'Political Misbehaving' in Schiavo Case

By Ed Susman, UPI.com, Jan. 9, 2006

Health Business

SAN FRANCISCO, Jan. 9 (UPI) -- The emotionally and politically charged debate surrounding the life and death of Terri Schiavo -- the woman in a persistent vegetative state whose life was extended by interest that reached the White House -- may not be an anomaly because few Americans have discussed end-of-life decisions with their families.

That according to Timothy Quill, professor of medicine and psychology at the University of Rochester, who said that the Terry Schiavo case was a conflict among members of the family that got out of hand.

"There was a lot of political misbehaving in the Terry Schiavo case," Quill said in a keynote lecture to the Society of Critical Care Medicine, meeting this week in San Francisco. "A lot of people who got involved in this case should not have gotten involved."

He suggested that the influence of Gov. Jeb Bush of Florida -- where Schiavo lived -- President Bush and the majority leader of the U.S. Senate, William Frist, R-Tenn., who Quill accused of diagnosing Schiavo "by television," did not help the agony of the woman's parents or her husband in the decision to remove feeding tubes from the woman who had been on life support for 15 years.

On the other hand, Quill, who is also an ethicist at the university, said the court system did its job by focusing on the wishes of the patient that could best be determined and on the medical facts.

Quill said that Schiavo-type cases are likely to crop up again and again because so few people in the United States -- estimated at fewer than one in five -- have executed a living will or have specified or discussed with family members end-of-life decisions.

"What happened to Terri Schiavo was terrible for Terri," said Greg Margolin, an intensive-care specialist at Banner Desert Hospital in Phoenix. "But in a way it was great for us because it got people talking about end-of-life decisions."

He told United Press International that he faces Schiavo-type decisions daily and runs into the same problems that the Schiavo family had: a lack of definitive written instructions from the patient who is now in a vegetative state, plus conflict among family members on what should be done.

"Dr. Quill saw the Schiavo case as 'families in conflict,'" Margolin said. "I see the case as 'families finally talking.' I think the rest of us were very fortunate that the case created so much controversy because it got our patients and their families thinking about the same thing."

Quill said the Schiavo case was distressing because of the length of time it took for the proper end-of-life decision to be accomplished. He said that in most cases, a person in a persistent vegetative state will recover after three months if he or she is going to recover at all. After six months, he said there is virtually no chance of recovery.

He said that individuals in a persistent vegetative state have no awareness of themselves or their environment; have no meaningful responses to stimuli; show no receptive or expressive language; and have bowel and bladder incontinence.

On the other hand, such patients but may have a regular sleep cycle, yawn, smile and have brainstem functions, Quill noted.

He said, however, that debate will continue because "there is not a consensus on what is the best for the patient." He said that, even in cases in which there is a living will or advance directives of the patient, family members may still dispute whether that is really what the patient meant.

Quill suggested that families in these conflicts talk to doctors about palliative measures of treatment that will keep a person comfortable and also discuss options with ethicists and legal experts.

"Only go to court as a last resort," he advised, "in case of serious unresolved medical, legal or ethical questions."

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