Ethics

Terri Schiavo suffered brain damage at the age of 26 in 1990 when her heart stopped briefly because of a chemical imbalance. She died on Friday 31 March aged 41, 13 days after a feeding tube was removed at her husband's request following a Florida court ruling. Subsequent appeals, including intervention by the President himself, did not reverse the decision.

Mrs Schiavo's husband, Michael, her legal guardian, had maintained that she would not want to have been kept alive artificially. By contrast her parents, brother and sister believed she had signalled her desire to live. As Terri never wrote a living will, there was no clear indication of her own views. As well as dividing Terri's own extended family, the case has divided politicians, journalists and the general public.

An ABC News poll found that 80% of Americans would not want to live if they were in Terri's position. I suspect part of me also in Terri's position, if I were conscious, might wish in the words of St Paul 'to depart and be with Christ'. As I doctor, I have seen patients fall victim to overzealous and heroic treatments at the end of life that have simply prolonged the dying process and ignored the biblical wisdom that speaks of 'a time to die'. I believe, as well as a time to die, that there is also a time to recognise that enough is enough. It is good medical practice to stop, or not to start, certain treatments in certain situations.

But in the case of Terri Schiavo, I am convinced that US lawyers made the wrong decision. Let me explain why.

First, the case has demonstrated the very worst kind of medical paternalism in that others have made a presumption that Terri would have wanted people to end her life, without any clear indication from her of what her own wishes might be. Given her own Catholic background and worldview, it is not unreasonable to assume that Terri might well have taken a similar view on the matter to that of her parents. When there is doubt, the benefit of that doubt must always be given in presumption of life. The decision undermined Terri's own autonomy and has created a precedent for undermining the rights of other vulnerable patients like her.

Second, the removal of the feeding tube in this case was a deliberate act aimed at bringing about Terri's death. Terri was brain damaged not brain dead. Her condition was neither life threatening nor progressive. She was not on a 'life support machine', but was simply receiving food and fluids through a tube placed into her stomach, which in turn was causing her no discomfort. She did not die from her brain damage but from being starved and dehydrated to death. Intentional killing, either by act or omission, whether motivated by compassion or not, is always morally wrong. It runs contrary not only to the Judeo-Christian ethic on which our legal system is based, but also to every medical ethical code from the Hippocratic Oath to the present day. 'Intention' is the key factor biblically, theologically, ethically, philosophically and, at least up until this point, legally. The sixth commandment does not beat about the bush. 'Thou shalt not kill.'

Third, I have deep misgivings about the real motivation, conscious or subconscious, of her husband. I cannot help but feel that he had a great deal to gain from his wife's death. He now is in a relationship with a new partner by whom he has two children. There are inheritance issues at stake. A court awarded him $300,000 and Terri $700,000 in a malpractice case in 1992. There are also questions about whether he acted in the best interests of his wife's life and health. Her teeth were not cleaned resulting in five tooth extractions, he had refused passing over her medical care to others, and he had also melted down her wedding and engagement rings to make one for himself. It must have been a real temptation for him, to believe that dying is what Terri would have chosen for herself.

Finally, I'm worried where all this might lead. There are thousands of patients in both the US and the UK who currently require tube feeding because of brain damage. Many of them will never recover. But that does not mean that they should be deprived of the basic care of symptom relief, food and fluids and human affection. The very heart of Christian ethics is about bearing one another's burdens, making sacrifices for the weak, and being willing to shoulder personal and financial cost. The way we respond to such special needs speaks volumes about the sort of society that we are. German doctors in the 1930s stopped feeding children whose lives they felt were of benefit neither to society at large nor those individuals themselves. Lethal injections followed quickly as more cost-effective solutions were sought. Helga Kuhse, Past President of the World Federation of Right to Die Societies, said in 1984: 'If we can get people to accept the removal of all treatment and care - especially the removal of food and fluids - they will see what a painful way this is to die and then, in the patients best interests they will accept the lethal injection.'

The Schiavo case is hugely relevant to the UK. On Tuesday 5 April Parliament gave final approval to the Mental Capacity Bill, which giving statutory force to 'advance refusals' and 'proxy decisions'. This makes provision for food and fluids to be removed from non-dying mentally incapacitated patients in their 'best interests', either in accordance with a 'living will' signed by them in the past, or on the authority of a third party, most likely a family member, who has been granted 'lasting powers of Attorney'.

It is a great tragedy that the Government, in a last-minute pre-election rush, is using its large majority to force through this Bill without a proper opportunity for MPs to reconsider the wisdom of these provisions in the light of the lessons of the Schiavo case.