Terri Schiavo died on March 31, 2005, at the age of 41. Virtually
thousands of others died or lay dying on that day throughout the world,
yet the death of Terri Schiavo gripped not only the attention of the media
throughout the United States and much of the world, but the attention of
the U.S. Congress, the U.S. President, the Vatican, and millions in the
United States and around the world. Why? Well, in the words of U.S.
President George Bush, “The case of Terri Schiavo raises complex
issues…. Those who live at the mercy of others deserve our special
care and concern. It should be our goal as a nation to build a culture of
life, where all Americans are valued, welcomed, and protected—and
that culture of life must extend to individuals with disabilities”
(The New York Times, March 31, 2005). Terri Schiavo, in her persistent
vegetative state of 15 years duration, was being kept alive, in her
Florida hospice bed, with the help of a feeding tube that artificially
delivered fluids and nutrition. The attempts of her husband over the last
7 years, in opposition to the wishes of his wife's parents, to remove
the feeding tube and allow his wife to die have created a firestorm of
controversy and debate in judicial, medical, political, ethical, moral,
and religious arenas. When Terri Schiavo died, some 13 days after the
feeding tube was removed, the noted civil rights activist Reverend Jesse
Jackson said, “She was starved and dehydrated to death!” (The
New York Times, March 31, 2005). A Vatican spokesman said
“Exceptions cannot be allowed to the principle of the sacredness of
life from conception to its natural death” (The New York Times,
March 31, 2005). Clearly, the death of Terri Schiavo rekindled a variety
of debates that were perhaps dormant but unresolved. The political debate
in the United States and the appropriateness of steps taken by the U.S.
President and Congress will likely continue through the next cycle of
elections and the process of selecting and approving judicial nominations.
They will also, undoubtedly, influence several aspects of medical research
and practice including end-of-life care. The religious and moral debates
regarding the sanctity of life will continue and also significantly impact
on medical research and medical practice. For those interested in reading
more about these particular issues I refer you to two excellent pieces in
the April 21, 2005, issue of the New England Journal of Medicine
(i.e., Annas, 2005; Quill,
2005). For clinicians and researchers in palliative care, however,
the death of Terri Schiavo has raised some rather specific clinical and
research issues that must be addressed. These issues pertain primarily to
the experience of suffering in the dying process.
What can we learn from the death of Terri Schiavo?
