Friday, March 25, 2005
By MARTHA HENDERSON
KNIGHT RIDDER TRIBUNE
As a geriatric nurse practitioner for 30 years, a clinical ethicist and a minister, I am familiar with cases such as Terri Schiavo's. She is "in-between" how a person in a persistent vegetative state appears and that of a purposefully responsive individual. Her case is challenging on four levels, yet there are helpful ways to look at each of these.
First, medically, Schiavo suffers from anoxic brain syndrome due to a lack of oxygen when she had a heart attack 17 years ago. The severe brain damage resulted in a persistent vegetative state with her inability to think, drink or eat, talk, or use her arms or legs. Although blinking and following a light is possible in some individuals such as Schiavo, her serene facial expression and her "smiling" is harder to explain from a purely neurological point of view.
Thousands of individuals die every day through lack of fluids and nutrition regardless of the underlying terminal illness. During this gentle process the body releases endorphins or natural painkillers to allow a person to "drift away," becoming less conscious and sleeping more until death comes. Withdrawing Schiavo's feeding tube would allow the brain damage, with an inability to eat or drink, to run its course. No one would be dehydrating or starving her; rather people with honest and good intentions would no longer be forcing her to live by artificial means.
Second, legally, Schiavo's case has been through "due process" over the last seven years, having been heard in six courts. The U.S. Supreme Court has denied the request by Schiavo's family to be involved on at least three occasions since it felt the lower courts competently adjudicated the case using standard procedures. Our country's legal system is based on working through the local or state courts of a citizen's community while limiting unnecessary intrusion of the federal government.
Legal right
Additionally, the living will of many states includes the category of "persistent vegetative state" in addition to "terminal illness" as appropriate to protect an individual's right to have life-prolonging measures withdrawn. As legal surrogate in the absence of a health care power of attorney, Schiavo's husband has the legal right to have the feeding tube withdrawn.
Third, ethically, certain principles help us to determine what is the "right" or "best" thing to do in such a dilemma. In our culture, the principle of autonomy or the right of individuals to make decisions about their medical care is the most important guide. The federal Patient's Self-Determination Act of 1990 requires that medical facilities ask all patients if they have an advance directive, that is, a living will or a health care power of attorney.
Unfortunately, since Terri Schiavo had neither, her husband, as the legal surrogate, made his decision based on his knowing his wife would not want to live this way. This method of decision-making is grounded in the ethical principle of "substituted judgment" or what do you think your loved one would choose if she/he could?
Another useful ethical principle in such cases is the imperative of "best interest." It involves weighing all the issues involved and making decisions based on ethical principles as well as the benefits outweighing the burdens. In such a case as Schiavo's, when the essential human capacities of higher brain functions, such as thinking, planning and remembering, and interacting according to personality traits are lost, one does not preserve a person's dignity by insisting he/she live in a debilitated, non-functional state.
Angelic expression
Fourth, religiously or spiritually, Schiavo's case is most poignant. It is apparent many people who love her are trying to advocate for her. Though I think she would rather die than live -- and her legal representative is doing his best to grant her that wish -- the issues posing the greatest difficulty are her angelic expression and whether or not she is truly responsive.
Based on the videotaping I have seen, I believe that she is slightly responsive and connected to her mother emotionally and spiritually. I further believe Terri Schiavo is a human being who is foremost a valued child of God. From a Christian point of view, there is nothing that can destroy those connections, not even death.
If Schiavo were allowed to die, she would be free at last to be well, whole and complete, and living a new form of life in union with God.
X Martha L. Henderson is a retired faculty member and geriatric nurse practitioner who has joint appointments in both the Schools of Nursing and Medicine at the University of North Carolina. She also serves on the Ethics Consult Committee at UNC Hospital. Distributed by Knight Ridder/Tribune.