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.


Resources for Advance Care Planning
Karen Vander Laan

Advance Care Planning is an ongoing process of individual, family and community understanding, reflecting, discussing and formulating a plan regarding preferences for end-of-life care.

Who makes health care decisions?

. the person, if competent

. the person, through an individual instruction

. an agent appointed by the person

. a guardian appointed by the state

. a surrogate appointed orally by the patient

. a surrogate selected from the list of family members who can make health care decisions on behalf of the person

Advance care planning may include:

. who will make decisions for you at a time when you cannot

. how much authority the decision maker will have

. how decisions might be made for you

. when medical treatment for you should be continued or foregone

. what it means for you to live well

An advance directive is a plan indicating preferences for future health care decisions if a person is unable to make decisions. Types of advance directives are:

. oral: plans made in conversation with family friends or your physician

. written: formal (signed, dated, witnessed) - the most effective and legally useful

. written: informal (a physician's note or personal letter)

Things to discuss with your loved ones and your health care providers:

. What does "living well" mean to you?

. Under what circumstances would you want the goals of treatment to change from prolonging life to only providing comfort?

. How do you feel about the control of symptoms during the dying process?

. Do you have any preference about organ donation or autopsy?

. Do you wish to express any religious or personal philosophy that helps explain how you would like to receive care and treatment at the end of your life?


. Five Wishes by Jim Towey, available at agingwithdignity.org. Five Wishes is an easy-to-use document that emphasizes the bio-psycho-social-spiritual nature of persons. Its format encourages personal reflection and elaboration on personal beliefs, values and goals ($5).

. Advance Directive for Health Care by Dr. John Kilner, available at cbhd.org. This kit offers a sample advance directive form, a booklet titled "Basic Questions on End-of-Life decisions" and an article discussing the importance of advance directives ($12).

— Calvin professor of nursing Karen Vander Laan is a clinical nurse specialist with specialties in neuroscience, surgery and orthopedics and 20 years of experience in critical care nursing. She is a Ph.D. student in the College of Nursing at Michigan State University, with a research focus on promoting Advance Care Planning in communities. She is a certified Advance Care Planning facilitator through Respecting Choices® and is available to make presentations in faith communities about Advance Care Planning. Contact Karen at kvanderlaan@calvin.edu

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