A Patient’s Right to Die and Be Placed on Life Support
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A Patient’s Right to Die and Be Placed on Life Support
Terry Shiavo's story
One of the most blatant episodes of life support struggle, Terry Shiavo's story was making headlines for many months now as the unconscious woman who for 15 years was living on substances she received from her feeding tube became the focus of a legal battle between her husband and her parents. Life support that is one of the most controversial issues of today’s medical practice has served to pump funds and human effort into the rescue of a meaningless and empty life of that woman, like the lives of many other patients who are tormented rather than saved by the artificial prolongation of their lives via life support systems.
Numerous courts considered the case, and now the battle came to an end as Terry is died from starvation caused by the removal of her breathing tube on March 18. Schiavo collapsed in 1990 from brain damage caused by a chemical imbalance that resulted from an eating disorder (Torday 2005). Since the time she lost consciousness from lack of oxygen, she was kept in the center in a persistent vegetative state in a hospice in Pinellas Park, Florida.
Terry's legal custodian, her husband Michael Schiavo, believed that Terry should be allowed to die and so insisted on the removal of the tube. Her parents, Bob And Mary Schindler, on the contrary, insisted that Terry 's life should be sustained further arguing that their daughter was responsive to outside stimuli (Word 2005). Both sides had their supporters that stage street protests in support of their viewpoints, and media, both in the US and abroad, have been following the story closely. Michael Schiavo insisted that his wife made her wishes and told her uncle and best friend that she would not like to spend the rest of her life in a vegetative state. George Felos, an attorney for Michael Schiavo, conveyed her words in this way: "She said, 'I don't want to be kept alive artificially -- no tubes for me. I want to go when my time comes. Take the tubes and everything out" (Barrett 2005). Terri's parents, in contrast, thought that their daughter's state might improve with intensive therapy, and make every effort to keep her alive.
The relatives fighting over Schiavo's unconscious body have made numerous attempts to resolve the issue in court. In seven years, the case was heard by as many as 19 Florida judges (Torday 2005). All of them invariably supported Michael Schiavo, refusing to order the reinsertion of the tube. The final removal of the feeding tube occurred on the rejection of the Schindlers' petition to the Florida Supreme Court where the couple's request was turned down on March 26. The Schindlers five times tried to turn to the US Supreme Court that always refused to get involved. The parents' appeal to the 11th U.S. Circuit Court of Appeals in Atlanta also met with no success (Torday 2005).
The case that seems to be a purely family matter was taken up by the highest US authorities, including the US President George Bush and Congress. George W. Bush on March 21 signed the law that allowed the Schindlers to seek the reinsertion of the tube. The law had before been passed by both the House and the Senate, with a 203-58 vote in the House. Opponents of the bill, including Michael Schiavo himself, were vigorously protesting against the action they saw as interference in people's private life. Bush, however, commented on the passage of the bill in the following way: "Democrats and Republicans in Congress came together last night to give Terri Schiavo's parents another opportunity to save their daughter's life." "This is a complex case with serious issues," he added. "But in extraordinary circumstances like this, it is wise to always err on the side of life" (Barrett 2005). This action nevertheless also failed as the federal judge turned the last appeal down, allowing Terri to drift towards death.
One more high-ranking government official who intervened in the case was Florida Governor Jeb Bush. He supported Terri's parents and argued for the reinsertion of the tube. Finally, he declared that he would not order the reattachment of the tube. He was obviously in no position to order this after the numerous court decisions in favor of Michael Schiavo and the collapse of the bill in the Florida Senate that called for the reinsertion of the tube.
Controversial Right-to-Die Cases
The crux of the case seems to be not a life-and-death decision, but the debate over the extent to which the government and society can interfere in the life of an individual person or family. Most cases considered hitherto seem to indicate that a person’s life has to be left in the hands of nature in case a terminally ill patient falls into a vegetative state, but forbid physician-assisted suicide
An example is the case Washington v. Glucksberg that was decided in the US Supreme Court on June 26, 1997 (No. 521 U.S. 702 (1997)). Dr. Harold Glucksberg in this case asked the question: “Did Washington's ban on physician assisted-suicide violate the Fourteenth Amendment's Due Process Clause by denying competent terminally ill adults the liberty to choose death over life?” (OYEZ, 1997). The court disagreed with the claim that the state’s ban violates basic human rights and liberties. The denial was grounded in the belief that the practice was “offensive to our national traditions and practices” (OYEZ, 1997), anf lifting the ban can be detrimental to national liberties and interests.
A similar Vacco v. Quill case (521 U.S. 793 (1997)) decided on June 26, 1997 sought to prove that “New York's ban on physician-assisted suicide violate[s] the Fourteenth Amendment's Equal Protection Clause by allowing competent terminally ill adults to withdraw their own lifesaving treatment, but denying the same right to patients who could not withdraw their own treatment and could only hope that a physician would do so for them” (OYEZ, 1997). The court ruled against the claim, pointing to a difference between euthanasia and removal of lifesaving treatment, since physician-assisted suicide includes causation and intent to terminate a patient’s life.
Fifteen years ago, the Supreme Court acknowledged that the patient has a constitutional right to refuse life-saving treatment. However, it demanded from the family or custodians the proof of the patient’s wishes. This, for instance, was required of the family Nancy Cruzan who was in a state of coma at the moment her case was considered in court. The case was returned to Missouri state court that arrived at the conclusion that she really had stated her wish to die before she lapsed into a coma. The case of the 25-year-old woman who “careened off the road, flipped over, and was thrown from her car into a ditch” in 1983 (University of Virginia) became the first right-to-die case to be heard in the US Supreme Court.
More Recent Cases
One of the most notorious cases in the right-to-die discussion is the one related to the activities of Doctor Kevorkian, a controversial medical practitioner who sought to prove his right to assist his patients in dying. That is why on March 26, 1999, in Michigan he was found guilty of second-degree murder. Death With Dignity Act, accepted in 1994 in Oregon voters, by a narrow margin of 51% to 49%, is believed to have been inspired by Kevorkian’s activities. Under this act, a competent adult is entitled to a request of a lethal injection by a medical professional in case he or she is terminally ill.
In Spain, the case of Ramon Sampedro became the focus of public attention as the man paralysed in an accident spent 29 years trying to defend his right to assisted suicide. The legal rulings he sought were obtained from Spanish courts as well as the European Commission in Strasbourg. After experiencing the disabling accident at the age of 29, he only died at 55.
Scholarly Evidence
In making decisions about a comatose patient’s destiny, the court has to differentiate between various conditions. Thus, Terri Schiavo was in persistent vegetative state (PVS), one in which a patient is more likely to obtain permission to terminate life-sustaining treatment from a court. There are also patients who are in a ‘minimally conscious state” (MCS), and who “unlike PVS patients, are able to feel pain (and pleasure); however, because they are so limited in their means of expression, no one can be sure to what extent a particular MCS patient is experiencing pain, suffering, and humiliation” (Mello, 1999). However, because these patients are still able to feel pain and suffering resulting from prolonged immobilization, they are in even greater need of permission to remove life support systems to end their lives. This argument is very important in evaluating the option of removal of the life support system: if the patient is able to feel pain and suffering (and it is likely that the physicians are not always able to adequately assess one’s sufferings).
Now we see more and more cases in which doctors argue against sustaining the life of the patient, saying that “that medicine must not be used to torture the dying” (Morreim 1994). This perspective of the physicians has to be endorsed on the grounds that doctors better than those removed from the medical field realize that the right to die will protect the patient from unnecessary suffering. In cases when patients are not expected by medical experts to recover, it is “morally mandatory to cease aggressive treatment” (Morreim 1994), since future treatment is pointless and often cruel.
Denial of life support as a way to prolong the patient’s suffering is related to the preservation of what many view as an intrinsic human right – the right to decide on one’s own life and death. This conclusion is inevitable “respecting [the patient’s] autonomy as expressed by the substituted judgment of [her] surrogate agent and consistent with the principle of nonmaleficence” (Bednarz, 2000). Even though the person in a vegetative state may not be considered as a fully-fledged person, deep inside the person may be thinking and feeling and his or her decisions have to be respected.
It is necessary, of course, to agree the course of action taken to the patient’s previous wishes. Thus, courts have adopted a ‘clear-and- convincing standard’ of these wishes that is often unnecessary to patients. To complicate the custodian’s task, “courts typically require that the patient have envisioned the precise medical situation he is now in when he made the statement expressing a preference for nontreatment” (Mello, 1999).
Conclusion
In conclusion, exact criteria for preservation or withdrawal of life support systems have not yet been developed by the legal system. The right to die should be an inherent right of the human being living in today’s world where people have more and more control over their rights. Courts have a point in demanding proof of the patient’s earlier wishes; however, since this evidence cannot always be gathered, this claim often results in people being kept alive artificially at the time when they do not really want to be reduced to a life of a comatose body. To simplify the court decisions on these cases, it would be useful to include a question on life support in the standard procedure of insurance policy preparation. Then every person who has signed on the paper, stating the wish that the life support system be removed in case of terminal illness or coma can be safely allowed to die in peace.
Besides, one needs to consider the economic aspect of the matter. A person lying prostrate in a developed nation that can afford the kind of treatment to keep the person alive is consuming a lot of financial and human resources that can be put to better use. We live at a time when a lot of people are still in need of food, clothing and most elementary things; at the same time, huge funds are being used to sustain the balance between life and death for specific persons.
The case for removal of life support is especially vivid with respect to patients, such as those in a minimally conscious state, who can still feel pain and suffering. These people should be unnecessarily tormented at the time when their chances of survival are minimal. The society would be more merciful in allowing these patients to die rather than subject them to sufferings that last years.
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