The Terri Schindler-Schiavo Case
By Latrelle Easterling, December 2003
Presentation of the Case
Terri Schindler-Schiavo has spent 13 years in a coma, attached to feeding tubes and unable to communicate. On February 25, 1990, Terri Schiavo collapsed in her home. While the actual circumstances that led to her collapse are speculative, doctors believe a potassium imbalance caused her heart to stop, temporarily cutting off oxygen to her brain (Associated Press April 30, 2001). Terri fell into a coma and was hospitalized and ultimately placed on a feeding tube to provide hydration and nutrition. According to the doctors attending to Terri in 2001, death would occur within one to two weeks of removal of the equipment that is providing food and hydration to her (St. Petersburg Times, 7 March 2001, sec. 3B).
After a prolonged hospitalization, Michael Schiavo, Terri’s husband, filed a petition to have the feeding tube removed in May of 1998. Bob and Mary Schindler, Terri’s parents, then filed suit to have Michael Schiavo removed as Terri’s guardian ad litem, and to prevent the feeding tube from being removed. Significant legal battles ensued that raised issues concerning whether Terri would ever recover, who has the right to speak on her behalf, whether treatment can be suspended, and what constitutes treatment. A lower court judge ordered on February 11, 2000 that the feeding tube may be removed. Both the Florida Supreme Court and the United States Supreme Court refuse to intervene, allowing the lower court ruling to stand. However, On April 26, 2001, Circuit Judge Frank Quesada orders doctors to reinsert Terri’s feeding tube after her parents filed motions alleging that false testimony was offered at the lower court hearing. During a hearing beginning October 17, 2001, five doctors offer testimony concerning whether Terri Schiavo will ever recover (Associate Press 17 Nov. 2003).
Five doctors examined Terri to assess her condition, and her chances for recovery. Two doctors argue that she can recover while the remaining three testify there is no hope of recovery. On November 22, 2002, Judge Greer rules that there is no evidence that Terri has any hope of recovery and orders her feeding tube may be removed. On June 6, 2003, the 2nd District Court of Appeal upholds the lower court ruling allowing for the feeding tube to be removed. On October 15, 2003, the feeding tube is removed. On October 21, 2003, the Florida legislature passed a feeding tube bill allowing the tube to be reinserted. (Associated Press 17 Nov. 2003).
Michael Schiavo believes that his wife is being made to suffer, and that her present status has robbed her of any remaining dignity. Terri’s parents believe that their daughter has been denied the opportunity to recover, and that with treatment she can enjoy a reasonable quality of life. The legal battle continues today with doctors disagreeing about Terri’s medical status, prospects for recovery and appropriate interventions. In the meantime, Terri remains attached to a feeding tube, spending her life in a medical institution totally incapacitated and unable to participate in the decisions concerning her very life.
Framing the Issue
This emotionally charged case has strained the limits of medical, legal and moral reasoning. The facts of the case raise crucial questions concerning human life, its purpose, ends and moral responsibilities. It also highlights the tension that medical technological advances have created between the health care community and faith communities. While science and religion have not always been dialogical partners, the need for the two to engage in meaningful discourse is epitomized in our modern technology-driven society. Regardless of our opinions concerning religion or science independently, the two have irreversibly intersected and must be engaged. For those traveling the highways of science and the long road of illness or death and dying, this intersection too often leads to a catastrophic collision rather than ordered navigation. There must be a roadmap that guides individuals through these hazardous intersections. Otherwise, far too many people travel in a perpetual state of cognitive dissonance, unable to interpret the road signs to reconcile their religious beliefs with scientific and medical technological realities.
This paper will use the aforementioned case to examine our society’s battle with death, the means employed to stave off death and their ethical and moral implications. I will also examine the issue of authority within the created being and who ultimately has authority with respect to the culmination of a human life. Finally, I will juxtapose these issues with the Christological concepts of life, death and suffering.
A Matter of Life and Death
“Death always has been and always will be with us. It is an integral part of human existence. And, because it is, it has always been a subject of deep concern to all of us. Since the dawn of humankind, the human mind has pondered death, searching for the answer to its mysteries. For the key to the question of death unlocks the door of life” Elisabeth Kübler -Ross
Not much has changed since these words were published in 1975. The word death still evokes emotions and fears in most individuals. It remains one of the few topics that elicit trepidation. For many the thought of leaving the temporal realm of life was we know it is unbearable. Death appears to many to be like a waterfall at the end of a flowing, glorious river. The destination is unknown and therefore predictably causes anxiety and foreboding. It is evident from our society’s fascination with staving off aging and its affects on the body that we cherish, almost worship life, and will go to extreme lengths to preserve it.
With the advent of technological medical developments, it has become much easier to prevent death and prolong life. These developments have been both a blessing and a curse. Few would argue that medical achievements such as the pacemaker, artificial heart, transplantations or cancer treatments are regrettable. Rather, they have provided treatments for otherwise debilitating or heretofore-terminal diseases or conditions. Those who receive such treatments often go on to live energetic, engaging lives. However, there are more controversial treatments that have brought with them arguments concerning whether they prolong life or simply elongate death . The ventilator, respiration or gastronomic feeding tube present more complicated dynamics and have muddied the waters of modern medicine. There is now a struggle between medicines intention to heal and life’s intention to eventually end. This tension between medicine and science also raises theological issues.
Renowned theologian Karl Barth stated, “God and God alone should make an end of human life” (Barth 1961, p. 404). Barth also reasoned that life was given to humanity “as an inalienable loan” (Barth 1961, p. 425). The terminology espoused by Barth, “gift” and “loan,” suggest that we are created out of love, and that although we are the embodiment of the giver’s gift, ultimately the gift is not ours to keep. In the end the gift must be returned to the lien holder. Therefore, if we do not own these lives it also flows that we do not have absolute control over them. Rather, we are stewards tasked with making something of these lives and caring for them in appreciation of the gift, but in anticipation of their ultimate return. Our stewardship should include an understanding of how the Creator would expect our lives to be maintained.
This ontological schema highlights the tensions present at our intersection. In light of Barth’s argument, how do we discern the will of God and good stewardship in the advent of medicine’s achievements? Are we to assume that if the mind of man can perceive and achieve it, that it is the will of God? Or has man stept out of his place and into the realm of the divine, building a medical tower of Babel? With respect to the Schiavo case, are the doctor’s playing God by continuing to sustain Terri’s life? If in fact she would die without the feeding tubes, is she in fact living or just experiencing a prolonged period of dying?
There are moral philosophers, such as Joseph Fletcher, who argue that not using every available means to sustain life is fatalistic and morally bankrupt. He postulates that medical and technological advances are the natural progression of a society created by God to achieve good, and to sustain life. Fletcher, who supports stewardship as well as dominion over nature, argues, “…humans have the right to use their intelligence in controlling physical nature rather than submitting to its ‘beastlike’ workings” (Talone 1996, p. 28).
In the case of Karen Ann Quinlan, perhaps the most famous case involving medical technology and end of life decisions, the attorney’s who argued that her parents should not be allowed to remove her from the respirator based their arguments on the theory that her parents only wanted to remove her from this life-sustaining machine because they could not bear to see her in pain. They argued that pain is an inevitable part of life, and must be endured both in birth and in death (Colen 1976, p. 50). However, Colen turned this argument on its head by espousing that their reasoning was in fact the most compelling rationale for ending this “medical molestation” of Karen’s body. He retorted that their legal machinations were,
Colen also articulates what few others are willing to admit. The decision to end life support is arguably not the first time that we engage in “playing God.” Rather, he argues that when the decision is made to use a respirator for exploratory surgery to determine whether life is still viable for example, that is also a decision tantamount to “playing God” (Colen 1976, p. 48). The latter decision is far more palatable because it sustains life, it prolongs our temporal existence and staves off death. The former decision offends our death-denying culture because it arguably robs us of the very thing we seem insistent on preserving at all cost.
Eric J. Cassell, in his essay “Dying in a technological society” frames the issue quite astutely. Cassell states,
The moral order analyzes facts and circumstances always keeping in mind that humanity is involved. It addresses human relationship, societal order and the pursuit of the highest good in relation to created being. The technical order deals with machines and their utilitarian value. While the technical order can serve to assist the moral order, it should not become the dominant cosmological view over against the moral order.
Cassell goes to on to state that with the dawn of this shift from a moral to a technical order, the focus of life has also changed. Rather than talking about “life expectancy,” the focus of this death defying culture has become our “death expectancy” (Hastings Center Report 1975, p. 43). And the growing expectation is that it should never come.
Understanding the Road Signs: Definitions
grant me the serenity to accept the things I cannot change,
Much of the controversy surrounding the issue of technology and medical care concerns the terminology employed, the attendant definitions and the moral implications of how those definitions are applied to the particular case. Concerning the case in point, Terri Schiavo has been deemed by several physicians to be in a “persistent vegetative state”. However, a different set of doctors have testified that she is not in such a state, and that her condition, with the proper therapy and care, can be improved. Much of the controversy concerning whether the medical technology deemed to be keeping her alive should be removed revolves around these diagnoses and definitions. There are at least two ways of interpreting this set of facts. On the one hand, if you believe that Terri is in a persistent, vegetative state with no hope of recovery, then efforts to keep her “alive” can be categorized as medical treatment. On the other hand, if you hold to the belief that Terri can recover from her condition, then the efforts to sustain her existence can be categorized as life affirming, and the duty that we owe to every human being.
There cannot be a reasoned, rational discussion without an understanding of the terminology employed in that communicative act. As articulated in the Episcopal Report, “It is vital to give … “euthanasia” as precise a meaning as we can, for clear definitions are essential to moral discourse” (Assisted Suicide and Euthanasia 1997, p. 11). If you were to consult Webster’s New Universal Unabridged Dictionary for a definition of euthanasia you would find the following entry:
This entry also indicates that euthanasia’s etymological origins in Greek meant “an easy death” (Webster’s 1992). The American Medical Association defines euthanasia as “The administration of a lethal agent by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering” (American Medical Association Prof. Ethics – E-2.21). According to a committee on medical ethics of the Episcopal Diocese of Washington euthanasia means, “one person intentionally causes the death of another who is terminally or seriously ill, often to end the latter’s pain and suffering. Euthanasia requires the explicit intention to end another’s life” (Assisted Suicide and Euthanasia 1997, p. 12). The Catholic Church defines euthanasia as,
While these definitions vary in tone, action and intentionality, they all concur that this act is usually done to relieve the suffering of the subject. The issue of suffering is central to a consideration of these issues, and will be addressed later in this project.
In the case of Terri Schiavo, the debate is not whether to inject her with a lethal dose of poison, rather the controversy surrounds whether the tubes, which provide hydration and nutrition, can be removed. Under the American Medical Association’s definition of euthanasia, the removal of the feeding tubes would not necessarily constitute euthanasia. Conversely, under the Catholic Church’s definition, the very act of withdrawing the feeding tube would be seen as causing her death, and would be considered an act of euthanasia. Also, under the Catholic understanding of this medical and technological quandary, the omission of food and water would be tantamount to euthanasia. It is important to note that Terri was raised Catholic, and her parents identify themselves as Catholic.
In the Schiavo case, should withdrawal of the feeding tube constitute euthanasia? Does the intention of the individual making the decision inform the debate? The Committee on Medical Ethics of the Episcopal Diocese of Washington draws a clear distinction between the intention to end life, and the intention to suspend ineffective or non-productive treatment. The Committee states,
However, the Catholic Church holds a very different opinion, regardless of intention. Responding to the removal of Terri’s feeding tube the Catholic Media Coalition stated,
The Coalition goes on to articulate that Pope John Paul II addressed the issue of withdrawing the administration of food and nutrition in medical cases on October 2, 1998. They quote him as saying that a similar case,
Is the Orthodox Catholic view on this subject the only feasible Christological view? Extreme arguments are rarely supported by reasoned, informed analysis of all considerations. It can be argued that the Catholic argument raises life to idolatrous levels. If the ultimate hope of the Christian is to see God “face to face,” then death should not be cursed as evil. This is not to support arguments that attempt to cast Paul as a supporter of suicide. However, there must be a rational point at which medical interventions are without merit, and allowing the process of death to occur is the higher good, for both the individual and the created order.
Richard A. McCormick, a Catholic theologian and ethicist, wrestles with the deep, abiding issues concerning the respect of life and death within a Christian context. He surmises that, “At some point continuance in physical life offers the person no benefit. Indeed, to keep ‘life’ going can easily be an assault on the person and his or her dignity (Talone 1996, p. 25). McCormick is said to be addressing the notion of “biologism,” which in this work is defined as, “see[ing] life only in terms of physical life and does not recognize the spiritual and eternal character of the person which is a constitutive part of the Christian tradition (Talone 1996, P. 25). Other Catholics as well argue that sustaining life, even through artificial feeding, is at times contrary to rational thought. Talone highlights the conclusion of the National Council of Catholic Bishops with respect to this issue. In their Directives for end-of-life care they state,
Talone goes on to talk about a cost-benefit analysis that is beyond the scope of this project, but is part of the ethical consideration that should be employed in these difficult cases.
The United Methodist Church recognizes this cost-benefit analysis in its understanding of end-of-life care. The Social Principles of the denomination clearly delineate an appreciation of the sanctity of human life, but they also recognize that all created being reaches a point of inviability. The Social Principles state,
However, the Social Principles also recognize limitations of life in this temporal realm.
While her parents, as well as doctors they have privately secured, argue that she can recover, it appears from the prolonged vegetative state highly unlikely. Michael Schiavo, and the doctors he has secured, argues that there is no meaningful hope of recovery for Terri. The doctor hired by the court to make an independent evaluation concurred with the doctor’s denying any chance for meaningful recovery. While the medical prognosis of the patient in this instance is in question, when the life of the patient no longer bears the marks of viability, there are moral and ethical arguments that support terminating all treatment. The criteria should be an objective analysis of what benefit this life sustaining, or perhaps death-prolonging treatment is achieving. Does Terri derive any benefit form continued attachment to a feeding tube serve? This should control the final analysis for all such unenviable circumstances.
A Christological View of Suffering and Death
For the imperishable must clothe itself with the imperishable, and the mortal with immortality. When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.” “Where, O death is your victory? Where, O death, is your sting?” 1 CO 15: 53-55.
I am fully cognizant of the fact that 1 Corinthian 15: 55 addresses the death of death, and the victory of eternal life in Christ Jesus. However, I am admittedly employing artistic license in appropriating that metaphor as a call to remember that death should also give us pause to evaluate our living, as well as our dying, in light of the victory eternal life. Perhaps in our life-worshipping culture, the ultimate sting of death should be our inability to continue living, and thereby our inability to “get it right” after we die. Perhaps there should be a little sting left in our dying.
Many in the Christian tradition hold that Jesus Christ provides a model for holy living and holy dying. Theologians often articulate the belief that Christ is the premiere “image and likeness of God” (Gunton 1992, p. 100). Those who support this theory postulate that,
While many scientists may argue that these religious considerations bear no direct weight on the technological questions at hand, theologians would argue that the failure to include theology in the debate is idolatrous. Martin Blocher questions the exclusion of God from the analysis when he states,
In light of this tenet, the life of Jesus holds important meaning for those who claim Christianity as their faith base. Perhaps there is wisdom to be gleaned from the life of Jesus in his final hours – the hours of his dying. During the final hours of the Passion Narrative, Jesus is about to enter into the darkest hour of his life. He is faced with the ultimate reality that the trajectory of his life has led him to the cross and crucifixion, the most humiliating death an individual can endure. After being led to the place where he is to be crucified, and just before he is nailed to the cross, Jesus’ captors offer him wine mixed with gall (Gospel of Matthew 27:34). However, Jesus refuses to drink from that bitter cup because he has chosen to drink from another bitter cup, the cup of salvation. After the hours of crucifixion have passed and Jesus nears the point of death, he is offered once again a mixture of wine. This time Jesus receives the sponge to his lips. Soon after receiving the sponge, Jesus “gives up the ghost” (Gospel of John 19:30).
It can be argued that Jesus refused to accept the first drink because it would have anesthetized him from his impending suffering, and lessened his conscious awareness of his sacrificial act. Jesus would not have been able to fully participate in his crucifixion (New Interpreter’s Bible Commentary 1995, vol. 8, p. 491). Although Jesus knew his impending ordeal would cause immense suffering and pain, he chose to endure it in submission to his Creator, and to fulfill his life’s purpose. It can further be argued that once that purpose was fulfilled, he allowed his suffering to be eased as he drank from the mixture of wine. At the point when Jesus knew his purpose in life had been fulfilled, he ceased to hold onto life in this temporal realm, but rather placed his life-spirit in the hands of his Creator (New Interpreter’s Bible Commentary 1995, vol. 9, p. 832).
What implications does this end-of-life dramatization have on a follower of Christ? It may in fact provide navigational tools for journeying toward our ultimate destiny. If Jesus’ life had purpose and meaning beyond his creating, and the fulfillment of that purpose was greater than his desire, comfort or will, our life holds commensurate characteristics. We, like Jesus, were each birthed into this cosmological order with a purpose, a divine purpose that transcends our temporal existence, desire or will. It is then our responsibility to live our lives toward a fulfillment of that purpose.
Pius XII addressed the issue of suffering and our call to approach the subject with intentional witness to our faith. When asked whether pain suppression was ever ethical within the Judeo-Christian tradition, Pius XII responded, “If no other means exists, and if, in the given circumstances, this does not prevent the carrying out of other religious and moral duties: Yes” (Pius XII in Bioethics 1999, p. 205). This interpretation of the Christian responsibility during suffering is commensurate with the events of Jesus’ dying on the cross. Jesus refrained form the initial offer of a narcotic because his life’s purpose had not been fulfilled. The salvific act for which he had been born had not been consummated. However, after the work of the cross had been completed, Jesus took the drink from the sponge.
Therefore, it is a valid view within the Christological model to lessen pain and suffering at the end of life. However, one should not extend this reasoned analysis beyond the bounds of applicability. A deep chasm exists between easing pain and ending it altogether through artificial means. To infer a prescription for euthanasia within this framework may be to broaden the analysis too broadly.
However, painkillers that cause unconsciousness need special consideration. For a person not only has to be able to satisfy his or her moral duties and family obligations; he or she also has to prepare himself or herself will full consciousness for meeting Christ. Thus Pius XII warns, ‘It is not right to deprive the dying person of consciousness without a serious reason’ (Bioethics 1999, p. 205).
The determination of whether one has either fulfilled their purposeful work in this temporal existence, or “met Christ,” is a highly subjective and personal matter. It cannot and should not be assumed or imposed on an individual. It is imperative that each individual be given an opportunity to work out his or her own soul salvation. This is why pastoral care and work with the dying is so critical. The individual should be given every opportunity to work through any questions of unfinished business, either secular or religious, for themselves.
At the beginning of this reflection I articulated that the superhighway of science and the boulevard of religion have intersected, and the trajectories cannot be reversed. While much has been gained from the achievements of medical science, our society is harmed when we lean too far on the technological side of life, and thereby neglect or deny our moral selves. While I am not arguing for a return “to the good old days,” (as if they were all that great), rather I am stating that a balancing of the two paths is required for ordered navigation. I resonate with the approach offered by Eric J. Cassell in his article, “Dying in a Technological Society,” where he states,
In attempting to avoid death and refusing to see it as the natural culmination of all life, we live in a state of denial, we rob “death of its meaning.” That denial causes us to refrain from engaging in perhaps the most compelling truth of death, that it is the defining moment of life. Perhaps this is the sting of death that we are attempting to anesthetize by worshiping and prolonging life. Perhaps an antidote to our technology-driven society can be to use the life and death of Jesus as our Global Positioning Satellite. By using his life as our ultimate navigational tool, the people of the Christian faith can remain steady as we journey this course.
Once death as occurred, in the Judeo-Christian sense, there is no opportunity to right wrongs or make amends for sins or offenses. The life stands as a testament, a finished volume of the individual who embodied that life. This stark reality should cause us to live life with enthusiasm and in earnest, but it should also encourage us to live to the highest moral good. To, in the words of John Wesley, “Do all of the good that you can, in all of the places that you can, in all of the ways that you can, for all of the people that you can, for as long as you can.” Yet, if we are unwilling to except the reality of death, if we vest all of our time, resources, energy and hope in the destruction of death, we run the risk of not running out of time to live to our highest good. Perhaps this is the most undignified life, a life that ignored the sting and unchangeable reality of death.
American Medical Association Ethical Guidelines, Database online. Available from: http://www.ama-assn.org/ama/pub
Assisted Suicide and Euthanasia: Christian Moral Perspectives, The Washington Report 1997, Pennsylvania: Morehouse Publishing.
Blocher, M. 1999, The Right to Die? Caring Alternatives to Euthanasia. Chicago: Moody Press.
Barth, K. 1961, Church Dogmatics, Vol. III: The Doctrine of Creation, Pt. 4, ed. B. W. Bromily and T.F. Torrance. Edinburgh: T&T Clark.
Boring, M. E., The Gospel of Matthew, Vol. VIII: The New Interpreter’s Bible: A Commentary in Twelve Volumes, 1995, Nashville: Abingdon Press.
Cassell, E.J. Dying in a technoligcal society. The Hastings Center Report: Death Inside Out, 1975 eds. P. Steinfels, R. M. Veatch 3: 43-48, New York: Harper & Row.
Colen, B.D. Karen Ann Quinlan: Dying in the Age of Eternal Life, 1976. New York: Nash Publishing.
Gunton, C.E. Christ and Creation 1992. Michigan: William B. Eerdsman Publishing
Kubler-Ross, E. Death: The Final Stage of Growth 1975. New Jersey: Prentice Hall.
O’Day, G.R. The Gospel of John, Vol. IX: The New Interpreter’s Bible: A Commentary in Twelve Volumes, 1995, Nashville: Abingdon Press.
Quill, T.E., Death and Dignity: Making Choices and Taking Charge 1993. New York: W.W. Norton & Co.
Seper, F. Card. 1999, Sacred congregation for the doctrine of the faith. Bioethics: An Anthology, eds. H. Keuse, P. Singer 21: 203-206, Oxford: Blackwell Publishers.
Talone, P.A. Feeding the Dying: Religion and End of Life Decisions 1996. New York: Peter Lang.
The Book of Resolutions of the United Methodist Church 1996. Tennessee: The United Methodist Publishing House.