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Feeding tube right-to-die case rocks Florida
MEDICINE AND HEALTH POLICY
Feeding tube right-to-die case rocks Florida Angeles), told The Lancet. Cotler said it would also “erase a great deal of the conjecture and the hype” if there were clarity about Terri Schiavo’s true medical status. Terri Schiavo’s parents have said that they have some 15 doctors who have testified that she is not in fact in a persistent vegetative state. “The treating physicians have a duty to make it very clear to the family what the medical facts constraining the case are”, Cotler said. “I am disappointed that a patient’s wishes and those of her proxy decision maker are being ignored”, Marc
Kahn (Tulane University School of Medicine, New Orleans, LA), told The Lancet. “Unfortunately, the ethical principle of autonomy has been ignored in deference to the principle of beneficence. Assuming the patient communicated her wishes to her husband either verbally or in writing, her wishes should be granted”, said Kahn, who has written on end-of-life issues (J Clin Oncol 2003; 21: 3000–02). “In this case, the wishes of her parents have taken precedence, in violation of the autonomy principle.” What makes the situation unique is that Terri Schiavo
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
he Florida state legislature and the state’s governor, Jeb Bush, have reversed the decision of a state court to remove a nasogastric tube from a 39year-old woman who has been in a vegetative state for 13 years after suffering a cardiac arrest, shining the spotlight on right-to-die issues in the USA. The woman’s husband, Michael Schiavo, has said that Terri Schiavo did not want to be kept alive artificially, but her family has objected, saying that she is still responsive, for example, to commands to open her eyes. On Oct 15, the last in a series of court decisions sided with Michael Schiavo, and the nasogastric tube was removed. On Oct 21, however, the Florida senate passed a bill, signed into law later that day by Governor Bush, that allowed a stay of the last court’s decision and led to the reinsertion of the nasogastric tube. “We have a woman who can smile, who can respond to her mom, who can follow a balloon around the room”, Florida state senator Daniel Webster, a Republican, told the ABC news programme Nightline. “And under current Florida law she is deemed alive. And I will tell you this, because of that, I could not bring myself to allow someone to pull food and water from that person when they’re in that particular state. I think that we erred on the side of right by erring on the side of life.” But medical ethics experts are calling the decision into question. “It’s unfortunate that the conversation has become politicised and publicised and that we’ve lost sight of the interests of the patient”, Miriam Piven Cotler (California State University, Northridge, and University of California at Los
T
Protestors outside Woodside Hospice Villas in Pinellas Park, Florida
THE LANCET • Vol 362 • November 1, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
is neither elderly nor comatose nor on a respirator. The case has been going on since 1998, when her husband began legal proceedings to have her nasogastric tube removed. Her cardiac arrest was the result of a potassium deficiency. Her future remains unclear, as a number of legal scholars have said that it is generally held to be unconstitutional for a legislature to overturn a court ruling, particularly when a new law applies in just one case. “The separation of powers is explicit under the Florida constitution”, said Lars Noah, a University of Florida law professor, “and no one doubts that the question of whether a patient in a persistent vegetative state chose to decline life-sustaining treatment is a judicial one”. Noah said the situation in the UK, where the House of Lords acts in a dual capacity as part of a legislative body and also as a final appellate tribunal, is different. Michael Schiavo’s attorney, George Felos, said his client will seek an injunction against the law. “We believe that a court sooner or later—we hope sooner—will find this law to be unconstitutional”, Felos told NBC’s Today television programme. Anti-abortion advocates are rallying behind the case, as well as the US Senate ban on so-called “partial-birth” abortions (see p 1464). Anti-abortion activist Randall Terry, who founded Operation Rescue, has been at the side of Terri Schiavo’s parents throughout the week. Cotler said that in 17 years of teaching and consulting on medical ethics, she has never seen such public attention to the issues surrounding a case. Ivan Oransky
1465
Feeding tube right-to-die case rocks Florida Angeles), told The Lancet. Cotler said it would also “erase a great deal of the conjecture and the hype” if there were clarity about Terri Schiavo’s true medical status. Terri Schiavo’s parents have said that they have some 15 doctors who have testified that she is not in fact in a persistent vegetative state. “The treating physicians have a duty to make it very clear to the family what the medical facts constraining the case are”, Cotler said. “I am disappointed that a patient’s wishes and those of her proxy decision maker are being ignored”, Marc
Kahn (Tulane University School of Medicine, New Orleans, LA), told The Lancet. “Unfortunately, the ethical principle of autonomy has been ignored in deference to the principle of beneficence. Assuming the patient communicated her wishes to her husband either verbally or in writing, her wishes should be granted”, said Kahn, who has written on end-of-life issues (J Clin Oncol 2003; 21: 3000–02). “In this case, the wishes of her parents have taken precedence, in violation of the autonomy principle.” What makes the situation unique is that Terri Schiavo
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
he Florida state legislature and the state’s governor, Jeb Bush, have reversed the decision of a state court to remove a nasogastric tube from a 39year-old woman who has been in a vegetative state for 13 years after suffering a cardiac arrest, shining the spotlight on right-to-die issues in the USA. The woman’s husband, Michael Schiavo, has said that Terri Schiavo did not want to be kept alive artificially, but her family has objected, saying that she is still responsive, for example, to commands to open her eyes. On Oct 15, the last in a series of court decisions sided with Michael Schiavo, and the nasogastric tube was removed. On Oct 21, however, the Florida senate passed a bill, signed into law later that day by Governor Bush, that allowed a stay of the last court’s decision and led to the reinsertion of the nasogastric tube. “We have a woman who can smile, who can respond to her mom, who can follow a balloon around the room”, Florida state senator Daniel Webster, a Republican, told the ABC news programme Nightline. “And under current Florida law she is deemed alive. And I will tell you this, because of that, I could not bring myself to allow someone to pull food and water from that person when they’re in that particular state. I think that we erred on the side of right by erring on the side of life.” But medical ethics experts are calling the decision into question. “It’s unfortunate that the conversation has become politicised and publicised and that we’ve lost sight of the interests of the patient”, Miriam Piven Cotler (California State University, Northridge, and University of California at Los
T
Protestors outside Woodside Hospice Villas in Pinellas Park, Florida
THE LANCET • Vol 362 • November 1, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet.
is neither elderly nor comatose nor on a respirator. The case has been going on since 1998, when her husband began legal proceedings to have her nasogastric tube removed. Her cardiac arrest was the result of a potassium deficiency. Her future remains unclear, as a number of legal scholars have said that it is generally held to be unconstitutional for a legislature to overturn a court ruling, particularly when a new law applies in just one case. “The separation of powers is explicit under the Florida constitution”, said Lars Noah, a University of Florida law professor, “and no one doubts that the question of whether a patient in a persistent vegetative state chose to decline life-sustaining treatment is a judicial one”. Noah said the situation in the UK, where the House of Lords acts in a dual capacity as part of a legislative body and also as a final appellate tribunal, is different. Michael Schiavo’s attorney, George Felos, said his client will seek an injunction against the law. “We believe that a court sooner or later—we hope sooner—will find this law to be unconstitutional”, Felos told NBC’s Today television programme. Anti-abortion advocates are rallying behind the case, as well as the US Senate ban on so-called “partial-birth” abortions (see p 1464). Anti-abortion activist Randall Terry, who founded Operation Rescue, has been at the side of Terri Schiavo’s parents throughout the week. Cotler said that in 17 years of teaching and consulting on medical ethics, she has never seen such public attention to the issues surrounding a case. Ivan Oransky
1465