Essays

Terry Schiavo and Her Physicians

Author: Samuel Metz

Date: 03/25/2005

Lest we forget, there are two and only two issues in the case of Terri Schiavo: Is she in a persistent vegetative state and what are her wishes? 

The first issue is resolved: All physicians examining her at the request of her husband and courts conclude her state is vegetative, as have all her attending physicians for 15 years. Two physicians requested by her parents disagreed, one of them uncomfortable with "persistent," suggesting experimental or yet-to-be discovered therapies might be curative. This logic renders a diagnosis of "persistent" impossible - the dead are not "dead," just "temporarily devoid of life until we find a cure for what killed them." 

Many distant physicians, undeterred by this unanimity, venture their own unsolicited diagnoses. Some were in Congress, a condition that clearly does not improve medical acumen. One medical adage says when physicians disagree, the one at the bedside has the high ground. Yet Dr. Frist, Senator from Tennessee, made his diagnosis from a few minutes of four-year-old videotape. Dr. Coburn, Senator from Oklahoma, made his simply by watching TV. It is more than bad medicine to make life-and-death decisions from a distance; it qualifies as negligence. 

Dr. Cheshire, a neurologist who ventured his opinion at the request of the "State of Florida" neither examined her nor conducted tests. Nonetheless he concluded all previous physicians caring for her were wrong in diagnosing her as vegetative. That a physician unknown to family, courts, or attending physicians would offer an uninvited opinion contradicting all prior medical judgments shows considerable chutzpah. That Dr. Cheshire is a director in an ethics center with a Christian agenda does little to enhance his impartiality. 

Dr. Cheshire’s opinion also demonstrates that if enough monkeys sit at enough typewriters, one will eventually type out the diagnosis you want.

What would Ms. Schiavo want done? Another pretty good adage is that if you want to know what the patient wants, ask the patient. Do not ask their clergy, or the leader of their espoused religion, or their parents or husband or employer or neighbors or pets. If the patient is unable to speak, read the patient’s written instructions. In their absence, ask the designated power of attorney. If none, ask the legal guardian; in this case, the spouse.

Others may object to the guardian’s decisions if they feel they contradict the known wishes of the patient. Courts hear the evidence and determine the worth of the objections. It is absolutely inappropriate to introduce other wishes regarding care of the patient; all that matters is the patient’s wish. The Schindlers, parents of Ms. Schiavo, do not dispute Mr. Schiavo’s claim that his wife would refuse care to maintain a persistent vegetative state. While many speculate on what other members of the patient’s family or religion or political party or sorority might want, this is irrelevant. What would the patient want?

Many players in this drama claim they object to the process; in fact they object to the result. Every court and judge acted in strict accord with our laws, no thanks to the unprecedented interference by legislative and executive agents at both state and federal levels. The result may be distasteful to those with their own private personal, religious, or political beliefs. The process, nonetheless, has been within bounds of common decency, respect for individual patient wishes, and judicial protocol. 

Our hearts go out to her family who must accept both her incurable status and her wishes not to be kept alive in this state. However, Ms. Schiavo is now free to have her end-of-life wishes respected. Regardless of whether others may have chosen differently, we have to live with it.