Terri Schiavo case

Terri Schiavo (born Theresa Marie Schindler on December 3, 1963) is a severely brain damaged American woman whose husband's efforts to remove her feeding tube and forbid anyone from attempting to feed her by mouth have prompted a fierce debate over euthanasia, guardianship, and the rights of the disabled. On March 18, 2005, her feeding tube was removed for the third time.

File:Terri schiavo and mom.jpg

Terri Schiavo and her mother.

Michael Schiavo, Terri Schiavo's husband, is her legal guardian. He contends that Terri is in a persistent vegetative state and that he is carrying out her wishes to not be kept alive in that state.

Terri Schiavo's family (parents and siblings) contest both of Michael's claims. They say she is responsive and in no discomfort, that her condition does not meet the medical definition of "vegetative," and that she would not wish to die. They also contend that Terri was a victim of domestic violence, both before and after her injury, and that Michael does not have her best interests at heart. They seek to revoke his legal guardianship of Terri, arguing, among other things, that his living with another woman since 1995, with whom he has two children, makes him legally estranged from her [1].

Although the courts that have heard this case have generally sided with Michael Schiavo, her family has vigorously appealed the courts' decisions and sought to prevent her death. Numerous disability rights organizations [2], religious organizations, the Florida legislature, the Vatican, and both houses of the United States Congress have joined the legal battle, siding with Terri's family. The ACLU also joined the legal battle, siding with Michael Schiavo.

Schiavo's condition

Terri's condition and prognosis are matters of dispute. Michael and Terri's personal physicians since 1991 contend that she is in a vegetative state. The medical definition of a vegetative state varies, but Stedman's definition is a state "in which an individual is incapable of voluntary or purposeful acts and only responds reflexively to painful stimuli." Terri's family claims that she does not meet that definition. The only facts which appear not 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 gastric feeding tubes, which is the life support mechanism around which the case revolves, though whether she could, instead, be spoon-fed is disputed.

Her family, and medical experts who support their position, claim that she smiles, laughs, cries, moves, and makes child-like attempts at speech. Sometimes she has been reported to say "Mom" or "Dad" or "yeah" when her parents ask her a question. When they kiss her, they claim 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 Terri should receive further tests and/or would likely respond to therapy. 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 Terri is in a minimally conscious state."[3][4]

Michael Schiavo, and the doctors he has chosen to care for and evaluate her, such as Dr. Ronald Cranford, contend that she is in a persistent vegetative state (PVS), that her occasional apparent responses are actually reflex or random behavior common to PVS patients, and that therapy would be fruitless. Accordingly, Michael halted all therapy for her in late 1992. [5]

In 2002, a trial was held to determine whether or not any new therapy treatments would help Terri Schiavo restore any cognitive function. A new CAT scan was done, as was an EEG.

Two doctors were selected by her parents, two by her husband, and one was appointed by the court. These five doctors examined the records, scans, videos, and Terri herself. The physicians were divided in their conclusions. Judge Greer ruled with the two chosen by her husband and the one assigned by the court that her state of PVS was beyond hope of significant improvement.[6] The second district court of appeals 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.[7]

Terri Schiavo could be evaluted with a PET scan in her current condition. However, an MRI cannot be done without first removing experimental electrodes which were implanted within her brain in 1992. The doctor who implanted them instructed Michael Schiavo to have them removed, but that has not been done.[8]

Cause

On the morning of February 25, 1990, at approximately 5:30 AM, Terri Schiavo collapsed in her home, resulting in irreversible brain damage from a lack of oxygen. According to her discharge summary from Humana hospital [9] , Terri Schiavo suffered cardiac arrest and anoxic brain damage, accompanied by hypopotassemia, seizures, respiratory failure, and an injured knee. The cause of her cardiac arrest was undetermined, but her low potassium was suspected.

At a malpractice trial (1992), a jury concluded that Terri suffered from bulimia, which caused her chemical imbalance, and cardiac arrest. Florida's Second District court upheld the finding that Terri suffered a cardiac arrest as a result of a potassium imbalance.

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

Since Mr Schiavo's petitioning the court to remove his wife's feeding tube, 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. A bone scan [10] 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. Terri Schiavo's family did not take notice of this scan until November, 2002. Some confusion resulted when Dr. Michael Baden, the famed forensic pathologist, suggested that physical trauma, specifically a head injury, might have caused Terri Schiavo's condition, though that was based on no knowledge of her history. Upon reviewing her medical history, he credited her bulimia-induced hypopotassemia for the cardiac arrest that caused her brain damage later interview. See also interview with Greta Van Sustren on March 18. Available online soon.

After the family discovered a bone scan report that may have suggested abuse-related injuries, they petitioned Judge Greer for a full evidentiary hearing to evaluate the new evidence. On November 22, 2002 Judge Greer, ruled that, not only did her personal physicians disagree with the concerns of trauma, but it was irrelevant to his determination that Terri would not want to be kept in a PVS, and so he denied their motion[11].

Terri's family and the doctor they selected to represent them, Dr. Hammesfahr, have suggested that she was battered, presumably by the person with whom she was alone at the time of her collapse: her husband. [12] According to testimony from her brother and one of her co-workers, the couple was having marital problems at the time of her injury, and Terri had told them that she was considering divorce. [13] [14]. Her friend also said the couple argued heavily the day before her collapse over the expense of Terri's haircut. Other witnesses say that Michael had a history of violent and erratic behavior [15] [16] [17] [18], that when she collapsed he did not promptly seek medical assistance for her, and that, despite his CPR training, he left her face-down on the floor, gasping for air [19]. Additionally, nurses who cared for Terri have sworn in affidavits that Michael was abusive to her after her collapse, as well [20] [21]

The Florida Department of Children and Families (DCF) has begun an investigation of the abuse allegations. Previous investigations have found Michael Schiavo innocent. ([22] PDF Report)

Guardianship

Michael Schiavo is Terri's legal guardian, but her family seeks his removal as guardian, so that they can assume responsibility for Terri's care. Michael has successfully fought those efforts in court.

In a September 27, 1999 deposition, he told why he refused to turn over guardianship to Terri's parents. He said it was, "because they put me through pretty much hell the last few years [with] the litigations they put me through [and] their attitude towards me because of the litigations. There is no other reason." After consultation with his attorney, he later added that "another reason would be that her parents wouldn't carry out her wishes."[23]

Since Terri's injury, Michael has moved in with another woman, and fathered two children with her. Some contend that this is a conflict of interest, and should disqualify him from guardianship. Living in open adultery is a second-degree misdemeanor in Florida, punishable "by a definite term of imprisonment not exceeding 60 days."[24] In the wake of the U.S. Supreme Court ruling in Lawrence v. Texas, 539 U.S. 558 (2003), the enforceability of this statute is doubtful.

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, Michael Schiavo has the legal right to decide her medical treatment, her family members have nonetheless used every legal measure available to them to prevent her death.

Raising the issue of a possible conflict of interest is the fact that Michael Schiavo stands to inherit the remainder of Terri's malpractice settlement upon her death.

Terri'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, Michael 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.[25]

However, her family disputes his recollections, claiming that Terri is 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 Michael first publicly recalled conversations in which Terri had expressed a wish to die rather than live in the condition in which she now finds herself.[26] Her family also cites an affidavit by a woman with whom he had a relationship prior to those legal settlements, indicating that Michael told her repeatedly that he did not know what Terri's wishes would be for her care[27], and the testimony of a close college friend, Diane Christine Meyer, who says that Terri told her in 1982 that Karen Ann Quinlan shouldn't have been removed from life support.

Terri's father, Robert Schindler, has stated that Florida Judge George W. Greer, who has pronounced the most recent decisions in the case, and who also appointed himself Terri's guardian ad litem (which Terri'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 Terri dies in accordance with the court order, that it will be an instance of "judicial homicide".

Michael Schiavo says that Terri 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 Terri, he has placed strict limits on the time her family is allowed to visit her, and he has refused to allow her to undergo any sort of therapy; instead, he had Terri placed in hospice, though she is not terminally ill.

Legal involvement and "Terri's Law"

In 2004, Michael Schiavo won a court case to have her feeding tube removed, which would have resulted in her death by dehydration. Lack of water intake causes electrolyte imbalance which causes a heart attack (Myocardial infarction) which results in cardiac arrest producing death. Six days later, the Florida Legislature, in emergency session, passed "Terri's law", giving Florida Governor Jeb Bush the authority to intervene in the case. Governor Bush immediately ordered the feeding tube reinserted.

During the six days that Terri's feeding tube was removed, Michael prohibited any attempt to feed her orally, and refused to allow a priest to place a small part of a sacramental wafer on her tongue[28] during Holy Communion.

On May 19, 2004, Florida Judge W. Douglas Baird overturned the law saying that it "summarily deprived Florida citizens of their right to privacy."

Governor Bush appealed the ruling to the Florida Supreme Court and on September 23, 2004 they reached a unanimous decision [29], ruling that the legislature and executive branches of government unconstitutionally intervened in a judicial matter. The appellants immediately appealed to the United States Supreme Court.

On January 24, 2005, the U.S. Supreme Court refused to hear the case, ending any further legal avenue for appeal.

Recent developments

On February 25, 2005, Judge Greer ruled that Michael Schiavo may order the feeding tube removed on March 18, 2005. The Florida Department of Children and Families is also attempting to intervene by investigating allegations of abuse by Michael 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, 2005. Similarly, their request to be permitted to attempt to spoon-feed Terri if the feeding tube is removed was denied on March 8, 2005.

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. [30] Although this bill was passed by the Florida House 78-37, the Florida Senate hours later defeated a different measure 21-16. [31]

Congress is also considering a bill to prevent Terri's death, called "The Incapacitated Person's Legal Protection Act" (H.R.1151, S.539). The primary sponsor of the House bill, H.R. 1151, is Florida Rep. Dave Weldon, a physician. Dr. Weldon says that medical evidence "prove[s] Terri is not in a vegatative state."[32]

On March 11, 2005, media tycoon Robert Herring offered US$1 million to Terri Schiavo's husband if he agrees to sign all rights to her parents. The offer expired on March 14, 2005, four days before her feeding tube was removed. Robert Herring is a supporter of embryonic stem cell research, who believes her condition could be curable in the future. Michael Schiavo's attorney, George J. Felos, stated that his client found the offer "offensive" and that he had already rejected other monetary offers, including one of US$10 million, to sign over his rights to Terri. [33]

Terri Schiavo's feeding tube was removed at 1:45 P.M. EST on March 18, 2005 [34]. Earlier in the day, U.S. Senate majority leader Bill Frist (R-TN) announced that she will be called to testify before the Senate's Health, Education and Labor Committee at a March 28, 2005 hearing. Frist, a practicing doctor, serves on the committee. Republican congressmen Dennis Hastert, Tom DeLay, and Tom Davis opened a congressional inquiry of the House Government Reform Committee, to take place in Clearwater on March 25, and issued subpoenas for Terri, Michael, and several hospice workers. According to the lawmakers, harming Schiavo or preventing her from appearing at the hearings would be a violation of federal law. [35] Judge Greer responded by defying the congressional subpoenas, and letting the order stand which gave Michael Schiavo permission to remove Terri's feeding tube. The judge said he saw no reason to change his earlier permission allowing Schiavo's husband to remove her feeding tube. Greer ordered that the tube be removed immediately, per Michael Schiavo's request.