Joshua E. Perry, JD, MTS; Larry R. Churchill, PhD; Howard S. Kirshner, MD
Acknowledgments: The authors thank the editors and 3 anonymous reviewers for insightful comments on an earlier draft of this article.
Grant Support: None relevant to this article.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Joshua E. Perry, JD, MTS, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 507B Light Hall, Nashville, TN 37232.
Current Author Addresses: Mr. Perry: Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 507B Light Hall, Nashville, TN 37232.
Dr. Churchill: Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 319 Oxford House, Nashville, TN 37232.
Dr. Kirshner: Department of Neurology, Vanderbilt University School of Medicine, 2100 Pierce Avenue, Nashville, TN 37232.
Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.
Joshua E. Perry, Larry R. Churchill, Howard S. Kirshner. The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives. Ann Intern Med. 2005;143:744–748. doi: 10.7326/0003-4819-143-10-200511150-00012
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Published: Ann Intern Med. 2005;143(10):744-748.
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