Do you see how the families’ desires conflict with Terry’s intended wishes?

Case Study
Perhaps the one case study that best depicts the effect that therapeutic jurisprudence might have involves the case of Theresa (Terri) M. Schiavo. Ms. Schiavo suffered a cardiac arrest in February 1990. She was without oxygen for approximately 11 minutes, or 5 to 7 minutes longer than most medical experts believe is possible to sustain without suffering brain damage. At the insistence of her husband, she was intubated, placed on a ventilator, and eventually extubated and received a tracheotomy. The cause of her cardiac arrest was later determined to be a severe electrolyte imbalance caused by an eating disorder, as Ms. Schiavo had lost approximately 140 pounds, going from 250 to 110 pounds, in the months before her cardiac arrest.
Ms. Schiavo was in a coma for the first 2 months after her cardiac arrest. She then regained some wakefulness and was eventually diagnosed as being in a persistent vegetative state (PVS). She was successfully weaned from reflexive behaviors. Characteristic of persistent vegetative state, Ms. Schiavo was not able to eat food or drink liquids, and a permanent feeding tube was placed so that she could receive nutrition and hydration.
Once the media became aware of Ms. Schiavo’s condition, court battles regarding the removal or retention of her feeding tube were initiated. During these hearings and trials, sufficient medical and legal evidence to show that Ms. Schiavo had been correctly diagnosed and that she would not have wanted to be kept alive by artificial means was introduced. Laws in the state of Florida, where Ms. Schiavo resided, allowed the removal of tubal nutrition and hydration in patients with PVS. The feeding tube was removed, but was later reinstated following a court order.
Questions:
What legal issues concerning the scenario do you see?
Do you see how the families’ desires conflict with Terry’s intended wishes? Identify the legal issues involved with this situation and then instruct a group of nurses about advanced directives and the lessons learned from Terry Schiavo.
Finally, if you could make a law and put it into the Florida Legislation, what kind of law would you write that gives tribute to the suffering that Terry went through? Let’s call it Terry’s law in respect for her…
ANSWER
Legal issues concerning the scenario:
Right to life: Does a person in a persistent vegetative state have the right to life?
Right to die: Does a person in a persistent vegetative state have the right to die?
Informed consent: Did Ms. Schiavo give informed consent to the placement of the feeding tube?
Advance directives: Did Ms. Schiavo have any advance directives that expressed her wishes regarding end-of-life care?
Substituted judgment: If Ms. Schiavo did not have any advance directives, who should make decisions about her end-of-life care?
How the families’ desires conflict with Terry’s intended wishes:
Ms. Schiavo’s husband, Michael Schiavo, wanted the feeding tube removed, while her parents, Bob and Mary Schindler, wanted it kept in place. Michael Schiavo argued that Terry would not have wanted to be kept alive in a persistent vegetative state, while her parents argued that she would have wanted to live at all costs.
Legal issues involved with this situation:
The legal issues involved with this situation include the right to life, the right to die, informed consent, advance directives, and substituted judgment.
Instructions for a group of nurses about advanced directives and the lessons learned from Terry Schiavo:
Advanced directives: Advanced directives are legal documents that allow people to express their wishes about end-of-life care in advance. There are two main types of advance directives: living wills and durable powers of attorney for healthcare. A living will is a document that states whether or not a person wants to receive life-sustaining treatment if they become terminally ill or incapacitated. A durable power of attorney for healthcare is a document that appoints someone to make decisions about a person’s healthcare if they are unable to make decisions for themselves.
Lessons learned from Terry Schiavo: The case of Terry Schiavo highlighted the importance of advance directives. It also showed that it can be difficult to determine a person’s wishes about end-of-life care if they do not have any advance directives.
Terry’s law:
Terry’s law could be a law that requires all adults to have advance directives. The law could also require healthcare providers to discuss advance directives with their patients.
Here are some specific provisions that could be included in Terry’s law:
All adults over the age of 18 must have a living will or a durable power of attorney for healthcare.
Healthcare providers must discuss advance directives with their patients at least once a year.
If a patient does not have any advance directives, the healthcare provider must appoint a surrogate decision-maker on the patient’s behalf.
Terry’s law would help to ensure that everyone’s wishes about end-of-life care are respected. It would also help to reduce the number of legal disputes over end-of-life care.