Healthcare Ethical and Legal Issues.
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Terminating an individual’s life when in there is no chance of improvement can be a matter of life and death. It calls for well-written medical, legal political and ethical laws that clearly states what is to be done when faced with such situations. Life termination has raised the eyebrows of the public, politicians as well as religious and activist groups. Some are pro-life while others are against it. Some substantial evidence while others base their arguments on emotions and self-drive. The cases call for amicable agreements, well-stated laws, as well as advance directives on what should be carried out in case one, is incapacitated
In February of 1990 at 26 years of age, Terri Schiavo collapsed in her St Petersburg, Florida. She hard cardiac arrest and had hypoxic for several minutes. The oxygen supply to her brain was cut off for several minutes. The paramedics tried to resuscitate her, but massive brain damage had already occurred. She remained in comatose for about two and a half months only to proceed into a persistent vegetative state (PSV). PSV is the rarest form of disability in which most of the brain tissue is dead, but the patient loses cognition and can only perform a few involuntary action on his or her own. Terri was intubated for her hydration and nutrition because she couldn’t feed on normal food(Jones & Whitaker, 2009).
The cause of her collapse is disputed. Michael Schiavo said that it was induced by potassium imbalance that he associated it with bulimia while her parents, the Schindlers, suspected that her husband tried to strangle her based on a court testimony by a neurologist. The testimony was that she suffered a neck injury on hospital admission (Lynne, 2005).
Due to unavailability of an advanced directive, Mr. Schiavo was appointed as Terri’s formal guardian. The Schindlers didn’t object his appointment. Her optimistic husband received nursing training with the hopes of taking her him. It, however, proved too overwhelming, and she was returned to the chronic care facility after three weeks. Intense physical and occupational therapies were administered with the hope of rehabilitating her. She was taken to California by Mr. Schiavo to try experimental thalamic stimulator implantation in her brain to improve or restore her consciousness level. The treatment failed (Wolfson, 2006).
Mr. Schiavo continued to live with her for several more months until guardian ad litem was appointed by the court (Hook & Mueller, 2005). The Schindlers encouraged Mr. Schiavo to move on and start dating. His belief about Terri’s recovery appeared to have changed. He had no hope that his wife’s health would improve. The Schindlers and Mr. Schiavo relationship deteriorated in 1992 after he and Terri were awarded damages in two malpractices suits regarding her infertility treatments and a possible association with the cardiac arrest (Hook & Mueller, 2005). In July 1993, a petition was filed by the Schindlers in court to remove Michael as Terri’s guardian but later dismissed as the first guardian ad litem found that he had been very aggressive and attentively cared for her.
Four years later, May 1998, a petition was filed to authorize the removal of her PEG tube, but the request was opposed by the Schindlers claiming that she would her wanted to be kept alive. A second guardian ad litem was appointed by the court to serve on behalf Mrs. Schiavo’s interests (Hook & Mueller, 2005). In December the same year, her guardian reported that Terri was in PSV and according to the physicians the chances of improvement were minimal, and Michael’s statement about Terri’s wishes not to be feed on tubes reflected the real wishes and intentions of Terri. The feeding tubes were supposed to be withdrawn (Hook & Mueller, 2005).
The trial to determine Terri’s wishes begun in January 2000 in Pinellas-Pasco County Circuit Court. The decision by Judge Greer to withdraw the nutrition and hydration tubes in order permit natural death raised a heated debate between right-to-die and pro-life advocates (Lynne, 2005). It was followed by a series of emergency motions, appeals and court orders to establish the trials jurisdiction but the physicians concurred with the earlier medical evaluations. It led to the public becoming increasingly interested in and vocal about the case. Several organizations were drawn into the case. Some claimed that the cessation of Artificial feeding tubes was an abuse and neglect. The tubes were removed but reintroduced later. In addition to the petitions, Florida House of Representatives passed Terri’s Law leading to reconnection of the tubes. The court battle continued, Michael Joined by the American Liberties Union to contest against Terri’s law as unconstitutional. The legal challenge culminated in the opinion of the judge declaring the law as unconstitutional. The series of events that occurred after became unique in the history of American politics, law, and bioethics (Lynne, 2005). The case progressed to involve the president. Consequently the tubes were disconnected in March 2005. She later died at age 41 ending the long legal, medical, and political struggle. The autopsy report was consistent with the initial report. She sustained severe and irreversible brain damage, and there was no hope of rehabilitation.
Practically Terri’s case raises a lot of questions. Whether her case was an act of Euthanasia or natural death remains controversial. There were two different paths she could have taken. It would have been considered as a case of euthanasia because the supportive treatment was utterly disconnected and she would have died later due to dehydration and starvation. Contrary, euthanasia would have involved the use of a drug or chemical by the medical physicians to terminate her life. Mr. Schiavo’s argument about Terri’s wishes had no evidence to support the claim.
The end-life-decision making issues involved in Terri’s case
In Terri’s case, there are a lot of decisions made concerning her well-being and ability to stay alive. The initial end life decision being the succession responsibility. The physicians and the court selected her husband as the guardian based on the long relationship she had with him. Furthermore, the legislation defined the hierarchy of succession because there was no advance directive Michael was the default guardian who was expected to act on her behalf as she was not in a position to make a sound judgment after the accident. The Schindlers agreed with the decision, but they later filed a petition in court to remove Michael as Terri’s legal guardian (LANG & Quill, 2016).
Another end-of-life decision made was the substituted judgment and decisions in best interest of the patient. According to the physicians and guardian ad litem arguments, the decisions were issued to the best of Terri’s interest as opposed to the Schindlers who opposed. They clearly indicated that the decisions they made were not for themselves but based on the patient’s wishes, she wouldn’t have agreed to remain on feeding tubes for the rest of her life (LANG & Quill, 2016).
The clinicians faced situational and prognosis decisions. As stated in the articles by several authors, Terri’s brain was severely damaged and were no chances of her improving to her usual initial life. The prognosis of PSV patients was destitute and therefore the only decision that could be made was to terminate her life by disconnecting the feeding tubes. The Schindlers being optimistic about their daughter, however, opposed the decision which was finally executed after a series of court trials and laws being enacted. In addition to that, a range of decisions had to be made from Terri’s resuscitation and finally removal of the tubes. The initiation of feeding tubes or hydration and ultimately disconnection of life-sustaining devices. Other decisions included supportive care initiation and life maintaining care through medical intervention to support Terri’s life (LANG & Quill, 2016).
Finally, the battle that arose in Terri’s case about the legality of methods of life termination. There were no clear laws about how such cases were handled and how the government would react. This fueled a heated debate which was followed by several court hearings until a law was signed by the United States of America's president, which supported Mr. Schiavo’s argument to end Terri’s life. It was enacted to prevent prosecution of Mr. Schiavo and physicians from being accused of committing murder (LANG & Quill, 2016).
Over a long period, the role of Healthcare committees in hospitals has been controversial. Their participation has been clouded by conflicts with some arguing that they might be acting on their best of interest and not the patient’s interest. It has led to most cases ending in courts particularly when two or more parties are involved. The committee has three primary functions: education, policy development and case consultation (Doyal, 2001).
The ethics committee should have formulated hospital policies on the ethic legal matters. Terri’s case would have been solved quickly based on the policies laid down by the hospital and the health care system on how the hospital would have terminated her life and to keep her on feeding tubes based on the clinical evidence by the doctors. Due to the sensitivity of Terri’s case, the committee would have been in the frontline in testifying in courts (Doyal,2001).
The second responsibility of the ethics committee in Terri’s case was to resolve the conflict between the Schindlers and Michael or the physicians by providing substantial evidence in support of the decisions by their staff. Furthermore, the committee was supposed to be the first in resolving the conflict by engaging them in discussions about Terri’s case the possible outcomes and the chances of improvement of her health. The Ethics committee was also supposed to train the hospital staff who were handling Terri’s case on the approaches they could use to settle the dispute without necessarily involving the courts (Doyal, 2001).
Moreover, the committee should have educated the public on such matters and the best choices that were available about ending Terri’s life or retaining her on the feeding tubes rather than the media inform the public based on their opinion. Such efforts would have prevented the worldwide attention as well as giving them the most appropriate information
Schiavo’s case arose over disputes about the application of end-life situation decision making. The case will be remembered because of the bitter battle between her husband and her parents. It has become a relevant case in ethics and law because of many reasons. Schiavo’s case called for legislative changes that clearly states decision-making at the end of life more clear to the families as well as the physicians (Robertson, n.d.).
Furthermore, Schiavo’s case has shown how misperceptions displacements of other conflicts and denials can prolong a case and make it difficult to solve. The case uncovered many fatal gaps and flaws in the fairness of the substituted judgment. It has also challenged the accepted definitions of the various medicolegal states. It is contested by those who sought Mrs. Schiavo’s continued tube feeding rather than death by dehydration and starvation following removal of feeding tubes. The case has challenged the broadly accepted bioethical issues calling for better education of the public by various bodies rather than leaving it to the media that might give the biased public information. The healthcare providers should engage the public in positive and constructive ways serving as legislatures and consultants in many occasions such as Terri Schiavo’s (Robertson, n.d.).
In conclusion, cases present tough situations that require the interplay between the healthcare systems and the families of the patients involved. Such cases need well-outlined laws and ethics that every decision maker should adhere to in cases of euthanasia. Besides, the physicians should provide all the relevant information necessary for the families to ensure that the cases are amicably solved. The Schiavo’s case demonstrates that such issues are best dealt with in private, within families and between patients and caregivers. The case was a great tragedy. It is our duty to respond in the most efficient way possible. Ignorance of critical ethical, legal and medical realities can fire great controversies.