Importance of End-Of-Life Care

The issue of euthanasia has remained highly debatable for decades. The supporters argue that a person is free to decide when to die, and if there are no chances for healing, euthanasia is a way to prevent unbearable suffering. The opponents of mercy killing, in turn, claim that it is not up to us to decide when to pass from this world and that healing might occur unexpectedly. The present essay discusses the issue of artificial maintenance of life in patients in the persistent vegetative state (PVS).

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One of the most well-known debates on the artificial maintenance of life are related to the case of Theresa Marie Schiavo, who fainted on the 25th of February 1990 because of cardiac arrest, and since that time, never regained consciousness. The husband of Terri and her guardian, Michael, wanted to remove the percutaneous endoscopic gastrostomy (PEG) tube from her body because there, Terri herself would have supported such a decision (Hook and Mueller, 2005). Terri’s parents, Mary and Robert Schindler, on the contrary, believed that nutrition and hydration should be withheld. Both positions are understandable and have weak and strong sides. Still, despite the existing moral and ethical issues, I support the idea proclaimed by Terri’s husband because it seems to be humane.

This clash of interests could be analyzed on several levels. On the legal level, “physicians must rely on surrogates (also known as proxies) to make decisions for the patient” in a PVS (Hook and Mueller, 2005, p. 1454). As it has already been mentioned, in the case of Terri, the court allowed Michael Schiavo to make decisions related to his wife. Therefore, from the legal perspective, it was fair to withdraw nutrition and hydration from Terri. What is more, according to Florida Statute 765.401, the priority in the process of decision-making on the life of a patient in PVS is given to his or her guardian and spouse, followed by adult children and only then parents. Overall, the history of debates on what to do with Terri shows that the judges followed this rule because the tube was withdrawn several times before the final withdrawal (Hook and Mueller, 2005). Still, Terri’s parents multiple times had managed to challenge the court’s decision.

Overall, the case of Theresa Marie Schiavo is a peculiar situation because it depicts how easily the court’s decisions could be manipulated and altered. This way, loopholes in laws make it almost impossible to make an informed decision on whether to withdraw or withhold nutrition and hydration from the patient that will never be conscious again (Kitzinger and Kitzinger, 2016). Such a situation creates an impression that both sides of the conflict defend the interest of their own, not of a patient. Furthermore, according to Schwartz, Posthauer, and Maillet (2013), the decision on withdrawal of the feeding tube should be discussed with the medical experts. In the given case, the healthcare professionals were on the side of Michael since they argued that there were no chances for healing. Nonetheless, the critical problem is that despite the strength of Michael’s argumentation, the Schindlers still managed to find a way to change the court’s decision several times in a row.

On the moral level, the striving of Terri’s parents not to remove the feeding tube is absolutely clear. The challenging state of their young daughter’s health did not kill their love and the hope for the better that is inherent to all parents. It is emotionally hard for mothers and fathers to accept the fact of their child’s death. It is usual for adult children to bury parents, not vice versa. If they had allowed physicians to remove the PEG tube at some point in the court proceedings, they would have felt that Terri’s death was their fault. It might be challenging to reassure family members because they commonly think that they know better how to alleviate the suffering of a patient (Marcolini, Putnam, and Aydin, 2018). This way, Mary and Robert Schindler hoped that one day some scientific development would bring their daughter back to life and that she is not dead.

The decision of Terri’s husband, Michael, was highly rational. It seems that he was devoid of illusions and soberly approached the situation. The doctors agreed that there were no chances for the healing and, hence, there was no sense in artificially keeping his wife alive. In the articles dedicated to the case of Terri Schiavo, there is no mentioning of Michael’s attempts to gain some benefits from the death of his spouse. Consequently, the primary motive behind his decision to cease feed Terri through a tube was an attempt to terminate her sufferings.

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To conclude, the case of Theresa Marie Schiavo is challenging because the arguments of both sides of the debate are reasonable. This case also raises numerous significant ethical and legal issues related to the life of patients in a PVS. I believe that it was more rational and better for everyone to withdraw Terri from the feeding tube as soon as the doctors said she had no chances for further conscious life.

References

Hook, C. C., & Mueller, P. S. (2005). The Terri Schiavo saga: the making of a tragedy and lessons learned. Mayo Clinic Proceedings, 80(11), 1449-1460.

Kitzinger, C., & Kitzinger, J. (2016). Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: family experiences. Journal of medical ethics, 42(1), 11-17.

Marcolini, E. G., Putnam, A. T., & Aydin, A. (2018). Focus: Nutrition and food science: History and perspectives on nutrition and hydration at the end of life. The Yale Journal of Biology And Medicine, 91(2), 173–176.

Schwartz, D. B., Posthauer, M. E., & Maillet, J. O. S. (2013). Practice paper of the academy of nutrition and dietetics abstract: ethical and legal issues of feeding and hydration. Journal of the Academy of Nutrition and Dietetics, 113(7), 981.

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