Introduction
The issues of life and death have always troubled human beings. In the modern society, even such eternally important concepts as life and death are regulated by the laws and legislative acts. One of the ways to rule if a person should continue fighting for his/her life or be deprived of such an opportunity is the so called health care directive, i. e. the document that “gives your family direction on what medical care you want or don’t want if you can’t communicate.
This document gives you the chance to write out your wishes” (ALLINA, 2009). This document becomes effective as soon as there is a necessity, i. e. an author of the directive is physically or mentally unable to communicate his/her will concerning the treatment procedures or their absence. The situation when a person leaves no health care directives up to the moment when there is a need of the latter becomes rather controversial, especially in the legal aspect. The case of Terri Schiavo is one of the most widely discussed examples of legal controversy surrounding the lack of health care directives.
Topic Background
The essence of the case under consideration is in the legal controversy that surrounded the court hearings dedicated to the decision of whether the treatment and artificial nutrition and hydration of Terri Schiavo was to be continued or stopped. The background to those hearings constituted 15 years of struggle that Terri Schiavo, an ordinary American, and her relatives leaved through between 1990 and 2005. The case began on 25 February, 1990, when Terri Schiavo fell from the stairs at her house in Florida. Apart from numerous traumas, Mrs. Schiavo suffered hypoxia that further developed to the extensive brain damage of the person. Finally, Mrs. Schiavo was diagnosed as a patient “in a persistent vegetative state” (Perry, Churchill, and Kirshner, 2005, p. 744).
The health condition of Terri Schiavo deteriorated rather quickly, so that the doctors did not see any possibility for her recovery and returning to the ordinary functioning (Dresser, 2004, p. 8). The husband and the parents of the patient supported her in the situation up to the moment in 1998 when Michael Schiavo, Terri’s husband, decided that his wife would have preferred to die rather than kept alive through the feeding tube.
This served as the impact to the series of court trials and legal controversy between Mr. Schiavo and the Schindlers, Terri’s parents (Cassell, 2005, p. 23). The husband addressed the Florida state court to rule the dispute and determine how the patient’s will in the case should be interpreted according to the case law, US Constitution, and the state constitution of Florida (Marks, 2004, p. 844).
The court hearings started in 2000, when Judge Greer considered the evidence presented by the opposing parties and rules, on April 24, 2001, that the artificial nutrition and hydration of the patient should stopped and the feeding tube should be removed (Perry, Churchill, and Kirshner, 2005, p. 746). In two days the court cancelled its decision and the treatment proceeded to be stopped for the second time in 2003. 6 days later artificial nutrition and hydration were resumed based on the so-called Terri’s law that entitled the Florida Governor to order the treatment resumption. Finally, the 2005 hearings resulted in the feeding tube being removed on March 18 and the patient’s death on March 31, 2005 (Perry, Churchill, and Kirshner, 2005, p. 746; Erikson, 2006, p. 6).
Community Impact of the Issue
The case of Terri Schiavo caused a lot of public discussion and controversy. According to Dresser (2004), the case under consideration is probably the most widely discussed one in the area of “life-sustaining treatment” in the American history (p. 8). Needless to say, there are supporters and the opponents of the Florida circuit court decision to remove the feeding tube that facilitated the functioning of Schiavo’s organism, but the basic laws indicate that the decision taken was correct. Thus, Florida State Constitution stipulates the right of every person for privacy and freedom of decisions regarding this person’s healthcare, and provides the possibilities for people to compile healthcare directions for these purposes (Marks, 2004, p. 843).
Further on, Chapter 765 of Title XLIV of the Civil Rights Act describes the legal actions that are to be taken if a person failed, due to this or that reason, to provide healthcare directives:
If an incapacitated or developmentally disabled patient has not executed an advance directive, or designated a surrogate to execute an advance directive, or the designated or alternate surrogate is no longer available to make health care decisions, health care decisions may be made for the patient by any of the following individuals, in the following order of priority, if no individual in a prior class is reasonably available, willing, or competent to act:
- guardian
- spouse
- adult child
- parent
- adult sibling
- adult relative
- close friend
- clinical or social worker (Onecle, 2006).
Drawing from this law, Mrs. Schiavo’s husband was the first person to decide her will as her official guardian given that Terri Schiavo left no health care directives prior to the 1990’s accident. Therefore, based on this law, on the evidence of Mrs. Schiavo’s preference not to live in the permanent vegetation state, expressed prior to the accident, and on the medical data proving the impossibility of recovery from the permanent vegetation state, the court seemingly made the right decision ruling to remove the feeding tube (Perry, Churchill, and Kirshner, 2005, p. 746; Erikson, 2006, p. 6). Accordingly, Perry, Churchill, and Kirshner (2005) consider the establishment of the clear guidelines for further proceedings in similar cases as the major community effect of Terri Schiavo case.
Related Impact
Moreover, the case of Terri Schiavo has had considerable related impact. Although the positive effect of this case is greatly doubted by scholars like Cassell (2005) and Dresser (2004), there is no dispute regarding the impact as such. For example, there is a great legislative significance of the case discussed, as Perry, Churchill, and Kirshner (2005) argue that the court ruling on this case established once again the priority of the law over any other considerations in the democratic society (p. 748). There are also other opinions expressed in the work by Perry, Churchill, and Kirshner (2005), according to which this case might serve a platform for violating and discriminating the rights of disabled people that are physically or mentally deprived of the possibility of expressing their health care will (p. 747).
The case might also have the financial impact, as funding of treatment of the patients with the health conditions identical, or similar, to Mrs. Schiavo’s ones might be considerably cut because of the court ruling that there is no need of treating the patients having no chances for recovery according to the medical examinations’ data. As well, the resources allocated for the above mentioned treatment proceeding might be cut based on the same ideas. On the other hand, people registered as official guardians might use the court ruling in Terri Schiavo case as a tool for speculating the health state of people they are in charge of for the purposes of accessing the funds allocated to their treatment.
Conclusions
Drawing from this, the impact of Terri Schiavo case on the funding and allocation of resources for health care facilities and procedures might be both positive and negative. In 2005 the circuit court of Florida was driven by law and medical evidence in its ruling to remove the feeding tube of Terri Schiavo. Based on the assumptions of Mrs. Schiavo’s guardian and on the facts presented by medical examiners of her health conditions, the court considered it impossible for her to recover. As Terri Schiavo did not leave any specific health care directives, the court based its opinion on her guardian’s considerations and medical data.
On the basis of evidence of Mrs. Schiavo’s preferences, the court decided that stopping her artificial nutrition and hydration will be the most ethical and legally correct decision (Garrett, Baillie, & Garrett, 2001, p. 112). As a result of Terri Schiavo case, there are now specific guidelines as for how the similar cases, given the similar circumstances, should be ruled. However, there is the negative impact also as the case discussed might be used as a coverage for somebody’s financial purposes. To avoid the latter, further legal investigations of the case and the laws applied to it should be carried out.
References
ALLINA. (2009). Health Care Directives. Healthcare. Web.
Cassell, E. (2005). The Schiavo Case: A Medical Perspective. Hastings Center Report, 35(3), 22 – 23.
Dresser, R. (2004). Schiavo: A Hard Case Makes Questionable Law. Hastings Center Report, 6, 8 – 9.
Erikson, J. (2006). Terri Schiavo Impact Continues One Year after Her Death. Oncology Times, 28(5), 6 – 7.
Garrett, T. M., Baillie, H.W. & Garrett, R.M. (2001). Healthcare ethics: Principals and Problems (4th ed.) Upper Saddler River, NJ:Prentice-Hall.
Marks, T. (2004). Terri Schiavo and the Law. Marks Commentary Final, 67, 843 – 847.
Onecle. (2006). Health Care Advance Directives. Florida Civil Rights CodeSection 765.401 – The Proxy. Web.
Perry, J., Churchill, L., and KIrshner, H. (2005). The Teri Schiavo Case: Legal, Ethical, and Medical Perspectives. Annals of Internal Medicine, 143, 744 – 748.