On February 25, 1990, 26-year-old Terri Schiavo collapsed in her home from a possible potassium imbalance caused by an eating disorder, temporarily stopping her heart and cutting off oxygen to her brain. On March 31, 2005, Terri Schiavo died after her feeding tube had been removed 13 days earlier. On these two points everyone connected with Terri’s case agreed. But on all other essential aspects of it, Terri’s husband Michael and Terri’s parents deeply disagreed.

The central point of disagreement was Terri’s medical condition. Terri’s husband and numerous physicians argued that she was in a persistent vegetative state. Based on this diagnosis, Michael Schiavo
requested that Terri’s feeding tube be withdrawn and that she be allowed to die with dignity in the way he asserted she would have wanted to.

Terri’s parents and some other physicians said she was not in a persistent vegetative state, and that she was capable of recognizing them and others. Based on this diagnosis, their belief that Terri would not want the intervention stopped, and their contention that passive euthanasia is morally wrong, they fought Michael’s attempts to remove the feeding tube.

What made this case especially difficult was that Terri left no written instructions that would have clearly stated her thoughts and intentions on the issue. So the ensuing legal and political
debates became based on what various people thought Terri would have wanted, as well as reflecting various aspects of people’s positions on personal rights regarding life and death.

The legal and political battles began in 1993, when Terri’s parents tried unsuccessfully to have Michael removed as Terri’s guardian. But the most heated aspects of the case began in 2000, when a circuit court judge ruled that Terri’s feeding tube could be removed based on his belief that she had told Michael that she would not have wanted it. In April 2001, the feeding tube was removed after state courts and the U. S. Supreme Court refused to hear the case. However, the tube was reinserted 2 days later when another judge ordered it. In November 2002, the original circuit court judge ruled that Terri had no hope of recovery and again ordered the tube removed, an order eventually carried out in October 2003. Within a week, however, Florida Governor Jeb Bush signed a bill passed by the Florida legislature requiring that the tube be reinserted. This law was ruled unconstitutional by the Florida Supreme Court in September 2004. In February 2005, the original circuit court judge again ordered the tube removed. On March 16 to 27, the Florida House introduced and passed a bill that would have required the tube be reinserted, but the Florida Senate defeated

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a somewhat different version of the bill. On March 19 to 21, bills that would have allowed a federal court to review the case passed in the U. S. House of Representatives and the U. S. Senate, but the two versions could not be reconciled. Over the next 10 days, the Florida Supreme Court, the U. S. district court, and a U. S. circuit court refused to hear the case, as did the U. S. Supreme Court.

The original circuit court judge rejected a final attempt by Terri’s parents to get the tube reinserted.

The public debate on the case was as long and complex as the legal and political arguments. The debate has had several positive outcomes. The legal and political complexities
dramatically illustrated the need for people to reflect on end-of-life issues and to make their wishes known to family members and others (e. g., health care providers) in writing. The case also brought to light the high cost of long-term care, the difficulties in actually determining whether someone is in a persistent vegetative state and in turn what that implies about life, the tough moral and ethical issues surrounding the withdrawal of nutrition, and the individual’s personal feelings about death. The legal community has proposed reforms concerning how these types of cases are heard in the courts and the processes used to resolve them (Moran, 2008).

Should Terri Schiavo’s feeding tube have been removed?

Every answer to this question stirs strong personal emotions, and this case will remain a watershed event for people on all sides of the debate about dying with dignity. That a state governor, state legislators, national legislators, the U. S. president, other elected and government officials, and numerous judges all became directly involved in the case demonstrates that passive euthanasia generates intense feelings and will remain an extremely controversial issue for years to come. The best course of action is to make your end-of-life intentions clearly known to others, a topic we will discuss later in this chapter.

In contrast, many people—including many physicians—go to extraordinary lengths to keep very premature infants alive, despite high risks of permanent brain damage or physical disability from the intervention. Some people point out that not only is the medical care at the time often more expensive for infants (an average of several thousand dollars per day for neonatal intensive care), but the potential cost to families and society if the person needs constant care could be enormous. In addi­tion, the emotional costs can be devastating to many families. But many such children are not affected negatively by the intervention and grow up to be normal in all respects.

Health care costs typically soar during the last year of a person’s life. For example, 30% of Medicare’s annual budget is spent treating people in the last year of their life. These costs vary a great deal depending on where you live. Appleby (2006) notes that the number of physician visits
and medical tests one undergoes differs across the United States for many reasons, including the number of physicians and hospital beds available, patient and family expectations, and the willing­ness of health care professionals to discuss the end of life.

The biggest challenge in confronting these differences in approach and cost is the difficulty in deciding when to treat or not treat a patient. There are no easy solutions to these dilemmas.

Concept Checks

1. What are the 10 ways in which death can be viewed socioculturally?

2. What are the criteria for determining brain death and clinical death?

3. What is the difference between active and passive euthanasia?

4. What are the issues regarding costs of life-sustaining interventions?