The case of Terry Schiavo made national headlines. The issue at the center of the case was whether or not Schiavo’s husband had the right to decide to end his wife’s death by refusing treatment. Her husband, as the next of kin, would normally not be questioned as to his decisions. However, Schiavo’s parents and family believed that the husband had a conflict of interest: his desire to remarry. Schiavo had been in a permanent condition, called a persistent vegetative state (PVS). Physicians argued that her brain scans indicated significant cerebral damage and also showed that her brain had deteriorated significantly over the seven years in this condition. Essentially, she was in a waking state of partial awareness; however, she lacked true consciousness. Her husband wanted to remove her feeding tube; her family did not want this done and filed suit. The case focused on death and dying. It also included the principles of beneficence, social justice and patient autonomy.
The argument for death focuses on beneficence. Is it acceptable to allow a person to remain in a PVS? It is not in the best interest of the patient? Likely in Schiavo’s case, it was cruel to the patient. Schiavo could have remained in this condition for decades. Her condition was the result of cardiac arrest, likely caused by bulimia. Cardiac arrest had occurred in 2000. She did not die until 2005; this included a seven year legal battle between her parents and her husband. Schiavo’s husband argued that Terry would not want to live in this condition. He stated that they had discussions about this; her parents claimed that she would want this condition. Furthermore, her parents argued that she was conscious (Fine, 2005, pp. 303-05). If she were conscious, there may have been some quality of life; however, since she was diagnosed as PVS, there was no quality to her life. It was therefore unacceptable to allow her to remain in this condition for decades. Furthermore, she was a case of medical futility; nothing could be done for her condition.
The case also must be considered as one of patient autonomy. Terry could not decide her medical condition. Therefore, the next of kin should do so. However, her husband had a conflict of interest in that he wanted to remarry; he could not do so unless she died. Divorce was not a legal option. Her parents had a conflict of interest because there was a financial settlement from a malpractice award. It must also be noted that the parents did not seem competent to judge the situation; they wanted their daughter alive at all costs. They could not accept her medical diagnosis. The question remains as to whom should be the one to make decisions when both had conflicts of interest, as well as the inability to see the situation clearly. However, in this case, Michael was the legal guardian and had convincing evidence that Terry would have objected to this. The courts affirmed this decision (Quill, 2005).
Schiavo also had no quality of life. She had no consciousness in her state. However, her family argued that she did. This was a breakdown of the medical community to educate the family about the reality of PVS. It also indicates a state of persistent denial on the part of her family, particularly her parents. It should be noted that this is still a problem within the medical community. The recent case of Jahi McMath clearly illustrates this ongoing issue. The physicians were obviously correct in their diagnosis of Schiavo. Upon autopsy, it was confirmed that her brain had atrophied to approximately half the weight of a normal brain (Fins & Schiff, 2005, p. 303). The family could not accept this. The legal issues involved an eight year battle. All of the legal issues cannot be discussed within the scope of this paper. However, it should be noted that the Florida legislature responded with a knee-jerk reaction mean to appeal to the voters; they quickly passed “Terri’s law” meant to keep her alive. This was a poor use of legislative resources.
There is not enough information provided to determine about the confidentiality issues of the case. However, there are some questions that must be asked. HIPAA law does not allow health care professionals to discuss medical care and prognosis with anyone except the next of kin. In this case, that would be Michael, the husband. At first, the relationship between the husband and the in-laws was amicable. It is doubtful that he would not have wanted them involved in her care. This was also before HIPAA was passed and medical confidentiality became a legal issue to the current extreme. Once the relationship deteriorated though, it must be questioned as to whether or not the husband approved for the parents to be involved in her care. They were most certainly entitled to see Terry. However, how were they legally entitled to all of the detailed medical information about their daughter? One must ask if any confidentiality laws were broken.
This case should have never extended for eight years. Her diagnosis was correct. After eight years, she was clearly in a PVS. This is not a quality of life that can support the decision to continue to prolong the patient’s life. The parents did not need legal counsel; they needed emotional counsel to accept the tragedy about their daughter.
