The death of Terri Schiavo has shown that living wills are an under-discussed and under-used option. Moreover, the obnoxious hoopla surrounding the case failed to address the central issue around Schiavo's situation: Who decides when to let a person die?
The advancement in medical technology requires medical providers and lawmakers to establish a universally accepted decision-making process for determining the future of individuals in similar situations.
Establishing a set process for choosing a surrogate decision maker typically scares most lawmakers. Still, a line of command for deciding the fate of a patient's life could eliminate the typical community battles over a person's fate.
The family quarrel between Michael Schiavo and Terri Schiavo's parents over Terri's life extended to a societal war between family, religious leaders, lawmakers and the courts. The 15-year process taken to decide Terri's fate should raise questions about our treatment of human life.
According to the Terri Schindler-Schiavo Foundation's Web site, Terri Schiavo's behavior did not meet "the medical or statutory definition of persistent vegetative state." Terri responded to stimuli, tried to communicate verbally, followed limited commands, laughed or cried in interaction with loved ones, physically distanced herself from irritating or painful stimulation and watched loved ones as they moved around her.
Many religious leaders agreed with the view of the Foundation, often using religious didacticism in an attempt to generate national disagreement with the courts.
However, through this process, finding an answer to the question of life and death remained impossible because of the existence of very differing religious beliefs.
A majority of Christian leaders believed Terri Schiavo's state represented one having life. According to the Sacred Congregation for the Doctrine of Faith, suffering during the last moments of life is "in fact a sharing in Christ's passion and a union with the redeeming sacrifice which He offered in obedience to the Father's will." These teachings of Christianity do little to objectively address the Terri Schiavo case.
In Judaism, prolonging life is admirable while prolonging death is inhuman and sinful. Hastening death -- often associated with assisted suicide and active euthanasia -- is considered a sin.
Because of the implicit subjectivity of religion, religious and legal leaders could not and will not find a universal, definitive line separating life and death. With no advanced directives, the discussion centered on what Terri Schiavo wished.
The processes for deciding Terri's wishes are best characterized by three types: substituted judgment, pure autonomy and best interests standard.
Substituted judgment would have required the surrogate decision maker to make a decision according to what Terri Schiavo would have done if she was competent.
Pure autonomy, exclusively for patients formerly competent, requires the same decision-making process. Both processes fail because the decision makers attempt to make a decision based on previous autonomous ones made by the patient in what tends not to be similar circumstances -- people usually do not lapse into a persistent vegetative state twice.
The best-interest standard provides the surrogate decision maker with the most applicable but subjective process: choose the option of the highest net benefit by weighing the benefits of all available options against the inherent risks and costs of the same available options.
However, the surrogate decision maker for Terri Schiavo -- as it is with other patients
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