Should The Decision To Keep A Person On Life Support Be Made By Family Members Only?

'Should the decision to keep a person on life support be made by family members only?'

This question has major impact on many people's lives, their deaths, and their quality of life. Many other questions can be asked in conjunction with this question. How would you like to be kept on life support? Would you want a doctor to make the decision of 'life or death'? The questions just keep on coming, and every time we seem to find ourselves divided. This issue is relevant because of the recent media coverage over Terri Schiavo's right to live or die and the fact that any of us could be in her situation. In the case of Quinlan1., the court asked, "If the patient could wake up for 15 minutes and understand his or her condition fully, and then had to return to it, what would he or she tell you to do?" It is a question everyone would want to discuss with individuals in that position. I intend to discuss the scientific background, the current situation, the way in which the situation has been managed and my own opinion on the situation.

Inaccurate reports in the media have allowed this situation to expand to include the individual voices of the world. Some believe that Terri's condition was brought on by domestic abuse subjected by Terri's husband Michael Schiavo, others, doctors included, believe that Terri's condition was caused by an eating disorder, namely bulimia. Not many people are even aware of what Terri's condition was: whether it be brain death, persistent vegetative state or minimal consciousness. With assurance from doctors, these conditions are all vastly different.

The medical definition of 'brain death' is: 'the cessation and irreversibility of all brain function, including brain stem' 2. Some people confuse brain death with PVS, however, it is not the same. When an individual is brain dead there is no activity anywhere in the brain, in PVS there is some activity in the brain steam and some other primitive regions.

Persistent vegetative state or PVS often follows a coma and refers to a state where an individual loses their higher cerebral functions of their brain, but their breathing and circulation (functions of the brainstem) remain comparatively normal. The individual may cry, laugh or open their eyes in response to external stimuli but they will not speak or follow commands. PVS is extremely hard to diagnose because it can take months to diagnose with confidence. The chances of recovery from PVS, when triggered by a prolonged lack of oxygen to the brain, decrease rapidly after three months3. The British Medical Journal conducted a study in 1996 concluding that there was a 43% error rate in the diagnosis of PVS4. This study makes it clear just how difficult it is to get an accurate diagnosis of PVS.

A patient that has been diagnosed as 'minimally conscious' can have dementia- but can respond to simple instructions or follow objects with their eyes. The individual can show occasional moments of awareness- through speaking, writing or using yes/no signals. The journal Neuroscience explains that the individual could be quite aware, but 'trapped' in a body, for the most part, unable to function.

Terri Schiavo was 5 feet and 3 inches, when Terri was a young adult she weighed over 200 pounds. She has been recorded to have dropped to 110 pounds before her collapse in 1990; this plummet in weight suggests an eating disorder, other information on this issue that suggests an eating disorder would be her dangerously low potassium level of 2.0. Chemicals interfere with cells metabolism everyday. We eat, drink or inject chemicals into our bodies' everyday; our bodies are chemical factories with millions of chemical reactions happening all the time. Occasionally, however, chemicals are abused or neglected, and our bodies suffer for our decisions. Normal potassium levels are between 3.5-5.0 mEq/L, potassium is needed to maintain many of our bodily functions, for example, muscle movement, regulating blood pressure (the heart would not beat without potassium)5. With low levels of potassium cellular processes become impaired and the person becomes weak. Low potassium levels can be caused by water pills (diuretic therapy) or chronic laxative abuse, or potassium loss through stomach or intestines (eg. Vomiting). Because 98% of potassium in the blood is found in the cells it is likely that some of Terri's Red Blood cells became shrivelled due to the lack of potassium. Because active transport is used to keep the potassium ions inside the cell, energy is required- but Terri became weak because of her low levels of potassium and therefore largely unable to continue this process.

Terri Schiavo was in a coma for a month after her admittance to hospital. When people come out of comas, they usually have four options; they do well, they suffer brain damage, slip into persistent vegetative state (may or may not open their eyes while not regaining consciousness), or they can just simply die. Terri's parents have argued that Terri is minimally conscious, which would have given Terri a much better chance at recovery than PVS (when triggered by a prolonged lack of oxygen to the brain).

This issue impacts every human being on Earth on an individual level. The effects of this issue can be seen by observing people that have been following this case, many of them have drafted living wills. A living will takes the difficult and guilt-ridden life-ending decisions out of family members' hands. A living will specifies what the individual's wishes are if they become incapacitated. The individual will be given peace of mind knowing that their family members will not be placed in such a situation.

There are two sides of the issue you can side with, either; only the family would know if Terri would want to be kept alive in an unconscious state or, because the family is overcome by emotion, the decision of whether Terri should live or die should be left to professionals that can evaluate the situation with trained knowledge.

The parents, or family members, can interpret Terri's idiosyncrasies because they have intimate knowledge of her behaviours. Little actions made by Terri could go unnoticed by someone that is not familiar with her subtle gestures. Because of the strong link