Bioethics Case Study: Terri Schindler Schiavo

In the early hours of February 25, 1990, 26-year-old Terri Schindler Schiavo collapsed in her home in St. Petersburg, FL from a cardiac arrest. There have been no diagnoses indicating a reason for her to collapse. Medical records state a discharge of hypoxic encephalopathy, which is a brain injury caused by the brain being starved of oxygen. This would put Terri in a vegetative state, which required life support. Then in June 1990, her husband Michael Schiavo was appointed guardianship by the courts. May 1998 Terri’s husband Michael filed a petition with George Felos, a right-to-die litigator to withdraw Terri’s life support. His request was denied because conflicts of interest and claims of his being bias. Michael firmly believed that his wife would not want to live on life support. This caused controversy with Terri’s family. Terri’s family believed that removing Terri from life support would go against her catholic beliefs, and Michael believed that his wife would not want to live this way. But Terri would continue to live the next 15 years the same way, with both sides fighting for what they believed was right for Terri.

Florida law states that a guardian is a surrogate decision-maker appointed by the court to make either personal and/or financial decisions for a minor or for an adult with mental or physical disabilities (Guardianship, 2015). This gives Michael the right to make all of Terri’s medical decisions. Terri’s parents continued to fight for Terri to remain on life support stating that Michael had moved on with his life since he moved in with his girlfriend and her two children, he no longer had Terri’s best interests in mind and he would benefit if Terri had died. After many court debates on February 25, Judge George W. Greer ordered for Terri’s feeding tube to be permanently removed on March 18, 2005 (Timeline of Events, 200). Judge Greer also ordered that Terri may not receive hydration or nutrition by mouth (Timeline of Events, 2008). Then on March 31, 2005, Terri Schindler Schiavo died from severe dehydration (Timeline of events, 2008).

This case involved the bioethical analysis of passive euthanasia, withdraw of treatment, and quality of life. This occurs when the patient dies because the medical professionals either don’t do something necessary to keep the patient alive or when they stop doing something that is keeping the patient alive (Active and Passive, 2014). Switch off life-support machines, disconnect a feeding tube, don’t carry out a life-extending operation, or don’t give life-extending drugs (Active and Passive, 2014). According to Terri’s family, they claimed that Terri’s catholic beliefs would not allow for passive euthanasia. After February 25, 2005, Terri had no quality of life due to the events leading up to this day. The standards for the quality of life would be for Terri to resume back to her normal daily activities. But instead, she remained in a vegetative state and could not interact with family or friends. The only function she could do on her own was breathe. But her family was insistent that Terri would improve with therapy, even though therapy was discontinued by her husband after her incident.

Lastly, bioethics considers the withdrawal of treatment necessary to maintain life (Active and Passive, 2014). Michael believed that his wife did not want to live in this type of state, he believed that she was suffering. He requested his wife’s feeding tube to be removed so she would be allowed to die. This case caused an unwarranted problem for the healthcare professionals that took care of Terri throughout the years. There was never a time when the bioethics committee evaluated Terri’s needs for medical care. A medical professional never addressed the public outcry about her death or bioethical concerns, so they lost the opportunity to educate the public on these ethical issues. Healthcare professionals were at a loss in what should be done so they had a hard time recapping what ethical direction to take. People argued that the principle of nonmalfeasance which means “First do no harm (Fremgen, 2016)” stopped the healthcare professionals from removing Terri’s feeding tube. Ethically, by removing the feeding tube Terri would suffer from dehydration and would starve to death, being a cruel way to die. But this was not true at all since Terri was in a vegetative state meaning she was in a clinical condition of complete unawareness of the self and the environment by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions (Multi-Society Task, 1994).

Terri’s body would continue to decline and eventually die. Hence, healthcare professionals did not violate the principle of nonmalfeasance. After this case, bioethical conversations started to happen within the healthcare community. Committees started to establish and offer guidance whenever there are bioethical concerns. More protocols and educating patients and family members have developed since this case. Terminating Terri’s feeding tube was not passive euthanasia or allowing the patient to die naturally (Fremgen, 2016) but considered as ceasing a treatment that should have never been determined permanent. Terri received a feeding tube to allow the healthcare professionals time to evaluate her condition and determine if she would be able to sustain her normal life, and not intended to extend it.

References

1. Timeline of Events: Terri Schindler Schiavo. (2008). Retrieved from Robert Powell Center for Medical Ethics and the National Right to Life Committee: https://www. nrlc. org/archive/MedEthics/TimelineTerri. html
2. Reynolds, D. (2004, September 15). Terri Schiavo Would Not Want To Go Against Catholic Church, Her Parents Argue. Retrieved from Department of Administraion Council of Development Disabilities: http://mn. gov/mnddc/news/inclusiondaily/2004/09/091504fladvschiavo. htm
3. Guardianship. (n. d. ). Retrieved August 5, 2019, from https://www. flcourts. org/Resources-Services/Court-Improvement/Family-Courts/Guardianship
4. Active and Passive Euthanasia. (2014). Retrieved from BBC: http://www. bbc. co. uk/ethics/euthanasia/overview/activepassive_1. shtml
5. Fremgen, B. F. (2016). Medical Law and Ethics (5th ed. ).
6. Multi-Society Task Force on PVS. (1994, May 26). Medical aspects of the persistent vegetative state (1). Retrieved August 5, 2019, from https://www. ncbi. nlm. nih. gov/pubmed/7818633/