The Terri Schiavo Case
At first glance, the Terri Schiavo case appears to be a compendium of issues. Some quarters disputed the verdict that Schiavo’s case was indeed an end-of-life issue. According to them, Terri Schiavo was never technically a dying patient because she was not terminally-ill. As a matter of fact, they contended that she was not even comatose nor brain dead and would have been alive today if only she was continuously fed and hydrated. Others were debating the issue of who, between the parents and the legal spouse, are better qualified to make end-of-life decisions for a patient who could no longer make such decision. These issues, however, were effectively settled by the Florida court when it granted guardianship to Terri’s husband, Michael, and then finally allowed him to cause Terri’s death by dehydration after deciding that Terri was already in a “persistent vegetative state” (Terri Schindler Schiavo Foundation, 2008).
Some people believe that the issues involved in the Schiavo case have already died with Terri’s death. The truth of the matter, however, is that one very important issue has survived Terri Schiavo’s death. It is the issue of whether Terri had properly exercised her “autonomy and [her] right of self-determination in the end-of-life context” (Snead, 2005). This question surfaced since the court already ruled her case to be an end-of-life case. In other words, did Terri Schiavo express her will to die clearly and unequivocally? Some people doubt that this was the case.
Self-determination is guaranteed under the Fourteenth Amendment and was defined under the Patient Self Determination Act (PSDA) of 1990. This law was implemented in December of the following year. Under the provisions of PSDA, patients have the right to decide on the kind of care that they prefer, including whether to “accept or refuse specific medical care.” A patient could avail of the provisions of this law and exercise his or her right of self determination by preparing a “living will or a durable power of attorney” which would be carried out when the time comes that said patient could no longer express or communicate his or her desire because of his or her condition (Healthcare professions delivery systems, n.d.).
In the case of Terri Schiavo, however, no living will was documented. Under the circumstances, the law authorizes a third party (in this case, the husband) to demand that the patient’s desire to die be carried out as long as said third party could produce a “clear and convincing evidence that the decision would have been the one the patient would have chosen had the patient been competent.” Without a clear and convincing evidence the patient’s right to self-determination would be violated (Snead, 2005).
Here lies the concern of some observers. According to them, the clear and convincing evidence requirement was not satisfactorily met in the Schiavo case. First, the patient’s desire was only communicated to the court by the husband nine years after Terri Schiavo collapsed and consequently became disabled. Second, the desire of the patient as described by her husband appeared to have been made in passing or in rather general statements, not a “firm, settled, [or] serious [and] well thought out, consistent decision to refuse treatment” under exactly similar circumstances. Yet, in spite of contradicting testimonies from Terri’s parents and closest friends, the allegation made by the husband was accepted as fact by the court (Snead, 2005).
The ramification of the Schiavo case, therefore, is clear: the law concerning the patient’s self-determination is easily subject to abuse or neglect. In order for the law to serve its purpose, it should be implemented with due diligence. The legislative branch of government created the law to safeguard the right of the patient. However, the judiciary branch should cooperate and do its part by ensuring that the requirement on clear and convincing evidence is satisfied before allowing any third party to impose its will and end an incompetent patient’s life. Otherwise, the law would prove ineffectual. Instead of ensuring the patient’s right to self-determination as envisioned, it would be violating it.
Healthcare professions delivery systems. (n.d.). Patient Self Determination Act 1990.
Retrieved October 7, 2008 from
Snead, O.C. (2005). THE (SURPRISING) TRUTH ABOUT SCHIAVO: A DEFEAT FOR THE
CAUSE OF AUTONOMY. Notre Dame Law School Legal Studies Paper No. 06-05.
Retrieved October 7, 2008 from http://ssrn.com/abstract=886373
Terri Schindler Schiavo Foundation. (2008). Retrieved October 7, 2008 from