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Considering the Case of Terri Schiavo
March 31, 2005

Last summer Calvin College professor Hessel Bouma III presented a paper at the annual meeting of the American Scientific Affiliation called "Lessons from the Terri Schindler-Schiavo Case."

So he's been watching the developments over the last few weeks in Florida, and Washington, D.C., including the death this morning of Schiavo, with more than a little interest.

Bouma, a biology professor and expert in the area of medical ethics, notes that the Schiavo case has its roots in the 1960s and 1970s when there was a rapid rise in biomedical technologies including cardiopulmonary resuscitation, cardiac by-pass machines, ventilators and organ transplantation.

The problem, he says, is that from the outset, scientific discoveries have led the way, often far out in front of carefully considered bioethical responses, public policy and legal decisions.

Bouma says there were four primary issues in the specific case of Theresa "Terri" Marie Schindler-Schiavo.

"First," he says, "what was Terri's condition and prognosis? Was she in a persistent vegetative state? What were the possibilities her condition might improve? Were there therapies that might help improve her condition? Second, what choices would Terri make for herself if she could choose for herself? Third, was it necessary or desirable to sustain her life in this condition, or might this be a situation in which death is preferable to life? Fourth, is removal of hydration and feeding tubes allowing a natural death to occur, or causing death by dehydration and starvation?"

Bouma notes that Schindler-Schiavo case is unique in many respects and carries troubling implications.

"Usually," he says, "courts become involved when the family of an incompetent person cannot achieve consensus on an appropriate course of action. Courts principally decide who should decide, not what the decision should be. Until now, medical ethical decisions regarding incompetent patients have been resolved in the courts, not the Executive and Legislative branches of government."

Bouma notes that an ABC News poll issued March 21 showed that 70 percent of Americans felt it was inappropriate for Congress to get involved in the case, and 67 percent said political leaders were trying to keep the brain-damaged woman alive in order to gain political advantage. Nearly eight in 10 Americans (78 percent) said they would not want to be kept alive if they were in Schiavo's condition. In addition the public supported the removal of Terri Schiavo's feeding tube by 63 percent to 28 percent.

Bouma says there are two other issues that complicate the case of Schindler-Schiavo.

"First, the malpractice settlement," he notes, "while modest in size and dwindling due to medical and legal costs, stands to be inherited by Michael Schiavo as her husband, or perhaps by the Schindlers if Michael divorces Terri. In response to this possibility, Michael has said he would donate whatever remains of Terri's medical trust fund to charity.

"Second, Michael Schiavo began dating other women - with the Schindlers’ blessings before any malpractice awards had been attained - and is engaged to be married to a woman who has borne two children with him."

Schindler-Schiavo was born in Pennsylvania on December 3, 1963. In November 1984 she married Michael Schiavo. On February 25, 1990, at age 26, Terri collapsed from cardiac arrest in her home and suffered brain damage due to lack of oxygen. The cardiac arrest was attributed to an imbalance of blood potassium, probably linked to bulimia. After several weeks, she emerged from a coma into a vegetative state requiring a percutaneous endoscopic gastrostomy (PEG) tube to provide her with nutrition and hydration but no assistance in breathing.

In February 1993, Michael Schiavo and the Schindlers had a falling out on her course of treatment. Michael decided further treatments were unwarranted and authorized "do not resuscitate" orders. That decision set into effect a series of disputes and court cases that ultimately stretched out for a dozen years.