Search Results

This chapter examines what we know and are learning about the permanent vegetative state and the minimally conscious state, as well as the new, promising techniques to distinguish between the two. It also reviews the evidence about Terri Schiavo's condition.

This introductory chapter begins with an overview of the Terri Schiavo case. In 1998, eight years after the collapse that caused Terri to enter a vegetative state, her husband, Michael Schiavo, began a long court battle to remove her feeding tube. Without it, Terri would certainly die. Michael insisted that this was what Terri would want. Her parents, Robert and Mary Schindler, disagreed. In court, they argued that Terri would not have wanted the feeding tube removed. The chapter then sets out the book's two main goals. The first is to provide an explanation of what happened and why in the battle over the removal of Terri Schiavo's feeding tube. A second aim is to see what lessons can be learned the Schiavo controversy in the larger context of the law, ethics, and culture of end-of-life decision making.

This chapter examines the impetus, motivations, and ultimate goals of the provision of basic care, and how these relate to the patient in a permanent vegetative state. It argues that while providing food and water to someone who hungers or thirsts is a most basic sign of human compassion and responsibility, such as not the case a person who cannot experience hunger or thirst. When a person's life has become only a biological effort, and when we recognize that nutrition and hydration are likely to be provided only to satisfy our own sense of caring rather than to respond to what the person can feel or would want, then we are not helping at all. The fear of letting another die when we might extend that life must be balanced by our understanding that we cannot use—or demand—another human being's existence to improve our own.

This chapter examines the limits of evidence regarding the wishes of a person in a permanent vegetative state. It argues that we should allow the evidence to be weighed fairly—a preponderance of evidence for one answer or another is preferable to a more onerous standard when determining the course of action with respect to permanently vegetative patients. We should not be required to produce overwhelming evidence of a wish to refuse treatment before allowing it to be withdrawn. Much more caution should also be exercised with living wills, especially those that are poorly written. For many, if not most, of us, a good discussion with loved ones and appointment of a health care proxy are better than even a well-written living will.

Under the law, the surrogate speaks for the patient, but it is the patient's wishes that must direct the surrogate's expression. In other words, the surrogate is supposed to be a mere conduit and should refrain from injecting personal wishes into his or her statement of the patient's wishes. This chapter asks the following questions: When surrogates speak for the patient, are they putting their own words into the patient's mouth and placing their own interests first? Realizing that this is a risk with our system of surrogate decision making, how do we account for it? Why do we even look to families to speak for patients? What is their proper role? Surrogacy factors unique to permanent vegetative state are also discussed.

This chapter examines how biopolitics overwhelms medicine and bioethics in the case of Terri Schiavo in which all branches of government became involved in an attempt to overturn her husband's decision to stop tube-feeding her so that she could die. It suggests that the goal for many in the compelling morality play of Schiavo was not to preserve her life or liberty, but to preserve their own political futures by avoiding imputed membership in the “culture of death.” The case of Schiavo, a young Florida woman in a permanent vegetative state, is a worst-case bioethics scenario in at least three senses: her case is one of the worst cases in American bioethics; it represents what can happen when opposing sides each take extreme positions; and the extreme positions taken are themselves a product of worst-case scenario thinking. This chapter analyzes the debate concerning Terri Schiavo's case, with particular emphasis on various parties involved such as her husband, Michael Schiavo, her parents and siblings, the courts, “right to life” groups and fundamentalist religious organizations, Congress, and President George Bush.

The argument here moves on to the justifiability of non‐voluntary euthanasia for patients lacking decisional capacity. Two categories of cases are examined: patients who were formerly competent and those who are never competent. For patients in the first category, especially those who have come to suffer from severe dementia or permanent vegetative state, reliance on advance directives, including euthanasia directives, is defended. For patients in the second category, especially infants with serious disabilities, euthanasia can sometimes be justified as being the best means of preventing unnecessary suffering.

This chapter describes the legal battle between Michael Schiavo and Terri's parents over the removal of her feeding tube. It details the widespread publicity generated by the case; how the U.S. legislature, the president, and the federal courts became involved in the case; and the continued animosity between Michael and Terri's family in the days leading up to her death on March 31, 2005.

This chapter examines legal cases that addressed the fate of incompetent patients in a permanent vegetative state (PVS). In particular, it considers the initial set of questions that arose when PVS first appeared in state and federal courts, such as whether a competent, dying person has the liberty to choose to die with a physician's assistance, or who decides when life support is withheld, or discontinued and withdrawn, from a competent patient. The chapter focuses on two U.S. Supreme Court cases that initiated debates over an incompetent patient's right to die: In Re Quinlan (1976) and Cruzan v Director, Missouri Dept of Health (1990). It also discusses state responses to Cruzan, which ruled that a competent person has a liberty interest under the U.S. Constitution's Due Process Clause in refusing unwanted medical treatment.

This chapter examines legal cases that addressed the fate of incompetent patients in a permanent vegetative state (PVS). In particular, it considers the initial set of questions that arose when PVS first appeared in state and federal courts, such as whether a competent, dying person has the liberty to choose to die with a physician's assistance, or who decides when life support is withheld, or discontinued and withdrawn, from a competent patient. The chapter focuses on two U.S. Supreme Court cases that initiated debates over an incompetent patient's right to die: In Re Quinlan (1976) and Cruzan v Director, Missouri Dept of Health (1990). It also discusses state responses to Cruzan, which ruled that a competent person has a liberty interest under the U.S. Constitution's Due Process Clause in refusing unwanted medical treatment.

This chapter examines the controversy surrounding the In Re Schiavo case, which highlighted the ideas of privacy, due process, and the right to die. The debate was the right of Terri Schiavo, who was in a permanent vegetative state (PVS), to end her life. The legal battle was between Terri's husband, Michael Schiavo, and her parents over whether her feeding and hydration tube should be removed in order to end her life. This chapter considers the issue of a person's liberty and personal autonomy that came to the fore in Terri Schiavo's case and how the right-to-die debate became politicized when Florida's legislators and governor, Jeb Bush, as well as Congress and President George W. Bush, got involved in the case. It also looks at the clinical death of Terri Schiavo in 2005 and the U.S. Supreme Court denials of certiorari with regards to her case.

This chapter examines the Law Hospital NHS Trust case (1996) involving Janet Johnstone, a patient in a permanent vegetative state (PVS). Johnstone received assisted nutrition and hydration (ANH) treatment for almost three years. The issue in this case is whether or not the State, through the courts, can allow medical professionals to discontinue the ANH treatment and bring about the death of a PVS patient. The case moved from the Court of Session to the House of Lords whose ruling favoured the discontinuance of the ANH treatment. The case highlighted ethical and clinical dilemmas. The ethical dilemma centred on whether or not it was right to discontinue Johnstone's life support. The clinical dilemma focused on whether or not it could ever be appropriate to continue to use scarce resources, namely the time and expertise of medical professionals.

This chapter examines the controversy surrounding the In Re Schiavo case, which highlighted the ideas of privacy, due process, and the right to die. The debate was the right of Terri Schiavo, who was in a permanent vegetative state (PVS), to end her life. The legal battle was between Terri's husband, Michael Schiavo, and her parents over whether her feeding and hydration tube should be removed in order to end her life. This chapter considers the issue of a person's liberty and personal autonomy that came to the fore in Terri Schiavo's case and how the right-to-die debate became politicized when Florida's legislators and governor, Jeb Bush, as well as Congress and President George W. Bush, got involved in the case. It also looks at the clinical death of Terri Schiavo in 2005 and the U.S. Supreme Court denials of certiorari with regards to her case.