The Schiavo Case: What Can We Learn?

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Monday, April 25, 2005 | The San Diego Center for Ethics in Science and Technology is hosting a public conference titled "The Schiavo Case: Are There Any Lessons?" This event is scheduled for Tuesday at 7 p.m. at the Neurosciences Institute in La Jolla. The meeting is open to the public and free of charge. Because space is limited, it is necessary to RSVP through the Ethics Center Web site at http://www.ethicscenter.net.

Although Terri Schiavo's death marked the end of her own personal ordeal, it certainly does not mark the end of the national debate on end-of-life decisions. Just the opposite: Terri Schiavo's death marked the next stage of an ongoing national discussion about how to die well. One of the paradoxes of contemporary medicine is that its progress has often come at a high price. In this instance, the life-extending and life-saving power of contemporary medicine has increased the chance that the time of our death will be a choice to be made by those with whom we were closest. A century ago, medicine could do little to stave off the arrival of death; now most Americans must decide when to discontinue the medical battle.

What can we learn from the Terri Schiavo case about this changing medical and moral landscape? Certainly many Americans of goodwill were troubled by what they didn't know. Many felt that the situation would have been morally clearer if there had been a clear and specific written statement of Ms. Schiavo's wishes. Looking to the future, we can see that this is an area of uncertainty that can be minimized, even if not totally eliminated. As we look to the legacy of Terri Schiavo's death, we can agree that the use of advanced directives, durable power of attorney for medical affairs, and increased discussions of end-of-life issues with family and friends will all contribute to reducing the moral indeterminacy of such end-of-life decisions.

Others who observed the Schiavo case found themselves with unresolved questions about her medical condition. How often, if at all, have people in Terri Schiavo's condition recovered, or at least improved significantly? Did she really meet the criteria for persistent vegetative state? What is a "persistent vegetative state"? Given her level of brain damage, what -- if anything -- was she capable of feeling? In what senses did she still have a personal identity or a sense of self? Clearly her body was the same body. Could she feel anything? There is a clear role for the sciences, especially the neurosciences, in clarifying this obscure moral terrain. Good ethics depend on good information, and many observers felt they did not have enough clarity about Schiavo's medical condition. Medicine and science can clarify this landscape, and the news media then have the responsibility of seeing that this information is available to the public at large.

There is another lesson to be learned from the Schiavo case. All too often discussion about tough cases becomes highly politicized. Rather than risking discourse with the "enemy," each side resorts to demonizing the opposition. It is easy to portray this dispute as a showdown between the forces of evil against the forces of good -- and both sides have used this ploy. This has been a difficult case precisely because there are two sides. One side sees this as a battle between those who wish to save a defenseless disabled person from a husband who wants to murder her by starvation. The other side sees this as a case of an embattled husband trying to carry out his wife's final wishes in the face of irrational and politically motivated attempts to advance a pro-life agenda even at the expense of extending Terri Schiavo's agony. The truth of the matter, however, is something more complex and more deserving of our attention. There are intelligent persons of good will on all sides of this debate, and we gain little by concentrating on the demons, no matter which set of demons we choose.

When we begin by demonizing the opposition, we have taken the first step to ensuring no possibility of resolution. However, there is another path: one which is far more likely to result in a positive resolution. Instead of beginning with what divides us, we should begin with our common ground. Is it possible that both sides loved Terri deeply and were concerned with her well-being?  Is it possible that both sides wanted what was best for her? Is it possible that both sides believed that it is wrong to cause a person in Terri's condition unnecessary suffering? Is it possible that both sides believed that they were doing what Terri would have wanted them to do? Is it possible that both sides felt that they were saving Terri from a worse fate?

Lawrence M. Hinman is director of the Values Institute and a philosophy professor at the University of San Diego and founder of  Ethics Updates and  Ethics Videos. Michael Kalichman is director of the  Research Ethics Program  and Professor of Pathology in the School of Medicine at University of California, San Diego. Together, they began a regional  Center for Ethics in Science and Technology  dedicated to "increasing awareness, understanding and discussion of the ethical implications of new developments in science and technology."