Ethics update: lessons learned from Terri Schiavo: the importance of healthcare proxies in clinical decision-making.
OBJECTIVE
In this review, we discuss issues of privacy and personal choice in end-of-life decision-making and existing options for directing end-of-life care, and highlight important differences between living wills, advance directives and other forms of healthcare proxies.


RESULTS
The events surrounding the death of Terri Schiavo raise many ethical, legal and moral issues that warrant discussion. In that context, we examine the implications associated with family disagreement over end-of-life care, the ramifications for healthcare providers and the role played by politicians, the courts and the media in galvanizing the debate. Groups promoting a variety of causes seized the opportunity to further their own agenda by using the internet and other methods to rapidly disseminate often false information, fueling arguments over misdiagnosis of persistent vegetative state and raising false hopes for neurological recovery.


CONCLUSIONS
It is incumbent upon the medical community, political and religious leaders and the media to educate the public appropriately about options regarding end-of-life issues and to foster open discourse and encourage the execution of advance directives or healthcare proxies. Although the content of this article deals with a specific case and legal rulings pertaining to the USA, the issues and questions raised are pertinent to healthcare providers and individuals around the world.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0410, USA. CohenN@medsch.ucsf.edu
Neal H
NH
Cohen
Heidi B
HB
Kummer
D005431:Florida; D006801:Humans; D016224:Living Wills; D019727:Proxy / Q000331:legislation & jurisprudence*