The majority of people on Earth do not expect to find themselves in the situation of choosing how to die. However, the unlucky ones who suffer from terminal illnesses sometimes make decisions to stop receiving any kind of medical treatment in order to depart peacefully. These people are very often unconscious, living in a persistent vegetative state with no hope for improvement or recovery. The matter is that American laws allow people to say ‘no’ to medical treatment. However, do family members have the right to make the choice for the terminally ill person? What justificatory conditions should be minimally required in order for euthanasia to be conducted? Is active euthanasia morally preferable to passive euthanasia and vice versa? What are the reasons to oppose voluntarily euthanasia? This paper will discuss Schiavo Case as one depicting morally problematic situation in professional practice, as well as analyze the possible answers and solutions, considerations, reasons and judgments connected to this ethical issue.
On February 25, 1990 Terri Schiavo collapsed from cardiac arrest, stopped breathing and suffered brain damage due to the lack of oxygen. For next 15 years she remained in a vegetative state and this was proved by electroencephalogram; it showed that her cerebral cortex was largely inactive. After a few weeks the diagnosis was changed to a persistent vegetative state or PVS. The thing is when a patient does not emerge from a vegetative state caused by oxygen deprivation to the brain within first three months the doctors consider it to be a permanent condition (Buresh, 2006).
So, Terri was unconscious, without real chances for recovery or regaining consciousness. Her husband Michael was appointed her guardian and, at first, he and Terri’s parents had an amicable relationship and were of the same opinion concerning her further treatment. However, when Terri’s husband won a lawsuit connected to malpractice in his wife’s treatment from infertility everything changed. He received a certain sum of money from a hospital and refused to share this money with Terri’s parents. This triggered conflict (Rathus, 2009). Nonetheless, the central point of disagreement between Michael Schiavo and Terri’s parents still became her medical condition. Terri’s husband and physicians argued she was in a helpless state. Terri’s husband made a request for her feeding tube to be removed to allow her to die with dignity, as she supposedly wanted to. Terri’s parents insisted that she was not in a vegetative state because she was capable of recognizing them and others. They thought passive euthanasia was morally wrong. Terry and her parents were Catholics and believed that every human life is precious and sacred, regardless of how disabled it might be. It means that they were of the opinion that no person’s existence should ever be violated. Terry could not voice her Christian ideas, as well as decide for herself the way in which she wanted to die. She also did not leave written instruction that clearly stated her thoughts about her further life in such a condition (Kail, 2010). According to the American law in such a case the spouse but not the parents of incapacitated adult patient has decisional authority (Silbergeld Jecker, Jonsen & Pearlman, 2007).
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A prolonged struggle between Terry’s parents and her husband for the right to make decisions about her further life lasted several years. It was characterized by involvement of the media, pro-life advocates, and legislative bodies. When Terry’s husband finally won and a feeding tube was removed, a law was enacted that prevented the withholding of nutrition and hydration from a patient in a PVS who had no written advance directive when a member of family challenges the withholding of nutrition and hydration. Later, the law was ruled unconstitutional and on March 31, 2005 Terri Schiavo died after feeding tube had been removed 13 days earlier (Lo, 2009).
The Schiavo Case raised many questions connected to the rightness of euthanasia and legality of allowing terminally ill patients to die. What rights did patients have if they were unable to speak for themselves? How could a person voice his or her desires? Was Terri’s constitutional right to reject unwanted treatment violated? What about the constitutional question of self-starvation? Among other crucial questions, this case touched upon the right to die, informal refusal of treatment, constitutional standing of the guardians, patient’s best interests’ protection and quality of life exemption from the obligation to preserve life. It also aimed at figuring out whether there is a spouse’s right of sovereignty that overrides the preservation of life as such. Terri did not leave specific instructions to terminate life support, if she were in a comatose state. Who then should decide to withhold medical treatment: husband, parents, court or doctor? (Colby, 2008)
There is no absolute sanctity of human life in Christianity. Life belongs to God, but sometimes people can make a decision, in which they forfeit their own lives in defense of somebody else or in martyrdom. Biological life is not ultimate, but penultimate which means that something is waiting for us after death. Euthanasia, as a kind of a good death, is viewed as a particular understanding of human being’s destiny. It does not take into account that a person has a future in Jesus Christ. According to Christian doctrine, euthanasia is not a proper option because human being and his/her body belongs to God and was created for a certain destiny. Theologically speaking, it is a practice, in which medicine turns its back on created goodness of human life, on goodness of its redeemed future. This is only a theological view on euthanasia.
How about moral side? People can call it a mercy killing or assisted suicide, but one thing is for certain: one particular human life is lost with the help of euthanasia. It is a fact that some terminally ill patients suffer a lot. That is why they have a moral right to ask doctors to relieve them from pain. What about patients who are in a state of coma? For this particular category of people their life is meaningless because they cannot feel or rationalize what is going on. In case of Terri Schiavo the doctors suggested that because of her persistent vegetative state and brain’s inactivity she is not supposed to suffer during passive euthanasia. This type of euthanasia presupposes that doctors let patient die by stopping treatment. This was exactly what happened with Terri Schiavo. Is it morally permissible for a doctor to stop fighting for a human life at some point? Is it not a violation of Hippocrates vow?
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Active or passive – both types of euthanasia are the same for patients like Terri Schiavo because they are in a state of coma with minimal or almost no brain activity. These are just two different names for a merciful murder. The main difference between them is that active euthanasia is quicker and apparently less painful, while passive euthanasia is longer and may cause pain. These two aspects are not related to the case of Terri Schiavo because according to the opinion of medical practitioners she was unable to feel anything.
Justificatory conditions present in the case of Terri Schiavo range from economical to psychological. It goes without question that treatment and sustaining of such patient is costly, but it does not matter until a member of family is alive, even if it is very hard to call such life a living. If there is no hope for improvement, would not it be better to spend money on something more sufficient. Creation of fund to research comatose patient’s condition or brain functioning can help to understand and probably cure millions of lives. Psychological devastation occurs in every family member of a patient in persistent vegetative state. Hope of survival is decreasing day by day and treatment that seems to be helpful in elimination of suffering only prolongs it.
In case of Terri Schiavo we were dealing with involuntary passive euthanasia. If to speak of voluntary euthanasia, are there any reasons to oppose it? Continued treatment of a comatose patient may be viewed as either prolonging life or postponing death. Who is to determine whether it is the first or the second? The removal of life-sustaining food and dehydration is something similar to playing the role of God. On the other hand, according to human laws, every person has a right to life with dignity, as well as a right to die with dignity. Consequently, why to deny patients’ right to die with dignity and not to prolong senseless existence?
If to consider the case of Terri Schiavo within the scope of ethical theories some new aspects of euthanasia’s morality resurface. According to utilitarian moral position, every action is viewed as morally good, if it produces more good things or less bad things that would any other possible alternative action. This consideration presupposes that if action is morally correct it is to maximize good or minimize bad. In the case of Terri Schiavo, death of a woman in persistent vegetative state is something that does well to her and her close relatives. Why is it so? Probably because there is no reason in further existence of a person whose brain activity is dead, who cannot feel or experience anything, cannot respond or react to anything. A person like Terri Schiavo is not capable of doing anything and it is hard to entitle such existence a living. So isn’t death better in such case? If a person like Terri Schiavo, being a Christian and knowing that there is heaven waiting for people after death, is stuck in between the world of alive and the world of dead, why is she to do? Actually, she herself cannot do anything, but her closest people are to decide, whether it is better for her to proceed to another stage of her life or continue being stuck between the two worlds. The idea of utilitarianism also states that we are to consider the happiness of everyone who may be affected by some kind of action, in our case this is euthanasia. How exactly does act of allowing terminally ill person to die affects her and her relatives? Does it maximize their happiness or at least minimize the collective unhappiness of the people surrounding her? Since according to medical data, a patient in a condition of Terri Schiavo is incapable of feeling anything, do we have to consider solely the happiness of her family? One more thing Schiavo Case is peculiar for is the fact that her relatives were not unanimous in their opinion concerning her further treatment and possibility of euthanasia’s performance. When she died, the happiness of her husband was maximized, while the happiness of all the other people from her family was minimized. So, in this case it is extremely complicated, if not impossible, to state that euthanasia of Terri Schiavo was good or bad without knowing her exact opinion about it.
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The main moral question that is impossible to answer unanimously in this case is whether it was a right thing to let a person in a persistent vegetative state to die in such a way, as Terri Schiavo died? On the one hand, it was a justified action, because medical professionals confirmed her further limited possibility of getting out of coma and leading normal life. In case of Terri Schiavo, euthanasia seems to be morally permissible because it does not cause pain to the very patient, but it seemingly corresponds to her own will, and it ends continuous doubts and sufferings of her relatives connected to her almost nil possibility of recovery. On the other hand, there still exists the aspect of sanctity of human life and importance of life preservation. Since up-sides almost equally correspond to down-sides, it is virtually impossible to state that Terri Schiavo’s euthanasia was good or bad. It was an action that had both positive and negative sides, which cannot be justified from religious point of view, but can be more or less understood from societal and medical viewpoint.
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To conclude, Schiavo Case was and remains an issue of great controversy. Debates over rightness or wrongness of her husband’s decision to perform passive euthanasia will probably never end. However, euthanasia as such is a thing that will never be absolutely right or absolutely wrong. It was and is a way out for people, who do not want or are unable to commit suicide at the point in their life when further living has no sense any more.