Managing Conflict at the End of Life

The media spectacle that surrounded the dying of Terri Schiavo is now two months past, and America’s culture warriors have moved on to other battlegrounds. Much has been said about which political players won or lost and whether key voting blocs will care. But does the experience offer any useful lessons about the subject in dispute — decision making at the end of life?

There is a widespread perception that the law failed Terri Schiavo, her family, and the country by not yielding a quick, clear resolution. Cultural conservatives and others who rallied to the side of Schiavo’s parents condemn the courts for failing to keep her alive. Many who backed her husband’s efforts to withdraw her feeding tube urge increased use of advance directives and living wills — and safeguards against challenges to the judgment of surrogate decision makers. Both sides look to the law to set clear rules, though the two sides differ sharply on what those rules should be.

Almost forgotten in this debate, and ignored in press coverage of the Schiavo affair, is the peripheral role of law when end-of-life dilemmas arise. The law sets some limits: active killing, for example, is impermissible, and clear advance directives must be followed if they have been properly given. In most U.S. jurisdictions, suicide is unlawful, as is the assistance of physicians in self-killing. But within these bounds, end-of-life questions are almost always resolved in the private sphere, by patients, their physicians, and their family members, working with nurses, social workers, and members of the clergy.