Cases that involve ending life support occur on a regular basisaround the country, however, most go unnoticed by the publiceye.
But a recent decision in Florida to reinstate a brain-damagedwoman's feeding tube presents a different problem in which thefamily members were divided on what action to take, in turndividing the country's opinion on what was the right thing todo.
Terri Schiavo has been in a vegetative state since a 1990cardiac arrest. Her husband, Michael Schiavo, has been trying toend the administration of a feeding tube since 1998, saying hiswife said years ago that she never wanted to live under thoseconditions.
"If a person is in a persistent vegetative state, it islegitimate to discontinue a feeding tube. If that is not the case,then the decision-maker must have clear and convincing evidence toshow it should be removed," said Jim West, an anesthesiologist onthe Medical Ethics Committee at Methodist Hospitals in Memphis.
He said the decision to end life support is usually left up tothe spouse. But if the spouse is incapable of making the decision,the responsibility moves to immediate family members.
Neal Aguillard, a pulmonary physician in Memphis, said Schiavo'scase differs from regular life support cases because she still hasthe ability to breathe on her own.
"Physicians usually do a brain flow study to determine ifsomeone is legally brain dead," he said. "Most people just havesome type of brain damage which means the only things left workingare simple functions that keep the body going."
Since the patient involved is not legally brain dead, ethicalissues and decisions arise that sometimes do not have a definiteright or wrong answer.
Andrea Coletta, senior University of Memphis public relationsmajor and student leader of Campus Crusade for Christ, said therecould be several equally ethical conclusions in a case likethis.
"It is evident that the husband loves his wife, but in one senseit is unfair to him (to sustain life support) because he should beable to move on," she said.
She also noted that Schiavo is approaching the decision from adifferent position than his wife's parents, who want to continuethe treatment, and they would understandably have differentviews.
West mentioned several cases that had similar situations,notably the Nancy Cruzan case. Cruzan crashed her car in 1983,resulting in permanent brain damage. Courts finally permitted herparents to remove the feeding tube in 1990.
"Most patients we deal with are in situations where familieswon't consent to stop treatment because they have a hard timeletting go," West said. "It is our job as the ethics committee tocounsel family members and to promote communication between thehealthcare team and the family."
