If that Ever Happens to Me: Making Life and Death Decisions After Terri Schiavo.

Lois Shepherd’s book, If that Ever Happens to Me: Making Life and Death Decisions After Terri Schiavo, has arrived on bookshelves at a particularly poignant moment in American politics as the country debates health care reform and the niche that end-of-life decision-making will occupy in upcoming legislation. Shepherd’s book sensitively and effectively examines the way in which conversations about end-of-life decisions have changed since the very public legal wrangling in 2005 over the fate of Terri Schiavo. As most will remember — and as Shepherd recounts — Theresa Schiavo (Terri) fell into a permanent vegetative state (PVS) after collapsing at her home in 1990. At the time, Terri was married to Michael Schiavo and enjoyed a good relationship with her parents, Robert and Mary Schindler. Following the collapse, Schiavo and the Schindlers kept constant watch over Terri, advocated for aggressive rehabilitation and insisted on all relevant interventions. Then, approximately 11 years after the PVS diagnosis, Schiavo sought to have Terri’s feeding tube removed against the wishes of the Schindlers. After a lengthy legal and political battle — first in Terri’s home state of Florida and then on a national stage — Terri’s feeding tube was removed on March 18, 2005, and she died 13 days later. The public response to the ordeal was largely sympathetic, and, as Shepherd details, polls have continued to confirm that most Americans would prefer not to have artificial nutrition and hydration if they were in a situation similar to Terri Schiavo’s. Yet few individuals have taken the time to put these wishes into writing or to name surrogates who are aware of and willing to execute these wishes. Shepherd does an admirable job of explaining the complexities of living wills, the standard of proof needed to verify unwritten wishes, and the legal limitations of advanced directives. Because Shepherd is using the Schiavo case as the cornerstone of the book, she speaks most specifically and frequently about patients in a PVS. But this perspective, while a viable example of a patient with no decision-making capacity, represents a state in which the vast majority of Americans will never find themselves. Shepherd’s book is certainly a positive contribution to the discussion of contemporary end-of-life decision-making, and her writing demonstrates an understanding of the legal and ethical challenges of the PVS case. Further, her ability to concisely but accurately explain medical and legal terms without condescension makes her writing approachable and enjoyable. Shepherd does explain the significance of earlier legal decisions that have contributed to the current state of end-of-life practices, and this background information would be particularly helpful to those who are new to the field. One critique of Shepherd’s book is that her stanch opinion on the subject matter can occasionally come across as dismissive of the arguments made by those who take a different point of view. Overall, I applaud Shepherd for her willingness to provide a fairly nuanced argument about end-of-life decision making in a fresh framework. I believe that others may reasonably disagree with some of the author’s conclusions, but I am also confident that Shepherd has intelligently and respectfully added to the ongoing conversation about dying in America.