The U.S. Supreme Court tacitly agreed with the opinion of a Penn bioethicist yesterday in declining to hear the case of brain-damaged Terri Schiavo -- effectively beginning the countdown to the end of her life.
Schiavo was diagnosed as being in a persistent vegetative state following a 1990 collapse caused by heart failure. She has since been at the center of a much-publicized legal battle between her parents and husband. She has been without food or water for a week.
Penn Bioethecist Arthur Caplan recently testified in Congress against the legislation that granted jurisdiction to the federal courts.
"Trying to shift these issues to Washington is wrong because it fixes something that isn't broken," said Caplan, who is the director of the Center for Bioethics.
He also chairs of the Department of Medical Ethics.
For 30 years -- since the Karen Quinlan case in which the New Jersey Supreme Court ruled to allow the removal of life-sustaining care -- there has been a consensus of how to manage the withdrawal of treatment, Caplan said.
When there is conflict among family members, they talk with an ethics committee at the hospital.
If the dispute cannot be settled, parties proceed to a local court.
"People want their family members to decide when they want treatment, not Jeb Bush, not Tom DeLay, not even George Bush," Caplan said.
At the Hospital of the University of Pennsylvania, it is rare that a family conflict over life support removal ever reaches courts, according to intensive-care specialist Horace DeLisser.
In instances of unexpected trauma -- particularly with young people -- when discussions about quality of life and death have not taken place, the family members are left with a difficult decision.
DeLisser -- co-chairman of the ethics committee at HUP -- urges family members to consider what would the patient have wanted.
According to DeLisser, surveys have indicated that more than 90 percent of individuals do not wish to be kept alive by artificial means.
Yet a study published in 1994 by the Multi-Society Task Force on Persistent Vegetative State estimated that 10,000 to 25,000 adults live in a PVS nationally.
When family members impose life support measures on patients, it is often in the hope for recovery, said John Hansen-Flaschen, chief of HUP's Pulmonary, Allergy and Critical Care Division.
Families sometimes continue life support in fear of misdiagnosis -- a fear compounded by patient movements that can lead to false hopes for recovery.
HUP neurologist Branch Coslett described the condition as "awake but not aware" with patients exhibiting "random responsiveness."
After a year in PVC, it is "unrealistic" to expect a patient to improve, DeLisser said. "If it were to occur, it would be a miracle."
And those "miracles" are likely the result of misdiagnosis, he added.
In Schiavo's case, Coslett said, it is unlikely that doctors have missed some deliberate response.
So in the end, DeLisser points to one lesson: "Get a living will, or [let your loved ones] know what your wishes are."
