The (Surprising) Truth about Schiavo: A Defeat for the Cause of Autonomy

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I. INTRODUCTION

A survey of the commentary following the conclusion of the Theresa Marie Schiavo matter leaves one with the impression that the case was a victory for the cause of autonomy and the right of self-determination in the end-of-life context. According to the prevailing account, the case involved a husband (Michael Schiavo) fighting for his right as a spouse to vindicate his profoundly disabled wife's wish to decline artificial nutrition and hydration. To do so, Mr. Schiavo had to overcome the efforts of his wife's parents (the Schindlers), and their religious conservative supporters (including politicians both in Florida and Washington), who fought to keep Ms. Schiavo alive at all costs. This battle of autonomy versus the sanctity of all human life (howsoever diminished) raged throughout literally every branch of government, as well as in the national and international media. In the end, though, it was the judicial branch that settled the matter, finding that Michael Schiavo had the right to implement his wife's wishes, free from any governmental intervention or obstruction. It was a decisive victory for autonomy and privacy, and demonstrated that an individual's desire to be free from unwanted life-sustaining measures can be honored, even after she is silenced by severe cognitive impairment.

The foregoing narrative is compelling, easy to understand, and fits perfectly within the overarching paradigm typically used to interpret the cultural, legal, and political conflicts of present day America. The only problem with this widely shared understanding of the Schiavo case is that it is wrong in almost every key respect. The above account misstates the formal question in dispute, the principal focus of the Florida courts' inquiry, the substance of the courts' various holdings, the basis for the courts' decisions, and the character of the participants in the larger public debate. In this essay, I will seek to correct these errors and demonstrate that, contrary to popular understanding, it is the defenders of autonomy and self-determination who should be most troubled by what transpired in the Schiavo matter. Far from being a victory for the cause of freedom, it is instead a cautionary tale of what can happen when the legal preconditions for exercising autonomy are absent or ignored.

II. WHAT ACTUALLY HAPPENED

It is useful to begin by noting briefly some of the more obvious factual flaws in the prevailing narrative. Contrary to the popular account, the Schiavo matter was not a dispute about which principle--respect for autonomy or the sanctity of all human life--should govern decision-making regarding the administration of life-sustaining measures. Nor was it a case about who--as between spouses and parents--is best situated to make such decisions for incapacitated loved ones. It also was not a case about who--as between the government and the private individual-should have the final say in this intimate and private domain.

To the contrary, both the Schindlers and Mr. Schiavo agreed from the outset that the relevant good to be defended was Ms. Schiavo's right to autonomy and self-determination. Despite the acrimony and discord between Mr. Schiavo and the Schindlers, they were in complete agreement that the proper task at hand was to discern and implement (if possible) Ms. Schiavo's wishes regarding artificial nutrition and hydration. Thus, the Schiavo case did not involve a philosophical quarrel about what is owed to the profoundly disabled--all parties to the conflict agreed that self-determination was the paramount value. Rather, the case was essentially a factual dispute about the content of Ms. Schiavo's intentions. Mr. Schiavo argued that she would not want to continue living under the circumstances, and the Schindlers asserted the contrary (1) (or alternatively, that her wishes had not been sufficiently established to support termination of artificial nutrition and hydration). …