Ethical principles can help the healthcare professional make consistent and well-reasoned ethical decisions even in difficult ethical dilemmas. Although ethical principles abound, in this module we will focus on four central principles often applied in the healthcare setting – beneficence, nonmaleficence, autonomy, and justice.Beneficence, nonmaleficence, autonomy, and justice … quite the smorgasbord of ethical principles! Although many ethical principles can be applied to help the healthcare professional in making an ethical decision, these four principles are central to decision-making in the healthcare setting. Let’s unpack each of these in turn.Beneficence is “a moral obligation to act for the benefit of others”Nonmaleficence is “an obligation not to inflict harm on others”Autonomy “obliges us to respect the decisions (self-determination) of adults who have decision-making capacity”Justice “obliges us to equitably distribute benefits, risks, costs, and resources” (Jahn, 2011)Understanding these principles, let alone applying them, can be a process in and of itself. Let’s begin with beneficence. How is it determined what is a benefit for another? After all, what one individual considers to be a benefit may not be considered to be a benefit for another individual. Depending on the perspective of those involved in an ethical dilemma, who are often classified as stakeholders, how these principles are understood and applied may differ.
1…Have you experienced an ethical dilemma in a health care setting where one (or more)
of the four ethical principles applies? This ethical dilemma can be a personal, professional
or even fictional one (i.e. tv or movie). Share this ethical dilemma with the class and
describe which ethical principle applies. 250 words.
2… Let’s unpack the ethical dilemma(s) presented in the Terri Schiavo case as we
respond to the following questions.
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The enduring legacy of Terri Schiavo. Video transcripts.
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What is the ethical dilemma(s) presented in this case?
Who are the stakeholders in this situation? Remember to consider individuals,
families, communities, and organizations in your answer.
Which ethical principles might apply? How? Be sure to identify the principle,
define it, and then explain how it would apply.
What would your recommendations be for handling this situation? Does your
response differ from the actual outcome in this case? Base your response, at
least in part, on the ethical principles. 250 words
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Video Transcripts – The Enduring Legacy of Terri Schiavo
URL: https://www.nytimes.com/video/us/100000002833402/the-enduring-legacy-of-terryschiavo.html?action=click&contentCollection=us&module=lede®ion=caption&pgtype=article
TV Announcer: [00:00:06] In the debate over a sick patients right to die there has rarely if ever been a case
like the one in Florida.
Narrator: [00:00:13] In 2003 America watched as a private family struggle became a very public feud.
TV Announcer: [00:00:19] Terri Schiavo husband and her parents in Florida have been fighting for a long
time about whether her feeding tube should be disconnected.
Narrator: [00:00:27] And a personal battle eventually sparked a political firestorm last year.
TV Announcers: [00:00:32] She being loaded the extraordinary session here on Capitol Hill today. This
Congress is about to commit a travesty.
Narrator Today we’re still grappling with end of life issues. But Will scientific advancements help to clarify
them or only make them more complicated.
TV Announcers: Some patients who appear to be entirely vegetative are actually quite the opposite.
Narrator: [00:01:03] Terri Schiavoh’s case started long before the cameras appeared. It was February of
1990 when the 26 year old suffered a cardiac arrest.
Bobby Schindler. [00:01:12] She went several minutes without oxygen from her Clapp’s and experienced a
profound brain injury. The first couple of days doctors and oceans go live or die.
Narrator: [00:01:22] Lack of oxygen left Schiavo with severe brain damage and in what doctors call a
persistent vegetative state or PBS a condition in which the parts of the brain that control thinking and
awareness are damaged or destroyed.
Narrator: [00:01:35] Only the brainstem which controls basic reflexes like breathing remains. Initially
Terri’s husband and parents cared for her together exploring potential treatments and rehabilitation. But four
years after her collapse Michael Schiavo says doctors gave him a grim prognosis.
Michael Schiavo: [00:01:55] It was to a point where Terri wasn’t going to function. There was nothing more
and they told us her mother was sitting right there at the time. There was nothing more they can do for Terri.
Narrator: [00:02:05] In 1998 Michael Shive petition to have his wife’s feeding tube removed saying she
had told him and others she wouldn’t want to live in this condition. Her parents Bob and Mary Schindler
fought desperately to keep her alive insisting that removing her feeding tube would be tantamount to
murder.
Bobby Schindler: [00:02:22] People think Terri was in a coma is brain dead. She was terminal. Terri was
not dying. Terri had a profound brain injury. And our family wanted to care for her just the way she was
Narrator: [00:02:35] With no living will expressing her wishes. It was up to the state courts to decide
Terri’s fate.
Attorney: [00:02:38] They went to court more than anybody has ever gone to court. In my experience in
fighting about an end of life care case this was probably the most litigated case that I can think of. We were
up and down the federal court system the state court system many many times
Narrator: At least 19 judges heard the case through various appeals and the decisions were all ultimately in
Michael Schiavoh’s favor going back to the original court ruling that said that there was clear and
convincing evidence that Terri would not want to be kept alive and that her feeding tube should be removed.
Michael Schiavo [00:03:11] She told me what she wanted and the courts heard it over and over and over
again.
Narrator: [00:03:22] For Terri’s parents the legal decisions were devastating. They appealed to the media
and the public .
Terri’s mother: Please, please save my little girl.
Attorney: [00:03:32] They became a cause. They got picked up by talk radio. They had religious groups
weighing in on their behalf. Various speakers: This innocent child was a fear across the board of euthanasia
assisted suicide abortion and abandonment of the disabled if you will. That’s what a lot of the motives were
that drove those who rallied to the side of Terri’s parents. That. Deliberately starve her to deal ss an act of
cruelty and evil.
Various speakers: [00:04:01] So Kerry touched a nerve with people because they saw a family that was
willing to care for her they don’t understand why they weren’t being allowed to do that. On both sides.
Emotions ran high tides reported 20 times as is the Roe versus Wade.
Michael Schiavo: [00:04:22] What are these people doing? Why Terri? There are feeding tubes removed
every day. To this day I don’t know why but it was very surreal.
Oprah/TV Announcers: [00:04:34] Should Terri Schiavo live or die. What evidence is there that this
woman has any brain function or not.
Narrator: [00:04:41] Michael Schiavo believes the media fanned the flames especially after the Schindler’s
released a series of videos that they said Prove Terri was conscious and aware. But Kaplan says the videos
were misleading.
Attorney: [00:04:55] It was irresponsible beyond belief that it was run unchallenged unexamined. It was too
attractive to the media not to use here she says. But it was assembled selectively and it was staged and it did
not indicate what she could do.
Narrator: [00:05:11] Kaplan says that what looked like intentional responses and Terry were just reflexes
that are common in people in a persistent vegetative state.
Attorney: [00:05:19] A lot of our bodily systems are run off that part of the brain that Terri still has that
tape use that fact made it look as if she was thinking and feeling .
Narrator: [00:05:30] While most of the doctors who examined Schiavo believed she was in a vegetative
state, not everyone in the medical community agreed.
Doctor 2: [00:05:35] There’s a toll that 14 specialists in brain injury and stroke which is her situation who
come out to point out that she’s not PBS not in a coma does respond is alert and actually has even deeper to
communicate.
Narrator: with each side entrenched arguments turn to threats.
Attorney 2: [00:05:53] It’s no fun getting up in the morning and looking under your car before you start the
engine to see if there’s a device because you’ve had people contact you saying that they’re going to blow you
to bits if you keep working on this case.
Michael Schiavo: [00:06:05] My house is invaded day in and day out and these are people pushing their
views on me and I don’t I don’t understand that. You have your view on things and you have your beliefs on.
That’s great but don’t stand outside somebody else’s house. And push that on them.
Narrator: [00:06:27] And the more the fight played out in public the more political it became
Senator Murman: [00:06:32] who’s going to look out for this girl’s rights. We have to.
Narrator: [00:06:36] In 2003 Florida legislators passed Terri’s Law which gave Governor Jeb Bush the
authority to reattach Schiavohs feeding tube. The tube had been removed by court order six days earlier.
“We did what was right and I’m proud of the legislature for restoring” The state law was eventually found to
be unconstitutional. But in 2005 the fight moved to Capitol Hill.
TV Announcers: [00:06:58] There are extraordinary events happening in Washington tonight as the U.S.
Congress and President move toward passing a law before morning to intervene in the case of Terri Schiavo.
Narrator: [00:07:08] By then Schiavo’s feeding tube had been removed again.
Representative Delay: If we do not act she will die of thirst.
Narrator: [00:07:15] Conservative lawmakers led the charge to pass a law that would give Terri’s parents
the chance to continue their fight in federal court.
Senator Frank: [00:07:23] These are extraordinary circumstances that center on the most fundamental of
human values and virtues the sanctity of human life.
Narrator: [00:07:34] Opponents argued that politicians had no place interfering in personal medical
decisions.
Various lawmakers: [00:07:39] Do we really want to insert ourselves in the middle of families private
matters all across America. This Congress should respect the law and the rulings of courts and not trample
the Constitution.
Narrator: [00:07:52] After a late night emergency session of Congress for the relief of the parents of Teresa
Marie Schiavo the bill came to a vote: 203 yeas 58 nays.
Lawmaker: [00:08:04] The bill is passed and without objection a motion to reconsider is laid upon the
table.
Narrator: [00:08:10] The bill was then rushed over to President Bush who signed it after midnight. But the
law wasn’t enough. A federal judge refused to order the feeding tube reinserted because he found the
arguments were unlikely to succeed in federal court. The Schindler family kept appealing to no avail. And
on March 31 2005 the long painful public struggle was over.
TV Announcers: [00:08:33] The end came this morning for Terri Shive Oh and her husband’s lawyer says
she died peacefully 13 days after her feeding tube was removed.
Bobby Schindler: [00:08:42] Terri we love you dearly but we know that God loves you more than we do
that your untimely death is God’s will.
Narrator: [00:08:51] Schiavo’s autopsy eventually confirmed what had been so hotly contested for years in
court proceedings. The damage to her brain had been massive and irreversible. Today nine years after
Schiavo’s death, while we are still struggling with end of life issues, advanced brain imaging is helping
scientists better understand the minds of people who are unable to communicate. And they’re finding some
surprising and unexpected results.
Dr. Owen: [00:09:18] It might be possible in some of these cases though. What you see is not what you get.
Narrator: [00:09:25] Adrian Owen is a neuroscientist who is using brain scans to search for glimmers of
consciousness in patients who’ve been diagnosed in a vegetative state. He says it wouldn’t have worked with
Terri Schiavo, but his method has shown promise with some patients. Owen puts them in a high tech scanner
and asks them to imagine doing certain activities like playing tennis or moving around their home.
Dr. Owen: [00:09:49] We’re trying to get the patient to do something. When we ask them to do it. But of
course they come in the youth because that’s part of the diagnosis of vegetative state. Now a question was
What can some of these patients do it with that brain.
[00:10:01] I want you to imagine playing tennis. The question is yes. Does your sister have a daughter.
We’re going to start the scan now.
Narrator: [00:10:15] He looks to see if his question will activate a specific part of the brain.
Dr. Owen: [00:10:22] That’s pretty good, its got this whole band of activity. We can see your brain lighting
up when you’re trying to ask the question
Narrator: [00:10:28] even though the sample size is small, Owens work has garnered attention from the
scientific community. He found that nearly 20 percent of the patients he’s tested. Patients who meet the
criteria for being vegetative have shown signs of awareness including some like Stephen who seem to
answer simple yes or no questions using only their minds. For now Owen is avoiding the toughest question
of all.
Dr. Owen: [00:10:53] We really haven’t got to the point of asking really tricky ethical questions like, “Do
you want to live or die?” and how important is because the appropriate ethical frameworks aren’t yet in place
for deciding what we would do with that information.
Narrator: [00:11:08] Almost all of the patients who shown evidence of awareness have suffered from
trauma or blows to the head not oxygen deprivation like Schiavo, but Bobby Schindler says the extent of her
injuries wouldn’t have made a difference to his family.
Bobby Schindler: [00:11:22] I think it’s important to understand this matter to my family in this battle that
matters to us. If Terri never improve her condition we loved her. We love her that way.
TV Announcer: [00:11:35] The family of a little girl left on life support after tonsil surgery goes horribly
wrong gets a really powerful ally.
Narrator: [00:11:43] Today Schindler and his family remain in the public eye. They run a nonprofit in
Terri’s memory to help families facing similar issues.
Bobby Schindler: [00:11:51] A team put together and we’re doing everything we can to get Jihae out of this
situation with the hospital.
Narrator: [00:11:58] In one way or another. Terri Schiavo’s plight continues to leave a mark on the nation.
It inspired an initial increase in living wills and advance directives just after she died. And in 2007 she
ranked just below Mother Teresa and Oprah on a list of people who moved most in the last quarter century.
Michael Schiavo: [00:12:16] I think the country have learned something. I hope they say. Remember the
Terri Schiavo story. What do you want me to do if something happens to you. And I’m hoping that’s Terri’s
legacy. So now she’s at peace. She has. What she wanted. And as her gravestone says at the bottom, “I kept
my promise.”
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