Social Death, Biological Death, and the Space Between | Emma Neish

        A black gravestone adorned with roses and the words, “I kept my promise” is perhaps one of the more perplexing burial markers to appear in Sylvan Abbey Memorial Park. Underneath, lie the remains of Theresa Marie Schiavo- a 41 year old woman whose gravestone lists three dates, December 3rd  1963, February 25th 1990, and March 31st, 2005 (Even in Death, Acrimony Over Schiavo 2005). The first date records her birth, the second reads, “departed from this earth” and the third, “at peace”. This nontraditional marker is a physical embodiment of the complex, ambiguous and ultimately inconclusive death of Terri Schiavo. Her life and prolonged death became a grim international soap opera that challenged our notions of a life and sparked unresolved debate about our understanding of death itself. This paper will examine definitions and conceptualizations of death and highlight the variability in such understandings. I will explore how these differences are expressed and what impact they make on our society. I will conclude by explaining the future implications of Terri Schiavo case and giving my position on this infamous death.

        Terri Schiavo was born to a Catholic family on December 3rd 1963 and at age 20, married fellow college classmate, Michael Schiavo (Terri Schiavo has died 2005). Six years later, in 1990, Terri collapsed and was brought to the hospital after suffering a cardiac arrest. Prolonged absence of blood and oxygen damaged her brain and she slipped into a coma (Terri Schiavo has died 2005). After three months, Terri’s condition deteriorated and was reclassified as a persistent vegetative state (Background on the Schiavo Case 2005). Her ability to breathe and blink independently indicated that she was not brain dead, however her continued inability to interact or respond to her surroundings suggested the loss of consciousness would be permanent (Background on the Schiavo Case 2005). Terri Schiavo remained in this vegetative state for fifteen years.

        A persistent vegetative state (PVS), as experienced by Schiavo, is a medical question mark. It is somewhere between alive and dead. Vital brain functions in PVS patients are intact, allowing them to breathe, blink and experience reflex movement. However, higher-level functions like cognition, sensation, and response are permanently destroyed (Background on the Schiavo Case 2005). Patients like Terri are biologically alive. Their heart circulates blood, their lungs respire, and with the assistance of feeding tubes, the body can sustain itself. Yet, through a different lens, Terri and other PVS patients are in fact, dead. The destruction of higher brain functions- the abilities distinguishing humans from other biologically “alive” things like plants – results in another kind of death. Consequently, Terri’s functioning body but absent mind remained in an unwavering limbo between alive and dead. The ambiguity of her condition was an invitation for debate and a source of national contention for years to follow.

        Terri’s condition remained hopelessly unchanged over the years and in accordance with Florida law, her husband Michael was appointed guardianship (Background on the Schiavo Case 2005). He called for the feeding tube to be removed. Terri’s parents objected to terminate care and fought to claim medical custody of their daughter (Terri Schiavo has died 2005). Michael Schiavo believed his wife would not have wanted to live in a vegetative state while her parents believed that removing the feeding tube was “an unconstitutional deprivation of (her) constitutional right to life” (Terri Schiavo has died 2005). The range of personal and professional opinions added another layer of complexity to Terri’s case. In addition to her medically vague PVS state, medical and legal professionals disagreed on how to conceptualize her existence and move forward in the case. Doctors couldn’t declare Terri “dead” if she could breathe, blink and reflexively respond to her environment, and her parents refused to accept the idea that providing food and water via a feeding tube was considered an extraordinary measure (Schindler 2015). Michael Schiavo and his lawyers argued that Terri’s mental capacity was so severely deteriorated that a diagnosis of death, while not a biological one, was deemed appropriate.

        Disagreement over death has roots in philosophy, culture, and even politics. Many debate whether the superior definition of death is derived from the objective body or the subjective mind. Philosopher Lamb, insists death must be thought of from a biologically objective angle. The “ethically superior formulation” he asserts, is the whole brain death- one with quantifiable and unambiguous criteria (Lock 1997, p.99). Placing both feet firmly on scientifically testable ground ensures that decisions about death “are more reliable than indeterminate assessments concerning the quality of residual life or speculations regarding personhood” (Lock 1997, p.99). Others, like Edward Bartlett and Stewart Youngner, argue that such a technical definition undermines the significance of personhood and places excessive importance on the physical body (Lock 1997, p.99).

        From a cultural perspective, national, regional, and ethnic differences expand the debate over disagreement about death. Western attitudes toward death are utilitarian, defensive and backed by technology. The United States, especially, conceptualizes death, “as an ailment that is amenable to intervention” (Lock 1997, p.95). We think of death as a biological failure- a distasteful malfunction of the body that should be combatted with medicine and the newest technology. Eastern countries, like Japan, treat death with laissez-faire acceptance. Cultures like this understand mortality as more than “merely biologic demise” (Lock 1997, p.107).

        As tensions between Terri’s husband and parents grew to a climax, media outlets rushed to publicize the increasingly ugly legal battle. National news picked up on the story and it wasn’t long until the family conflict exploded into a political feud. Terri’s life in a hospital bed of tubes became the six o’clock “great political issue” (Terri Schiavo has died 2005). The Schindler’s legal appeal to remove Michael Schiavo’s guardianship rights involved Florida circuit court judges and district court judges. Successive appeals during the next decade bumped the Schiavo case from “state courts to federal courts, to the US Supreme Court…to Congress in Washington (Kruse 2015). Increasing political and governmental involvement prompted some to capitalize on the politics as an opportunity to further their own opinions. Florida governor Jeb Bush received thousands of emails with messages like, “lets see what kind of compassionate conservative you really are”, and “if you have aspirations for a higher office, don’t let this be the rallying cry for those who would oppose you” (Kruse 2015). In response, Bush indulged his aggressive supporters and threw himself into the political debates.

        Finally, in 2005, Michael Schiavo successfully petitioned the courts to have Terri’s feeding tube removed and she passed away almost two weeks later (Terri Schiavo has died 2005). Terri’s husband made the right call in terminating ‘life-support’ because there was no real life to support. Autopsy reports revealed severe atrophy of the brain–to the point where it weighed “less than half the size it would have been under normal circumstances” (Kruse 2015). Even more important, was her inert existence – devoid of improvement or signs of recovery. Donning the role as Terri’s physician, I would have advocated for the termination of life support in the few months following her PVS diagnosis. The miraculous and presumably tearful emergence from a coma is a scene solely for the movies. Moreover, any miniscule chance for Terri’s recovery would be outweighed by the less glamorous reality of her situation. Continuing intense, life-supporting care for fifteen years is a financial nightmare. Sitting bedside with a camera, attempting to capture wisps of consciousness in order to “save” your daughter is an emotional nightmare. And being the reason behind the debates, sorrows and international squabbling quickly becomes a profound personal nightmare. Terri Shiavo had no quality of life in the fifteen years prior to her death. Her parents, their lawyers, and politicians arguing for the continuation of care should have considered the impossible medical odds and seen that it was not only futile but also immoral to prolong her “life”. Having to decide the fate of one’s child is understandably heart wrenching, but the Schindlers senselessly clung to hope in a selfish denial of their loss. What should have been a painfully obvious decision to terminate life support instead became a painfully convoluted mess of emotions, moral dilemmas, political ploys, and public hysteria. A person dies when there is no life to live and Terri Schiavo should have been granted this death.

        Her situation proves to be the inherent individuality of this delineation. We can formulate objective criteria about the exact moment of biologic death based on brain activity, reflexes, or pupil dilation. We can compose a subjective evaluation of quality of life, level of consciousness or remnants of personhood. But when cases such as Terri’s inevitably occur, and lines between the objective and subjective are blurred, who do we call upon to determine death? The person who can most knowledgeably speak to a good death is the dying individual himself. If incapacitated that duty should fall to the closest relative or individual. In the Schiavo case that person was deemed, in my opinion correctly, to be Terri’s husband, Michael. In Terri’s case, I am incredulous twofold. First, that the decision introduced totally unqualified, and inappropriate authorities like Jeb Bush and the Pope into such an intimate and what should have been private familial matter. And second, that this painful decision turned national spectacle continued for fifteen years, during which Michael Schiavo’s life was at a standstill, and Terri’s was nonexistent. I can ponder a ‘good’ death and fine-tune its ideal timing and location but to me, a ‘bad’ death is one that provides opportunity for debate by lawyers, undergraduates, and presidents decades after it takes place.

        Disagreement about Terri’s life and death was embodied by lawsuits, death threats against Michael Schiavo and eventually a stalemate that lasted over a decade (Kruse 2015). Terri lay in a hospital bed waiting for one group to yell loud enough as both sides fought to enact their opinions. Though the Schiavo case was an extreme- involving Michael Schiavo, the Schindlers, doctors, lawyers, judges, governors, congressmen, reporters, senators, supreme court justices, the president, the pope, and not to be forgotten, Terri Schiavo – it demonstrated how a familial decision about the fate of a loved one could so easily and rapidly be placed in the hands of the government. The invasive redirection of death from family to government becomes even more unsettling when one considers our society’s ambiguous conceptualization of death. Lack of consensus for medical, legal, and political procedures for handling death introduces an impossible number of variables – prohibiting efficient and accurate decisions. However, when families indeed personally handle death, recent life sustaining technologies, variable definitions of death, and our modern ideation of “good deaths” complicate death to a point where it is no longer feasible for a single family to deal with its effects alone. The societal impact of these increasingly complicated deaths include the rise of nursing homes, hospice care, and the professionalism of death. Dying is now removed from the homes of the family and placed in a fluorescently lit hospital room. No longer is death considered a spiritual beginning – a final journey to whatever lies beyond. It is now a morbid show requiring a dying subject, the hospital setting and physicians in the supporting roles. Ultimately, I find this detracts from the significance and dignity of death, “having been stripped of culture, (it) can no longer transcend biology to act as a touchstone for mortality” (Lock 1997, p.95).

        As inscribed on Terri’s headstone, fifteen years after her “departure from this earth”, she attained “peace”. While Terri may have attained peace on that day, the country didn’t. “Old polarizations took (over, differences) became intolerances”, and societal opinions surrounding end of life issues turned hostile and deeply divided (Didion 2005). Although the Schiavo case was “resolved” and perhaps is now unknown to newer generations, it raised a moral dilemma that our increasingly sophisticated society will face indefinitely.

 

 

References 

1) ‘Even in Death, Acrimony Over Schiavo.’ 2005. Msnbc.com. 21 June. Available from: <http://www.nbcnews.com/id/8299372/ns/us_news/t/even-death-acrimony-over- schiavo/#.VgMpXUtLpg027> . [Sept. 2015]

2) ‘Background on the Schiavo Case.’ 2005. Cable News Network. 25 March. Available from: <http://www.cnn.com/2005/LAW/03/25/schiavo.qa/>. [Sept. 2015]

3) Didion, J. 2005, ‘The Case of Theresa Schiavo.’ The New York Review of Books. N.p., 9 June. Available from: <http://www.nybooks.com/articles/archives/2005/jun/09/the-case- of-theresa-schiavo/>.  [27 September 2015]

4) ‘Terri Schiavo has died.’ 2005. Cable News Network, 31 March. Available from: <http://www.cnn.com/2005/LAW/03/31/schiavo/>. [Sept. 2015]

5) Schindler, B. 2015. ‘Jeb Bush Was Right to Try to Save Terri Schiavo.’ The Wall Street Journal, 25 Feb. Available from: < http://www.wsj.com/articles/bobby- schindler-jeb- bush-was-right-to-try-to-save-terri-schiavo-1424909183>. [Sept. 2015]

6) Kruse, M. 2015 ‘Jeb ‘Put Me Through Hell’.’ POLITICO Magazine: 29 Jan. Available from: <http://www.politico.com/magazine/story/2015/01/jeb-bush-terri-schiavo-114730>.

[Sept. 2015]

7) ‘Michael Schiavo Relative Reports Threat.’ 2005. Cable News Network, 29 March. Available from: < http://www.cnn.com/2005/LAW/03/29/schiavo.threats/>. [Sept. 2015]

8) Ivan, L & Melrose, M 2007: The Way We Die. Pari Publishing, Italy

9) Wijdicks, E. 2002. Brain Death Worldwide, 20-25.

10) ‘Determination of Death Act Summary.’ 2015. Uniform Law Commission. Available from: <http://www.uniformlaws.org/ActSummary.aspx?title=Determination%20of%20Death% 20Act>. [Sept. 2015]

11) ‘Diagnosis of Death.’ 1979. US National Library of Medicine, 3 Feb. Available from: <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1597667/>. [Sept. 2015]

12)  Lock, M. 1997. ‘Displacing Suffering: The Reconstructions of Death in North America and Japan’.

 

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