Case Study
Perhaps the one case study that best depicts the effect that therapeutic jurisprudence might have involves the case of Theresa (Terri) M. Schiavo. Ms. Schiavo suffered a cardiac arrest in February 1990. She was without oxygen for approximately 11 minutes, or 5 to 7 minutes longer than most medical experts believe is possible to sustain without suffering brain damage. At the insistence of her husband, she was intubated, placed on a ventilator, and eventually extubated and received a tracheotomy. The cause of her cardiac arrest was later determined to be a severe electrolyte imbalance caused by an eating disorder, as Ms. Schiavo had lost approximately 140 pounds, going from 250 to 110 pounds, in the months before her cardiac arrest.
Ms. Schiavo was in a coma for the first 2 months after her cardiac arrest. She then regained some wakefulness and was eventually diagnosed as being in a persistent vegetative state (PVS). She was successfully weaned from reflexive behaviors. Characteristic of persistent vegetative state, Ms. Schiavo was not able to eat food or drink liquids, and a permanent feeding tube was placed so that she could receive nutrition and hydration.
Once the media became aware of Ms. Schiavo’s condition, court battles regarding the removal or retention of her feeding tube were initiated. During these hearings and trials, sufficient medical and legal evidence to show that Ms. Schiavo had been correctly diagnosed and that she would not have wanted to be kept alive by artificial means was introduced. Laws in the state of Florida, where Ms. Schiavo resided, allowed the removal of tubal nutrition and hydration in patients with PVS. The feeding tube was removed, but was later reinstated following a court order.
Questions:
What legal issues concerning the scenario do you see?
Do you see how the families’ desires conflict with Terry’s intended wishes? Identify the legal issues involved with this situation and then instruct a group of nurses about advanced directives and the lessons learned from Terry Schiavo.
Finally, if you could make a law and put it into the Florida Legislation, what kind of law would you write that gives tribute to the suffering that Terry went through? Let’s call it Terry’s law in respect for her…
Full Answer Section
Instructions to Nurses About Advanced Directives and Lessons Learned from the Terri Schiavo Case
Advanced directives are legal documents that allow people to state their wishes about medical care in the event that they become incapacitated. They can include documents such as living wills, healthcare proxies, and do-not-resuscitate (DNR) orders.
It is important for nurses to be familiar with advanced directives and to respect the wishes of their patients. In the Terri Schiavo case, some nurses expressed concern about removing her feeding tube, even though it was her husband's wish and a court order had been issued. Nurses should be aware that they have the right to refuse to participate in procedures that they believe are unethical, but they should also respect the wishes of their patients and their families.
Terry's Law
If I could make a law and put it into the Florida Legislation, I would write a law that requires all adults to have an advanced directive in place. This law would also provide education to the public about advanced directives and the importance of making their wishes known.
I would call this law "Terry's Law" in respect for her and the suffering that she went through.
Conclusion
The Terri Schiavo case was a complex and tragic one. It raised a number of important legal and ethical questions. It is important for nurses to be familiar with these issues and to respect the wishes of their patients and their families.
Sample Answer
Legal Issues
The Terri Schiavo case raised a number of complex legal issues, including:
- The right to die: Schiavo's case raised the question of whether patients have the right to refuse life-sustaining treatment. This is a difficult question to answer, as it balances the individual's right to self-determination with the state's interest in preserving life.
- The role of the family: Schiavo's case also raised the question of who should make decisions on behalf of patients who are unable to make their own decisions. In Schiavo's case, her husband and her parents disagreed about whether or not to remove her feeding tube.
- The role of the courts: The Schiavo case also raised the question of the role of the courts in making decisions about life-sustaining treatment. In this case, the courts intervened to prevent Schiavo's feeding tube from being removed on several occasions.
How Terry's Intended Wishes Conflict with the Families' Desires
Schiavo's husband, Michael Schiavo, testified that she had told him that she would not want to be kept alive by artificial means if she were in a vegetative state. Her parents, however, disputed this claim, arguing that she would want to be kept alive.
The courts ultimately sided with Michael Schiavo, finding that there was clear and convincing evidence that Schiavo would not have wanted to be kept alive by artificial means. However, the case highlighted the difficulty of determining a patient's wishes when they are unable to communicate them directly.