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Terri Schiavo case

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File:Terri Schiavo.jpg
Terri Schiavo before her collapse in 1990.

Theresa (Terri) Marie Schindler Schiavo (pronounced SHY-voh) (born December 3, 1963) is an American woman from St. Petersburg, Florida who has suffered severe brain damage since a catastrophic collapse as a result of an eating disorder. The efforts of Schiavo's husband, Michael, to remove her gastric feeding tube have prompted a fierce debate over bioethics, euthanasia, legal guardianship, federalism, and civil rights. On March 18, 2005, Michael ordered her feeding tube removed after a Florida court blocked her parents' efforts to prevent the removal. If the tube remains removed, Terri will die within a few days by dehydration and/or starvation. Lack of water intake causes electrolyte imbalance that causes a heart attack (myocardial infarction) which results in cardiac arrest producing death.

Replacing the tube would require about two hours to transport Mrs. Schiavo from the Pinellas Park nursing home where she is under hospice care (by the Hospice of the Florida Suncoast, based in neighboring Largo) to a nearby hospital, then surgery followed by several days' hospitalization until her electrolyte balance could be restored. [1].

Michael Schiavo, Mrs. Schiavo's husband and current legal guardian, contends that he is carrying out his wife's wishes not to be kept alive given her present state, though Terri did not put any wishes in writing in the form of a living will. Mrs. Schiavo's parents, Bob and Mary Schindler, and her siblings, dispute Michael's position, holding that Terri is "responsive" and in no discomfort, and that she would not wish to die. The courts that have heard this case have all sided with Mr. Schiavo thus far, but her parents have vigorously appealed the courts' decisions and sought to prevent the cessation of life support. The Roman Catholic Church, U.S. President George W. Bush, Florida Governor Jeb Bush, and many Republicans in the Florida Legislature and U.S. Congress have sided with Mrs. Schiavo's parents. Other groups and individuals, such as the American Civil Liberties Union and many Democratic legislators, have expressed support with Michael.

Early life

Schiavo was born as Theresa Marie Schindler. She grew up in the Huntingdon Valley area of Lower Moreland Township, a suburb of Philadelphia, as the oldest of three children. She graduated from a private Catholic high school in nearby Warminster Township in 1981. As a teenager, she was overweight but managed to reduce her weight significantly with the help of a physician. In 1982, she met Michael Schiavo at Bucks County Community College in Newtown; the two married on November 10, 1984. The couple moved to St. Petersburg, Florida in April 1986, at about the same time that Bob and Mary Schindler relocated there.

Initial medical crisis

On the morning of February 25, 1990, around 5:30 a.m., Schiavo collapsed in her home in St. Petersburg, resulting in irreversible brain damage due to a loss of oxygen. According to her discharge summary from Humana Hospital, Terri suffered cardiac arrest and anoxic brain damage, accompanied by hypokalemia (abnormally low levels of potassium in the blood), seizures, respiratory failure, and an injured knee from the fall. The cause of her cardiac arrest was undetermined, but the low potassium was suspected.

In 1992, a medical malpractice suit was brought against Schiavo's medical care providers. The jury concluded that Schiavo suffered from bulimia, which caused her chemical imbalance and subsequent cardiac arrest and had not been properly diagnosed by the hospital. The hospital appealed, and the case was settled in 1993 before the appeal could be decided, with Terri Schiavo receiving $750,000 and Michael Schiavo receiving $300,000 from the hospital. Florida's Second District Court later also found that Schiavo suffered a cardiac arrest as a result of a potassium imbalance.

Michael Schiavo first sought permission to remove his wife's feeding tube in November 1998. Her feeding tube was removed first on April 26, 2001, but was reinstated two days later on an appeal by her parents.

Since then, questions about the cause of Schiavo's collapse have been raised by Schiavo's family, and by Dr. Hammesfahr, a neurologist they hired to examine her in 2002. Hammesfahr was disciplined by the Florida Board of Medicine in 2003 (PDF file) and has been accused of falsely claiming to be a Nobel Prize nominee. [2]

A bone scan [3] done one year after her injury showed (according to the radiologist who evaluated it) that she had also suffered previous traumatic injuries to multiple ribs (on both sides), to both sacroiliac joints, to both knees, to both ankles, to several thoracic vertebrae, and to her right thigh, plus a minor compression fracture of the L1 vertebra. Mrs. Schiavo's family did not know of the existence of this scan until November 2002. Forensic pathologist Dr. Michael Baden, has suggested that physical trauma, specifically a head injury, probably caused Mrs. Schiavo's condition,[4] (though in a later interview[5] he agreed the bulimia/hypokalemia explanation was possible). The trauma is also consistent with her cardiac arrest, fall, CPR attempts and eventual resuscitation.

Upon becoming aware of the bone scan report possibly suggesting abuse-related injuries, the Schindlers petitioned Judge Greer for a full evidentiary hearing to evaluate the new evidence. On November 22, 2002 Judge Greer denied the motion, stating that the issue of trauma 12 years earlier was irrelevant to the current case[6].

The Florida Department of Children and Families (DCF) has begun another investigation of the abuse allegations. Previous investigations have found Mr. Schiavo innocent, and the charges baseless. ([7] PDF Report) The doctors who were the defendants in the 1992 malpractice lawsuit made no attempt to introduce any evidence suggesting that Mrs. Schiavo was battered as part of an affirmative defense to mitigate their responsibility for her cardiac arrest.

Schiavo is now hospitalized at a hospice in Pinellas Park, in the Tampa Bay Area.

Schiavo's condition

Issues of dispute

Mrs. Schiavo's condition and prognosis are matters of dispute. The only facts which appear not to be in dispute are that she is not in a coma, she is severely brain damaged, and she is partially blind. Since her collapse, she has been fed through a gastric feeding tube. This is the life support mechanism around which the case revolves. The following is the difference of opinion on the matter:

  • Since 1991, the Schiavos' personal physicians, and six different court-appointed physicians, have concluded that Schiavo is in a persistent vegetative state (PVS). [8] Patients in a persistent vegetative state have severe brain damage and are in a state of "wakefulness without awareness." In many cases, including that of Schiavo's, a coma progressed to the vegetative state. Patients in a persistent vegetative state are usually considered to be unconscious and unaware. They may experience sleep-wake cycles, or be in a state of chronic wakefulness. They may exhibit some behaviors that can be construed as arising from partial consciousness—reflex or random behaviors, such as grinding of teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus. They are unresponsive to external stimuli, except, possibly, painful stimuli. Schiavo halted most therapy for his wife in 1994, including speech and occupational therapy. In 1998, Mr. Schiavo initiated legal action to withdraw his wife's life support.
  • Mrs. Schiavo's parents claim that their daughter does not meet that definition. Her parents claim that she smiles, laughs, cries, moves, and makes child-like attempts at speech, that she attempts to say "Mom" or "Dad" or "yeah" when they ask her a question. They claim that when they kiss her, she looks at them and sometimes "puckers up" her lips. They cite the testimony and affidavits of 33 physicians and therapists (including 15 neurologists), who, after reviewing video segments provided by her parents, believe that Mrs. Schiavo should receive further tests and/or would likely respond to therapy. However, only two of these physicians had access to her full medical history and examined her in person. Some of these physicians have claimed that there is a "strong likelihood that Mrs. Schiavo is in a 'minimally conscious state.'" There were six video segments provided by Schiavo's parents, totaling four minutes and twenty seconds in length (edited down from four and a half hours of videotape). The video selected for these segments may be indicative of her general responsiveness, or they may represent moments where Schiavo's behavior seemed to be coincidentally appropriate to what was going on around her; the rest of the recorded video has not been released publicly.

Medical opinions

Most of Schiavo's cerebral cortex has been completely destroyed, replaced by cerebrospinal fluid. Dr. Ron Cranford, a neurologist at the University of Minnesota assessed Schiavo's brain function in 2001 as part of a court-ordered assessment. He was quoted in Florida Today as saying "[Schiavo] has no electrical activity in her cerebral cortex on an EEG (electroencephalogram), and a CT (computerized tomography) scan showed massive atrophy in that region." [9] [10]

About 70 to 90 percent of Schiavo's upper brain has been destroyed, and in addition there is damage to the lower brain, which controls functions such as breathing and swallowing. Three Florida neurologists viewed 12 of Schiavo's computed tomography scans on March 22. After viewing the scans, Dr. Leon Prockop (a professor and former chairman of neurology at the University of South Florida's College of Medicine) was quoted by the Sun-Sentinel as saying that Schiavo's is the "most severe brain damage as I've ever seen." Dr. Walter Bradley, the chairman of neurology at the University of Miami's Miller School of Medicine, said that he "[d]oubts there's any activity going on in the higher levels of her brain." [11]

In 2002, a trial was held to determine whether or not any new therapy treatments would help Schiavo restore any cognitive function. A new computed axial tomography scan (CAT scan) was done, as was an electroencephalogram (EEG). The CAT scan showed severe cerebral atrophy.

Five doctors were selected: two by Schiavo's parents, two by Michael Schiavo, and one by the court. These five doctors examined Terri Schiavo's medical records, brain scans, the videos, and Mrs. Schiavo herself. The physicians were divided in their conclusions. The two doctors selected by Schiavo's parents (one of whom was a radiologist, not a neurologist; the other of whom made several claims about therapies supposedly developed by him which the court found spurious) supported their conclusion; the two doctors selected by Schiavo's husband and the doctor appointed by the court supported Mr. Schiavo's position. Greer ruled with the latter that Mrs. Schiavo was in a PVS and was beyond hope of significant improvement. [12]

Florida's Second District Court of Appeal reviewed all the evidence and upheld the trial court's decision, saying had they heard the case themselves they would have ruled the same as Greer. Some physicians, such as Dr. Peter Morin and Dr. Thomas Zabiega, both neurologists, say that no such diagnosis can reliably be made without more sophisticated tests such as an MRI or PET scan.[13] Judge Greer reviewed a six-hour tape of Schiavo and concluded that her vegetative condition was factual and not subject to legal dispute (see link 5, above).

Mrs. Schiavo could be evaluated with a PET scan in her current condition. However, an MRI cannot be done without first surgically removing experimental electrodes which were implanted within her brain in 1992, something that Mr. Schiavo has chosen not to do. [14]

Guardianship

Under Florida law Mr. Schiavo is Mrs. Schiavo's legal guardian, although her family is seeking his removal as guardian ostensibly so that they can assume responsibility for Mrs. Schiavo's care. Under Florida law, guardians of disabled persons are required to file comprehensive annual reports and care plans, and are not allowed to deviate from those plans. To this date Mr. Schiavo has successfully fought the efforts of Mrs. Schiavo's parents to remove him as Mrs. Schiavo's guardian in court.

In an appearance on ABC News's Nightline on March 15, 2005, he cited Mrs. Schiavo's parents' expressed willingness to keep her alive by any means necessary, including quadruple amputation, as a key reason for denying transfer of guardianship to the Schindlers.[15] [16]

Controversy

The fundamental differences on both sides of the issue are focused mainly upon the disputed medical evidence presented by each side. Even though the courts have consistently ruled that, as her husband and legal guardian, Mr. Schiavo has the legal right to decide her medical treatment, her family members have nonetheless used every legal measure available to them to prevent the disconnection of her feeding tube.

Raising the issue of a possible conflict of interest is the fact that Mr. Schiavo stands to inherit the remainder of Mrs. Schiavo's malpractice settlement upon her death. Mr. Schiavo has publicly responded to this charge by claiming that, of the original $1,050,000 awarded in the malpractice suit, less than $50,000 is left, the rest having been spent under a judge's supervision on medical care for Mrs. Schiavo and the ongoing legal battle. He has also stated that, if he does receive this money, he will donate it to charity.

Mrs. Schiavo's family has been battling her husband over her fate since 1993. Although she never wrote a living will expressing a wish to refuse nutrition or medical treatment if disabled, Mr. Schiavo claims that he recalls conversations they had had which make him sure she would not want to continue living in such a state, and two of his relatives have supported that claim. [17]

However, her family disputes his recollections, claiming that Mrs. Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by intentionally starving or dehydrating herself to death, and that she apparently never expressed such a desire to anyone in her own family or circle of friends. It was only after the courts awarded more than $1 million in legal settlements (mostly to cover the cost of her long term care and rehabilitation) that Mr. Schiavo first publicly recalled conversations in which his wife had expressed a wish to die rather than live in the condition in which she now finds herself.[18] Her family also cites an affidavit by a woman with whom he had a relationship prior to those legal settlements, indicating that Mr. Schiavo told her repeatedly that he did not know what Mrs. Schiavo's wishes would be for her care [19]. The Schindlers' legal fight has been and continues to be funded by a variety of sources on the political right ([20]).

Mrs. Schiavo's father, Bob Schindler, has stated that Judge George Greer, who has pronounced the most recent decisions in the case, and who also appointed Dr. Jay Wolfson as Mrs. Schiavo's guardian ad litem([21]) (which Mrs. Schiavo's family says was illegal), has never called her into the courtroom or visited her to observe her condition first-hand. Schindler feels that if his daughter dies in accordance with the court order, that it will be an instance of "judicial homicide."

Mr. Schiavo says Mrs. Schiavo would not have wanted to live "as a vegetable" and that he is fighting for her "right to die." As the legal guardian of Mrs. Schiavo, he has placed limits on the time her family is allowed to visit her and placed Mrs. Schiavo in a hospice.

Politicians and pundits

Politically this has roughly divided along traditional political lines. Publications such as National Review, The Weekly Standard, and The Wall Street Journal have vocally supported the Schindlers' position to keep the feeding tube in place. The New York Times has supported the rights of Michael Schiavo. Peggy Noonan has predicted that the Republicans will face fallout from their own base if they fail in keeping Schiavo alive, mainly because the controversy is much more important to social conservatives. [22]. However, Nat Hentoff, whose opinions fall variously on the left and right of the U.S. political spectrum, has argued in the leftist Village Voice against removing Mrs. Schiavo from the feeding tube. (see below)

Republicans House Representative Tom DeLay of Texas and Senator Bill Frist of Tennessee have spoken in favor of keeping Mrs. Schiavo alive, as has President George W. Bush. Democratic Senators Tom Harkin and Kent Conrad have also supported federal intervention in the Schiavo case, although Republican Representative Dave Reichert was against it. Especially outspoken Democratic congressmen who have protested the federal intervention include Henry Waxman, Robert Wexler, Barney Frank, and Debbie Wasserman Schultz.

According to a talking points memo circulated among Republcian senators, the Schiavo case offered "a great political issue" that would appeal to the party's core supporters. Senate Majority Leader Bill Frist denounced the memo and asserted that the Republican Party's interest in the case was solely based on moral grounds. [23] Powerline (blog) [24] and Jim Geraghty [25] of National Review Online, who were involved in breaking the Killian documents story, have questioned the authenticity of the memorandum, as has Michelle Malkin. [26] Republican senators have not denied the authenticity of the memorandum.

As events have unfolded, the media storm regarding the controversy has increased. Conservative radio hosts, such as Michael Medved, Rush Limbaugh, Michael Savage, Bill Bennett, and many others have been increasingly commenting on these matters, as have religious commentators such as Rabbi Daniel Lapin, The 700 Club, and other more conservative religious groups. Celebrities such as Mel Gibson and Patricia Heaton have been also speaking out on it. [27]

Mickey Kaus of Slate has also raised allegations about the authenticity of the Republican talking points memorandum. [28] Dahlia Lithwick of Slate has complained the Republican action is opposite to their stated support of marriage rights. [29]

Liberal commentators, such as Harvard Law School professor Laurence Tribe, have been promoting the cause of non-intervention into the decisions of Mr. Schiavo regarding his wife.

In 2004, Michael Schiavo won a court case to have his wife's feeding tube removed. Days later, the Florida Legislature, in emergency session, passed "Terri's Law," giving Florida Governor Jeb Bush the authority to intervene in the case. Bush immediately ordered the feeding tube reinserted.

On May 19, 2004, Florida Judge W. Douglas Baird overturned the law saying that it "summarily deprived Florida citizens of their right to privacy." Bush appealed the ruling to the Florida Supreme Court and on September 23, 2004 they reached a unanimous decision [30], ruling that the legislature and executive branches of government unconstitutionally intervened in a judicial matter (see Separation of powers) and that "Terri's Law" is an "unconstitutionally retroactive legislation"[31]. The appellants immediately appealed to the U.S. Supreme Court. On January 24, 2005, the Supreme Court refused to hear the case.

Recent developments

State court

Nineteen different judges have at various times considered the Schindlers' request on appeal in six state courts. All have sided with Michael Schiavo. [32] The final ruling came on February 25, when Judge George Greer ordered the feeding tube removed on March 18. The Florida Department of Children and Families—whose leadership, like the rest of the state executive branch, is controlled by Republican state government—attempted to intervene by investigating allegations of abuse by Schiavo. This could have resulted in a 60-day delay before the feeding tube was removed, but the request for the delay was denied on March 10. Similarly, their request to be permitted to attempt to spoon-feed Mrs. Schiavo if the feeding tube is removed was denied on March 8.

Monetary offers

On March 11, media tycoon Robert Herring (who believes that embryonic stem cell research could cure Schiavo's condition in the future) offered $1 million to Michael Schiavo if he agreed to waive his guardianship to his wife's parents. He rejected the offer, as he had rejected other monetary offers, including one of $10 million. The offer expired on March 14, 2005, four days before her feeding tube was removed. Schiavo's attorney, George J. Felos, said his client found the offer "offensive."

Florida Legislature

On March 17, members of the Florida Legislature were considering a bill that would make removing food and water from patients in a persistent vegetative state illegal without a living will. Although this bill was passed by the Florida House of Representatives by a vote of 78 to 37, the Florida Senate defeated a similar measure hours later, 21 to 16.

U.S. Congress

Schiavo's feeding tube was removed again on March 18, 2005 at 1:45 p.m. EST. Around the previous midnight, U.S. Senate Majority Leader Bill Frist, a Republican from Tennessee, and Michael Enzi of Wyoming, also a Republican, announced that Terri Schiavo would be called to testify before the U.S. Senate Committee on Health, Education, Labor, and Pensions on March 28, 2005 in Washington. Frist, a cardiologist, serves on the committee; Enzi is its chairman. Because of her condition, Schiavo cannot testify, but the letter that they sent gave her federal protection as a prospective witness (a law used in the 1950s and 1960s, designed for Mafia witnesses, makes it a federal crime to prevent a person from testifying before Congress).

Republican leaders in the House of Representatives, including Dennis Hastert of Illinois, Tom DeLay of Texas, and Tom Davis of Virginia, opened a congressional inquiry of the House Government Reform Committee, to take place in Clearwater on March 25, and issued subpoenas for Terri and Michael Schiavo and several hospice workers. Greer struck down the subpoenas as unconstitutional and let the order that gave Schiavo permission to remove the feeding tube stand. Greer ordered that the tube be removed immediately, per Mr. Schiavo's request.

On March 19, 2005, congressional leaders announced that they were drafting a bill which would allow Schiavo's parents to sue in federal court. In the very early hours of March 21, Congress approved emergency legislation. Despite an absence of quorum, the Senate approved the bill(S 686 CPS) by voice vote. The bill passed unanimously, with 97 Senators not present. Meanwhile, in the House of Representatives, deliberation continued during an unusual Sunday session. When it came to a vote, the motion was passed 203-58, with 174 Representatives not present on the floor at the time of the vote. The vote concluded at 12:41 a.m. EST; Bush returned from vacation at his Prairie Chapel Ranch in Crawford, Texas to Washington, D.C., and signed the bill into law at 1:11 a.m., the first time he had returned from a vacation during his tenure as President.

The U.S. Congress may also consider another bill to prevent Schiavo's death, called the "Incapacitated Person's Legal Protection Act" (House Resolution 1151). The primary sponsor of the House bill is Dave Weldon (R-FL), a physician. Weldon claimed that medical evidence "prove[s] Terri is not in a vegetative state," although he hasn't examined her.

Public reaction

According to an ABC News poll conducted over the weekend of March 19-20 and published on March 21, 70 percent of Americans believe that the issue of Terri Schiavo's death should not be a federal matter and opposed the legislation tranferring the case to federal court. In the same poll, a 63 to 28 percent majority said that they support the removal of Schiavo's feeding tube. A 67 to 19 percent majority agreed with the statement that "elected officials trying to keep Schiavo alive are doing so more for political advantage than out of concern for her or for the principles involved." [33]

U.S. District Court

Schiavo's parents, Bob and Mary Schindler, filed a request for an emergency injunction with the U.S. District Court for the Middle District of Florida in Tampa on March 21. A two-hour hearing on the injunction was held on March 21 before Judge James D. Whittemore, who refused to order the feeding tube reinserted on March 22.

U.S. Court of Appeals

The case was appealed. In the early morning of March 23, 2005 the 11th Circuit Court of Appeals in Atlanta denied the request to reinsert the feeding tube. The three-judge panel ruled 2-1. The 11th Circuit Court of Appeals said the woman's parents "failed to demonstrate a substantial case on the merits of any of their claims. There is no denying the absolute tragedy that has befallen Mrs. Schiavo," the ruling read. "We all have our own family, our own loved ones, and our own children. However, we are called upon to make a collective, objective decision concerning a question of law." Later that day, the Eleventh Circuit refused to hear the case as a whole (en banc).

Florida Legislature

On March 23, 2005 the Florida Senate again debated a law that would make removing nutrition and hydration from patients in a persistent vegetative state illegal without a living will. It was rejected, 21-18.

U.S. Supreme Court

Mrs. Schiavo's parents appealed again to the US Supreme Court late night on March 23, 2005. They argued that Congress intended for the feeding tube to be reinserted when they passed the "Incapacitated Person's Legal Protection Act." The case first goes to Justice Anthony Kennedy, who can either act alone or with the eight other justices.

Interest in living wills

One of the results of this case is that Americans are showing an increased interest in living wills. Prior to the Schiavo case becoming highly visible, it was estimated that only 20 percent of Americans had a living will. Some feel that this will be the push Americans need to make their end-of-life wishes known.

A number of entities have reported an upswing in requests for forms or other information on living wills. The non-profit organization Aging with Dignity has said that they have received thousands of calls and e-mails concerning living wills. The Westfield, New Jersey-based U.S. Living Will Directory national registry reported the number of hits on their website went from about 500 to 600 per day to well over 5,000. Others, such as lawyers, hospitals, and state bar associations, have also seen an increased interest in living wills.

Many have highlighted Schiavo's case to make the point that people should make living wills regardless of age or current health status, pointing to the fact that even younger people can face terminal illness or have an accident. For example, when Schiavo suffered her brain injury when she was only in her mid-20s. They also feel that expressing one's wishes verbally is not enough, and that those wishes should be formally documented. Legal experts say that the entire court battle could have been avoided if Schiavo had properly documented her wishes prior to her collapse.

See also

These people were important figures in removal of life support discussions and/or lawsuits:

Sources

  • Terri Schiavo Case: Legal Issues Involving Healthcare Directives, Death, and Dying. Findlaw. A detailed compilation of legal documents related to the Schiavo case. [34]
  • The New York Times Database (1996-present): An index of 71 articles from The New York Times relating to the Schiavo case (requires free registration) [35].
  • "Before fight over death, Terri Schiavo had a life." CNN. October 25, 2003. [36]
  • Fackelmann, Kathleen. "Schiavo not likely to experience a painful death, neurologists say." USA Today. March 23, 2005. [37]
  • Lamendola, Bob. "Neurologists see little sign of activity in Schiavo's brain." South Florida Sun-Sentinel. March 23, 2005. [38]
  • Rufty, Bill. "Doctors Lament Misuse of Proper Terminology in Schiavo Debate." March 23, 2005. The Ledger. [39]
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