Autonomy, non-malfeasance, beneficence, and justice were all referenced throughout

the Terri Schiavo case. In regards to autonomy, Terri was unable to make decisions for
herself due to her being in a persistent vegetative state, therefore her loved ones were
held responsible for making her medical decisions. Terri’s husband, Michael, reported
that Terri had told him that she would not want to have extensive measure taking to
prolong her life, if she were in a condition like this. Terri’s family, however, believed
that Terri was aware, although she was in a persistent vegetative state, and fought to
keep a feeding tube in, to sustain Terri’s life. Being respectful of both Terri’s parents
and husbands wishes, by Terri’s physicians, displays autonomy. Non-malfeasance was
represented by the feeding tube placement. Terri was not being harmed by the feeding
tube, however it was prolonging her untimely death. The feeding tube did not affect
her prognosis, but rather it just prolonged her time until death. Terri’s family believed
that the feeding tube was giving beneficence, however, Michael Schiavo and many
healthcare professionals believe that the feeding tube was not benefitting the patient,
as her condition would never improve. The many protests shown in the video in
support for saving Terri’s life, although she was in a PVS, represent justice for Terri.
Society played a large role in Terri’s case, and influenced a lot of people in support for
extensive measures to be taken to sustain Terri’s life (Terri 2014).

3. What information would you give the family if asked “How long will it take her
to die? Will it be painful?”

Typically, death occurs within six months without treatment (including tube feedings).
Individuals, such as Terri, who are in a persistent vegetative state, are unable to
experience thirst, hunger, or pain. The only way an individual can feel pain, is if their
brain cortex can receive and interpret a pain stimulus, however this is highly unlikely,
because individuals in a PVS do not have a functional brain cortex. In Terri’s case, she
would not be suffering without tube feedings, as she has an unfunctional brain cortex,
and wouldn’t be able to interpret these stimuli (Arenella 2016).

4. If this case were placed before a Catholic cleric, what do you think they would
support?

Yes, I believe that the Catholic cleric would be supportive of keeping Terri’s feeding
tube in place. Catholics believe that patients in a vegetative state, “are still living
beings with inherent dignity, deserving the same basic care as other patients,”
including nutrition and hydration even by artificial means, also including basic
necessities of the patient. The Church feels obligated to bear witness to the provide
support, including financial support, and believes that the Church should “bear
witness to her commitment to serve human life from conception to natural death.”
The Church believes that nutrition and hydration cannot be withheld from patients in
a PVS because it could be considered that life is dismissed as a burden. They see the
act of withholding life sustaining measures could be viewed as euthansia (Q&A 2007).

5. If you were Terri, what would you want done?

If I were Terri, I would not have wanted the feeding tube placed to sustain my life.
Knowing what I know about being in a vegetative state, I know that I would not be
myself, or even be aware of my own surroundings. Knowing that comfort measures
and life-sustaining measures, such as a feeding tube, would be only prolonging my
death, I would not want these measures taken. I personally have dealt with my
grandfather at the end-stages of his life during hospice, and although my
grandfather’s and Terri’s situations differed, they were similar in ways that my
grandfather was unaware of the situation at the end of his life. Our family could have
made him suffer through chemotherapy, however the end result would have been the
same, death. The placement of Terri’s feeding tube was just prolonging her outcome,
which was death, and I would not want these measures taken if I were placed in this
situation (Arenella 2016).

6. How would you argue in favor of the husband?

Michael Schiavo was very adamant that Terri would not have wanted the feeding tube
placed, and reports that she told him several times that she would not want these type
of artificial measures taken in this type of situation. Michael was Terri’s husband, who
spent the most time with Terri, as they lived together. I would consider Michael to be
the person who knew Terri best, and who would be the person to know what Terri’s
wished would have been in a situation like this. I thought that the media and society
painted Michael like a monster regarding Terri’s case. Michael lost his wife when she
sustained a cardiac arrest, even though her body had been resuscitated. Terri,
according to all studies and testing completed on her, was in a vegetative state, where
she did not know her surroundings, and therefore would not regain brain function. In
my opinion, I think Michael’s wishes to have the feeding tube removed was completely
justifiable (Q&A 2007).

7. How would you argue in favor of the parents?

Robert and Mary Schindler were trying to hold onto hope that their daughter Terri
would be one of those people, that in extremely rare cases, recover from a PVS.
However, in Terri’s case, where her PVS lasted 15 years before her untimely death,
where as in those rare cases of recovery occurred within 6 months (Arenella 2016). The
Schindler’s thought that Terri would be able to recover through continuous therapy.
They were holding onto hope that their child would be one of the miracle cases. Terri’s
parents thought that because Terri was showing signs of responsiveness and
functioning by moving her eyes to follow people around the room, that she was aware
of her surroundings. Terri’s parents were holding onto hope, and wanted to do
everything that could in attempt to not only save Terri’s life, but also they wanted to
help her regain brain function. Terri’s parents were doing what every loving parent of
a child would do for their child (Q&A 2007).

8. What decision did the courts hand down?

Ultimately, the court decided that “Terri’s Law” was unconstitutional, and removed
Terri’s feeding tube on March 18, 2005. Terri died 13 days after the feeding tube was
removed on March 31, 2005 (Q&A 2007).

9. Should the government be involved in these decisions?

I believe that the government should be involved in these decisions, because the
government establishes a set of laws that must be followed, rather than relying on
emotions to make difficult decisions. The court relies on facts and laws, rather than
being sensitive “to the struggle that all members of Theresa's family have endured
since she fell unconscious in 1990." By letting emotions allow you to make a decision,
such as a decision in Terri’s case, your views are being clouded, and you are not
making the right decision based upon the facts (Phillips 2004).

10. What is the position of the professional association the group chooses regarding
withholding/withdrawing nutrition and hydration?

In 2003, Florida legislatures passed “Terri’s Law,” that allowed Governor Bush to
intervene, and mandated that Terri’s feeding tube be reinserted. However, the
American Dietetic Association recognized that withdrawing/withholding nutrition and
hydration centers on the obligation to withhold medically inappropriate treatment,
and to honor a patient's wishes to withhold care. Withholding or withdrawing
nutrition of hydration must be handled on a case-by-case basis, and must involve the
consultation of a registered dietician (Position 2008). In Terri’s case, the feeding tube
was not beneficial to the treatment to her, but it was life-sustaining, and Michael
Schiavo stated multiple times that Terri would not have wished this (Q&A 2007).

Works Cited
Arenella, C. (2016, January 30). Coma and Persistent Vegetative State: An Exploration of

Terms. Retrieved February 24, 2020, from

file:///Users/jenna/Downloads/coma and pvs.pdf

Phillips, R. (2004, September 23). Florida Court Strikes down “Terri’s Law”; CNN.

Retrieved February 24, 2020, from http://www.cnn.com/2004/LAW

/09/23/schiavo/

Position of the American Dietetic Association: Ethical and Legal Issues in Nutrition,

Hydration, and Feeding. (2008). American Dietetic Association. Retrieved

February 24, 2020, from doi: 10.1016/j.jada.2008.03.027

Q&A from the USCCB Committee on Doctrine and Committee on Pro-Life Activities

regarding The Holy See’s Responses on Nutrition and Hydration for

Patients in a “Vegetative State” . (2007, September). United States Conference of

Catholic Bishops. Retrieved February 24, 2020, from

file:///Users/jenna/Downloads/Q&A %20from%20USCCB.pdf

Sullivan, J., Seem, D. L., & Chabalewski, F. (1999, April). Determining Brain Death.m

Retrieved February 24, 2020, from https://doi.org/10.4037/ccn1999.19.2.37

Terri Schiavo Documentary: The Case’s Enduring Legacy. (2014, April 24). New York

Times. Retrieved February 24, 2020, from

https://www.youtube.com/watch? v=O-rQ3tIabvM