Lessons from the Schiavo Case

In response to the recent interest in the Terri Schiavo case, in which Ms. Schiavo's medical condition was described as a persistent vegetative state, and her feeding tube was removed according to her wishes as relayed by her husband following a long court battle, we have assembled the following reflections from our Calvin experts on the subject. The text for the following articles was taken from a panel discussion held for students to debate the issues surrounding the case.


Positive Outcomes of the Terri Schiavo case
Hessel Bouma III

Over the last three decades, a number of biomedical cases have worked their way through the courts to establish that patients are free to choose what may or may not be done to them, and if they are competent to make a decision, how to designate who should be their surrogate decision maker, and how they should leave "clear and convincing evidence" of their wishes. I believe that in the case of Terri Schiavo the doctors and the courts, over a period of seven years, followed sound medical, moral and legal principles in upholding Ms. Schiavo's wishes.

Nearly all of the neurologists who examined her - among them the leading neurologists in the U.S. dealing with the persistent vegetative state (PVS) - testified that she was in PVS.

A person in PVS has periods of waking and sleeping but during waking periods shows no signs of awareness of the surrounding environment. The damage to the higher cortical regions of the brain is so significant that awareness is lost. The longer this condition persists, the less likely there will be any recovery, and if there is any recovery, the less the recovery will be. There is no documented evidence of someone in PVS coming out of it after 30 months.

Within several months of her cardiac arrest, Ms. Shiavo's husband of five years, Michael Schiavo, asked the local court to recognize him as the appropriate surrogate decision maker, and Ms. Shiavo's parents, Robert and Mary Schindler, supported his request. The court therefore appointed him.

One of the best possible outcomes of this case is that people are thinking and talking about what they would or would not want done if they were to be rendered incompetent. That's a good starting point, but it's not enough. We need to put our wishes into writing and designate who we want to be our surrogate decision makers in the event that we are incapacitated.

Second, I think this case encourages the Christian community to think about the issues surrounding dying and death and the possible appropriate and inappropriate uses of medical technology. From a Christian perspective, I believe that we are not obligated to eke out every last moment of biological life. Recognizing God's sovereignty over life and death, we may withhold and withdraw medical treatments, accepting an earlier death with less pain and suffering, but not arrange an act intending our death.

Third, I think there is a challenge for us to reassure the community of people with disabilities that honoring the wishes of persons such as Terri Schiavo will not become an imperative for persons with disabilities to forego medical treatments. This has been consistently upheld in medicine, medical ethics and the law, but recent rhetoric on the part of some has sought to obscure these realities.

Fourth, I believe this case upheld that these kinds of difficult decisions are best dealt with at the personal, family and health care-provider levels, with intervention only from the judiciary branch if absolutely necessary. It is a frightening prospect to me if these personal, family and health care tragedies were to be subjected to the politics of the legislative and executive branches of the government. The legislative and executive branches of government have roles to play in helping develop sound policies to assist society in facing issues surrounding death and dying, but that does not extend to individual cases.

— Calvin biology professor Hessel ("Bud") Bouma III has extensive expertise in biomedical ethics. He is co-author of Christian Faith, Health, and Medical Practice (Eerdmans, 1989), has served on the boards of Hospice of Greater Grand Rapids (1993-1998) and Hospice of Michigan (1999-2004), is on the biomedical ethics committees of Spectrum Health and Metropolitan Hospital, and currently is vice president of the Executive Council of the American Scientific Affiliation and chairs the ASA Bioethics Commission. He has presented papers on the Schiavo case at Trinity Western University, Oxford University and Calvin College, and he has an article forthcoming in the Journal of the American Scientific Affiliation on the Terri Schiavo case.

The Four-Part Series:
Positive Outcomes of the Terri Schiavo Case — Hessel Bouma III
Shedding Light on the American Health Care System — Cheryl Brandsen
The Law of the End of Life — Jeffery Tatum
Resources for Advance Care Planning — Karen VanderLaan