Community/Public Health Nursing 6th Edition by Mary Nies ,Melanie McEwen

Exercise 13

The world watched while Terri Schiavo's situation unfolded amid numerous legal and legislative challenges surrounding whether her feeding tube should be discontinued, and conflict developed between her parents and her husband and guardian, Michael. Disability rights groups and right-to-life advocates kept vigil for weeks outside the nursing home where Terri resided. Terri, a 41-year-old brain-damaged woman, died on March 31, 2005, 7 years after experiencing an anoxic event that led to her condition. Although previous court decisions have clearly established a person's right to discontinuation of treatment, including the provision of food and fluids, there was no documentation or advance directive indicating Terri's wishes. Terri's parents offered to assume guardianship of their daughter, believing her to be both responsive to her environment and desiring life in her current condition. Michael fought to have her feeding tube removed, stating that in previous discussions Terri had said that, in a similar situation, she would not want to continue living. Medical discussions focused on the extent of her "vegetative state" and capacity to respond to her environment. Seven years later, amid numerous court challenges and Michael's obtaining a reported million-dollar-plus malpractice settlement designated for his wife's care, the court ordered that Terri's feeding tube and all hydration be stopped as requested by her husband. She died several days later.
What do you think When is life meaningless What are the relevant issues when families are in conflict about what medical treatment the person with a severe disability would want in the absence of written advanced directives What values and ethical principles should be considered Williams (2005), a physician, suggests that a key question to be considered is "How should we have looked at Terri Was she a person (or nonperson) in a persistent vegetative state, perhaps with diminished rights, or was she a severely handicapped person with rights that were not considered fairly " When medical care is futile (i.e., useless or burdensome), it should be stopped; however, what guides our practice when treatment, such as artificial nutrition through a feeding tube, is withdrawn because a life is seen to have no value or the care of that person is deemed excessively burdensome
Many hoped that the Patient Self-Determination Act of 1990 would motivate people to prepare advance directives for decision making in life-threatening illness. However, many people do not consider these issues, leaving families as surrogates to decide what the individual would want. Hopefully, Terri's case, which polarized the nation on what should be done in her situation, has stimulated people to think through, discuss with loved ones, and complete advance directives that are communicated to a health care provider.