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Bioethics: End of Life Decisions

Introduction
Terri Schiavo’s case involved a dispute between her parents and her husband, Michael, on
whether it was right to remove Terri’s feeding tube or not. Terri had stayed in a persistent
vegetative state since 1990, and her husband decided that the feeding tube be removed in 2003.
The husband claimed that the removal of the feeding tube was in honor of his wife’s wish not to
be kept in a vegetative state or comatose state. Terri’s parents, on the other hand, argued that their
daughter was not in a comatose state since she could blink, smile, and follow the movements of
her parents around the room. The physician’s examination also revealed that Terri could respond
to pain, blink, and even raise her leg when asked to. The bioethical issue, in this case, involved
assisting the parents of Terri in coming to terms with the fact that their daughter’s life was ending
and, at the same time, honoring Terri’s wish. Medical professionals face challenges in coming up
with critical decisions to see their patients through the end of life struggles.
Bioethical Analysis
In Terri’s case, the healthcare providers were faced with challenges of facing her parents
with the reality that they had to remove the feeding tube. Clinicians face many challenges when
providing end of life care to patients (Woo, Maytal, & Stern, 2006). Similarly, the dying patients
and their families are as well faced with challenges. For instance, they all have to deal with
managing the pain and suffering of the patient. Medical professionals should as well consider the
psychological, physical, and social experiences of patients and their families while providing end
of life care (Woo, Maytal, & Stern, 2006). They are faced with the challenge of making the
tough end of life decisions and break the bad news to the dying patients as well as their families.

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In Terri’s case, she had clearly stated to her husband that she did not want to be kept in a
vegetative or comatose state. Such a wish is called an advance directive. An advance directive is
recognized under state law as a formal way in which a dying patient can communicate his or her
wishes to healthcare professionals, friends, and families if they are unable to voice their
preferences (Tejwani et al., 2013). An advance directive is communicated to the healthcare
providers, the family, and the friends of the dying patient by a surrogate, in this case, her
husband, Michael. The directive must be implemented based on the preferences of the patient.
Physicians are expected to honor the wishes of their clients, as indicated in the advance directive,
no matter how hard it may be for them. For this reason, the feeding tube was to be removed.
The primacy that ethics and law give to advance directives of patients has, however, not
been unchallenged. While advance directives are based on the principle of patient autonomy, it
has been argued that there are circumstances under which it is justifiable to overule patient
autonomy (Cerminara & Meisel, 2018). One of these circumstances is when patient decisions are
in conflict with the interest of other peiple, particularly their close family members. Treating
patient autonomy as paramount ignores the fact individuals are part of a large network of
relationships that include their children, siblings, spouses, and parents (Cerminara & Meisel,
2018). Thus, when making decisions, such as whether their lives should be prolonged or not, it is
important to take into account the interests of other people, such as their children or parents. For
instance, prolonging the life of a patient in vegetative state like the one that Schiavo was in may
prolong not only the suffering of the patient but also that of their close family members. On the
other hand, shortening it results not just in grief of family and friends but also burden to other
people such as a dependent minor.

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The concern about the interests of other people has not only been raised in cases
involving end-of-life decisions of patients but also in cases such as pregnancy termination.
Regarding the latter, it has been argued that the interests of the unborn child should also be
considered, not just the mother. Such kinds of concerns have, however, not exerted significant
influence on medical ethics and law regarding end-of-life decisions and other similar cases. All
these cases, patient autonomy remains the main guide in determining the ethics and legality of
decisions that are made.
Conclusion
The decision of the healthcare provider in Terri’s case was influenced by her advance
directive, as communicated by her husband. Given the primacy of patient autonomy in ethics and
law regarding such matters, the healthcare provider was expected by the law to implement the
advance directive of the client. The feeding tube was, therefore, removed in line with Terri’s
desires of not wanting to be kept in a vegetative state. No matter how hard the decision was for
the healthcare provider and Terri’s parents to take, it was to be implemented based on her wish.
The removal of the feeding tube was thus in order as the physician was honoring Terri’s wish.

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References

Cerminara, K. & Meisel, A. (2018). End-of-Life Care. The Hastings Center. Retrieved on 21 st
April, 2020 from https://www.thehastingscenter.org/briefingbook/end-of-life-care/
Tejwani, V.et al., (2013). Issues surrounding end-of-life decision-making. Patient preference and
adherence, 7, 771–775. https://doi.org/10.2147/PPA.S48135
Woo, J. A., Maytal, G., & Stern, T. A. (2006). Clinical Challenges to the Delivery of End-of-Life
Care. Primary care companion to the Journal of clinical psychiatry, 8(6), 367–372.
https://doi.org/10.4088/pcc.v08n0608