April 8, 2005

VUMC panel examines medical, ethical points of Schiavo case

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Howard Kirshner, M.D., left, Larry Churchill, Ph.D., and Joshua Perry, J.D., took part in the panel discussion.
photo by Anne Rayner

VUMC panel examines medical, ethical points of Schiavo case

Medical Center faculty, staff and students filled the seats of 208 Light Hall Monday to hear a panel discussion on the Terri Schiavo case, which has caught the attention of the nation and dominated headlines and editorial pages for much of the past month.

Larry R. Churchill, Ph.D., Ann Geddes Stahlman Professor of Medical Ethics and professor of Medicine, Howard S. Kirshner, M.D., professor of Neurology, and Joshua E. Perry, J.D., fellow in the Center for Genetics and Health Policy, presented on different areas of the case to shed legal, medical and ethical light on the subject.

“The goal of today's discussion is not to take one side or the other, but to provide more information on the history of this case and how the legal and medical systems are set up to deal with guardianship and end-of-life issues,” Perry said.

Perry gave the chronology of Schiavo's case through each appeal, and said that the court system upheld its legal duties and gave the case “more due process than any other guardianship case in history.”

He pointed out that the courts were to determine Schiavo's medical condition and her wishes for medical treatment, and ruled repeatedly that she was in a persistent vegetative state (PVS) and her intent was not to be kept alive by a feeding tube.

Kirshner outlined how PVS is determined and how it differs from brain death, comas, stupor and locked-in state. He provided the medical management guidelines for such patients, which state that a feeding tube is a medical treatment, that treatments that provide no benefit to the patient may be discontinued, and that medical treatments provide no benefit to patients in a PVS.

Looking at the intent side of the Schiavo legal battle, Churchill spoke about the ethical issues at hand, namely autonomy. He described autonomy as an ethical principle with a legal history — the right to be self-determining and, in medicine, to make one's own medical decisions.

“But there are limits to the autonomy of patients: ignorance, coercion and incompetence,” he said. “Advance directives, such as a living will, are designed to sustain self-determination beyond the loss of competence.” Churchill said that in the past, the courts have upheld written, as well as unwritten, living wills.

The panel opened up to a question and answer format, allowing the audience to get involved. Topics were raised covering everything from the possibility that Schiavo felt pain as she was dying to whether or not removing a feeding tube is euthanasia.