Media Advisory: Ethics Surrounding Schiavo Case to Be Discussed at Stanford Public Forum.

STANFORD, Calif. -- The legal and ethical dilemmas surrounding the Terri Schiavo case will be the subject of a panel discussion at noon Thursday at the Stanford University School of Medicine. The presentation, titled "When Life Should End: Who Should Decide," will take place in room M-104 of the Alway Building.

The speakers will be David Magnus, PhD, director of the Stanford Center for Biomedical Ethics, and Deborah Rhode, JD, director of the Stanford Center on Ethics. The discussion will be moderated by Julie Parsonnet, MD, senior associate dean for medical education.

Schiavo is the Florida woman whose feeding tube was removed March 18 after a court accepted her husband's contention that she wouldn't want to be kept alive by artificial means. Her parents reject that assertion and lodged several unsuccessful appeals to try to have the feeding tube reinserted.

The panel discussion is sponsored by the Center for Biomedical Ethics and is free and open to the public. For information, contact 650-723-5760.

Magnus has followed the case for several years and has been widely interviewed about the issues it raises. Below is a Q&A with Magnus on the Schiavo case:

Question: The term, "starving her to death," was used many times to describe what would happen when the feeding tube was removed from Terri Schiavo. Is that an accurate description?

Magnus: Not at all. That would be like saying that when we remove ventilator support we are suffocating someone. Palliative care experts have established that discontinuing hydration and nutrition is one of the most painless ways for someone's life to end. Gastric tubes are invasive medical interventions, and patients have a right to refuse medical treatments.

Q: In such cases, how do you reach conclusions as to whether it is ethical to keep a patient alive?

Magnus: The key is to do the best we can to respect the values and wishes of the patient. Patients have the right to refuse treatment, and we try our best to ascertain what they would want to do given their situation. Living wills are actually far less help than people realize, except in a narrow range of cases. The most important thing is for a person to have conversations with family members about his/her values and what he/she would want in a range of cases, and to designate a decision maker in an advanced directive. The one exception to the rule (that we try to do what the patient wants) is that we do not always offer treatments that are medically ineffective.

Q: California law differs from Florida in dealing with end-of-life decisions. How so?

Magnus: In Florida, there is an assumption about who would be the appropriate person to say what the patient would want. So the spouse is the decision maker unless there is reason to believe that the spouse is not doing what the patient would have wanted (if there is no spouse, then adult children; if no adult children, then parents). In California, the treating physician is responsible for selecting an appropriate surrogate based on several criteria to determine the person most likely to do what the patient would want. In addition, California has a very different standard that makes it easier for hospitals to discontinue treatment believed to be medically inappropriate.

Q: What bothered you the most about the way the media played the story?

Magnus: There were so many ways in which the coverage was misleading. First, it was not made sufficiently clear that patients have a basic right to refuse treatment. That means the real question in this case was about the standards we adopt for knowing what a patient wants. Different value systems get embodied into state law, and the laws basically fall into three types. States such as Missouri and Pennsylvania have decided that life (even in a persistent vegetative state, or PVS) is so valuable that clear and compelling evidence is required before a surrogate can authorize discontinuing treatment. States such as Florida are neutral between being in a PVS and no longer living, and so less evidence is required to authorize discontinuing treatment. Then there are states such as California that have basically said life in a PVS is not a worthwhile goal for medicine. Hospitals are not required to offer such treatment, though patients are given the opportunity to find other institutions that will allow them the treatment they desire.

The failure to present the case in this way gave rise to a lot of irrelevant -- and often misleading discussion -- such as whether the patient was really in a PVS or a minimally conscious state, or whether a gastric tube was different from ventilator support.

Q: As you look over this national debate, has it been good or bad for the country?

Magnus: A bit of both. It is good for people to recognize that they need to have conversations with their loved ones to ensure that their wishes and values will be respected. On the other hand, the topic was sensationalized and incorrectly presented as a right-to-life issue rather than the right-to-refuse-treatment case that it actually was. It was pretty clear early on that this case was going to be a lot more about politics than about how end-of-life decisions should be made. The fact that the actions by the Florida legislature and by Congress had to do with one patient -- and not the system -- highlights that Terri Schiavo was used to score political points rather than to seriously address the topic.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions -- Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.