Running head: FIGHTING FOR DEAR LIFE: AN ETHICAL CASE STUDY ON

Fighting for Dear Life: An Ethical Case Study on Terri Schiavo
Catherine Grace Bautista
Adventist University of Health Sciences
Ethical and Legal Issues in Healthcare
HTCA543
Dr. Stanley Dobias
February 24, 2015

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Introduction
Death is inevitable. However, for some of us, we fail to express our final wishes to our loved ones and this more often than not ends in conflict. In the United States, it is necessary for an individual to have a living will since this provides answers to end of life issues that would be in question. The story of Terri Schiavo was a case study worthy of note given that concerns or conflicts about end of life care have never been a source of familial dispute in my native country, the Philippines. Her 15-year saga brought about several questions that correspond to moral, ethical, and legal issues.
Terri Schiavo’s end of life issue has now set a treacherous precedent for all vulnerable
Americans, especially those who are in the marginalized sector: the disabled, those who have terminal illnesses, those who can no longer speak for themselves, and perhaps one day even to those who are indigent and unable to pay for costly health care. These individuals may become gradually compelled to make the choice to die and “get out of the way” notwithstanding their true wishes.

Early Years
Therese Marie Schindler was born to devout Catholic parents, Robert and Mary in a Philadelphia suburb on December 3, 1963. Her father was an industrial equipment dealer while her mom was your typical Italian mother who enveloped guests in their residence with hugs and kisses. They were equally devoted to each

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member of the family. (Evans, 2010)
Terri has been battling with her weight since younger days. In fact, during her senior year she reached around 200 pounds. However, when she started off in college, she shed off about 65 pounds. She met Michael Schiavo in her sociology class at
Bucks County Community College. According to friends and family, Michael was
Terri’s only love. They were engaged during the first year of meeting and exchange their vows on November 10, 1984. Shortly thereafter, they settled in St. Petersburg,
Florida where Michael got a job managing a restaurant at nights and Terri worked at an insurance company during the day. ("," n.d.)

Beginning of the Crisis
However, their marital bliss was literally short-lived. On February 25, 1990,
Terri Schiavo collapsed at her home after a distress call from Michael Schiavo who was found face down in their apartment in St. Petersburg. Her arrest was attributed to a potassium imbalance associated with bulimia. The Schindlers, on the other hand, suspected that Michael tried to strangle her based on the testimony by a neurologist where it indicated that she suffered a neck injury during admission. She was subsequently diagnosed with PVS or Persistent Vegetative State and a PEG or
Percutaneous Endoscopic Gastrostomy was inserted into the stomach for continuous delivery of vitamin-enriched liquid sustenance. (Eisenberg, 2005)
In the State of Florida, Michael Schiavo was granted legal guardianship of Terri

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in June 1990. At the outset, the Schindlers and Schiavo shared their grief and efforts to help Terri through care and rehabilitation. Michael Schiavo sought damages for medical malpractice from the doctors who previously examined Terri. He won a total of $1.3 million, some of which was put into a trust fund to pay off medical care costs.
Sooner than later, there had been fallout between the parties that initially started over money, which subsequently escalated to a bitter quarrel over Terri’s life that eventually spilled into public view.

The Fallout
Numerous sources in different media platforms highlighted that Michael
Schiavo made no mention of his wife’s alleged wish to die and conversely pleaded for the opportunity to take care of his wife the rest of her life. This was the ultimate reason why he sought over $20 million to meet the cost of her future medical and neurological care provided that her life expectancy would be around 50 years old. He further mentioned in the jury that he pursued nursing in order to provide accurate care for his wife given his debilitating condition. However, his statements to the jury were contradictory to the actions he later executed when he started to withdraw any further treatment and rehabilitation, taking into account the time when Terri suffered
UTI or Urinary Tract Infection. He ordered the medical staff not to treat it and was merely following doctor’s recommendations. He further entered a DNR or Do Not
Resuscitate in her chart, but later retracted after the Schindlers vehement objection.

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(Gibbs & DeMoss, 2008)
When Michael came to terms with Terri’s diagnosis was the same time that he started his intense relationship with Jodi Cantonze whom he had a connection for over 13 years and fathered 2 children with her. ("," n.d.) In 1993, the Schindlers formally challenged Michael’s guardianship that was later dismissed in court. It was also this moment that Michael actively mentioned that Terri has expressed her end of life issues orally on an occasion that her grandmother was on a life support stating that should she ever be in that situation, she would not want to be a burden to anyone. This statement indicated her desire not to exist in that unbearable state.
(Eisenberg, 2005)
It should be noted that in the state of Florida, oral expression of end of life wishes is considered. In the same manner that a feeding tube, is seen as a life support device on par with a respirator.

Final Moments: Fourteen Days to Die
Several years after the litigation of Terri Schiavo’s case, Judge Greer has finally concluded the trial in 2005 where he issued a detailed, written opinion on what he determined that Terri was indeed on PVS stating that she no longer has the hope of ever regaining consciousness; and thereby feeding tube should be withdrawn. On a
Friday afternoon of March 18, 2005, Terri’s PEG tube was removed following a court order. With the withdrawal of ANH or artificial nutrition and hydration, she is

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expected to die within seven to fourteen days. (Fuhrman, 2005)
As a nurse, I am committed to the preservation of the dignity and life of a person, reading the facts about this painful ordeal is so devastating. It should be known that before this unkind act, Terri was not dying nor was she terminally ill. She was not brain dead or comatose. She was otherwise seen as healthy, mentally disabled woman. PVS diagnosis is subjective and has been disputed by many medical experts in different fields including neurology. She breathes on her own and does not require the aid of a ventilator. Her only dependence was the feeding tube for her source of liquids and nourishment.
Visiting hours were limited to the immediate family of Terri, videos and photographs are forbidden. Personal accounts of the family about her state describe her with skin, sunken, eye sockets sticking out, cheekbones dominate her face and teeth are seen protruding. (Fuhrman, 2005, p. 8) Mary Schindler stopped calling on her daughter at the hospice after a week without nourishment or hydration stating that it was too excruciating for her to see her with the skeleton look on her face. She disclosed that she could not bear witness Terri starve to death. (Fuhrman, 2005). On
March 27, David Gibbs, the Schindlers personal lawyer described Terri to be rapidly declining. A final Catholic rites were given to her, but she failed to take the host for the reason that her tongue was too dry and parched. She was only given a drop of the wine. This was the same time that the Schindlers has sought to appeal to Governor
Jeb Bush to which he articulated that he respected the court order and cannot go

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against it. He mentioned that he does not have influence from the U.S. constitution or the Florida Constitution for that matter to intervene in such a case after a decision has made final. (Fuhrman, 2005, p. 11) On March 30, disturbing accounts of Terri by
Suzanne Vitadamo, her sister illustrating how she looked with her skin turning blue.
Her breaths were labored with eyes half-open and the pupils were moving back and forth rapidly. She described seeing her sister as what death looks like. (Fuhrman,
2005) On March 31st, Friday at 9:05 in the morning, Terri Schiavo has finally succumbed to death. Thereafter, the immediate families of Terri were not allowed to spend the last moments with her before her body was set to be taken to the Pinellas
County Coroner’s office for an autopsy.

Life that Matters
Terri Schiavo’s circumstance was a case of nonvoluntary/active euthanasia. She was being killed when her wishes were unclear. Her husband claimed that she has expressed her desire, but at best it was uncertain. She left no advance directive. In fact, some of those close to Terri reported that she has reacted to the removal of her feeding tube and has expressed a desire to live, but her verbalizations were very indistinct. Terri has survived 15 years in her current state. She will likely to live for many more years if she was given minimal care that all living things need to survive – and that was in the form of nutrition and hydration. Personally, I believe that government should never let an innocent life be intentionally taken by anyone without

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proper justification. The opinion of Judge Greer should not have been seen as enough. The judiciary system should have been vigilant when a husband wanted to end the life of his own wife; the legislative and the executive branches of the US government must have intervened to check the inappropriate power executed by the judiciary. For me, there is no such thing as a life not worth living. It is evident that every person would like to die with dignity and grace. Several ethical questions were raised by Terri Schiavo’s case and to this date have been controversial. Was Michael
Schiavo acting in her best interest? Is terminal dehydration painful? Is there no other way to terminate her suffering? Was it fair or just to employ the distribution of scarce resources? These and more questions pose a challenging task for us to look back into the 15-year saga and continue to draw good out of the sad and tragic way in which
Terri was treated. (Hook & Mueller, November 2005)
As a future healthcare administrator, it is necessary to ease the preparation of directives for our patients and ourselves. Most importantly, we need to facilitate discussions between patients and their surrogates and other family members about medical issues, in particular the LSTs or life sustaining treatments. It is an unmistakable lesson from the case that physicians should take the time and discuss with patients, their health care goals, fears, beliefs, directives are competent, that is, that they are truly informed consent and refusal and that they should accurately reflect the wishes of our patients. It was evident during the course of the litigation;

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supporters abound, especially from the persons with disabilities. Tragically, the
Schiavo case illustrated that many disable persons felt devalued marginalized and threatened in the society. We need to heed to their message and be an advocate for their sector, and become actively engaged in the promotion of their concerns and acceptance especially in the field of healthcare. (Hook & Mueller, November 2005)

Conclusion
After reading several books and articles, watched countless documentaries from both sides of the fence; one thing was certain. Nobody really has an answer to what
Terri Schiavo would have wanted. While the husband is the typical surrogate in this case, his status has been challenged several times over the decade by her parents. In the same manner, it was mentioned that there is no absolute certainty over her cognitive status. Was she minimally conscious or was she in a permanent vegetative state? As a human being, being starved to death helplessly despite the presence of comfort measures delivered pharmacologically and what not, Terri could and still feel pain from dehydration and starvation. She was left to die and remained as a silent witness amidst all the drama that transpired around her over the years.
Theresa Marie Schindler Schiavo was not terminally ill or near death. Her case did not constitute an end-of-life decision, instead a resolve to end a life.

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References
Eisenberg, J. B. (2005). Using Terri: The Religious Right’s Conspiracy to Take Away Our
Rights. San Francisco: Harper San Francisco, a div. of Harper Collins
Publishers.
Evans, A. R. (2010). Is God Still at the Bedside?: The Medical, Ethical, and Pastoral Issues of
Death and Dying (1st ed.). Grand Rapids, Michigan: Wm. B. Eerdmans
Publishing Co.
Fuhrman, M. (2005). Silent Witness: The Untold Story of Terri Schiavo’s Death (1st ed.).
New York: Harper Collins Publishers.
Gibbs, D. C., & DeMoss, B. (2008). Fighting for Dear Life: The Untold Story of Terri
Schiavo and What It Means for All of Us . [Kindle]. Retrieved from https://kindle.amazon.com Hook, M.D., C. C., & Mueller, M.D., P. S. (November 2005). The Terri Schiavo Saga:
The Making of a Tragedy and Lessons Learned [Mayo Clinic Proceedings]. ,
80(11), 1449–1460. Retrieved from http://www.mayoclinicproceedings.org/article/S0025-6196(11)61439-0/fulltext Terri Schiavo Case. (n.d.). In Wikipedia. Retrieved February 15, 2015, from http://en.wikipedia.org/wiki/Terri_Schiavo_case