Life After Schiavo
By Tarris D. Rosell, Associate Professor
Central Baptist Theological Seminary, Kansas City, KS
Terri Schiavo has died, her cremains interred. The news media has long since focused attention elsewhere. And now-after fifteen years of having lived in a severely brain-damaged state, sustained by daily enteral tube-feedings, unknowingly enmeshed in a twelve-year family feud over her treatment plan-it finally is all over for Terri.
But it is not all over for others. Indeed, the repercussions of her dying will remain with the Schiavo and Schindler families, and all of us, for years yet to come.
There is of course the lingering sense of loss and sadness experienced now and forever by those who loved their wife, daughter, sister, patient, and friend. Life after Terri`s death surely involves grief along with some relief.
Most of us, including those who claimed to advocate on her behalf, did not personally know Ms. Schiavo. Yet, we too are affected by her dying and death. Deep political and ideological divisions remain among us. People of good will remain at odds regarding what happened, what should have happened, what ought now to happen or in the future with regard to similar patient situations.
I have yet to find anyone willing to request similar medical treatment in her own future case, however. On that matter alone there is near unanimity. No one of my acquaintance says they wish to be tube-fed and hydrated for fifteen years after entering into anything like persistent vegetative state or especially a minimally conscious state.
Beyond that agreement, perspectives differ widely on the Schiavo case. Within our own families and social circles we continue to disagree about what "really" happened to Terri`s brain and body, within the Schiavos` marriage and their extended family. We see differently the various court proceedings, state and federal legislative interventions garnering executive signatures. Speculations vary on what was in the hearts and minds of protesters and supporters on both sides, or in the nonprofit coffers of those who seemed to profit at Terri`s expense. We understand differently the biases of media or religious spokespersons. We are a people divided.
Even the autopsy report* is not expected to settle the issue of Terri`s disputed diagnosis. Many are disinclined to base their judgments on medical findings, scientific evidence or jurisprudence. The physiological facts about Terri Schiavo may not impact at all the ideological beliefs at play here. So one could anticipate the autopsy itself will forever be disputed, the examiners will be seen as biased or bought. Some will claim a pending miracle was thwarted by Terri`s death or that she did not receive therapies that could have made a difference in outcomes.
For years to come, we will live in the wake of socio-political process gone awry. "Separation of powers" became a murky concept in the Schiavo case. There was evidence of one branch of government encroaching upon that of another, the federal upon state`s jurisdiction, Church upon State, and the public upon the private sphere. It will take some time even for the world`s greatest democracy to work through this national moral morass.
Misinformed and uncivil discourse propounded of late impacts unfairly physicians, patients and proxies who face decisions about foregoing artificial nutrition and hydration. How will references to "starvation", "murder", or "torture" affect those who have made or will need to make these already wrenchingly hard treatment decisions? Will some hesitate to utilize tube-feeding at all for fear that it cannot be stopped? Will life-sustaining, death-prolonging treatments continue for other patients long after the medically and ethically appropriate thing to do is to withhold and/or withdraw? Will reactive legislation soon reverse a decades long societal consensus that patients or their legal surrogates may refuse any and all treatments as a matter of constitutionally protected right to privacy?
Will a living will matter in the days just ahead? Will we honor a properly executed healthcare directive, a designated healthcare proxy, or even prior family conversations about end of life care? What will life be like, and dying, after the Schiavo fiasco?
If there is a good to come of this tragedy, it may be in the partial breaking of a death-denying taboo. Families are talking together about dying and death, about what would constitute a good death or not. We are conversing about when a feeding tube would be desirable, and when our family surrogates had better stop such treatments "if you don`t want me to come back and haunt you!"
Thousands are requesting and executing advance directives for the first time. One can hardly do so without acknowledging mortality. When we accept the inevitability of our own demise, we may think more clearly, less fearfully, about acceptable and refusable medical treatment options for ourselves and for those we love. It could result in respectfulness for those who choose differently. End of life care may be enhanced instead of impeded. If so, one dimension of life for us, after Terri Schiavo`s tragic death, could actually improve. In her memory and for our own sakes, let us hope for this end.
*On June 16, 2005 (after this article), a 38-page autopsy report backed her husband`s contention that she was in a persistent vegetative state, severely and irreversibly brain-damaged and blind.
