Jennifer Shackett 
RS 260 EY
December 2, 2004

Withdrawal of ANH in the Case of Terri Schiavo

Nutrition and hydration, along with air, are human needs, and therefore, we have a moral obligation to providing these basic human necessities to patients who require such care. Artificial Nutrition and Hydration, or ANH, is a medical treatment that supplies hydration and nutrition to individuals who have lost the ability to desire or receive hydration and nutrition by natural means. This type of medical treatment helps to maintain fluid balance, electrolyte balance, and nutrition in the individual's body. ANH, like a respirator, should be granted to a patient. As a general principle, life-support systems should be used until it is clear whether the patient can recover and the benefits and harms of the treatment options can be assessed. ANH may benefit a patient by supporting life; however, it is also possible that ANH can cause harm to the patient. For example, force-feeding a dying patient, who no longer feels hunger or thirst, may do more harm than good by causing an infection and maintaining a patient in a state where he or she has no enjoyment in life (Moskop). When a patient is in such a state for a very long time, all life supports can be ethically removed. Such is the case of Terri Schiavo, whose case will be explored in this paper.

ANH is used in a variety of cases, but is most commonly used in cases such as Terri Schiavo's. Fourteen years ago Terri Schiavo fell into a coma after taking a sudden and unexpected collapse at home. Terri eventually fell into a much deeper form of a coma, PVS, or persistent vegetative state. PVS is a form of extremely deep unconsciousness. In a persistent vegetative state the individual's cerebrum is impaired. The cerebrum is the part of the brain responsible for those responses that are recognized as specifically  human. For example, the cerebrum is responsible for determining intelligence, personality, touch sensation, motor function, and the interpretation of sensory impulses. Even though this part of the brain is malfunctioning, another part of the brain is still functioning. This part of the brain controls involuntary functions such as blinking, breathing, sleep cycles, and involuntary muscle contractions. This is the reason that a patient with PVS, such as Terri Schiavo, may open their eyes, blink, or follow movement with their eyes. Since there is only a malfunction in one part of the brain, an individual in a persistent vegetative state is not dead (Bishops). In a case such as Terri's, the best form of treatment is ANH.

Although the patient is not dead, recovery of a PVS patient after twelve months is extremely rare. When it becomes clear that a patient is not going to recover decisions must be made on whether to withdraw the ANH or not. Family members of PVS patients have an extremely difficult time making the decision to withdraw ANH because it is hard for the family members not to feel that the withdrawal of ANH was the cause of death. Family members, as well as medical experts, make their final decision based on their answers to a set of questions such as: “Is the procedure beneficial to the patient in terms of preservation of life or restoration of health? Is it serving a lifesaving purpose? Is it adding a serious burden? Is death already imminent, so that the proposed treatment may add briefly to the life span in such a way as to prolong the dying process without actually preserving life?” (Bishops). The answers to these questions cause the ethical and moral dilemma surrounding this form of treatment to arise.

A huge part of the ethical debate regarding ANH involves making a distinction between treatment and care. In the case of Terri Schiavo, many would argue that we are not obliged to continue treatment, but are obliged to continue supplying the proper care. The reasoning behind this argument is because treatment is no longer useful in reviving Terri from her unconscious state. The question then arises if feeding through ANH is considered treatment or care. If it constitutes treatment, then it can be discontinued. However, if it constitutes care, it must be continued. It is argued that the supplying of nutrition and hydration is considered care, not treatment, and therefore must be  continued. They also argue that a patient in a persistent vegetative state is not imminently terminal and therefore, the nutrition and hydration is serving a life-sustaining purpose. There is also great concern that Terri would suffer if the treatment was removed. For Terri Schiavo, death would be inevitable without ANH, since she is unable to supply nutrition and hydration for herself.

Another argument for the prolonged used of ANH is that as Christians we are morally obliged to uphold the “absolute inviolability of innocent human life” (Pope). Supporters of continuing use of ANH to treat Terri Schiavo argue that the “deliberate decision to deprive an innocent human being of his life is morally evil” (Graham). They believe that removing ANH treatment is a severe act of disobedience to God and His moral law. Pope John Paul II, in his speech “Life-Sustaining Treatments and the Vegetative State”, stated “the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act” and therefore the removal of ANH would be considered a “serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person” (Pope). We are thereby obliged to do everything we can to preserve life, including providing any and all medical treatments deemed necessary, such as Artificial Nutrition and Hydration.

While I strongly believe that we are morally obliged to uphold the dignity and life of every human being, I also feel there comes a time when ANH and other forms of life support should be withdrawn. I believe we have a duty to provide nutrition and hydration when it is beneficial to the patient and when it causes “no undue burden of pain or suffering or excessive expenditure of resources” (Bishops). To me, treatment is only successful when it improves the condition of the patient or reverses the course of the disease or illness. In the case of Terri Schiavo, the ANH treatment is no longer successful and can be ethically removed.

Terri Schiavo is no longer benefiting from the Artificial Nutrition and Hydration. This is made evident by the fact that, after fourteen years of being treated with ANH, Terri has made no progress. She occasionally may blink, open her mouth, or follow movement with her eyes: however, this does not mean she is making progress. She is exhibiting these kinds of movement because the part of the brain that controls involuntary functions has not been damaged in Terri and is still fully functioning. Terri has not come out of her coma in fourteen years which means she is in an irreversible coma. Since her coma is irreversible, ANH is a futile attempt at restoring her health.

Keeping Terri Schiavo on ANH for fourteen years has cost the state of Florida an overwhelming amount of money. Estimates of the cost are as high as $500,000 each year since she has collapsed fourteen years ago. There are between 16,000 and 35,000 Americans in a persistent vegetative state. The cost of their care can range anywhere between $1 billion and $7 billion each year (Arnst). This is far too much money to be spending on people who are in irreversible comas. The money spent to fund the use of ANH could and should be used for other causes: helping out the 43 million uninsured Americans for example. We cannot continue to expect our society to indulge in trying to keep people alive for as long as possible no matter how much it costs.

Withdrawing treatment from patients in irreversible comas is not unethical. One reason is that withdrawing treatment does not cause pain or suffering on the part of the patient. If treatment were withdrawn from Terri Schiavo, she is incapable of feeling pain due to her brain no longer retaining the neural apparatus necessary for pain recognition. Prolonged use of ANH also causes extreme burdens on the patient herself, as well as her family. Our obligation ceases when the burden surpasses the benefits. Death is inevitable for all of us, but more specifically for those patients in an irreversible coma. Death is not something to be feared. It is a gift from God. Meilaender writes that “we should not aim at death nor continue the struggle against it when the time has come” (69). In Terri Schiavo's case the prolonged use of ANH is the best example of her family struggling against death. The time has come for her family to acknowledge death, stop opposing it and just let it be. Allowing Terri to die is not the same as killing Terri. The first is ethical while the latter is unethical.

Supporters for prolonged use of ANH themselves have stated that when treatment becomes excessively burdensome it is morally okay to withdraw treatment. Catholic theologians, who support the preservation and dignity of each human life, have viewed medical treatment as being excessively burdensome if it is “too painful, too damaging to the patient's bodily self and functions, too psychologically repugnant to the patient's liberty and preferred activities, or too expensive” (Graham). Keeping Terri Schiavo alive on ANH after fourteen years creates an excessive burden financially and she is no longer able to practice her liberty to make her own choices. Terri Schiavo has become an enormous burden on her family as well as society. Treating her with ANH is futile; after fourteen years she has no chance of recovering. Withdrawing her life-support system is an ethically sound decision that needs to be made.

Works Cited

Arnst, Catherine. Getting Rational About Rationing. Nov. 2003. McGraw-Hill Co.
            http://www.keepmedia.com/pubs/BusinessWeek/2003/11/17/306934/?extID+100
47&data=terri_schiavo

Catholic Bishops of Pennsylvania. Nutrition and Hydration: Moral Considerations.

Revised Edition, 1999. www.pacatholic.org/bishops'%20statements/nutr.htm

Graham, George P. Artificial Nutrition and Hydration: It Is Time To Take A Stand.

Ignatius Press, May 1999. www.catholicculture.org/docs/doc_view.cfm?recnum=1085

Meilaender, Gilbert. Bioethics: A Primer for Christians. Wm. B. Eerdmans Publishing
Co. Grand Rapids, Michigan, 1996.

Moskop, John C. Artificial Nutrition and Hydration. The Bioethics Center, The Brody
School of Medicine at East Carolina University. Ethics and Health Care Vol. 6.

No. 2. Fall 2003. http://www.ecu.edu/medhum/newsletter/fall2003_p3.htm

Pope John Paul II. Life-Sustaining Treatments and Vegetative State:  Scientific Advances
and Ethical Dilemmas. 20 March 2004.

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