In this article, I attempt to untangle some of the cultural,
philosophical, and ethical currents that informed the Schiavo case. My
objective is to better apprehend what the Schiavo case means for
end-of-life care in general and to assert that our discourse about the
ethical issues attendant to brain injury will be impoverished if we limit
our discussions about disorders of consciousness solely to the vegetative
state. If we ignore emerging developments in neuroscience that are helping
to elucidate the nature of these disorders and fail to broaden the
conversation about brain injury, beyond the unmitigated futility of the
permanent vegetative state, we will imperil others who might improve and
be helped. Through such efforts we can help mitigate the tragedy of the
Schiavo case and overcome the rhetoric that marked the national discourse
in March 2005. Once the complexity of disorders of consciousness is
appreciated, rhetorical statements about a right to die or a right to life
are exposed as being incompatible with the challenge of providing care to
such patients. This is especially true as neuroscience brings greater
diagnostic refinement to their assessment and management, a topic
addressed in this article, which specifically focuses on the clinical and
ethical implications of the recently described minimally conscious state.
Instead of staking out ideological positions that do not meet the needs of
patients or families, we should strive to both preserve the right to
die for those who are beyond hope while affirming the right to
care to those who might benefit from coming advances in neuroscience.
If we can achieve that delicate balance, we will be able to transcend the
partisan debate that shrouded the life and death of Theresa Marie Schiavo
and begin to articulate a palliative neuroethics of care for
those touched by severe brain injury and disorders of consciousness.