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The mêlée that surrounded the last days of Terri Schiavo's life was reminiscent of a classical Greek tragedy. Much like Antigone, Ms. Schiavo became enmeshed in irresistible and opposite forces, resolved to use her situation as an arena for the determination of political and legal issues as diverse as the exercise of states' rights, the extent of individual rights, the role of the judiciary, the re-opening of the abortion debate, and the regulation of stem cell research. As Europeans watched the drama unfold, the forces at play in the United States clashed head-on, in a rhetorically inflammatory spectacle which, on this side of the Atlantic, left many aghast. Most unsettling was the prospect of individuals wielding the power of state and national legislatures in what was, ultimately, an intensely personal affair. In the United Kingdom, the struggle was a stark reminder of the differences, not only between British and American political culture, but between our approaches to legal issues which present themselves at the end of life. The existence of well-established procedures and principles, and the extensive involvement of neutral third parties and the courts in pursuit of an objective determination of an individual patient's 'best interests', are key to the conclusion that Terri Schiavo's case would have been handled at least as effectively and efficiently as it was by the courts in Florida and the United States. That issues of consent and capacity can be determined by British courts on the basis of generally applicable principles leads to the subsequent conclusion that a 'best interests' determination leaves significantly less scope for conflict than the individualistic, much more personal and determinative construct of the 'substituted judgment' test in the United States.

This article sets out how a case like that of ms. Schiavo is likely to be decided in a Dutch court and compares that with the law in the United States. In the Netherlands there is one case with striking similarities: the decision of the Arnhem Court of Appeal of 1989. After describing that case (which to a large extent still reflects the legal state of the art), comments are given on several aspects of the issue, such as the labelling of artifical feeding as a medical intervention, the role of the physician, the position of the proxy or surrogate, the ways to resolve dispute in case of conflict, and the significance of advance directives. The analysis will show that, although there is more consensus on the issue now than there was 16 years ago, there are still several questions that need to be addressed in the future.

Parents sometimes demand 'full active treatment' for a terminally ill child, even against medical advice. They think that they should decide their child's best interests, not medical staff, who may conclude too readily that the child's life is 'not worth living'. Only parents who know and love their child can decide that. Doctors and nurses, on the other hand, feel they have the training and experience to assess the pain and distress of heroic measures and whether they are justified in cases where a child cannot survive, or will have profound disability. This paper reviews recent case law in the United Kingdom and Australia on the role and processes of courts where a hospital (or a parent) applies for a court order regarding treatment. The author concludes that it is possible but unlikely that a court would direct medical staff to provide treatment they regard as clinically inappropriate.

The case of Terri Schiavo in the USA served to intensify the debate in Germany which itself had in part already been characterised by fundamentalism. Now that some time has elapsed and the political debate has quietened, this case is to be taken up again in discussing the permissibility and the prerequisites of passive euthanasia for patients in a persistent vegetative state. A short reconstruction of the facts of the case (II) is to be followed by a survey of the case law of the Criminal Panels (III) which is essential to understand the present legal policy debate to be discussed at a later stage (IV).

Although tragic, the plight of Terri Schiavo provides a valuable case study. The conflicts and misunderstandings surrounding her situation offer important lessons in medicine, law, and ethics. Despite media saturation and intense public interest, widespread confusion lingers regarding the diagnosis of persistent vegetative state, the judicial processes involved, and the appropriateness of the ethical framework used by those entrusted with Terri Schiavo's care. First, the authors review the current medical understanding of persistent vegetative state, including the requirements for patient examination, the differential diagnosis, and the practice guidelines of the American Academy of Neurology regarding artificial nutrition and hydration for patients with this diagnosis. Second, they examine the legal history, including the 2000 trial, the 2002 evidentiary hearing, and the subsequent appeals. The authors argue that the law did not fail Terri Schiavo, but produced the highest-quality evidence and provided the most judicial review of any end-of-life guardianship case in U.S. history. Third, they review alternative ethical frameworks for understanding the Terri Schiavo case and contend that the principle of respect for autonomy is paramount in this case and in similar cases. Far from being unusual, the manner in which Terri Schiavo's case was reviewed and the basis for the decision reflect a broad medical, legal, and ethical consensus. Greater clarity regarding the persistent vegetative state, less apprehension of the presumed mysteries of legal proceedings, and greater appreciation of the ethical principles at work are the chief benefits obtained from studying this provocative case.

Since the enactment in Queensland of the Powers of Attorney Act 1998 (Qld) and the Guardianship and Administration Act 2000 (Qld), a decision can be made to withhold or withdraw life-sustaining medical treatment from an adult who lacks capacity to make such decisions for herself or himself. The Guardianship and Administration Tribunal of Queensland has been asked to consider the law in relation to these decisions on a number of occasions since the legislation was passed. This article explores the relevant provisions of these statutes and some of the difficulties that arise from how they are currently drafted. It also examines how the Guardianship and Administration Tribunal has dealt with applications to withhold or withdraw life-sustaining measures, and suggests a course that might avoid some of the difficulties that are inherent in Queensland's legislative regime.

HOLDING: Tube feeding may be withheld or withdrawn from a person in a persistent semi-conscious state even though her living will did not explicitly decline tube feeding, and there is no clear and convincing evidence of her intention to decline tube feeding.

HOLDING: Before withdrawal of tube feeding may be permitted, a guardian must establish, by clear and convincing evidence, the treating and consulting physicians' education, training, and experience; the physician's history and experience with the patient; the fact that the physician personally examined the patient; and the opinions required by statute. Each physician should also testify to his opinion that the other physician in the matter is qualified, by reason of advanced education or training, limited practice, experience, or certification as a specialist, to make the findings and provide the opinions about the patient which are required by the statute. The consulting physician's opinion should be more than a conclusory adoption of the attending physician's opinion. Rather, it should be independently stated and, ideally, should include the reasons upon which it is based.