Capture the teaching moment.

Terri Schiavo, 41 years old, died two weeks after the feeding tube which had kept her alive since 1990 was removed. She had suffered brain damage from cerebral anoxia and was long ago declared to be in a "persistent vegetative state."

Thus, the life and death of Terri Schiavo became an epic legal battle, one which profoundly stirred the national interest. The case was riveting, if for no other reason, because the questions it raised were so tough! Debate continues about the significance of her death, with everyone still grappling with the facts, the laws, and the cast of characters. The image of Terri's lifeless face is embedded in our collective psyche.

The questions go on and on. Was Terri or was Terri not in a persistent vegetative state? Even renowned medical authorities couldn't seem to come to agreement on that fundamental question. And even if she was, was this an end-of-life issue? Was Terri really dying? Or was she simply a disabled person who needed help to remain alive? Was she being kept alive by extraordinary means? Does a feeding tube constitute heroic artificial measures?

There were so many cross currents running, not the least of which was the long-standing battle between Terri's husband Michael and her parents Bob and Mary Schindler. Do you think Michael had Terri's best interests at heart? Were Terri's wishes really being honored as Michael claims? Certainly, there was a lack of clear and convincing evidence of Terri's desires. Too, there were innuendoes of financial gain as it may have related to Terri's care and her husband's real intentions. Then there were the hints of spousal abuse. Why was Michael so opposed to Terri's parents taking responsibility for her physical care?

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Did the whole case become a political football? Did the "pro-life" movement seize an opportunity to use Terri's suffering as a convenient vector to mobilize its interests? Was Terri's pathetic predicament exploited for political or social gain?

And last but hardly least, should the government have ever gotten involved in deciding Terri's fate? Should congressmen be given the responsibility of deciding who lives and who dies? Should state governors be allowed to take control of the destiny of those whose wishes are unknown? What can come of all this???

It's certainly not my intent to rehash the strengths and weaknesses of each question or argument. God knows that's been well done across all the media, and if nothing else, in our heart of hearts we know that there were no easy answers. Regardless of your persuasion, this case was heart breaking and tragic. It mattered not if you were Democrat or Republican, liberal or conservative, to the left or right of center. Which side you come down on is not relevant. What is relevant I believe, is the dialogue that a case like this generates and the learning opportunity it affords.

Bioethics is a sub-study of philosophy that looks at ethical decision making within the context of science and technology. Since the 1970s members of numerous academic disciplines, including biology, medicine, philosophy and religion (and most recently, politics) have become mired in ongoing discussions of complex bioethical issues. From then on, it became incumbent on medical, nursing and allied health educational programs to address issues of life and death within their respective curricula. (Coincidentally, the National Board for Respiratory Care (NBRC) exam matrix now includes "advanced directives" as an item heading in its content areas.)

Topics such as advanced directives and criteria for biological death are relatively straightforward concepts that can be easily learned in school. But a person's gut response to a bioethical dilemma isn't something that could have ever been learned in school. The real learning lies in a willingness to examine other points of view and perspectives. It's not about coming to a "correct answer". Our job as teachers is to impart to future health care providers that they be able to support their views. As disturbing as a situation may be, students must learn to intelligently defend their opinions. Students should come to see that acting overly emotional or confrontational with regard to an ethical problem is not the way to bring others to their side.

Nurses and allied health practitioners frequently find themselves on the sidelines of significant controversies in bioethics. Respiratory care practitioners in particular, are closer to end-of-life issues than other technical practitioners. From a practical standpoint, these caregivers will contend with these issues with respect to their own job actions; however it's that time-acquired ability to state situations objectively and with reason that will ultimately gain them respect as true professionals.

Throughout any educational process, educators are on the lookout for "teaching moments". Unlike lesson plans which have been planned well in advance, "teaching moments" present themselves spontaneously at any point along the way. So many happenings can be transformed into "teaching moments". Terri Schiavo's life and death exemplified the considerable moral perplexities regarding personal values and responsibilities. As such, it became the ideal time to launch a classroom discussion of bioethics. It was the perfect opportunity to capture the teaching moment, a teaching hour or maybe even a teaching day.

Allied health students inherently want to know more about current real life situations and about controversial scenarios in which they may eventually find themselves. Recognizing this, we, as health educators can create our own teaching moments. These impromptu sessions will liven the entire class, launch thought-provoking discussion and help to develop the critical thinking skills necessary to intelligently articulate one's point of view.

A take home message here is: Capture the teaching moment and run with it. This is especially hard for those of us in allied health. We're always trying to cram into two years lesson plans better suited for four, but sometimes we just have to let go. As difficult as it may be, let's not become slaves to the lesson plan every single minute. Let's learn when to stick with the curriculum and when it's okay to stretch it or abandon it altogether, so as to analyze current events and to respond to students' concerns and personal opinions. What can happen is that the lessons learned may end up being very different from what we, the teachers, originally had in mind, i.e. not the list of learning objectives for the day. But remember--some of life's greatest discoveries and greatest lessons have come about unexpectedly. So sometimes, we should just recognize a valuable teaching tangent and go for it. Terri unfortunate death has given much to life and learning. May she rest in peace.

by Sandra McCleaster RRT