Ethics & End-of-Life

Hello class,

Today we will focus on the ethical dilemmas associated with the Terri Schiavo case.  The ethical question here is Does one have the right to die?  As we have learned, Terri Schiavo lived in a persistent vegetative state for 15 years.  Her husband, Michael and her parents, the Schlinders had differing opinions regarding Terri's right to die.  Despite numerous medical opinions that Terri had little to no chance of returning to a normal life, her parents insisted that as a devout Catholic, Terri would not want to be removed from life support.  However, Michael, her husband, was trying to abide by Terri's wishes.  Unfortunately, these wishes were not written in any form.  In Florida, the law is clear in that it states that artificial feedings are considered life support and Terri was being fed through a feeding tube.  She also was able to breath on her own since her brainstem was not affected.  Ethically, the principles of autonomy, freedom need to be expired.

The questions are:

1.  Does Terri have the right to die?

2.  Is Michael, as her husband, able to decide Terri's fate?
"In the event that an advance directive is absent, the patient's wishes about treatment and death can still be honored"(Porter, Johnson, & Warren, n.d., p.86).

3.  Do the Schlinders have a say in Terri's fate?
The Schlinders brought this case to the media which in turn reached political involvement as high as the president.

4.  Where and how will her care be funded?
Michael won a medical-malpractice suit of 1.5 million dollars of which 700,000... dollars was placed into a fund to pay for medical costs.  However, the majority of this money went to legal battles.

5.  What are the goals of treatment?

6.  How can the patient benefit from treatment?

7.  How can harm be avoided in her care?

Such decisions depend on individual experiences, religion, moral and ethical values.  We live in a society that encourages life at all costs.  We, as a society fear death.  What is the difference between quality and quantity?

8.  Was this a case of medical futility?
Medical futility is defined as : the unacceptably low chance of achieving a therapeutic benefit for the patient" (Butts & Rich, 2008, p. 464).

Terri's case, lasting 15 years with no measurable improvement, meets the definition of medical futility.

Lets review several ethical principles:
Autonomy:  the ability of an individual to speak/make decisions for oneself
Freedom:  The ability to decide one's own course of treatment
Beneficience:  To do good and prevent harm in caring for a patient (Westrick & Dempski, 2009).
Nonmaleficence:  protection of the patient from circumstances that may cause harm (Westrick & Dempski, 2009).

With unlimited funds, Terri could be kept alive and survive in a nursing home in a persistent vegetative state.  She was able to survive largely due to her age.  It is unknown how long Terri would have survived.


Think about these questions.  I look forward to your discussions.

References:

Butts, J. B., & Rich, K. L. (2008). Nursing Ethics Across the Curriculum and Into Practice ( Second Edition ed.). Sudbury, Ma.:  Jones and Bartlett Publishers.

Porter, T., Johnson, P., & Warren, N. (n.d.). Bioethical issues concerning death.  Critical Care Nurse Q, 28(1), 85-92.  Retrieved from OVID with Full Text.

Westrick, S.J., & Dempski, K. (2009). Essentials of Nursing Law and Ethics. Sudbury, Ma.:  Jones and Bartlett Publishers.