Thursday, April 2, 2015

Ten Years After Terri Schiavo, Death Debates Still Divide Us: Bioethicist


  1. The picture of Terri Sciavo which begins this article, along with numerous images of Terry Schiavo available on Google images seem to put into perspective the statement that: "He did not want her to live in a permanent vegetative state, unconscious, unresponsive and unable to interact with the world since he felt that she would not want to be in that condition." You are seeing a patients who is, allegedly "unconscious, unresponsive and unable to interact with the world." This is the patient who would be, by legal mandate, dehydrated and starved to death.

    "The facts did not support those, including Terri Schiavo's parents, who held that she was not in a permanent coma. An autopsy definitively settled that question. Her brain was severely atrophied, weighing less than half of what it should have. No treatment then or now could have reversed the brain damage she suffered. She was not conscious for all those years and never again would be." A great many of my patients have brains weighing less than half of what they should be, with severe atrophy. Nonetheless, they are happy and sad, they go to special education programs and their parents are highly committed to their care and have a relationship with them. I am puzzled by the naivete of an esteemed bioethicist who would think that brain size is the final determinant and that "an autopsy definitively settled the question." Indeed, the brain size and atrophy was well established by premortem brain imaging. The autopsy added little or nothing.

  2. “You have an estranged husband who is living with another woman being praised for deliberately starving and dehydrating his wife.” See:

    The article ends with a list of patients given hopeless prognoses whose recovery was much better than anticipated.

  3. See also:

  4. "What was it about Terri Schindler Schiavo and her tragic case that captivated the world? It's a question that I suspect many of you asked yourselves during the media firestorm that surrounded this long drama which ended in the dehydration and starvation death of a beautiful, courageous woman.

    The answer is before our eyes. It was her humanity, her courage, and a will of iron that kept her alive in the face of determined efforts that began in 1998 to remove the tube that nourished her. And it was not only pro-lifers who were stirred by her helplessness. Disability rights activists told the world over and over again that if a severely brain-injured woman can suffer this ghastly fate, the same mentality that justified her death could be applied to other categories of people with disabilities...

    But what happens when love isn't enough? Why did so many people want Terri to die? What would you do if it was your loved one with a disability who received an irreversible death sentence through a court order? These are the questions that Terri's family, the Schindlers, attempt to answer in their book, A Life That Matters: The Legacy of Terri Schiavo--A Lesson for Us All.


  5. "As I argued one year ago, my primary issue with the Terri Schiavo episode was that instead of rational arguments for ending her life, there was an underlying sense that one must be crazy to care about someone who could not think. I appreciate the complexity of end of life issues and recognize that there is legitimate debate among good-intentioned people regarding how to deal with those questions.

    But it is a major leap to go from terminal illness to valueless life. To debate and discuss how aggressively to treat a patient with an incurable disease is healthy. To discuss ending the lives of people because we see no value in their continued existence is reprehensible."


    See also:

  6. Luchetti M. Eluana Englaro, chronicle of a death foretold: ethical
    considerations on the recent right-to-die case in Italy. J Med Ethics. 2010

    In 1992, Eluana Englaro was involved in a car accident in Italy that eventually left her in a permanent vegetative state requiring artificial nutrition and hydration. This paper, after briefly reviewing Eluana's case, gives a chronicle of Eluana last months until her death on 9 February 2009, and discusses the right-to-die controversy in Italy. For many years, Mr Englaro, Eluana's father, would litigate to enforce what he considered to be his daughter's wish to discontinue life-prolonging treatment. In July 2008, the Court of Appeal of Milan has given its authorization for artificial life support to be withdrawn. This ruling sparked a crusade, led by the government and the Vatican, against the court and Eluana's father, which included insinuations that the latter was murdering his daughter. Public opinion has overwhelmingly been sympathetic to the father's difficult decision, in stark contrast to the reactionary stance taken by the government. With the notable advances of medicine, doctors are increasingly faced with ethical issues. The vegetative state is just one of the many clinical conditions that obligate health professionals to reflect on ethical matters. The withdrawal of life-supporting care, and of artificial nutrition and hydration in particular in permanent vegetative state patients remains a measure which violates a tradition and a consolidated practice. It was thus inevitable that it would create great controversy. We should work towards making a decision process that ensures that continuation or suspension of artificial nutrition and hydration follows an explicit procedure, promoting the sharing and respect of the diverse moral responsibility of family members, nursing and medical staff.

  7. Unlike Schiavo’s parents, Mr. Englaro has appeared on TV frequently in the last decade, asking officials to free his daughter from ‘‘the inhumane and degrading condition in which she is forced to exist’’. He argued that Eluana said plainly during her life that she would not wish to live in a vegetative state. The man has been fighting for 10 years, particularly against Catholic officials and politicians who follow the Vatican’s line, that removing life support is equivalent to euthanasia. During that time, the case has sparked controversy because of the current debate in Italy on end-of-life issues. Now, the final decision of the Cassation Court confirms a lower court ruling that authorised doctors may be permitted to let Miss Englaro die. The court rejected an appeal from Milan prosecutors, saying it was ‘inadmissible’ because the case did not concern the general interest, as the prosecutors argued, but individual rights. Meanwhile Eluana’s lawyers labeled this judgment ‘perfect’. Catholic politicians were quick to condemn the ruling and promised a law that would reverse it. Critics of the decision accuse judges of sneaking in euthanasia through the back door. The Vatican harshly criticized the court’s decision. Cardinal Tettamanzi, the archbishop of Milan, says he is hoping civil authorities will ‘change their minds’ about allowing ‘a beloved creature of God’ to be deprived of food and water. Also, the Italian government of Silvio Berlusconi has attacked the court ruling and questioned the ability of judges to determine that her condition is ‘irreversible’. Roberto Formigoni, President of the Lombardy region, stated that “…any doctor who kills a patient by removing the feeding tube would face disciplinary action for failing to honour commitments to the well-being of their patients”. Indeed, both the government and Catholic officials are worried the Englaro decision will pave the way for a court ruling or legislation in the Italian parliament that would legalize assisted suicide or euthanasia. Luca Volonté of the Catholic party claimed that “the Cassation Court has authorised the first state homicide”. Isabella Bertolini of Premier Berlusconi’s Party accused the Cassation Court of “signing Eluana Englaro’s death warrant and opening a deep wound in the country which will be hard to heal’’...

    It often happens that when conflicts involving end-of-life issues reach the public, they are considered essentially religious in nature. Instead, such decisions should primarily follow ethical and moral principles. Some medical societies, including the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI), have taken up a position to guide physicians dealing with terminally ill patients. In general, the ideal guidelines when dealing with the end-of-life issues should take into account several aspects, including the distinctions between withholding and withdrawing treatments, adequate pain management, and relieving burden. Information to the families should be delivered in ways that are sensitive to their cultural, religious, and language needs. Because print and broadcast media reports influence public perception and opinion about medical conditions, they have a social responsibility to educate by accurately explaining the basic facts necessary to understand the issues. It is easier to be touched than to reflect.

    Statement of Eluana Englaro (after the accidental death of a friend, and shortly before her car crash): If ever I will not be what I am now, I’d rather prefer to leave.

    Striano P, Bifulco F, Servillo G. The saga of Eluana Englaro: another tragedy
    feeding the media. Intensive Care Med. 2009 Jun;35(6):1129-31.