Revisiting Terri Schiavo
Professor John D. Schuetze, Wisconsin Lutheran Seminary, Mequon, WI
The news has just been announced. After years of legal battles and power plays, the struggle between parents and husband has ended. Terri Schiavo has died.
Some might argue that Michael Schiavo won. Yet in cases like this, there are no winners, only losers. No one can walk away from the game feeling triumphant.
One thing that we can all learn from the life and death of Terri Schiavo is that end-of-life care and the decisions that go with it are never easy. What often complicates matters is that these decisions are filled with emotion. Now that the dust has settled a bit, it might be good for us to review this case and consider the principles that apply.
There are two key issues that are basic to end-of-life health care — who decides and how does a person decide. In the case of Terri Schiavo, her husband was given the responsibility to make decisions for her medical care. In recent years, medical care has moved from medical paternalism toward patient autonomy. This means that rather than the doctor deciding what should be done, each person has the right to accept or refuse medical care. When that person is no longer able to make those decisions, another person is given the responsibility and right of “substituted judgment.” Supposedly such a person will decide “what the patient would have wanted.”
In some says this reflects the biblical principle that we are stewards of our lives and the lives of loved ones. We are our brother’s (and sister’s) keeper. But at the same time, none of us enjoys absolute autonomy in making these decisions. These rights are limited by God and by the laws of the land. The government also has a responsibility to protect the lives of its citizens. Where the government’s responsibility and individual rights begin is not always clear as this case demonstrates. And to replace one custodian (Michael Schiavo) with another (Terri Schiavo’s parents) simply because we don’t like the decision that the person is making is not a good course of action either. The decision Michael Schiavo made was within the confines of the law and acceptable medical practice. Within this country, it is legal and medically acceptable to remove a feeding tube. In 1990 food and fluids were also withdrawn from Nancy Cruzan, another person with severe brain damage. This same action has been quietly taken in many other cases in the decade and a half that has followed. This doesn’t make the action to withhold nutrition and hydration in each case morally right, only legally and medically acceptable.
This leads to the second key point — how do we make these difficult and emotional medical decisions. Within the realm of medical care, as well as within North American society, these decisions are usually made on the basis of the quality of life principle. Personhood in our culture is more and more being defined in terms of cognitive function and ability to relate to others. On the other hand, we as Lutheran Christians make our decisions based on the sanctity of life principle which recognizes that each human life is valuable regardless of the quality that life has.
This distinction has a profound effect on our medical decisions. Secular society asks the question, “Is this life worth living?” to which most will answer “no.” None of us would hope for such a life, either for ourselves or for our loved ones. It is not a life for which we long, but one that we pray God would protect us from facing. Yet God is the one who ultimately decides our lot not only in the next life but in this life as well. And in this world of sin and sickness, some will live such a life. But saying that such a life is not worth living is making a judgment call we don’t have the right to make.
Rather than asking the question, ” Is this a life worth living?” we should be asking, “Is this a treatment worth giving?” Is this treatment in the best interest of this life? Such an approach does not make a value judgment on the life of the person. It judges whether the treatment is something that will prolong this life regardless of its quality.
This does not mean that the answer to this question will always be “yes.” In some cases, treatment may be futile. It may be futile to insert a feeding tube in a patient when death is imminent. It may be futile to perform CPR on an elderly person should that person suffer heart failure. To refuse such medical care would reflect good Christian stewardship of life.
Not only will such treatment be futile but it could also be unduly burdensome. This would be the second reason why we might refuse treatment for ourselves or for our loved ones. If the pain and suffering that the treatment causes seem to outweigh the benefits that the person will receive, a Christian may choose to withhold or withdraw the treatment. In such a case a person isn’t choosing death. The sanctity of life principle is still upheld. The value judgment is directed at the treatment and not at the quality of the person’s life.
Applying these principles will not be easy. As the Schiavo case illustrates, we will often be fighting the opinions of a secular society that feels our health care dollars are better spent preserving lives that are worth living. Yet as we try the best we can to apply these principles in the fear of God, we want to do so in an evangelical manner. We want to remember that our main goal is not to save lives for this life but for the next. Equating a thirsting Schiavo with a thirsting Savior does little to win over hearts to the gospel. Only when hearts are won for Christ will those people realize the great value that a loving God places on lost sinners. Only then will these hearts value the lives of their fellow human beings.
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