Terri Schiavo case

File:TerriSchiavo2.jpg

Terri Schiavo before her 1990 collapse.

Theresa Marie Schiavo (December 3 1963–March 31 2005), commonly known as Terri Schiavo (pronounced SHY-voh)¹, was an American woman from St. Petersburg, Florida, who spent the last 15 years of her life in a persistent vegetative state. Her husband's successful efforts to discontinue life support prompted a fierce debate over bioethics, euthanasia, legal guardianship, federalism, and civil rights, while overcoming active counter-efforts to keep her alive. [1] [2]

On February 25, 1990, Terri Schiavo suffered severe brain damage caused by a cardiac arrest brought on by chemical imbalances in the blood due to bulimia. She was hospitalized at the Hospice of the Florida Suncoast in Pinellas Park, in the Tampa Bay area. On March 18, 2005, her gastric feeding tube was removed under court order. The removal of the feeding tube resulted in Schiavo's death by dehydration. Florida courts had previously ruled that Schiavo was in a persistent vegetative state and consequently could not experience the suffering normally associated with starvation and dehydration, because conscious awareness is impossible in the absence of cortical activity. An autopsy was performed to determine the exact causes of her condition, but the results have not yet been released.

Michael Schiavo, her husband and legal guardian, contends that he carried out his wife's wishes not to be kept alive in her vegetative state. Mrs. Schiavo's parents, Bob and Mary Schindler, who are both practicing Catholics, dispute Mr. Schiavo's position, as have Mrs. Schiavo's brother and sister. The courts all ruled in favor of Mr. Schiavo, and the feeding tube was removed three times. The parents vigorously appealed the decisions, leading to the reinsertion of the feeding tube the first two times. Vatican officials, U.S. President George W. Bush, Florida Governor Jeb Bush, many Republicans, and several Democrats in the Florida Legislature and U.S. Congress have sided with Mrs. Schiavo's parents. Other groups and individuals, including the American Civil Liberties Union as well as many Democratic and several Republican legislators, have expressed support for the position of Michael Schiavo.

Terri Schiavo died on March 31 2005, at around 9:05 a.m EST, after 13 days without a feeding tube. [3]

Terri Schiavo's husband,Michael Schiavo went on to live with another women and have two children with her, though he still kept his marriage with Terri.

Early life

Schiavo was born as Theresa Marie Schindler. Her parents named her after Saint Theresa of Avila. She grew up in the Huntingdon Valley area of Lower Moreland Township, Pennsylvania, a suburb of Philadelphia, as the oldest of three children; her younger siblings are Robert Jr. (Bobby) and Suzanne.

Her childhood and high school years were spent as a chubby and shy girl who loved animals and kept hamsters and birds as pets. By her senior year in high school, Schiavo was overweight, with a height of 5'3" and a weight of 250 pounds. Schiavo went on a NutriSystem diet and was able to lose 100 pounds. [4] Schiavo may have developed an eating disorder around this time in order to cope with her perceived weight problem. [5] In 1981, Schiavo graduated from the private Catholic high school, Archbishop Wood High School, in nearby Warminster Township.

Terri met Michael Schiavo in 1982 in a sociology class at Bucks County Community College in Newtown, Pennsylvania, where they were both students. He was her first boyfriend. After dating for five months, the couple got engaged and were married on November 10, 1984. They moved to St. Petersburg, Florida in April 1986. Bob and Mary Schindler, Terri Schiavo's parents, also moved to St. Petersburg three months later. In Florida, Terri worked as an insurance-claims clerk for the Prudential insurance company, and her husband was a restaurant manager. Terri Schiavo's friends began to have suspicions about her eating habits. After meals out, she would immediately excuse herself to go to the bathroom. Michael Schiavo was aware of her unusual eating patterns, but did not realize their potential danger.

In 1989, the Schiavos began visiting an obstetrician and receiving fertility services and counseling in the hopes of having a child. At this time, Terri Schiavo's weight had dropped to 110 pounds, and she had stopped menstruating. However, the physician who examined Terri Schiavo did not take a complete medical history, which would have indicated an eating disorder. [6]

Initial medical crisis

On the morning of February 25, 1990, at about 5:30 a.m. EST, Schiavo collapsed in the hallway of her St. Petersburg apartment. Michael Schiavo awoke out of bed and immediately called Terri's parents and dialed 911 emergency services. Schiavo had suffered a cardiac arrest, and while waiting for the paramedics to arrive she experienced a loss of oxygen to the brain. Attempts were made to resuscitate her, but she remained unconscious and slipped into a coma. In order to keep her alive, Schiavo was intubated, ventilated, and given a tracheotomy; she was also given a percutaneous endoscopic gastrostomy (PEG) to provide nutrition and hydration. Schiavo emerged from her coma two and a half months later at Humana Northside Hospital, but never recovered consciousness nor exhibited any evidence of higher cortical function.

According to her discharge summary from Humana Hospital, Schiavo suffered cardiac arrest and anoxic brain damage, accompanied by seizures, respiratory failure, and an injured knee from the fall. The cause of her cardiac arrest is believed to be due to a bulimia nervosa-induced hypokalemia (abnormally low levels of potassium in the blood). At the time of her hospital admission, her blood potassium level was 2.0 mEq/L; the normal range for adults is 3.5–5.0. Medical records noted: "she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day and drinking about 10–15 glasses of iced tea" [7].

Rehabilitation efforts

On May 12, 1990, Schiavo was discharged to the College Park Skilled Care and Rehabilitation facility. The court appointed Michael Schiavo as Terri's legal guardian without objection from the Schindlers on June 18. Schiavo was transferred to Bayfront Hospital for further rehabilitation efforts on June 30. Terri Schiavo came home to her family in September, but after being overwhelmed with Schiavo's needs, the family sent her back to the College Park facility. In November, Michael Schiavo took Terri to California for an experimental procedure involving the placement of a thalamic stimulator implant in Terri's brain. The experimental treatment took several months and was unsuccessful; Michael returned to Florida with her in January 1991 and admitted her to a brain injury center in Bradenton, often "taking her to parks and public places in hopes of sparking some recovery."

Michael Schiavo also began studying nursing at St. Petersburg Community College to better care for his wife; eventually, he became a respiratory therapist and emergency room nurse. [8]

Malpractice suit

In 1992, Michael Schiavo brought a medical malpractice suit against the obstetrician who had been treating Terri for infertility, charging that the doctor had failed to diagnose the hypokalemia. The jury concluded that Schiavo had indeed suffered from bulimia, which had caused her hypokalemic blood imbalance and subsequent cardiac arrest, and had not been properly diagnosed by the obstetrician. The case was appealed and then settled in January 1993 before the appeal could be decided; Terri Schiavo received $750,000 and Michael Schiavo received $300,000. Florida's Second District Court was also later to find that Schiavo's cardiac arrest had been the result of a potassium imbalance.

Schiavo's condition

Left: Scan of normal 25-year-old's brain; right: Terri Schiavo's 2002 CT scan at age 38.

Issues of dispute

Schiavo's condition and prognosis were issues of dispute between her parents and their supporters, and the legal and medical establishment. The only facts that the parents did not dispute were that she was not in a coma, but severely brain-damaged and partially blind. Following her collapse, a gastric feeding tube was used to provide minimal life support.

Since 1991, the Schiavos' personal physicians and six different court-appointed physicians had concluded that Schiavo was in a persistent vegetative state (PVS). Patients in a persistent vegetative state have severe brain damage and are in a state of "wakefulness without awareness." In many cases, the persistent vegetative state occurs after a coma, which is consistent with Schiavo having been in a coma following her collapse. 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.

Terri Schiavo's parents contend that her behavior, as seen in this image from one of the videos released by her parents, showed that she was aware of the people around her. Neurologists who examined Schiavo disagree, saying that her level of brain damage made responsiveness impossible, and that her behavior represented reflex or instinctive actions.

Schiavo's parents claim that their daughter did not meet the definition of a persistent vegetative state. Her parents argue that at times her actions were indicative not of reflex or instinctive behavior but of responses to external stimuli. For example, the Schindlers claim that their daughter smiled, laughed, cried, moved, made childlike attempts at speech, and that she attempted to say "Mom" or "Dad" or "yeah" when they asked her a question. They claim that when they kissed her she looked at them and sometimes puckered her lips. Schiavo's parents videotaped Terri for four and a half hours and produced six video segments totaling four minutes and twenty seconds. Schiavo's parents cite the testimony and affidavits of 33 physicians and therapists (including 15 neurologists) who, after reviewing these four and a half minutes of video segments, believe that Schiavo should have received further tests and/or would have likely responded to therapy. 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 was a "strong likelihood that Mrs. Schiavo is in a "minimally conscious state." None of the physicians saw the full four and a half hours of video. (The six video segments have been released publicly. The rest of the recorded video has not been released by Schiavo's parents.) [9]

Schiavo's parents stated that several days after the removal of the feeding tube, Schiavo made an attempt to say "I want to live" in response to their attempts to coach her. An emergency motion to restore the feeding tube claims that "she managed to articulate the first two vowel sounds, first articulating AHHHHHHH and then virtually screaming WAAAAAAAA". The alleged incident occurred only in the presence of family members and has not been independently confirmed. Schiavo had been unable to speak since her heart attack in 1990. Judge Greer said that Schiavo's utterances came only after being touched, which was consistent with evidence presented in 2002. "All of the credible medical evidence this court has received over the last five years is that this is not a cognitive response, but rather something akin to a person jerking his/her hand off a hot stove long before he/she has thought about it," Greer wrote. [10]

Medical opinions

The lack of oxygen to the brain suffered after Schiavo's heart attack in 1990 caused catastrophic brain damage. Dr. Ron Cranford, a neurologist at the University of Minnesota, assessed Terri Schiavo's brain function in 2001 as part of a court-ordered examination. His exam showed that Schiavo's cerebral cortex had been completely destroyed and replaced by cerebrospinal fluid. The upper brain was about 80 percent destroyed, and there was also damage to the lower brain. The only part of the brain that remained intact was the brain stem, which controls involuntary functions such as breathing and heartbeat—allowing Schiavo to survive (with a feeding tube) even though she no longer had any cognitive function. 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." [11]

Three Florida neurologists viewed 12 of Schiavo's CT scans on March 22 [12]. After viewing the scans, Dr. Leon Prockop (a professor and former chairman of the neurology department at the University of South Florida's College of Medicine) was quoted by the Sun-Sentinel as saying that Schiavo's scan exhibits 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 "doubts there's any activity going on in the higher levels of her brain". [13]

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, and showed severe cerebral atrophy. An EEG showed no measurable brain activity.

Terri Schiavo's parents, the Schindlers, hired their own doctors to determine whether Schiavo was in fact in a persistent vegetative state. Both concluded that Schiavo was not in PVS.

Schiavo was not evaluated with a positron emission tomography (PET) scan in her current condition, though she could have undergone one. A magnetic resonance imaging scan (MRI) could not be done without first surgically removing experimental electrodes which were implanted within her brain in 1992, something that Michael Schiavo chose not to do. At any rate, neither a PET nor an MRI could have changed the fundamental finding of both X-rays and CAT, which is that over 50 percent of Terri's brain is destroyed.

Five doctors were selected to provide their expert opinions to the trial: 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 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 Terri Schiavo was in a PVS and was beyond hope of significant improvement. [14]

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. Judge Greer reviewed a six-hour tape of Schiavo and concluded that her vegetative condition was factual and not subject to legal dispute. Observers have criticized the qualifications and objectivity of doctors for the Schindler family. One of the Schindler family's doctors, Dr. Maxfield, was a radiologist, not a neurologist. The other, Dr. Hammesfahr, advocated a treatment he had developed called "vasodilation therapy" that the court found to be a non-standard and generally unrecognized procedure with little chance of success.

Effect of removing feeding tube

Neurologists have noted that if Schiavo was indeed in a PVS, she did not experience pain, hunger or thirst due to the removal of the feeding tube. [15] Perry G. Fine, the vice president of medical affairs at the National Hospice and Palliative Care Organization, was quoted in the Los Angeles Times as saying: "What my patients have told me over the last 25 years is that when they stop eating and drinking, there's nothing unpleasant about it. In fact, it can be quite blissful and euphoric...the word 'starve' is so emotionally loaded. People equate that with the hunger pains they feel or the thirst they feel after a long, hot day of hiking. To jump from that to a person who has an end-stage illness is a gigantic leap". [16][17]

On March 25, Robert Schindler told the media that his daughter's lips and eyes were "bleeding" from lack of hydration, that her skin was "peeling", and that she was "fighting like hell to stay alive." [18] In a news conference the following day, Michael Schiavo's attorney, George Felos, disputed Schindler's account, saying "she looked beautiful. In all the years I've seen Mrs. Schiavo, I've never seen such a look of peace and beauty upon her." [19]

In most cases, patients die ten to 14 days following the removal of a feeding tube. On March 31 2005, 13 days after her feeding tube was removed, Schiavo went into cardiac arrest and died. Allowing death to occur by withdrawing life support is a form of passive euthanasia.

Controversy

Michael Schiavo

Under Florida law, Michael Schiavo, Terri's husband, was her legal guardian. Schiavo says his wife would not have wanted to live as a vegetable, and that he was fighting for her right to die. As a result, he had her placed in a hospice. Following a falling out with the Schindlers, he placed limits on the time the rest of her family was allowed to visit her. He successfully fought the efforts of Terri Schiavo's parents to replace him as guardian and take control of her care.

Although his wife never wrote a living will, Mr. Schiavo says they had conversations which make him sure she would not want to continue living in such a state; both Michael's brother (Brian Schiavo) and sister-in-law (Terri's best friend) testified in support of this claim. Michael Schiavo recalled Terri saying, "I don't want to be kept alive on a machine."

In 1994, after three years of trying traditional and experimental therapies, Schiavo accepted the diagnosis of an irreversible persistent vegetative state, sometimes referred to as a permanent vegetative state. In consultation with Terri's physician, Schiavo halted most therapy for his wife. In May 1998, seven years after Terri's collapse, Michael Schiavo filed a petition to discontinue life support for Terri Schiavo.

In an appearance on ABC News's Nightline on March 15 2005, Michael Schiavo cited the willingness that Mrs. Schiavo's parents expressed to keep her alive by multiple extreme measures, including quadruple amputation if needed, as an important reason for denying transfer of guardianship to them or other parties with similar desires. [20]

Many of the hospital staff describe Mr. Schiavo as a very supportive husband who berated nurses for not taking better care of his wife; in 1994 the administration of one nursing home attempted, unsuccessfully, to get a restraining order against him because he was demanding more attention for his wife at the expense of other patients' care. [21] According to Jay Wolfson, one of Mrs. Schiavo's court-appointed guardians, due to the attention Terri has received in the fifteen years she has been bedridden, she has never developed any bedsores.

Raising the issue of a possible conflict of interest is the fact that Mr. Schiavo stood 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 had also had a contract drafted stating that should the Schindlers refrain from any further legal action, he will donate whatever his inheritance may be to charity. The Schindlers refused the offer.

On March 11 2005, media tycoon Robert Herring (who believes that embryonic stem cell research could have cured Terri Schiavo's condition in the future) offered one million dollars to Michael Schiavo if he agreed to waive his guardianship to his wife's parents. The offer was rejected, Schiavo having reportedly found it "offensive." Michael Schiavo's attorney, George Felos, stated that Mr. Schiavo has rejected other monetary offers, including one of $10 million. These offers may have been made under the misconception that the removal of Mrs. Schiavo's feeding tube remained simply a matter of Mr. Schiavo's choice. It was ruled in February 2000 that Mrs. Schiavo would choose to have the tube removed, and Michael Schiavo did not have legal standing to overrule this legal determination.

Michael Schiavo has been criticized by the Schindlers and their supporters for entering into a romantic relationship with another woman, Jodi Centonze, while still legally married to Mrs. Schiavo. Mr. Schiavo and Centonze have had two children together. Mr. Schiavo denies wrongdoing in this matter, stating that he has chosen not to divorce Mrs. Schiavo and relinquish guardianship because he wanted to carry out her final wishes not to be kept alive in a persistent vegetative state.

Bone scan

A bone scan [22] performed one year after her 1990 injury showed, according to the radiologist who evaluated it, that Mrs. Schiavo had suffered prior traumatic injuries to multiple ribs (on both sides), to both sacroiliac joints, both knees, both ankles, several thoracic vertebrae, and to her right thigh, in addition to a minor compression fracture of the L1 vertebra. Mrs. Schiavo's parents did not know of the existence of this scan until November 2002, twelve years after her brain damage and entry into an incapacitated state. Forensic pathologist Dr. Michael Baden, provided with the scan but not with her history, suggested that physical trauma, specifically a head injury, probably caused Mrs. Schiavo's collapse, [23], though in a later interview [24], after learning her history, he agreed that the bulimia/hypokalemia explanation was also possible. The trauma is consistent with her cardiac arrest, fall, CPR attempts and eventual resuscitation.

Upon becoming aware of the bone scan report possibly suggesting previous abuse, the Schindlers petitioned the Pinellas-Pasco Circuit Court for a full evidentiary hearing to evaluate the new evidence. On November 22 2002, probate judge George Greer denied the motion, stating that the issue of trauma twelve years earlier was irrelevant to the current case. [25]

Mrs. Schiavo's parents and Dr. William Hammesfahr, a neurologist they hired to examine her in 2002, claim that she had been battered by her husband. Hammesfahr was later to be disciplined by the Florida Board of Medicine in 2003 regarding overbilling charges for a stroke treatment (the same treatment that he proposed to use in order to treat Schiavo in 2002), but the board's action was reversed on appeal in 2004 by Florida's Second District Court of Appeals. [26] Hammesfahr has also falsely claimed to be a Nobel Prize nominee (he was "nominated" by someone who was ineligible to nominate him). [27]

Schindler family

Terri Schiavo's parents and siblings have been battling her husband over her fate since 1993. Even though the courts have consistently upheld the ruling that Schiavo would choose to have her life support discontinued, certain of her family members have used every legal measure available to them to prevent the disconnection of her feeding tube.

The Schindlers took videos of Terri that purportedly show her responding to them. They enlisted the services of Galaxywave, Inc., "psychic healers" who claim to possess "Remote Healing ADAM Technology". On several occasions, the Schindlers put Schiavo in contact with these psychics via cell phone during their visits with her. [28]

Her parents claim that Schiavo was a devout Roman Catholic who did not wish to violate the Church's teachings on euthanasia by intentionally starving or dehydrating herself to death, and that she never expressed such a desire to anyone in her birth family or circle of friends. The Schindlers' legal fight has been and continues to be funded by a variety of sources on the political right. [29]

Schiavo's father, Bob Schindler, has criticized Judge George Greer because he never called her into the courtroom or visited her to observe her condition firsthand. Schindler called the court order to remove the feeding tube "judicial homicide".

The cause of the breakdown in communication between the Schindlers and Michael Schiavo is controversial. There was an apparent confrontation on Valentine's Day of 1993. [30] On that day, Michael Schiavo was in Terri's nursing home room studying to become a nurse so that he could personally care for his wife. When the Schindlers arrived, Michael maintains that Bob Schindler began to demand money, became belligerent, and stormed out of the room. According to Mary Schindler's later testimony, Michael Schiavo had promised to reimburse the Schindlers for letting him live rent-free at their condominium and for other financial assistance. While conversing about financial issues, the Schindlers suggested that they could now afford specialized care for Terri with the money from the malpractice suit. According to Mary Schindler, Michael denied this request and threatened that the Schindlers would never again see their daughter.

On March 28 2005, The New York Times reported that the Schindlers plan to sell a list of people and organizations who have contributed financially to their legal fight to a direct-marketing organization that will solicit money from these people for a wide range of rightist causes, particularly anti-abortion groups. [31]

Legal involvement and "Terri's Law"

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 reinserted two days later on an appeal by her parents.

On October 10 2003, the final remaining appeal filed by the Schindlers was dismissed. Five days later, on October 15 Schiavo's feeding tube was removed for the second time. On October 21, the Florida Legislature, in emergency session, passed "Terri's Law," which gave 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, [32] ruling that the legislative and executive branches of government unconstitutionally intervened in a judicial matter (against the separation of powers under the U.S. Constitution) and that "Terri's Law" was unconstitutionally retroactive legislation. [33] The family immediately appealed to the U.S. Supreme Court. On January 24, 2005, the Supreme Court refused to hear the case.

Nineteen different Florida state court judges have at various times considered the Schindlers' request on appeal in six state appellate courts. Appellate courts do not reconsider evidence, but can only rule whether a trial is conducted properly; none of these courts have found legal grounds to overturn the initial ruling. [34] The final ruling came on February 25 2005 when Judge George Greer ordered the feeding tube removed on March 18 2005.

Public opinion

Protesters in front of Schiavo's Pinellas Park, Florida hospice, March 27 2005.

Various Christian organizations demanded that Schiavo's feeding tube be reinserted. Most of these groups were affiliated with the Christian right, but the Reverend Jesse Jackson, a Democrat and civil rights activist, also called for Schiavo's feeding tube to be re-inserted. On March 29, Jackson prayed with the Schindler family outside of Schiavo's Florida hospice. Some groups, such as Not Dead Yet, also protested the removal of Schiavo's feeding tube because they felt it violated the rights of the disabled.

Forty-seven protesters, including many children, have been arrested outside the hospice where Schiavo was located. Most of these have arranged non-violent staged arrests for trespassing, usually by crossing a police line in a symbolic attempt to bring water to Schiavo. One man ran past police and reached the front door of the hospice; he was stunned with a Taser and was apprehended.

Arrests have been made in two separate murder plots against Michael Schiavo: one in which a North Carolina man is accused of offering $250,000 for the murder of Michael Schiavo and $50,000 for the murder of Judge Greer; and the other in which an Illinois man robbed a Florida gun store as part of an effort to "rescue Terri Schiavo". Additionally, the wife of one of Michael Schiavo's brothers has been targeted; a white car drove by her home three times over the course of several hours, and on the last pass the driver shouted to her "If Terri dies, I'm coming back to shoot you and your family". Another of Michael Schiavo's brothers says that he receives death threats every time the case is in the news. [35]

Judge Greer and his family are under protection from U.S. Marshals due to death threats for having ruled against restoring Terri Schiavo's feeding tube. Additionally, he has been asked to leave his Southern Baptist congregation, Calvary Baptist Church, in Clearwater, a move some might see as excommunication. [36]

Nonetheless, most polls show that a majority of Americans believe that Michael Schiavo should have the authority to make decisions on behalf of his wife and that the United States Congress overstepped its bounds with its intervention in the case. [37]

According to an ABC News poll from March 21, seventy percent of Americans believe that Terri Schiavo's death should not be a federal matter, and are opposed to the legislation transferring the case to federal court. In the same poll, a 63 percent majority said that they support the removal of Schiavo's feeding tube. A 67 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." [38]

A poll by CBS News showed that eighty-two percent of respondents believe the Congress and President should stay out of the matter, while seventy-four percent thought it was "all about politics". Only thirteen percent think Congress acted out of concern for Terri Schiavo. Furthermore, the approval ratings of Congress sank to thirty-four percent, its lowest since 1997. [39]

One of the effects of this case is that Americans are showing an increased interest in living wills. Legal experts say that the entire court battle could have been avoided if Schiavo had properly documented her wishes prior to her collapse. Many newspapers ran articles and editorials on the importance of having a living will.

Timeline

1984

• November: Michael Schiavo and Terri Schindler were married.

1989

• Michael and Terri began visiting an obstetrician and received fertility services.

1990

• February 25: Terri collapsed of a heart attack and went into a coma.

• May: Terri emerged from her coma but remained unconscious.

• May 12: Terri was discharged to a rehabilitation facility.

• June 18: Court appointed Michael Schiavo as Terri's legal guardian without objection from the Schindlers.

• September: Terri was taken home to be cared for by her family, but after being overwhelmed with her needs, she was returned to the rehabilitation facility.

• November: Michael took Terri to California for an experimental procedure using a thalamic stimulator implanted in her brain. The procedure took several months.

1991

• January: Michael and Terri returned from California to Florida. Terri was admitted to a brain injury center in Brandenton.

• March: Dr. W. Campbell Walker performed a bone scan on Terri. The scan showed prior traumatic injuries to multiple ribs (on both sides), both sacroiliac joints, both knees, both ankles, several thoracic vertebrae, and her right thigh. In addition, the scan showed a minor compression fracture of her L1 vertebra.

• Michael began studying nursing at St. Petersburg Community College to better care for his wife. He would eventually become a respiratory therapist and an emergency room nurse.

• Terri's physician and 6 court-appointed physicians concluded that Terri was in an irreversible persistent vegatative state (PVS).

1992

• Michael brought a medical malpractice suit against the obstetrician who had been treating Terri for infertility. Jury finds the obstetrician had not properly diagnosed Terri's condition. The case was appealed.

1993

• January: The medical malpractice suit against Terri's obstetrician was settled before an appeal is decided. Terri received $750,000. Michael recieved $300,000. Terri's award was placed in a trust fund controlled by a third party for her medical care.

• February 14: On Valentine's Day, Michael and Terri's parents disagreed on how they should spend the award money. The disagreement escalated into a vitriolic fight. Both sides stop speaking to the other.

1994

• Administrators at nursing home sought a restraining order against Michael because of his demands for better care for his wife. Gloria Centonze, who worked there at the time, recalls a frequent comment among the nurses: "He may be a bastard, but if I was sick like that, I wish he was my husband."

• Michael accepted the diagnosis that Terri is in an irreversible persistive vegatative state. In consultation with Terri's physician, Schiavo halted most therapy for his wife.

• Terri developed a urinary tract infection. Following a doctor's recommendation, Michael chooses not to treat it. Michael entered a "do not resuscitate" order, which he later rescinded after the parents protested.

1998

• May: Michael Schiavo filed a petition to discontinue life support for Terri Schiavo.

• November: Terri's parents become aware of the bone scan report that was performed in 1991. Terri's parents and Dr. William Hammesfahr claim the trauma shown in the bone scan was a result of Terri being abused by Michael. Provided with only the scan information, forensic pathologist, Dr. Michael Baden suggested a head injury caused the traumau. After learning Terri's full history, Dr. Baden agreed that the traumau was consistent with her cardiac arrest, fall, CPR attempts, and eventual resuscitation. The parents petitioned the Pinellas-Pasco Circuit Court for a full evidentiary hearing to evaluate the new evidence. Judge George Greer denied the motion.

2000

• Michael was issued a license for nursing by the State of Florida, Department of Health.

2001

• Dr. Ron Cranford (neurologist) assessed Terri's brain function as part of a court-orderd examination. His exam showed that Terri's cerebral cortex had been completely destroyed. Her upper brain was 80% destroyed, and there was much damage to the lower brain.

• March: Three Florida neurologists viewed 12 of Terri's CT scans. Dr. Leion Prockop said it was the "most severe brain damage I've seen". Dr. Walter Bradley said that he "doubts there's any activity going on in the higher levels of her brain"

2002

• A trial was held to determine whether or not new therapy treatments would help Terri restore any cognitive function.

A new CAT scan was done and showed severe cerebral atrophy. An EEG was done and showed no measurable brain activity.

Five doctors were selected to provide their expert opinion: Two by Terri's parents, two by Michael, and one by the court.

The doctors selected by the parents said Terri was not in a persistent vegatative state. (One Dr. Maxfield was the Schindler family's doctor, and was a radiologist rather than a neurologist. The other Dr. Maxfield made several claims about therapies supposedly developed by him which the court found to be a non-standard and generally unrecognized procedure with little chance of success.)

The doctors selected by Michael and by the Court said Terri was in a persistent vegatative state. (Dr. Ron Cranford is a proponent of euthanasia.)

Terri's parents videotaped Terri for four and a half hours. Parents brought the video to court to prove Terri is aware and semi-conscious. Judge Greer ruled the tapes failed to show previous medical diagnoses were incorrect. The video was later edited down to four minutes and twenty seconds' worth of clips and was released publicly.

Judge Greer ruled that Terri Schiavo was in a PVS and was beyond hope of significant improvement.

• Florida's Second District Court of Appeal reviewed all the evidence and upheld the trial court's decision.

Recent developments

Florida Legislature

On March 17, 2005, members of the Florida Legislature considered 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 18. On March 23, the Florida Senate again debated this proposed law, which was again rejected, 21 to 18.

U.S. Congress

Schiavo's feeding tube was removed again on March 18 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 in Washington. Frist serves on the committee; Enzi is its chairman.

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. Because of her condition, Schiavo obviously could not 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).

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, in accordance with Mr. Schiavo's request. Congress subsequently took no action to attempt to enforce the subpoenas.

On March 19, congressional leaders announced that they were drafting a bill which would transfer the case from state court to 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, 3-0, with 97 of 100 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 (156 Republicans and 47 Democrats in favor, 5 Republicans and 53 Democrats against), with 174 Representatives (74 Republicans and 100 Democrats) 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 at 1:11 a.m. when it became Public Law 109-3 [40].

The bill, colloquially known as the Palm Sunday Compromise, was extremely controversial. It applied only to Terri Schiavo and gave federal courts jurisdiction to review alleged violations of her constitutional rights, without regard to prior state court rulings. However, Congress did not attempt to create any new substantive rights for Schiavo, or include any provision requiring the federal court to order reinsertion of the feeding tube pending review.

President Bush came under fire from right-to-die supporters, accused of having double-standards because as Governor of Texas he had personally signed into Texas law a right-to-die law, the Advance Directives Act.[41] This law, one of only three in the nation, allows a hospital under certain circumstances to end life-prolonging measures even against a living will or the will of the patient's family.

The U.S. Congress may also consider another bill to prevent Schiavo's death, called the "Incapacitated Person's Legal Protection Act" (H. R. 1151). As Schiavo's death has already occurred, such a bill is not likely to be made into law.

Politicians

Politically, views on the case have been roughly divided along traditional political lines, although there is significant variance on both sides. Editorials in publications such as the National Review, The Weekly Standard, and The Wall Street Journal have supported keeping the feeding tube in place (with some of their commentators dissenting); The New York Times, among others, has supported the position of Michael Schiavo. On the other hand, some conservatives, such as former Representative Bob Barr, have expressed concern about the implications for federalism of a bill that involves the federal government in a matter traditionally left to the states. [42] Many Democrats have simply stayed away from the controversy.

Republican House Representative Tom DeLay of Texas and Senator Bill Frist of Tennessee, a cardiac surgeon, have spoken in favor of keeping Schiavo alive, as has President George W. Bush. Critics say that Frist's stance on this issue appears to indicate a reversal in his personal opinion, as he has previously argued for the definition of brain death to be extended to include anencephalic conditions of the type seen in this case. 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.

On March 22 2005, the Los Angeles Times reported on then-Governor George W. Bush's signing of a 1999 bill that allowed medical professionals to remove life support from a patient, even over the objections of family members, if they determined that there was no further hope for the patient. Many people felt this was inconsistent with his position in the Schiavo case. White House Press Secretary Scott McClellan said that those raising the 1999 bill were "uninformed" and that the "legislation that he signed into law actually provided new protections for patients". Bush's detractors note that Bush did give his support to medical professionals making end-of-life decisions for patients unable to express their wishes, such as Sun Hudson, a six-month-old boy whose breathing tube was removed that week at Texas Children's Hospital over the objection of his mother. [43] Bush's supporters state that the new protections were in comparison to the legal situation before the bill; they state that decisions about end-of-life decisions had previously been left up to hospital protocol and usually allowed the family of the patient 48 hours to object to the decision, whereas after the bill was passed there was a legally required waiting period of seven days in which the family of the patient could object.

On March 26 2005, the Los Angeles Times reported that DeLay and his family decided in 1988 to allow his father to die after he was badly injured in a tram accident. "Extraordinary measures to prolong life were not initiated", said the medical report of Charles DeLay, and cited "agreement with the family's wishes". The Los Angeles Times contrasted this with his current stance on the Terri Schiavo case. [44]. Unlike Schiavo, Charles DeLay was in a coma, required a ventilator and intravenous lines to remain alive, and deteriorated in condition over the period of his care.[45]

Talking points memorandum

According to a talking points memo purportedly circulated among Republican senators and reported by ABC News and The Washington Post, the Schiavo case offered "a great political issue" that would appeal to the party's base (core supporters) and could be used against Senator Bill Nelson, a Democrat from Florida who is up for reelection in 2006, because he had refused to co-sponsor the bill. [46]

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. Various commentators from the Weekly Standard [47] [48], Slate [49], National Review [50], and blogs such as Power Line [51] have raised questions about the authenticity of the memo. The source of the memorandum has not been disclosed by either ABC News or the Washington Post, but both news organizations are standing behind the story. Howard Kurtz of the Washington Post, however, has reported the controversy about the memorandum's authenticity. [52]

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. The claims were chiefly that the rulings of the state court judges were biased or unfair, and that removal of the feeding tube constituted a risk that Schiavo, as a Roman Catholic, would face extended time in purgatory. A two-hour hearing on the injunction was held on March 21 before Judge James D. Whittemore.

Early on March 22, he refused to order the feeding tube reinserted. In his opinion, he applied the mandatory four-prong test set out by the 11th Circuit for preliminary injunctions, and concluded that the Schindlers were "exceedingly unlikely to prevail on the merits of the case", one of the four prongs.

U.S. Court of Appeals

The judgement 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 majority opinion agreed with the district court that Schiavo's parents had failed to prove one of the four required prongs: that they had "failed to demonstrate a substantial case on the merits of any of their claims". In affirming the district court's analysis, the panel pointed out that Congress had considered the issue of expressly directing the district court to order the reinsertion of the feeding tube pending litigation on the merits, and had refrained from including such a directive. Thus, Congress had left the 11th Circuit's existing procedural law in place, and the district judge had applied the circuit's existing test correctly.

Later that day, the 11th Circuit Court refused to rehear the case as a whole (en banc). Two of the twelve judges wrote dissenting opinions, but the actual vote is not public record. On March 30, the Court agreed to consider a petition by Mrs. Schiavo's parents to have a new hearing to decide whether the feeding tube should be reinserted. Later that day, the court denied the petition. Judge Stanley F. Birch Jr., in a concurring opinion, rebuked President Bush and Congress for acting "in a manner demonstrably at odds with our founding fathers' blueprint for the governance of a free people."[53][54]

U.S. Supreme Court

Schiavo's parents appealed again to the U.S. Supreme Court late on the night of March 23. They argued that Congress intended for the feeding tube to be reinserted when they passed the "Relief of the Parents of Theresa Marie Schiavo Act" (S 686 ES). The case first went to Justice Anthony Kennedy, who is responsible for all emergency appeals from the 11th Circuit. Although he could have acted alone, Kennedy chose to refer the case to the entire Supreme Court.

The Court declined to grant certiorari on the morning of March 24 in an unsigned one-sentence order (as is typical for nearly all rejections of appeals). One reason why the Court may not have accepted the case is that doing so might force the Court to develop a uniform nationwide test for the issuance of preliminary injunctions under Rule 65 of the Federal Rules of Civil Procedure. The Court has consistently denied review in every case raising that possibility for the past few decades, which is why every circuit has its own test for when such injunctions should be issued.

Florida governor and executive

Following the Supreme Court's refusal to hear the case, Florida Governor Jeb Bush announced that he was going to investigate whether or not the Florida Department of Children & Families could take over Schiavo's care, on the grounds that the organization has the legal right to gain custody of incapacitated adults in emergency situations. On March 24, Judge Greer issued an injunction denying the Florida state government's right to take such an action. Governor Bush subsequently announced that he would take no action, denying that he had the authority to do so. This assertion was contested by Randall Terry and others, who claim that the governor has the executive power to take custody of Schiavo. [55]

Final stages

On March 26 2005, Bob and Mary Schindler announced that their legal options had been exhausted. Paul O'Donnell, Franciscan monk and spiritual adviser to the Schindler family, announced to those holding a vigil outside the hospice in Pinellas Park, "The family would request that everyone go home, be with your children, hold them close and share every moment you have with them".

On March 27, she was given the Anointing of the Sick ("Last Rites"). In accordance with Catholic tradition, a drop of wine was applied to her tongue, but a small piece of bread was unable to be offered. She had also been given Holy Communion through the feeding tube just before it was removed.

At 9:05 a.m. EST on March 31 2005, Terri Schiavo died at the age of forty-one. According to the Schindlers' spokesperson, a few minutes before she died her parents and siblings were told to leave the room by her husband, Michael Schiavo. David Gibbs, the Schindlers' attorney, said the Schindlers were "with Terri up until ten minutes before she passed". They were allowed back into the room after she had died. [56]

About fifty supporters of the Schindler family were holding a vigil for Schiavo just outside the hospice; many of them burst into tears when her death was announced.

Autopsy

Michael Schiavo has said an autopsy will be performed on his wife, [57] by Pinellas County's chief medical examiner, Dr. Jon Thogmartin. Although supporters of the Schindlers contend that an autopsy is required by Florida law when a body is to be cremated, the strict wording of the statute states only that the medical examiner has the authority to conduct an autopsy before a cremation if he or she deems it necessary. [58]

While the cause of death has not yet been determined, it is probable that it was due to heart failure resulting from the effects of dehydration, which interferes with body chemistry and causes abnormalities in the heart rate known as arrhythmia.

The body of Terri Schiavo arrived at the office of the medical examiner within three hours of her death. However, it may take weeks until the full autopsy report is published. A thorough brain exam alone requires preserving the remains in a solution for a week to ten days. [59]

Burial

In an effort to prevent Schiavo's burial from becoming a media spectacle, her body is slated to be cremated following the autopsy, and the ashes buried at an undisclosed location somewhere near Philadelphia, her hometown. This is also what Michael Schiavo wanted.

Aftermath

House Majority Leader Tom DeLay has promised the American people that "the men responsible" for Schiavo's death will be made to pay, but says that for now, people should concentrate on mourning. [60]

Note

¹ Michael Schiavo pronounces his name as /'ʃaɪvoʊ/ (SHY-voh). "Schiavo" in Italian is pronounced /'skjavo/. Other Americanized pronunciations include /'skjɑvoʊ/ or /ski'ɑvoʊ/.

See also

Individuals who played significant roles in public debates and/or legal action regarding the issue of removal of life support:

• Sun Hudson
• Spiro Nikolouzos
• Karen Ann Quinlan
• Nancy Cruzan

Rhetorical terms used during the public and political debates

• Culture of life
• Culture of death
• Right to life
• Right to die

References

• Terri Schiavo Case: Legal Issues Involving Health care Directives, Death, and Dying. Findlaw. A detailed compilation of legal documents related to the Schiavo case. [61]
• 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) [62].
• "Before fight over death, Terri Schiavo had a life." CNN. October 25, 2003. [63]
• Breed, Allen G., and Matt Crenson. "Doctors: Schiavo tapes don't tell story." Associated Press. March 26, 2005. [64]
• Carey, Benedict, and John Schwartz. "Schiavo's condition holds little chance of recovery." The New York Times. March 26, 2005.
• "Excerpts from diagnoses of 6 Schiavo doctors." Associated Press. March 24. [65]
• Fackelmann, Kathleen. "Schiavo not likely to experience a painful death, neurologists say." USA Today. March 23, 2005. [66]
• Graham, Judith. "Schiavo's expressions misleading, experts say." Chicago Tribune. March 25, 2005. [67]
• Lamendola, Bob. "Neurologists see little sign of activity in Schiavo's brain." South Florida Sun-Sentinel. March 23, 2005. [68]
• Rufty, Bill. "Doctors lament misuse of proper terminology in Schiavo debate." The Ledger. March 23, 2005. [69]
• Schwartz, Jerry. "Friends remember Schiavo before maelstrom." Associated Press. March 31, 2005. [70]

External links

Primary sources

• Cerminara, Kath; Goodman, Kenneth (2005). KEY EVENTS IN THE CASE OF THERESA MARIE SCHIAVO. University of Miami Ethics Programs and the Shepard Broad Law Center at Nova Southeastern University. Retrieved March 31, 2005.
• Circuit Court for Pinellas County, Florida Probate Division (1998). Report of Guardian Ad Litem. Hospice Patients Alliance. Retrieved March 31, 2005. (PDF)
• State of Florida, County of Duval (2005). Affidavit. Retrieved March 31, 2005. (PDF)
• Supreme Court of Florida (2004). JEB BUSH, Governor of Florida, et al., Appellants, vs. MICHAEL SCHIAVO, Guardian of Theresa Schiavo, Appellee.. Retrieved March 31, 2005. (PDF) (Florida Supreme Court Decision overturning Terri's Law as unconstitutional)
• United States Senate (2003). SENATE AMENDMENT - "Terri's Law". Retrieved March 31, 2005. (PDF)
• Wolfson, Jay (2003). A REPORT TO GOVERNOR JEB BUSH AND THE 6TH JUDICIAL CIRCUIT IN THE MATTER OF THERESA MARIE SCHIAVO. Conigliaro, Matt; Abstract Appeal. Retrieved March 31, 2005.

Informational sites

• Conigliaro, Matt (2005). THE TERRI SCHIAVO INFORMATION PAGE. Retrieved March 31, 2005.
• Yahoo! Inc (2005). Directory > Government > Law > Cases > Terri Schiavo Case. Retrieved March 31, 2005.
• Zorn, Eric (2005). FOR YOUR REFERENCE – THE SCHIAVO CASE. Chicago Tribune. Retrieved March 31, 2005.

Advocacy and commentary sites

• BlogsForTerri (2005). BlogsForTerri Serving, protecting, defending. Retrieved March 31, 2005.
• Terri Schindler-Schiavo Foundation (2005). Retrieved March 31, 2005.