Law's effect on the quality of end-of-life care: lessons from the Schiavo case

The political circus surrounding Terri Schiavo's death is unlikely to repeat itself soon in other cases but the underlying event that precipitated the furor is a recurrent clinical problem-the problem of conflict among family members about withdrawing or withholding life-prolonging treatment for an incompetent patient who had left no advance directive or appointed healthcare proxy. The laws of most states purport to solve this problem by automatic appointment of one person among the disputing family members. However, this forced resolution of the family conflict does not clearly reflect the prior values of the incompetent patient and is likely to intensify rather than ease that conflict, providing no demonstrable benefit to the incompetent patient and complicating the psychological processes of mourning for the surviving family. This article explores the benefits of a different legal rule that would require family consensus before life-prolonging treatment is withdrawn or withheld for an incompetent patient who has indicated no prior wishes regarding the resolution of family conflict.