Return to Transcripts main page

American Morning

Life-and-Death Issue

Aired October 15, 2003 - 08:33   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


SOLEDAD O'BRIEN, CNN ANCHOR: A feeding tube will be removed today from a Florida woman, who has been in a coma-like state for 13 years. Terri Shiavo suffered heart failure back in 1990. Her husband wanted her to be allowed to die. Her parents believe she can be rehabilitated, and have asked an appeals court to keep her alive.
Joining us this morning to discuss all of this is the chief of medical ethics at Weill Cornell Medical Center. Dr. Joseph Fins has this perspective on this life-and-death situation.

And this scenario, I have to imagine, this one has gotten a lot of attention obviously, but it's not unusual. I mean, it's a debate that goes on across many families.

DR. JOSEPH FINS, WEILL CORNELL MEDICAL CENTER: Right. And the best way to prevent the debate is to have a conversation ahead of time, so that everybody knows and you don't have a family divided against itself with the most difficult and the most tragic moments.

O'BRIEN: Divided in this way: The husband says let her die. He says that would be her wish. The parents say let us take over. Let us try to rehabilitate her. The doctors say she's in a persistent vegetative state. Even when there's not a legal fight like this, what goes into the process between the doctors and the family members about when and how to end someone's life?

FINS: Right. The first thing is to clarify the diagnosis. And I think in this case it has been clarified by all of the expert testimony. And to make it clear to both sides that there's no recovery from this permanent vegetative state. It's a situation of permanent unconsciousness. Unlike a coma from which people can recover, this is a permanent situation. And the nature of her illness and her injury 13 years ago really bodes very badly for any kind of rehabilitation or recovery.

So, I think the family might be, the parents, under a misconstrual about what might be possible, and that can lead to erroneous judgments on their part.

O'BRIEN: In cases like this and in other cases that you are familiar with that are similar to this one, are medical ethicists brought in to sit down with all of the family members and have these sorts of discussions?

FINS: Ideally that's what would we do. There's a lot of water under this bridge. But ideally, upstream from this tragic moment right now, we try to bring the people together, have conflict resolution, get the facts on the table. Also, it's most important to know what Terri would have wanted. It's really her wishes that should direct the care.

O'BRIEN: The $64,000 question here, of course, because she didn't really quite say. And how do you then balance the wishes of family members, all of whom, no one doubts, really love this woman?

FINS: I think there's some dispute about what she did and did not say, but the courts have said that these were her wishes. But also, the decision-making hierarchy is that your husband has higher standing than your parents, and their next of kin generally would have the right to make these judgments. It differs from state to state.

O'BRIEN: If she had stated her wishes clearly in a living will...

FINS: Or an advanced directive, right.

O'BRIEN: ... would that have -- there would be none of this issue whatsoever? Or are there times when there's a lack of clarity in that document as well?

FINS: There can be, but generally that really resolves the problem. And in a very similar case, the Cruzan (ph) case, Sandra Day O'Connor, in the Supreme Court case, said why don't we have a way of having advanced directives? And that was the genesis of the patient self-determination act, a law saying that individuals, when they come into hospitals and nursing homes and facilities, have the right to execute an advance directive while they have capacity for a period of time, when they may not, to direct their care, to prevent this kind of situation.

O'BRIEN: In this particular case, is it your sense that it's just based on a failure to fully embrace a prognosis that most experts agree with...

FINS: I think that's a very big part of it.

O'BRIEN: ... on the behalf of the parents?

FINS: Absolutely. And I think, you know, the people who are vegetative can appear to be awake. They're not. It's a state of permanent unconsciousness.

O'BRIEN: So at the end of the day, what are the lessons to be learned from this horribly tragic case? Again, I don't think anyone is saying that nobody loves this woman. Everybody loves her in this case.

FINS: Right, right. I think it's preparation and having the discussions ahead of time. If there's a silver lining, it's to talk with your loved ones about these issues before you find yourself in this situation.

O'BRIEN: It's such a sad case, terrible to find themselves in this situation.

FINS: It is tragic, yes.

O'BRIEN: Dr. Fins, it's nice to have you.

FINS: Thank you very much.

O'BRIEN: Thanks for clearing that up for us. We appreciate it.

FINS: Thank you.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com.







Aired October 15, 2003 - 08:33   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SOLEDAD O'BRIEN, CNN ANCHOR: A feeding tube will be removed today from a Florida woman, who has been in a coma-like state for 13 years. Terri Shiavo suffered heart failure back in 1990. Her husband wanted her to be allowed to die. Her parents believe she can be rehabilitated, and have asked an appeals court to keep her alive.
Joining us this morning to discuss all of this is the chief of medical ethics at Weill Cornell Medical Center. Dr. Joseph Fins has this perspective on this life-and-death situation.

And this scenario, I have to imagine, this one has gotten a lot of attention obviously, but it's not unusual. I mean, it's a debate that goes on across many families.

DR. JOSEPH FINS, WEILL CORNELL MEDICAL CENTER: Right. And the best way to prevent the debate is to have a conversation ahead of time, so that everybody knows and you don't have a family divided against itself with the most difficult and the most tragic moments.

O'BRIEN: Divided in this way: The husband says let her die. He says that would be her wish. The parents say let us take over. Let us try to rehabilitate her. The doctors say she's in a persistent vegetative state. Even when there's not a legal fight like this, what goes into the process between the doctors and the family members about when and how to end someone's life?

FINS: Right. The first thing is to clarify the diagnosis. And I think in this case it has been clarified by all of the expert testimony. And to make it clear to both sides that there's no recovery from this permanent vegetative state. It's a situation of permanent unconsciousness. Unlike a coma from which people can recover, this is a permanent situation. And the nature of her illness and her injury 13 years ago really bodes very badly for any kind of rehabilitation or recovery.

So, I think the family might be, the parents, under a misconstrual about what might be possible, and that can lead to erroneous judgments on their part.

O'BRIEN: In cases like this and in other cases that you are familiar with that are similar to this one, are medical ethicists brought in to sit down with all of the family members and have these sorts of discussions?

FINS: Ideally that's what would we do. There's a lot of water under this bridge. But ideally, upstream from this tragic moment right now, we try to bring the people together, have conflict resolution, get the facts on the table. Also, it's most important to know what Terri would have wanted. It's really her wishes that should direct the care.

O'BRIEN: The $64,000 question here, of course, because she didn't really quite say. And how do you then balance the wishes of family members, all of whom, no one doubts, really love this woman?

FINS: I think there's some dispute about what she did and did not say, but the courts have said that these were her wishes. But also, the decision-making hierarchy is that your husband has higher standing than your parents, and their next of kin generally would have the right to make these judgments. It differs from state to state.

O'BRIEN: If she had stated her wishes clearly in a living will...

FINS: Or an advanced directive, right.

O'BRIEN: ... would that have -- there would be none of this issue whatsoever? Or are there times when there's a lack of clarity in that document as well?

FINS: There can be, but generally that really resolves the problem. And in a very similar case, the Cruzan (ph) case, Sandra Day O'Connor, in the Supreme Court case, said why don't we have a way of having advanced directives? And that was the genesis of the patient self-determination act, a law saying that individuals, when they come into hospitals and nursing homes and facilities, have the right to execute an advance directive while they have capacity for a period of time, when they may not, to direct their care, to prevent this kind of situation.

O'BRIEN: In this particular case, is it your sense that it's just based on a failure to fully embrace a prognosis that most experts agree with...

FINS: I think that's a very big part of it.

O'BRIEN: ... on the behalf of the parents?

FINS: Absolutely. And I think, you know, the people who are vegetative can appear to be awake. They're not. It's a state of permanent unconsciousness.

O'BRIEN: So at the end of the day, what are the lessons to be learned from this horribly tragic case? Again, I don't think anyone is saying that nobody loves this woman. Everybody loves her in this case.

FINS: Right, right. I think it's preparation and having the discussions ahead of time. If there's a silver lining, it's to talk with your loved ones about these issues before you find yourself in this situation.

O'BRIEN: It's such a sad case, terrible to find themselves in this situation.

FINS: It is tragic, yes.

O'BRIEN: Dr. Fins, it's nice to have you.

FINS: Thank you very much.

O'BRIEN: Thanks for clearing that up for us. We appreciate it.

FINS: Thank you.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com.