The Terri Schiavo case: Legal, ethical, and medical perspectives

Vanderbilt University, Nashville, Tennessee, USA.
Annals of internal medicine (Impact Factor: 17.81). 12/2005; 143(10):744-8.
Source: PubMed


Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.

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    • "Deciding for oneself: ''Autonomists'' and ''Altruists'' Some participants were adamant about deciding for themselves (''Autonomists''): ''That's my feeling that I think I ought to be able to dictate how I want it to end, you know'' (African American participant #1-1). Among whites, another reason for deciding for oneself and formalizing this in writing was motivated by discussions about the widely popularized Schiavo case [19]. Autonomists wanted to assure that their wishes would be carried out: ''I have heard so much about other people being kept on machines and kept alive and – but they're not able to speak out and tell the doctor that they don't want to be on that machine, but their loved ones are there and they already told them earlier that they didn't want to be, but yet the doctors will keep them on there and they'll have to go to court and all this and they'll go against the man's wishes who's laying there on that machine. "
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    • "Its use, furthermore, should be considered in principle, ordinary and proportionate, and as such morally obligatory”. A final reason was whether allowing feeding tube to be removed would initiate a slippery slope leading to treatment limitations for disabled persons, or to legalizing assisted suicide or euthanasia[13], [54]. "
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    • "As medical technology becomes more advanced, judgments about whether to undertake invasive medical procedures have increasingly become a serious and difficult issue to resolve; this is true not only for patients in whom medical testing clearly demonstrates an end-of-life status but also for patients in a comatose state with very little prospect of recovery and for frail, elderly individuals [1-3]. To resolve these issues, various points must be clarified. "
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