Ase Study: The Schiavo case: Ethics and the end of life : what have you learned from this dilemma?
Essay has three parts: an introductory paragraph or two; the body of the paper two paragraphs, and a concluding paragraph. Pages: 3 pages; double-spaced; Times New Roman; size: 12.
In essay format, type what you have learned from the Schiavo case and how you could use such knowledge if you may become advocate for your loved regarding their end of life care.
The Schiavo case: Ethics and the end of life
By: MICHAEL KALICHMAN and LAWRENCE M. HINMAN
Modern science has brought us much that is beneficial. In medicine in particular, we are pushing the limits both at the beginning of life with in vitro fertilization technology and at the end of life with improvements in medical care. However, we are now learning that these benefits have a price. For both the beginning and end of life, we must face questions that were previously out of our hands. Some of these questions may be easily answered, but many require us to choose between two courses of action, both of which carry a cost. Such questions are the domain of ethics.
This past week, we saw an example of such a dilemma in the national debate over whether Terri Schiavos feeding tube should remain in place.
Tragically, this question has divided the people who best knew and loved her. Terris parents, convinced that she is still capable of consciousness and recovery, have fought using every available means to sustain her life.
Terris husband, convinced that she has undergone massive and irreversible brain damage and that it was against her wishes to be sustained in such a condition, is now fighting to allow her to die. Both Terris parents and her husband clearly believe that they are acting in Terris interests. In such a case, we are not likely to find an answer that will satisfy the concerns of everyone. However, we have an ethical responsibility to clarify the issues and seek the best possible resolution based on the available information.
Consideration of such a case must begin with the person whose life is in question. What is it about the circumstance of Terri Schiavo that raises questions of harm? There are multiple areas for concern, and many of the questions are largely medical: Is the individual conscious, is he or she experiencing mental or physical suffering, and what are the chances for any meaningful recovery? If clinicians are wrong in their diagnosis that Terris higher brain functions have been lost, then it is possible that she remains aware of her surroundings and circumstances. At the very least, this would mean that she could experience hunger, thirst or physical discomfort, but be without apparent means to express her needs. However, much more worrisome, she may be suffering unbearable physiological or psychological pain but be unable to tell us. Again, because she has no means to communicate those conditions, she has no means to have the pain alleviated. In short, Terri could be suffering, but have no recourse to alleviate that suffering. Fear of this state is certainly one factor for those who express the wish that they not be kept alive under such circumstances.
Medical concerns are not the only issues at stake for an individual.
Religious concerns might override medical recommendations. Terri Schiavos parents maintain that her Roman Catholic beliefs would have meant that a decision to withdraw her feeding tube would be seen by her as a sin. Because Terri left no written instructions, there is no way to know
whether this was her belief. However, if it was, then it is noteworthy that this choice would not be altered even if medical information definitively demonstrated that no further recovery was possible and that Terri experienced awareness consistent only with pain and suffering.
If we are to judge by the best available evidence, it is far more likely that the damage to Terris brain is incompatible with awareness or consciousness. If that is the case, then our concerns shift to what Terri would have desired in such a case. Ideally, all of us, including Terri, will have provided explicit and written instructions about our wishes should we become incapacitated to the point of being unable to communicate.
However, most of us have not put in writing anything that could amount to an advance directive, living will or health care proxy. Without this information, it is reasonable to turn to those who were closest to the patient. Unfortunately, as in the Schiavo case, there is no guarantee that the loved ones will agree, either about what they think Terri would have wanted or about what they believe to be in her best interests.
There are at least four things we can learn from the Terri Schiavo case.
First, we see the importance of clear statements about our own preferences at the end of life. Providing clear direction is a gift we can give to those who love us, a gift that avoids putting them in the agonizing situation of trying to make choices on our behalf without knowing what we would want. To some extent, this can be accomplished through advanced directives, but heartfelt, face-to-face conversations play an important role in this process as well.
Second, we can see the crucial role that science and medicine play in this process. The more that science A±A± and here, the neurosciences play a particularly important role A±A± can elucidate what someone such as Terri Schiavo is actually feeling, the more informed our decisions can be.
Moreover, the more reliable medicine can be in its predictions about future recovery, the more confidence we can feel about our decisions.
Third, the legislature and judiciary have a responsibility to establish laws and decisions so as to encourage that the best possible choices will be made by the appropriate people when end-of-life issues arise. Ideally, we would all hope that this is an area in which legislators and judges will set partisan politics aside.
Finally, we should recognize that while Terri Schiavos life is important in its own right, the real challenge that lies before us is not how to solve her case, but how to structure end-of-life decision-making in a way that will minimize the possibility of such a situation arising again. This challenge presents an obligation for all of us to engage in meaningful dialogue. Scientists and clinicians have a role in explaining what we do know and what we dont know about brain function and injury. The news media have a responsibility to not simply report the inevitable political rhetoric, but to aid the public in reaching better-informed judgments by clarifying the scientific aspects of cases such as this one.
Although no easy solutions are likely, we can certainly do better by an increase in general awareness, understanding, and discussion of the science and ethics of end-of-life decisions.
Michael Kalichmans Web site on research ethics is at video/. The Center for Ethics in Science and Technologys Web site can be found at http://ethicscenter.net.
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