CBHD: Terri Schiavo-- the first anniversary- Andrew Fergusson

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	Andrew Fergusson, MB MRCGP
	Post Date: March 31, 2006

Terri Schiavo – The First Anniversary

by Dr. Andrew Fergusson

On March 31st 2005 a brain-damaged woman in a Florida hospice died some days after her tube-delivered food and fluid were withdrawn by court order (1). The case of Terri Schiavo may yet prove to be to end-of-life decision making what Roe v. Wade was to the abortion debate. Or it may not. A year on, with the “pro” view held out in a book just published by husband Michael Schiavo and the “anti” view argued in a book by Terri’s parents, Mr. and Mrs. Schindler, where are we?

On our associated website, www.bioethics.com, which deals daily with news and comment from the ever broadening world of bioethics, the visitors’ poll for the month of March 2006 has been asking: As we approach the anniversary of the death of Terri Schiavo, what have we learned?

Perhaps significantly, that question has stimulated less response than previous polls, but consideration of the percentages supporting the four options on offer may be instructive.

Bioethical issues are global concerns – 18.6%
This particularly interests me. A year ago, I entered the studios of CNN in central London three days running to comment from a conservative British perspective on Terri’s case. Through following pro-life news services in Europe, I had known of the case for several years, but had never expected its drama to grip the news headlines not just across the USA, but around the whole western world. Individuals and families could identify with the personal tragedy and make their own subjective interpretations. Given how little reliable medical information came across courtesy of the media circus, opinion in Europe was probably as unreliable as opinion in the USA.

However, sitting in that studio a year ago, I suddenly realized that bioethics had gone global, and I have wondered since what future cases in which future countries will affect people’s subjective responses and the consequent public policy decisions around the world.

More public debate is needed on life issues – 18.6%
Tying for last place was the conclusion that many of the serious issues that should have been central to the Schiavo decision need more discussion, and need it publicly. That discussion is needed in Florida, across the USA, and around the world, and should include:
How much confidence can we have in medical diagnosis and prognosis?
How much influence do the financial costs of health care inevitably have?
Was the tube feeding a “futile treatment” or did a majority deem Terri Schiavo had a “futile life”?
Was the intention of stopping her tube feeding that she would die?
If so, why put family and health care attendants (and perhaps Terri herself) through the experience of a slow and unpleasant death by dehydration and starvation?
Why not get real and legalize the lethal injection the “right-to-die” movement wants?
How should a civilized society manage the next Terri Schiavo?

The need to appoint a health care agent – 20.0%
Probably not statistically significant, but more respondents were more practical, recognizing that it makes sense to plan ahead in case each of us is one day without capacity, technically “incompetent” to say what we do want done and what we do not want done in the event of being unable to speak for ourselves regarding our own health care decision making.

There is some anecdotal evidence from physicians linked with CBHD (2) that patients and their families are much more ready now to start such discussions with professionals when they are reminded of Terri’s name. If that is so, some good will have come from this sad case.

Powers of attorney, proxies, and advance directives may all have a part to play here and CBHD has resources
available (3).

Interestingly, in the UK, where the way health care is delivered is significantly different (though becoming more American!), the recently launched consultation (4) on the Code of Practice to accompany the 2005 Mental Capacity Act has just re-ignited the debate there about the strengths and weaknesses of trying to protect yourself in advance. There is only space here to point out that the healthy do not make their health care choices in the same way as the sick, and what we decide in advance at home may not be what we would have decided at the time had we been able to do so.

But “something’s got be done, doctor” and CBHD Fellow Nick Yates has helpfully reminded us recently (2) that these decisions are better made with the family at the fireside than in a crisis with clinicians at the bedside.

Nothing – 42.9%
These respondents, taking here the view that “history teaches us nothing except that history teaches us nothing” head the poll. Well, at least it reminds us why we need a Center for Bioethics and Human Dignity and that CBHD has a continuing job to do! CBHD