Ethical Principles Violated In 1990, Terri Schiavo suffered cardiac arrest leading to a persistent vegetative state. Over the next 15 years, her case received international attention as her husband and parents argued over how to fulfill Terri's end-of-life wishes. 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 (Fine, 2005) On March 31, 2005, Terri Schiavo (born December 3, 1963) died -- the final complication of a cardiac arrest on February 25, 1990. Her death was preceded by the withdrawal of artificially administered hydration and nutrition through a feeding tube. Prior to her death, Terri's saga was the focus of intense medical, ethical, and legal debates in the United States and elsewhere. These debates were characterized by confusion about the facts, ethical principles, and laws relevant to the case. Much of the confusion revolved around a number of ethical and legal questions including: Is it ethically and legally permissible to withhold or withdraw life-sustaining treatments from patients who do not want the treatments? Is withholding or withdrawing life-sustaining treatments the same as physician-assisted suicide or euthanasia? Is artificially administered hydration and nutrition a medical treatment or mandatory care akin to bathing? What were Terri's values, preferences, and goals regarding life-sustaining treatments? Several issues raised and argued that the central question of the Terri Schiavo case is a struggle between sanctity of life versus quality of life (Grossenbacher, 2007). Expressed as an ethical principle, the central focus in this case is respect for autonomy. Many have argued, however, that the proper moral framework is not autonomy at all, but rather sanctity of life, discrimination toward the disabled community, or the moral character of those empowered to decide. Examining these alternative frameworks is important, both to discern why respect for autonomy is the key ethical feature of this case and to display the weaknesses of the alternatives (Fine, 2005). Several commentators argued that the central question of the Terri Schiavo case is a struggle between sanctity of life versus quality of life. Likewise, medical codes of ethics echo this legal consensus when they frame end-of-life issues in terms of autonomy and affirm the right of patients to informed consent and respect for their wishes, even beyond their loss of competence, when it can be reasonably determined what they would have wanted. Of course, to assert that respect for self-determination is paramount does not mean that it is the only principle at work in this and similar cases-it also does not mean that discerning someone's preferences for medical care from the accounts of others is simple or without problems. Rather, our claim is that using self-determination as the primary framework is simply the best we can do and is far less problematic than relying on medical or parental beneficence, quality of life, or sanctity-of-life judgments. Relying fundamentally on these other norms would jeopardize the rights of Terri Schiavo and patients like her to receive or not to receive continuing interventions and would threaten this basic principle of U.S. law and American medical ethics. The Terri Schiavo case will probably remain controversial, with some people feeling strongly that the wrong decision was made (Grossenbacher, 2007).