A family tragedy has turned into a national debate in the United States. Should the feeding tube that was keeping a 41-year-old brain-damaged woman alive for the past 15 years have been removed? The courts have weighed in on the question. So has the U.S. Congress. But the case of Terri Schiavo has raised ethical issues that could have repercussions beyond the fate of one woman.
Whether siding with Terri Schiavo's parents, who want their daughter to receive nourishment, or her husband, who says Terri would not want to be kept alive like that, difficult ethical issues underlie this tragic case. Many Americans are already debating them: If there is no hope for an individual's recovery, should end-of-life care be continued? And who should make such decisions?
According to Arthur Caplan, one of America's most prominent bio-ethicists, an even larger ethical quandary is confronting American society.
AC: "Probably the biggest ethical issue is the battle between those who favor life over those who favor liberty. For many years in American medicine, we've tried to respect the position that people can choose to end medical treatment even if it means they will die. That's probably the hardest ethical battle of all."
VOA: When you mention life versus liberty, are you just talking about liberty when it comes to medical issues, issues of life and death, or does it creep into other matters involving freedom, involving liberty?
AC: "The idea that someone can say no to medical treatment has its roots in two concepts. One is the right to be free from unwanted bodily intrusion. No one can touch you or intervene with you without your permission. That's a very core value because even things as basic as the right to not be sexually assaulted or raped come from this notion of freedom, from bodily intrusion. The other core concept is privacy, that you have a right to be left alone, that no one should interfere with you or meddle with you.
"Those notions of autonomy and privacy, which combine to make this so-called liberty interest, are foundational for many different types of freedoms that individual citizens in the United States enjoy. So to try and compromise the right to say no to medical treatment will probably puzzle courts and create ethical turmoil here, if that's the way things go, because you're tapping into some very core values that support many different areas of choice."
VOA: If a judge from a court sought you out to get ethical guidance on this how would you advise that judge?
AC: "I would say this: 'Feeding tubes, Judge, are medical treatments. There are those who would say they are not. I've actually heard statements coming out of the Vatican in the past couple of months that say feeding tubes are ordinary care, more like giving someone a blanket.
"'But that isn't true. Feeding tubes are surgically implanted. You have to put artificial substances into them to make them work, and you need to have doctors and nurses and technicians to keep them in place without complications. So, Judge, you need to understand that we're talking about a medical treatment. Since it is a medical treatment, people have the right to refuse it, stop it or forego it.'"
VOA: In this case, unfortunately, Terri Schiavo never wrote down her wishes. And now it comes down to the word of her husband against the word of her parents.
AC:"So I'd say, 'Judge, we now have a terrible dilemma, a divided family. And you have to decide who you're going to listen to. My view is, the husband has priority over the parents. And I say that because she chose to live with him, she clearly loved him, and that marriage was intact. Now, Judge, if you want to have somebody corroborate or confirm that she may have said these things, he brought forward witnesses who did testify that she said she didn't want to be this way.'"
VOA: What ethical issues do you foresee discussing with your college students and thinking about or writing about yourself down the road?
AC: "I think it's very important that we talk about how America deals with science. There is an odd American mixture. We believe -- some of us -- that God, or the divinity, will work a miracle and Terri will come back to us. But at the same time, we keep talking about 'you can't take a feeding tube away.' So we have two gods: technology and, for some of us, a religious god. And for some purposes of public policy, it's sometimes hard to see how both can be elevated at the same time. That's the American dilemma."