The present paper aims at providing bioethical analysis world-famous case of Terri Schiavo, a patient who was artificially kept alive for more than 15 years in a vegetative state. Ms. Shiavo experienced cardiac arrest, which led to brain injury, on February 15, 1990 (Fine, 2005). As a result, the patient’s midbrain was able to control the vegetative functions, while the upper brain was inactive (Fine, 2005). This led to unconsciousness with open eyes, which was sustained until her death on March 31, 2005. The patient’s husband, Michael Schiavo, insisted that Terry was unplugged from the feeding tube, while her parents, Robert and Mary Schindler, wanted that their daughter was kept alive as long as possible. Thus, the primary stakeholders were Terri Schiavo, Michael Schiavo, Robert and Mary Schindler, the hospital (care provider), and the State of Florida (legal framework provider). The central bioethical issue is if the patient should be allowed to die if she did not give informed consent, and the opinions of stakeholders differ.
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In a society with multiple patients’ values of modern pluralistic societies, it is crucial that bioethical analysis is conducted based on a comprehensive framework. The framework should take into consideration the principles of autonomy, justice, beneficence, and non-maleficence while keeping in mind the ideas of evidence-based practice and patient-centered care. Such a decision-making process (DMP) was introduced by Forte et al. (2018). The process included four comprehensive steps that could help a team of care providers make ethical decisions in complicated situations. First, the care providers should focus exclusively on the disease, which implies making the correct diagnosis and possible projections. In Ms. Schiavo’s case, care providers were unsure about the patient’s condition, as she was described as comatose, brain dead, vegetative, minimally conscious, locked in, and disabled at different times (Fine, 2005). Without a diagnosis or a relevant prognosis, stakeholders cannot adequately follow the principles of beneficence and non-maleficence.
Second, the care providers should have focused on the family members and assessed their values and beliefs. This act would be coherent with the principle of autonomy, as the relatives represent the will of the patient (Forte et al., 2018). In this case, relatives were unsure about their will. Third, the care provision team should collaborate with the team members to understand if the preferences of the stakeholders should be limited by the principles of justice (legal framework), beneficence, and non-maleficence. The legal framework provided the relatives of the patient with the opportunity to reject life-sustaining treatment if they could prove that the patient would have wanted so (Fine, 2005). Finally, a decision should be made based on the goals of care, communication between the stakeholders, and adherence to bioethics (Fine, 2005). In Ms. Schiavo’s case, it was decided that there was not enough evidence that unplugging her from the feeding tube would be ethical; thus, the final decision was made to continue life-sustaining treatment.
The decision to unplug would have been illegal and breached the principle of autonomy, as there was no evidence provided that the patient would want to be unplugged from the feeding tube. Additionally, the decision to stop life-sustaining treatment would be against the principle of non-maleficence, as it would kill the patient. Thus, care providers were sure that it could not be done. However, continuing treatment was associated with going against the principle of beneficence, as it was not beneficial for the patient. Thus, Ms. Schiavo’s case was complicated in terms of bioethics; however, the medical personnel made the correct choice despite the resistance of the public and Mr. Schiavo.
Fine, R. (2005). From Quinlan to Schiavo: Medical, ethical, and legal issues in severe brain injury. Baylor University Medical Center Proceedings, 18(4), 303-310. Web.
Forte, D., Kawai, F., & Cohen, C. (2018). A bioethical framework to guide the decision-making process in the care of seriously ill patients. BMC Medical Ethics, 19(1), 78. Web.