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Molly Lukacs, Mattie Lefever, Olivia Kelly, and Lexi Gassman

Medical Ethics Assignment- Terri Schiavo Case

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

Persistent vegetative state is when a person can appear to be awake but does not show

any evidence of being aware of themselves or their environment and remains in that state for

longer than four weeks. A person in a vegetative state may have automatic reflexes that do not

require any function from the part of the brain used for thinking. The brainstems basic functions

are preserved which is why people can survive in this state for years (Jennett, 2002).

Brain death is when there is a total absence of all neurological activities in the brain. A

person who is brain dead will not respond to stimuli, so they will not have reflexes or

movements. A person who is brain dead will show consistencies with the loss of brain and brain

stem function. If a person is declared to be brain dead there is no going back, there is no chance

their neurological functions will return (Golia & Pawar, 2009).

The difference between brain death and persistent vegetative state is the function of the

brain stem. When a person is brain dead, they will have lost the function of all their brain as well

as the brain stem and will have no reflexes. When a person is in a persistent vegetative state, they

still have basic functions of their brain stem and are still able to have automatic reflexes. Terri

Schiavo was in a persistent vegetative state, because she still had reflexes but did not show any

real knowledge of the environment around her.

2. Discuss which bioethical principles from class are involved in this case and why?
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One of the bioethical principles that was involved in the Terri Schiavo case was non-

malfeasance. Non-malfeasance means that no harm was done to the patient. While she was on

feeding and hydration tubes, which could have been seen as a burden, they were not harming her.

The treatment she was getting in her vegetative state did not make her condition worse. The care

she was receiving through the nutrition and hydration tubes were not necessarily creating harm

or injury to Terri. Beneficence was another principle involved in the case. Beneficence is simply

helping, making sure whatever is being done helps the patient. In this case, her husband and the

doctors were the ones who made sure to help Terri by having the nutrition tube removed. Terri’s

husband waited eight years before petitioning the court to have the tube removed. He knew that

his wife would not have wanted to live life like that and that she was not going to recover. After

fourteen appeals, the court helped make the final decision that the tube would be removed.

Ultimately, both the court and Terri’s husband helped to remove all tubes which is what Terri

would have wanted. It was clear she was not going to recover and keeping her in that state was

not helping Terri (McQuoid-Mason, n.d.).

3. What information would you give the family if asked “How long will it take her to

die? Will it be painful?”

If the family asked, “How long will it take her to die? Or Will it be painful?” We would

explain to them first that nutrition and hydration are considered medical treatment and when a

person is dying, it is very common for food and water to be refused. If the person is on fluids it

can potentially lead to fluid overload and more suctioning, which could be viewed as a burden to

the patient. Also before there were tube feedings, people would die naturally by not eating. Force

feeding does not follow a natural process. After making the decision to discontinue fluids and
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nutrition, death occurs between ten and fourteen days. This is due to the imbalance of

electrolytes and dehydration. As for pain and suffering, patients typically do not experience thirst

or starvation. Once the patient’s fluid levels become imbalanced, the body produces hormones

that act as sedatives, ultimately keeping the patient comfortable. Giving the patient fluids

throughout this process can only prolong death and cause additional issues.We would make sure

that the family was aware that it is justifiable to withhold liquids if they wanted to do so (Ritchie

and Kvale, 2009).

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

support?

If this case were placed before a Catholic cleric we believe that they would support Terri

Schiavo’s husband in removing her feeding tube. The Catholic Church has several specific views

on medical ethics. One of the basic tenets of the Catholic viewpoint is Natural law. Natural law

means to allow nature to take its course however, if death is imminent, direct intervention to end

life is wrong. Situations such as euthanasia and physician assisted suicide is never acceptable in

the eyes of the Catholic church. Removal from life support, however, is an acceptable situation.

When nutrition and hydration are not bringing the patient any benefit, it is completely okay to

discontinue nutrition and hydration (“A Catholic Guide to End of Life Decisions”, n.d.).

According to the WVU handout, Withholding Nutrition and Hydration, artificial nutrition and

hydration are considered medical treatments. With that being said, Terri’s feeding tube would be

considered “life support” and the Catholic church allows removal from life support

(“Withholding Nutrition and Hydration”, n.d.) .

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

In the state that Terri was in there was nothing anyone could do. She was still present in

the sense that she had automatic reflexes but her brain was not functioning; she wasn’t thinking.

When Terri’s husband petitioned the court to have her feeding tube removed, she was medically

at a place where the tubes were just prolonging her life in a vegetative state (“The Terri Schiavo

Case”, n.d.). We agreed that if we were Terri, that we would want to have our nutrition and

hydration tubes removed. Having nutrition and hydration is an extra burden that is not needed,

especially if there is not a chance of recovery. While we realize it would be difficult for our

families to make that decision, we would not want to live out the rest of our lives in a vegetative

state. The measures taken to keep us alive, could potentially cause more harm than good and

could be therapeutically useless. We realized how hard it would be for our families to make

those choices, and we realized how important in that situation a living will would be.

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

It was probably extremely hard to be at such odds with his in-laws, who told Michael it

was murder to have Terri’s tube removed. Michael Schiavo did not have an easy choice to make.

He had seen Terri in her persistent vegetative state for years before he petitioned to have the tube

removed. Michael knew that Terri was not going to get any better and that keeping her connected

to the tube was not helping her (“The Terri Schiavo Case”).

In the case, Michael testified many times that Terri commented that she would never

want to be kept alive “on anything artificial” (“The Terri Schiavo Case”). While word of mouth

is direct, there is no concrete evidence or proof that Terri made any audible request. Since there

was no proof, one could then look at law. The law sets legal rights of married people regarding
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child custody, division of assets, and right to support (Dent 592). Right to support is where we

would argue in favor of the husband. Michael was legally married to Terri, so he should have

had all rights to make financial, medical, or any other decision necessary to support his wife.

When someone marries, he/she leaves their parents household to join themselves legally with

another person. Ultimately, as her husband, Michael should have had the final say in what was

best for his spouse as he had certain rights/benefits through marriage that the parents did not. He

felt that Terri would not have wanted to be connected to hydration and feeding tubes and knew

that she was not going to get any better. His actions were justifiable due to his position as a

supporter of her will by being her husband.

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

We can see how the parents would have difficulty letting go of their daughter who was

taken from them quite abruptly. They are seeing her frequently move her eyes or make noises,

and to someone without any knowledge of persistent vegetative states, he/she would think that

Terri was reacting to their voices or other stimuli. To look at someone who appears to be reactive

and make the decision to remove their feeding tube, knowing that will end their life, would be

difficult if not impossible. Especially because the person in this case is their daughter. Her

parents felt that if they had Terri’s tube removed it would be murder. They wanted to love and

take care of Terri in her vegetative state. Her parents also could have felt that food and fluids

were part of the bare minimum of human treatment (Ritchie and Kvale, 2009).

Sources state that many issues arose between the parents and Michael Schiavo after

Michael won a medical malpractice lawsuit that gave Terri a large sum of money. The family

was working together up until this point. It was stated in the case that Michael refused to divorce
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Terri, even while he had a new girlfriend. Through this, it can be seen how the parents believed

Michael did not have the best intentions. The family accused him of maintaining the marriage to

inherit Terri’s trust fund if she died. If we were to argue for the parents, we would make sure to

mention the fact that Terri was still reactive to stimuli and that Michael did not have the best

intentions for his wife (“The Terri Schiavo Case”).

8. What decision did the courts hand down?

Michael Schivo petitioned the court in Florida to have his wife, Terri’s feeding tube

removed. He was opposed by Terri’s parents who claimed that Terri was still conscious. The

court ruled in favor of Michael agreeing that Terri was in a persistent vegetative state and would

not wish to continue the life-prolonging measures. Terri’s tube was removed but reinserted days

later after “Terri’s Law” was signed. Over the years this case brought the interest of various

groups, members of the Florida Legislature, the United States Congress, and the President of the

United States. The Terri Schiavo case was appealed in court fourteen times, along with various

petitions, hearing, and motions in the Florida courts. The final ruling on the case was the Terri’s

feeding tube be removed (“The Terri Schiavo Case”).

9. Should the government be involved in these decisions?

As a group, we agreed that the government should not be involved in these decisions.

This case lasted for seven years because the government and the media got involved. These life

and death choices should be left to the family and the last wishes of the person. When the

government gets involved it creates a “media circus” that results in processes being dragged out
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and making private matters become very public. These decisions are very personal matters that

should be handled in that way. This case became so public that it turned Terri into a “symbol”

for how not to die. Instead of letting Terri just die, like she would have wanted, she was put all

over the media because of the government's involvement in the case. When “Terri Law” was

signed and Terri’s tube was re-inserted, President Bush signed a bill that allowed Terri’s case to

be heard in federal courts (“The Terri Schiavo Case”). The government should not get a say in

making end-of-life choices, they should be left up to the family and the medical advice of

doctors.

10. What is the position of the professional association the group chooses regarding

withholding/withdrawing nutrition and hydration?

All of the professional associations we are interested in (i.e. nursing, dietetics, and

physician assistant) have a code of ethics. All of the codes contain some provision about the

preserving the dignity of a person. To our group preserving dignity is included in the death and

dying process and that prolonging someone’s life in the way that Terri’s was is in a way

stripping a person of their dignity. Nutrition and hydration are extraordinary measures and can be

viewed as more of a burden than a benefit. As a group we think that the decision to withdraw

nutrition and hydration is justifiable. If someone is in a persistent vegetative state or brain dead

keeping them hooked up to nutrition and hydration just delays the inevitable and is unfair to the

patient, especially if it was known that they would not want to live like that. If the hydration and

nutrition are not bringing any benefit to the person, and they would not want to live like that then

why have unnecessary measures taken to keep them alive? Not eating and drinking is a normal

part of the dying process. While the decision is extremely difficult for the family to make, it is
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completely justifiable to have the nutrition and hydration tubes removed. Every dying patient

needs a bed, human contact, warmth, and to be as pain free as possible. Nutrition and hydration

are medical treatments that can ultimately be a burden to the patient. When a person is in a

persistent vegetative state, the brain cortex is not working any longer which means that they are

not experiencing pain, thus they would not suffer due to the lack of hydration or nutrition tubes

(Ritchie and Kvale, 2009).

References

A Catholic Guide to End of Life Decisions. Retrieved March 2, 2019, from

https://www.ncbcenter.org/publications/end-life-guide/

Dent, George W., "The Defense of Traditional Marriage" (1999). Faculty Publications. 515.

https://scholarlycommons.law.case.edu/faculty_publications/515

Golia, A.K., & Pawar, M. (2009). The Diagnosis of Brain Death. Retrieved February 07, 2019,

from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772257/

Jennett, B. (2002, October 01). The vegetative state. Retrieved February 07, 2019, from

https://jnnp.bmj.com/content/73/4/355.short

McQuoid-Mason, D. (n.d.). An introduction to aspects of health law: Bioethical

principles, human rights and the law. Retrieved from

https://www.ajol.info/index.php/sajbl/article/view/41790

Ritchie, C. S., & Kvale, E. (2009). Nutrition at the End of Life: Ethical Issues. Handbook of

Clinical Nutrition and Aging, 235-244. doi:10.1007/978-1-60327-385-5_13

The Terri Schiavo Case. (n.d.). Retrieved March 13, 2019, from

https://www.cdc.gov/training/ACP/page52792.html
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Withholding Nutrition and Hydration. Retrieved March 2, 2019, from

http://fozzy.wvsc.edu/-hall/advisor/medicalethics/RefusingTreatment/refusingtreatment