End-of-Life Ethics
Since she lost supply of oxygen to the brain following a cardiac arrest in 1990, Mrs. Schiavo was declared by medical professionals to be in a “persistent vegetative state”. The legal definition of such a state in the state of Florida is that a person is in a “permanent and irreversible condition of unconsciousness”, whereby they cannot recover. As such, her husband posited that withdrawal of hydration and nutrition would safeguard Mrs. Schiavo from the suffering that she was facing. Such an effort was legally permitted under Florida’s end-of-life protocols. Mrs. Schiavo’s parents thought otherwise, arguing that she was still alive and deserving of their care. They also argued that the doctors had a duty of care towards Mrs. Schiavo and that it was imperative to put in place all the necessary initiatives to keep her alive. This paper presents an argument for Mrs. Schiavo and the ethics behind keeping her alive.
End-of-Life Ethics
The efforts that were put in place by Mrs. Schiavo’s husband and the resultant removal of her feeding tube as part of ‘aiding’ her to ‘naturally’ die demonstrated a high level unethical conduct and disregard for human life (Caplan, McCartney, & Sisti, 2006). Mrs. Schiavo’s condition was only ‘terminal’ and ‘end-stage’ at the point at which hydration and nutrition were removed (Caplan, McCartney, & Sisti, 2006). She could have lived for more years had she continued to receive care. In such a construction, withdrawing nutrition and hydration was active euthanasia that cannot be ethically accepted nor clinically warranted. Just like life support cessation is prohibited under all other circumstances, it cannot be allowed in cases where one suffers from extreme cognitive or physical limits (Jecker & Schneiderman, 1996).
Responding to the question of whether it was ethical to have removed the feeding tube for Mrs. Schiavo, resulting in her death, it is important to start with an understanding of being in a persistent vegetative state and its diagnosis. Various studies have demonstrated that individuals who are considered to be in such a state are not necessarily dysfunctional and cannot be considered to be non-existent to the extent of taking away their autonomy and possible desire to live (Koch, 2005). According to Shewmon (2004), as opposed to popular definitions of the vegetative state, one cannot categorically conclude that individuals in such a state have totally lost their cortical function. Thus, as much as an individual may have lost visual, sensory, and motor functions, they cannot be argued to be non-existent (Schoenle & Witzke, 2004).
Research has established that 12 percent to 34 percent of all the individuals who are diagnosed with persistent vegetative state are at the minimal conscious and could positively respond to therapy (Schoenle & Witzke, 2004). Given such a determination, it is highly unethical to consider facilitating death among such individuals who have alternatives that could prolong their lives. It was argued that removal of Mrs. Schiavo’s feeding tube was aimed at ending her suffering (Caplan, McCartney, & Sisti, 2006). Nevertheless, it is highly unlikely that Mrs. Schiavo was suffering if it was believed that all her cerebral function had stopped. On the other hand, if she was at least minimally conscious, then allowing her to die by thirst and starvation caused her more suffering than she was facing in her condition (Schoenle & Witzke, 2004). Hence, it was highly malicious for Mrs. Schiavo’s husband and the involved doctors to posit that they were giving her a helping hand. The assumption that there is no need to continue treatment because it will be “futile”, in the sense that it will not produce any curative value, is an imposition of the frustrations of the doctor for not being able to do anything that will sustain health on a patient (Jecker & Schneiderman, 1996).
An important issue in law and ethics involves determining what is meant by personhood. Personhood cannot be considered an existential attribute that is based on physical and cognitive abilities. On the contrary, personhood is based on a communal attribute that is based on the relationship that one develops with others (Koch, 2005). Considering Mrs. Schiavo as not a person that requires care and support because of his cognitive disability could be equated to denying support and proposing euthanasia to other people who may have cognitive or even physical disabilities. Based on such a construction of personhood, it is evident that Mrs. Schiavo was a person that is equal to others. Her parents even postulated that her being had been dictated by their unwavering, historically anchored commitment to the continuance of their relationship (Caplan, McCartney, & Sisti, 2006).
Conclusion
The debate surrounding the ethicality of the issues of termination and continuation involving the case of Terri Schiavo should be informed by an understanding of what it means to be a person and the level to which physical and cognitive ability contribute to personhood. No one certainly knew about the status of her cognitive ability, including whether she was permanently unconscious or minimally conscious. As such, there was no ground based on which one could assert with absolute certainty that Mrs. Schiavo was experiencing discomfort from starvation and dehydration or not. Furthermore, medical ethics provides the need to respect individual autonomy. No one knew what Mrs. Schiavo would have wished to be done with regards to her health as she did not leave any directive. Hence, no one had sufficient neurology to make definitive determinations concerning whether she needed to be aided towards death or not.
References
Caplan, A., McCartney, J., & Sisti, D. (Eds.). (2006). The Case of Terri Schiavo: Ethics at the End of Life. New York: Prometheus Books.
Jecker, N., & Schneiderman, L. (1996). Stopping futile medical treatment: ethical issues. In D. Thomasma, & T. Kushner (Eds.), Birth to Death: Science and Bioethics (pp. 169–176). New York: Cambridge University Press.
Koch, T. (2005). The ideology of normalcy: The ethics of difference. Journal of Disability Policy Studies, 16(2), 123-129.
Schoenle, P., & Witzke, W. (2004). How vegetative is the vegetative state? Preserved semantic processing in VS patients—evidence from n 400 event-related potentials. Neurol Rehabil, 19, 329–334. Shewmon, A. (2004). Critical analysis of conceptual domains of the vegetative state: sorting fact from fancy. Neurol Rehab, 19, 343–347.
