Case Analysis – CASE 1- The Case of Terri Schiavo

Case Analysis – CASE 1- The Case of Terri Schiavo

In the Terri Schiavo case, the right-to-die question was at the center of a protracted legal battle that lasted from 1990 to 2005. In 1990, Terri experienced cardiac arrest, which left her brain damaged and in a permanent vegetative condition. In 1998, her parents, Robert and Mary Schindler, opposed her husband, Michael Schiavo’s request to have her feeding tube removed. Terri’s wishes, the type of injuries she sustained, and moral reasons were important factors. According to witness testimony, Terri expressed her wish to not be sustainably living. Terri’s wishes were doubted, leading to the reversal of the initial approval for tube removal in court. The reintroduction of the feeding tube through Governor Jeb Bush’s “Terri’s Law” was one intervention impacted by political and religious concerns. Nevertheless, legal challenges continued, and in 2005, the Florida Supreme Court finally ordered its removal. The case spurred a national conversation on autonomy rights and end-of-life care. Terri Schiavo passed away soon after the court’s final decision.

Ethical Issues

Autonomy versus Beneficence

The conflict between autonomy and beneficence in the Terri Schiavo case highlights the tension between respecting an individual’s right to self-determination and the duty of healthcare providers to promote the well-being of the patient. Michael, Terri’s spouse, said that turning off life support was in line with her earlier declarations of preference, stressing personal choice. On the other hand, her parents invoked the concept of beneficence, believing that keeping her on life support was in her best interest. This conundrum highlights how difficult it may be to strike a balance between a person’s autonomy and doing good deeds, especially when the patient’s wishes are ambiguous or contested (Olejarczyk & Young, 2020).

Justice and Fairness

In terms of justice and fairness, the question is who gets to interpret Terri’s intentions the most accurately and how medical professionals may resolve disagreements so that everyone is treated fairly. The difficulties in attaining justice and fairness in end-of-life decision-making are highlighted by the court cases and varying opinions among family members. Healthcare workers must resolve these moral conundrums while adhering to the values of justice, openness, and regard for the rights and dignity of all parties concerned (Olejarczyk & Young, 2022).

Stakeholders

Terri Schiavo

The disabled person at the heart of the dispute is Terri. She believes that she is unable to express her preferences or take part in choices regarding her medical treatment. Her quality of life and well-being are of utmost importance, as her fate is determined by others. Healthcare providers are focused on Terri’s treatment as a patient, and they have a duty to respect moral precepts like beneficence and autonomy while making decisions (Haddad & Geiger, 2023).

Michael Schiavo (Terri’s Husband)

Terri’s legal spouse and principal caregiver, Michael, feels he is aware of Terri’s preferences for care toward the end of life. He argues that Terri would not want to be kept alive in her current state and is in favor of turning off life support. He saw himself as operating in conformity with Terri’s presumptive autonomy and wants, putting her right to self-determination and her standard of living first.

Terri’s Parents

Terri’s parents strongly disagree with Michael’s choice to turn off Terri’s life support. They think Terri would choose to be kept alive and to get medical care indefinitely. They saw themselves as defending Terri’s right to life and clinging to the hope that she may recover despite the likelihood being very low. Their position highlights the moral precept of beneficence and demonstrates their strong emotional relationship with Terri and wish to keep her alive.

Healthcare Professionals

The medical staff caring for Terri must balance giving her medical care with adhering to strict ethical and legal guidelines. They have to consider the patient’s desires (as determined by her surrogate decision-makers), the family’s intentions, and the medical prognosis (Ansari et al., 2021). From their vantage point, they aim to balance values like beneficence, autonomy, non-maleficence, and justice while providing compassionate care in accordance with legal laws and professional standards.

The Legal System

In settling conflicts and making decisions about Terri’s care, the legal system—including courts and judges—is essential. From their vantage point, they have to evaluate pertinent statutes and court rulings in order to decide what to do. To guarantee that choices are made in compliance with legal and ethical requirements, they seek to strike a balance between the patient’s rights, the family’s interests, and the ethical principles guiding medical decision-making.

Analysis of the Dilemma from the Healthcare Professional’s Perspective

From the standpoint of a medical expert, the Terri Schiavo case poses a challenging moral conundrum that calls for a thorough study of the Four Principles Approach—autonomy, beneficence, non-maleficence, and justice—as well as other bioethical concepts. First and foremost, Terri’s autonomy must be respected by healthcare professionals, as Michael has argued. The ability of individuals to choose their own medical care and treatment alternatives is emphasized by autonomy. According to Michael, Terri would not consent to being kept alive in her present state in this instance, which is consistent with the autonomy principle. Healthcare providers need to carefully assess this claim in light of other information, taking into account any prior declarations of Terri’s preferences and making sure that her autonomy is honored to the greatest degree feasible.

Second, healthcare professionals have a duty to act beneficently and in Terri’s best interest. The duty to improve patients’ well-being and deliver interventions that maximize benefits while limiting risks is emphasized by this notion. To decide on the best course of action for Terri, medical personnel must evaluate her current state of health, her prognosis, and available alternatives for treatment (Varkey, 2020). Healthcare practitioners are also obligated to provide justice and fairness in the decision-making process and to minimize harm (non-maleficence). They have to carefully weigh the advantages and disadvantages of several treatment choices, steering clear of any that would put Terri through needless pain or harm. They also have to make sure that decision-making procedures are just and equitable, taking into account the opinions of all parties concerned and abiding by the law and ethical norms.

A Comparison to the Marlise Muñoz Case

Description

In 2013, Marlise Muñoz, a 33-year-old lady from Texas, passed away due to a pulmonary embolism. She was 14 weeks pregnant during the incident. Despite being certified brain dead by medical professionals, Muñoz’s family’s wishes to withdraw life support were first denied due to Texas legislation, which required ongoing life support for pregnant patients. The legal dispute arose between Muñoz’s right to die and her family’s desire to respect her wishes.

Similarities

End-of-Life Decision-Making

Similar to the Terri Schiavo case, the Muñoz case involves difficult judgments about withdrawing life support for an impaired patient. Both scenarios underscore the complexity of end-of-life care and the significance of clearly communicating the patient’s intentions.

Divergent Understandings of the Patient’s Desires

Family members and medical professionals disagreed on the patient’s desires in both situations. Although Muñoz’s family originally faced opposition from legal and medical authorities, they wished to respect her presumed desires to not be artificially sustained (Ansari et al., 2021).

Differences

Reproductive Rights

In contrast to the Terri Schiavo case, the Muñoz case pertains to the extra dimension of reproductive rights. Due to Muñoz’s pregnancy at the time of her brain death, concerns regarding the autonomy of the pregnant woman and the unborn have been raised.

Legal Framework

The two situations have different legislative frameworks for end-of-life care. While the Muñoz case included Texas legislation particularly addressing the rights of pregnant patients, the Terri Schiavo case principally involved the interpretation of Terri’s wishes and Florida law.

Impact of Schiavo’s Case

Significant influence has been exerted by the Terri Schiavo case on later issues concerning end-of-life decision-making. It has highlighted the significance of expressly communicating patients’ desires regarding their medical care and creating advance directives (Varkey, 2020). Many states have passed or updated legislation pertaining to end-of-life care in response to these predicaments. These laws include clauses addressing the removal of life support and the designation of healthcare proxies.

Policies, Procedures, and Standards

Following situations such as Terri Schiavo’s and Marlise Muñoz’s, medical facilities and law enforcement agencies have put in place extensive protocols and procedures. These precautions include procedures for identifying brain death, rules for following advance directives, and legal channels for settling disagreements on care for the dying. Healthcare personnel are also trained in ethical decision-making and communication techniques so they may effectively handle difficult circumstances, including patients’ autonomy and family relations. In the end, these initiatives seek to promote patient-centered care and protect patients’ rights and dignity at the end of life by making sure that patients’ desires are honored, ethical standards are maintained, and conflicts are resolved fairly and openly.

Conclusion

My perspective on advance directives has been profoundly impacted by researching the Terri Schiavo case. The need for having precise and formalized advance directives in place has been highlighted by observing the intricacies and court battles surrounding Terri’s situation. It has brought attention to the possible repercussions of not having one’s wishes clearly expressed, particularly when incapacitation prevents people from communicating their choices.

Now that I have had this exploration, I’m seriously thinking about finishing my own advance directives. The event has provided a potent reminder of both the unpredictable nature of life and the value of making advance plans for future medical decisions. Having advance directives in place would guarantee that my desires are known and honored in the event of incapacity and would give clarity and advice to my loved ones and healthcare staff. This proactive measure will provide peace of mind, knowing that my preferences will be respected, especially in difficult situations, and it is consistent with my values of autonomy and dignity in healthcare decision-making.

References

Ansari, R. M., Harris, M., Hosseinzadeh, H., & Zwar, N. (2021). Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis. International Journal of Environmental Research and Public Health, 18(18), 9869. https://doi.org/10.3390/ijerph18189869

Haddad, L. M., & Geiger, R. A. (2023, August 14). Nursing ethical considerations. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Olejarczyk, J. P., & Young, M. (2020). Patient Rights. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/#:~:text=A%20patient%20has%20the%20right

Olejarczyk, J. P., & Young, M. (2022, November 28). Patient rights and ethics. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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CASE 1: The Case of Terri Schiavo
Introduction

We will use case analysis to extend our examination of patient autonomy with one of the earliest cases surrounding patient rights and patient autonomy. However, the case of Terri Schiavo has tested the balance of decision-making when patients may no longer speak for themselves.

Instructions

Before writing your case analysis, make sure you have gone through the readings associated with the Schiavo Case Analysis. The articles listed below are provided to assist you with completing the assignment. While you are welcome to use other sources as well, it is not necessary.

The Module Notes of Modules 1 – 4
Cyranoski, D. (2012). The mind reader. Nature, 456, 178-180.
Ditto, P. (2006). What would Terri want? On the psychological challenges of surrogate decision making. Death Studies. 30(2), 135-148. Retrieved on October 13, 2010, from Academic Search Premier database
Fins, J. (2009). Brain injury: the vegetative and minimally conscious states. Garrison, NY: The Hastings Center, Bioethics Briefing Book.
Mathes, M. (2005). Terri Schiavo and end-of-life decisions: The law help us out? MEDSURG Nursing. 41(3), 200-202.
Perry, J., Churchill, L. R. & Kirshner, H.S. et al. (2005). The Terri Schiavo case: Legal, ethical, and medical perspectives. Annals of Internal Medicine. 143(10), 744-748.
Terri Schiavo Documentary: The Case’s Enduring Legacy | Retro Report | The New York Times
After reviewing the case study articles, respond to the following questions:

Provide a brief introduction of the Terri Schiavo case.
Identify at least two ethical issues that relate to this dilemma.
Identify at least five stakeholders and briefly describe the situation from their perspective.
Analyze the dilemma from the perspective of the healthcare professional, applying one of the frameworks that are discussed in the module or one that you may use in your professional work. Be sure to address each element.
Identify a more recent case involving patient decision making when they are no longer able. After providing a brief introduction to the case, identify some of the similarities and differences. In what ways has Schiavo’s case impacted this case? Explain what types of policies, procedures, and standards have been put in place to assist in preventing such a dilemma.
Briefly discuss what you have learned from your exploration of the Terri Schiavo case. Has the case influenced your view of advanced directives? Presuming you have not already, are you now considering completing your own advance directives? Why or Why Not?