Terri Schiavo case

Terri Schiavo case

Theresa Marie "Terri" Schiavo (December 3, 1963 – March 31, 2005) was a woman from St. Petersburg, Florida whose medical and family circumstances and attendant legal battles fueled intense media attention and led to several high-profile court decisions and involvement by politicians and interest groups. Schiavo, then 26, collapsed in her home in 1990 and experienced respiratory and cardiac arrest. She remained in a coma for ten weeks. Within three years, she was diagnosed as being in a persistent vegetative state (PVS).

In 1998, when it became legal to do so, Terri's husband and guardian Michael Schiavo petitioned the courts to remove her gastric feeding tube; Terri's parents, Robert and Mary Schindler, opposed this. The courts found that Terri was in a PVS and that she should not be kept alive. In 2003, the matter began to receive national attention.

By March 2005, the legal history around the Schiavo case included fourteen appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in Federal District Court; Florida legislation struck down by the Supreme Court of Florida; a subpoena by a congressional committee in an attempt to qualify Schiavo for witness protection; federal legislation (Palm Sunday Compromise); and four denials of certiorari from the Supreme Court of the United States.

Despite intervention by the other branches, the courts continued to hold that Schiavo was in a PVS, and would want to cease life support. Her feeding tube was removed a third and final time on March 18, 2005. She died thirteen days later at a Pinellas Park hospice on March 31, 2005, at the age of 41.

Early life

Theresa Marie Schindler grew up in the Huntingdon Valley area of Lower Moreland Township, Pennsylvania, a suburb of Philadelphia, Pennsylvania, as the eldest of three children of Robert and Mary Schindler. Her younger siblings were Robert Jr. (Bobby) and Suzanne (now Suzanne Vitadamo). By her senior year in high school, Schiavo was overweight, with a height of 5 feet, 3 inches (160 cm) and a weight of around 200 pounds (90 kg). She went on a NutriSystem diet and lost about 55 pounds (25 kg). She may have developed an eating disorder around this time. In 1981, she graduated from Archbishop Wood Catholic High School.

She met Michael Schiavo in 1982 in a sociology class at Bucks County Community College. He was her first boyfriend. After dating for five months, the couple became engaged. When they were married on November 10, 1984, at Our Lady of Good Counsel Church in Southampton, Pennsylvania, Terri weighed 140 pounds. They moved to St. Petersburg, Florida, in April 1986. Schiavo's parents also moved to St. Petersburg three months later. In Florida, she worked as an insurance claims clerk for the Prudential insurance company, and Michael was a restaurant manager.

In 1989, the Schiavos began visiting an obstetrician and receiving fertility services and counseling in the hopes of having a child. At this time Schiavo's weight had dropped to 120 pounds, and she was not menstruating (lack of menstruation, or amenorrhea is sometimes associated with excessive weight loss, as is thought to be the case with Mrs. Schiavo).

Initial medical crisis

On the morning of February 25, 1990, at approximately 5:30 a.m. EST, Schiavo collapsed in a hallway of their St. Petersburg apartment. Firefighters and paramedics arriving in response to Michael's 9-1-1 call found her face-down and unconscious. She was not breathing and had no pulse. They attempted to resuscitate her, she was defibrillated several times, and transported to the Humana Northside Hospital. There she was intubated, ventilated, and eventually given a tracheotomy, with a poor prognosis.

She remained comatose for two and a half months. When she emerged from the coma, Schiavo regained a sleep-wake cycle, but did not exhibit repeatable and consistent awareness of herself or environment. The long period without oxygen led to profound brain injury ("anoxic-ischemic encephalopathy" noted at autopsy), severely damaging those parts of the brain concerned with cognition, perception, and awareness. While initially fed by means of a nasogastric feeding tube, she eventually received a percutaneous endoscopic gastrostomy (PEG) feeding tube—inserted through the abdominal wall. Dr. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, cared for Schiavo during her initial admission to hospital; both he and Dr. Victor Gambone, an internist and Schiavo family physician, independently made the PVS diagnosis within approximately one year after Schiavo's cardiac arrest. Other neurologists—Drs. Jeffery M. Karp, James H. Barnhill, and Thomas H. Harrison—also examined Schiavo over the years and made the same diagnosis; they also shared a very poor opinion about her chances for recovery. No dissent regarding Schiavo's condition or the PVS diagnosis was raised by any parties at this point in court. The parents consistently pressed for rehabilitation both before and after the malpractice settlement but were excluded from medical information and decisions.

The cause of her cardiac arrest has never been determined. For a time, it was believed that her cardiac arrest had been caused by an imbalance of electrolytes in her blood. On admission to hospital, her serum potassium level was noted to be very low, at 2.0 mEq/L; the normal range for adults is 3.5–5.0 mEq/L. It was speculated that her low potassium level had in turn been caused by an eating disorder; her medical chart contained a note that "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". However, there has never been any hard evidence that Schiavo had an eating disorder, and the low potassium could have been a spurious result caused by the intravascular administration of fluids during the attempt to resuscitate her.

Michael Schiavo filed and won a malpractice suit against Terri's obstetrician on the basis that the physician failed to recognize and diagnose bulimia in Terri. In May 1992, while on appeal, the case was settled for $1 million.

Rehabilitation efforts

Schiavo's parents contended that her behavior in this image from one of the videos released by her parents showed that she was aware of the people around her. Most neurologists who examined Schiavo disagreed, saying that her behavior represented reflex or instinctive actions.

Schiavo came home to her family in September; however, after becoming overwhelmed with her needs, the family sent her back to the College Park facility. In November, Michael took her to the University of California, San Francisco for an experimental procedure involving the placement of a thalamic stimulator implant in her brain. The experimental treatment took several months but was unsuccessful. Michael returned to Florida with her in January 1991 and admitted her to the Mediplex Rehabilitation Center (specializing in brain injuries) in Bradenton, Florida, often "taking her to parks and public places in hopes of sparking some recovery". There she received 24-hour care. On July 19 1991, Schiavo was transferred to the Sable Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy until 1994.

Michael trained and became a respiratory therapist and emergency room nurse and continued to personally provide Terri with some of her care.

"Do-not-resuscitate" order

In March 1994, after more than three years of trying various therapies, Michael, according to Jay Wolfson (Schiavo's third guardian ad litem), came to terms with his doctors' diagnosis of an irreversible persistent vegetative state, and transferred his wife to a nursing home in Largo, Florida . In early 1994 she contracted a urinary tract infection and Michael, in consultation with his wife's physician, halted most therapy for his wife and entered a "Do Not Resuscitate" (DNR) order. He later rescinded this after the Schindlers and the nursing home protested. Wolfson later wrote in his report that Michael's decision had been based on consultation and was "predicated on his reasoned belief that there was no longer any hope for Theresa's recovery."

Five years of family conflict

From 1998 to the end of 2002, the families were locked into a struggle in the courts, first to decide if Terri should be removed from life support and then the appeals by Terri's parents to block this determination. This legal struggle received no publicity of note. This phase started with Michael's initial petition to have the feeding tube removed and involved four legal decisions of note. In many ways, the legal status at the end of these five years was the same as immediately after Michael had first filed, but up until the end of this time, the story had received little coverage in the media, and thus it was still a family affair.

Petition to remove feeding tube

In May 1998, Michael filed a petition to remove Schiavo's feeding tube, which her parents opposed. Richard Pearse was appointed by the court as a second guardian ad litem, and on December 29, 1998, reported "Dr. [Jeffrey] Karp's opinion of the ward's condition and prognosis is substantially shared among those physicians who have recently been involved in her treatment". Pearse concluded from Karp's and Dr. Vincent Gambone's diagnosis of PVS that Schiavo was legally in a persistent vegetative state as defined by Florida Statutes, Title XLIV, Chapter 765, §101(12). This includes the "absence of voluntary action" and an "inability to communicate or interact purposefully."

Pearse found that there was no possibility of improvement but that Michael's decisions might have been influenced by the potential to inherit what remained of Schiavo's estate. Due to a lack of a living will and questions regarding Michael's credibility, Pearse recommended denying his petition to remove her feeding tube. The issue of conflict of interest raised by guardian ad litem Pearse attached to the Schindlers as well, he reported, since, had they prevailed in the various litigation over guardianship, they as the presumed heirs-at-law would have inherited the remainder of Mrs. Schiavo's estate upon her death.

Schiavo's end-of-life wishes – Schiavo I

Given the lack of a living will a trial was held during the week of January 24, 2000, to determine what Schiavo's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes were heard. Michael claimed that Schiavo would not want to be kept on a machine with no hope for recovery. Her parents claimed that Schiavo was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration. Judge George Greer issued his order granting Michael’s petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the court found that Schiavo was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal (or "2nd DCA") and came to be known by the court as Schiavo I in its later rulings.

Oral feeding and the Second Guardianship Challenge

In March of 2000, the Schindlers filed a motion to permit oral feeding of Schiavo, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Schiavo was not responsive to swallowing tests and required a feeding tube, Judge Greer ruled that Schiavo was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request. The Medical Examiner in his report was more definitive and concluded that Schiavo could not have swallowed and thus could not have received sufficient nutrition or hydration by mouth to sustain life.

In 2000, the Schindlers again challenged Michael's guardianship. Their new evidence cited that he had relationships with other women and that he had failed to provide appropriate palliative care and treatment for Theresa. The Schindlers further suggested that he was wasting the assets within the guardianship account by transferring Schiavo to Pinellas Park, Florida hospice "after it was clear that she was not 'terminal' within Medicare guidelines" for hospices. By this time, while still legally married to Terri Schiavo, Michael was in a relationship with Jodi Centonze, and had fathered their first child. Michael denied wrongdoing, stating that the Schindlers had actively encouraged him to "get on with his life" and date since 1991. Michael said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (to not be kept alive in a PVS) were carried out. The court denied the motion to remove the guardian, allowing that the evidence was not sufficient and in some instances, not relevant. It set April 24, 2001 as the date on which the tube was to be removed.

Three appeals – Schiavo II

In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of their daughter's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure. (Page 65 of this 146-page document) The 2nd DCA upheld Greer's decision but remanded the issue in order to give the Schindlers an opportunity to file a new motion. On April 24, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against removal of feeding tube until this was settled. The feeding tube was reinserted on April 26. On appeal by Michael, the 2nd DCA reversed Judge Quesada's order. In the same time frame, Michael filed a motion to enforce mandate of the guardianship court (that the feeding tube be removed). The 2nd DCA denied the motion. (These three decisions, all published in a single order by Florida's Second District Court of Appeal , came to be known by the court as Schiavo II in its later rulings.)

Challenging the PVS diagnosis – Schiavo III

After the failure of challenges to Michael's guardianship and to the ruling on Schiavo's end-of-life wishes, the Schindlers adopted the position that Schiavo was not in a PVS and began to challenge that diagnosis in court. Schiavo's parents claim that their daughter did not meet the definition of a persistent vegetative state, and was in a "minimally conscious state" instead. Her parents argued that at times her actions indicated responses to external stimuli, not instinctive or reflex behavior. For example, the Schindlers claimed that their daughter smiled, laughed, cried, moved, made childlike attempts at speech, and attempted to say "Mom" or "Dad"; or "yeah" when they asked her a question. They claimed that when they kissed her, she looked at them and sometimes puckered her lips.

On August 10, 2001, on remand from the 2nd DCA, Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability that Schiavo herself would decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the 2nd DCA.

On October 17, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Schiavo's wishes back to the trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Michael could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Schiavo's condition. (These decisions, all published in a single order by the Florida Second District Court of Appeal, came to be known by the court as Schiavo III in its later rulings.)

PVS diagnosis ruling – Schiavo IV

Left: Scan of normal 25-year-old's brain; Right: Schiavo's 2002 CT scan at age 38. The bright dot is an electrode that was implanted as experimental treatment in 1990.

In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer's court to determine whether new therapy treatments could help Schiavo restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan) was performed, which showed severe cerebral atrophy. An EEG showed no measurable brain activity. The court viewed a six-hour tape of Schiavo and concluded that her vegetative condition was factual and not subject to legal dispute.

In accordance with the 2nd DCA's instructions, five doctors were selected to provide their expert testimony to the trial: two by Schiavo's parents, two by Michael, and one to have been selected by mutual agreement of the parties:

• The Schindler family selected Dr. William Maxfield (a radiologist) and Dr. William Hammesfahr (a neurologist).
• Michael Schiavo selected Dr. Ronald Cranford and Dr. Melvin Greer (both neurologists).
• The parties having failed to agree, the court selected Dr. Peter Bambakidis (a neurologist).

These five doctors examined Schiavo's medical records, brain scans, the videos, and Schiavo herself. Drs. Cranford, Greer, and Bambakidis testified that Schiavo was in a persistent vegetative state. Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state.

As part of the court-ordered medical exam, six hours of video of Schiavo were taped and filed at the Pinellas County courthouse. The tape included Schiavo with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Schiavo "clearly does not consistently respond to her mother". From that six hours of video, the Schindlers and their supporters produced six clips totaling almost six minutes and released those clips to public websites.

Judge Greer ruled that Schiavo was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr's testimony which claimed positive results in similar cases by use of vasodilation therapy, the success of which is unsupported in the medical literature. This ruling was later affirmed by Florida's 2nd District Court of Appeal, which stated that "this court has closely examined all of the evidence in the record," and "we have...carefully observ[ed] the video tapes in their entirety." The court concluded that "...if we were called upon to review the guardianship court's decision de novo, we would still affirm it." (This decision by the 2nd DCA came to be known as Schiavo IV in later rulings.)

2003 petition

At about the start of 2003, the Schindlers began to create more publicity and to lobby for their case to keep their daughter alive. They selected pro-life activist Randall Terry as their spokesman but continued to pursue their available legal options.

On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube to provide for "eight weeks' therapy". Accompanying the petition were four affidavits from members of the Schindler family and one from Dr. Alexander T. Gimon. At the hearing the Schindlers' counsel read into the record additional affidavits from three speech professionals and two nurses.

One of the nurses, Carla Sauer Iyer said in her affidavit that her initial training in 1996 consisted solely of the instruction, "do what Michael Schiavo tells you or you're terminated." She stated that on five different occasions, she tested Schiavo's blood sugar levels after Michael visited her, and she found that her blood sugar levels were so low it wouldn't even register a number. She stated that it was medically possible that Michael injected his wife with insulin in an attempt to kill her. Iyer stated that standing orders were not to contact the Schindler family, but that she "would call them anyway." Iyer stated that she eventually called the police and was fired the next day.

On September 17, Judge George Greer denied the petition, and wrote that "the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them clearly demonstrate this to be true." Regarding Iyer's statements, Greer wrote that they were "incredible to say the least" and that "Ms. Iyer details what amounts to a 15-month cover-up [April 1995 through July 1996] which include the staff of Palm Garden of Largo Convalescent Center, the Guardian of the Person, the guardian ad litem, the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler...It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had Iyer contacted them [in 1996] as her affidavit alleges."

Terri's Law

Main article: Government involvement in the Terri Schiavo case

On October 15, 2003, Schiavo's feeding tube was removed. Within a week, when the Schindlers' final appeal was exhausted, the Florida Legislature passed "Terri's Law," giving Governor Jeb Bush the authority to intervene in the case. Bush immediately ordered the feeding tube reinserted (see Government involvement section).

Bush sent the Florida Department of Law Enforcement to remove Schiavo from the hospice. She was taken to a hospital, where her feeding tube was surgically reinserted. She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem, Dr. Jay Wolfson, to "deduce and represent the best wishes and best interests" of Schiavo, and report them to Governor Bush. Wolfson's report did not change Michael's role as Terri's legal guardian and did not otherwise obstruct him legally.

Michael Schiavo opposed the Governor's intervention, and was represented, in part, by the ACLU. At the same time, Robert and Mary Schindler, Terri's parents attempted to intervene and participate in the "Terri's Law" case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida 6th Circuit, the same circuit as for Judge George W. Greer. They appealed, and, on February 13, the Florida Second District Court of Appeal (2nd DCA) reversed Baird's ruling, allowing them to participate. On March 17, Baird denied the Schindlers the right to intervene a 2nd time, and the Schindlers, represented by the conservative American Center for Law and Justice (ACLJ), appealed the right to participate in the "Terri's Law" case, with the court scheduling an oral argument date for June 14. The Schindlers' other attorney, Pat Anderson, was concurrently challenging Michael Schiavo's right to be Terri's guardian, and, on June 16, she made a petition for writ of Quo Warranto, a pleading that asks "by what right" someone acts in an official capacity.

On May 5 2004, Baird found "Terri's Law" unconstitutional, and struck it down. Bush appealed this order to the 2nd DCA, but, on May 12, they issued an "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution." The 2nd DCA, in sending it directly to the Florida's Supreme Court, invoked "pass through" jurisdiction.

The Florida Supreme Court then overturned the law as unconstitutional.

Wolfson's investigation and report

Wolfson visited Schiavo at least daily over the course of a month. In December, 2003, he submitted his report, referring to himself in the third person as "the GAL". His central finding was: "The GAL was not able to independently determine that there were consistent, repetitive, intentional, reproducible interactive and aware activities." He notes further, that when joined by her parents no success was gained in eliciting a repetitive or consistent response from Schiavo.

In examining medical records and consultations surrounding the case, Wolfson concluded: "(that there is) well documented information that she is in a persistent vegetative state with no likelihood of improvement, and that the neurological and speech pathology evidence in the file support the contention that she cannot take oral nutrition or hydration and cannot consciously interact with her environment." He observed further that while there appeared to be agreement about Schiavo and PVS: "the Schindlers have adopted what appears to be a position that Theresa is not in a persistent vegetative state, and/or that they do not support the fact that such a medical state exists at all."

Wolfson addressed two criticisms that media attention had affixed to the Schindlers and Michael Schiavo, respectively. That the Schindlers would keep their daughter alive to the point of her "limbs being amputated," was not accurate according to Wolfson. Of suggestions that Michael Schiavo refused to relinquish his guardianship because of financial interests or to cover up previous abuse, Wolfson reported that "there is no evidence in the record to substantiate any of these perceptions or allegations."

In addressing the issue of law surrounding the case, Wolfson concluded "that the trier of fact and the evidence that served as the basis for the decisions regarding Theresa Schiavo were firmly grounded within Florida statutory and case law, which clearly and unequivocally provide for the removal of artificial nutrition in cases of persistent vegetative states."

Final motions

From about the start of 2005, publicity for this case again began to grow and climaxed in the last half of March with Terri's last days, dominating the national news through most of that month.

The Schindlers filed two motions in an effort for forestall the removal of Terri's feeding tube. No stay was granted by the appellate courts, and on March 18, 2005, Schiavo's feeding tube was removed for a third time.

Motion details

On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations The Schindlers wanted Schiavo to be tested with an fMRI and given a swallowing therapy called VitalStim. The motion was accompanied by thirty-three affidavits from doctors in several specialties, speech pathologists and therapists, and a few neuropsychologists, all urging that new tests be undertaken. Patricia Fields Anderson, the Schindler family attorney, still held out hope "that Terri might be able to take nourishment orally, despite past findings that she is incapable." Judge Greer formally denied the motion and ordered the "removal of nutrition and hydration from the ward" . Anderson argued that Greer did not specify "artificial nutrition and hydration" versus "oral nutrition and hydration" and stated that "the withholding of food and water...was not ordered by the Court but by Michael Schiavo." In his order, Greer also set a time and date for the removal of the feeding tube: "1:00 p.m. on Friday, March 18, 2005."

On February 28, the Schindlers filed a motion, asking for permission to attempt to provide Schiavo with "Food and Water by Natural Means." This second motion asked for permission to "attempt to feed" Schiavo by mouth. Judge Greer denied the second motion on March 8, saying "it has become clear that the [second] motion is part and parcel of [the previous] motion on medical evaluations. The same declarations are being used for both motions and the motion appears to be an alternative pleading to the [previous] motion. Both are asking for an experimental procedure." The following day, Greer denied the first motion as well, citing that an affiant doctor for Michael cautioned that fMRI was an experimental procedure that should be conducted in an academic setting, because Schiavo had already undergone swallowing tests and failed, and because VitalStim had only been performed on patients who were not in a PVS. Greer noted that "[m]ost of the doctor affidavits submitted are based on their understanding of Schiavo's condition from news reports or video clips they have seen. Many are obviously not aware of the medical exams undertaken for the 2002 trial..."

Federal involvement

Main article: Government involvement in the Terri Schiavo case

Following Greer's order on March 18 2005 to remove the feeding tube, Republicans in the United States Congress subpoenaed both Michael and Terri Schiavo to testify at a congressional hearing. It is contempt of Congress to prevent or discourage congressional witnesses from testifying. The purpose of the subpoenas was thus to postpone the feeding tube removal.

Greer told congressional attorneys, "I have had no cogent reason why the (congressional) committee should intervene." He also stated that last-minute action by Congress does not invalidate years of court rulings. Although Senate Majority Leader Bill Frist, Senator Rick Santorum, and House Majority Leader Tom DeLay, brought the possibility of sanctioning Greer on charges of contempt of Congress, Congress did not attempt to enforce the subpoenas or take any action against Greer.

Palm Sunday Compromise

Main article: Palm Sunday Compromise

Governor Bush and Congressional Republicans anticipated Greer's adverse ruling well before it was delivered and worked on a daily basis to find an alternative means of overturning the legal process by utilizing the authority of the United States Congress. On March 20, 2005, the Senate (with only three members present) passed their version of the resolution, followed by the House of Representatives, a private bill which came to be called the "Palm Sunday Compromise" (S-686), transferring jurisdiction of the Schiavo case to the federal courts. The bill passed the House on March 21 at 12:41 a.m. EST. President Bush flew to Washington D.C. from his vacation in Texas in order to sign the bill into law at 1:11 a.m. EST. As in the state courts, all of the Schindlers' federal petitions and appeals were denied, and the U.S. Supreme Court declined to grant certiorari, effectively ending the Schindlers' legal options.

At the same time, the so-called Schiavo memo surfaced, causing a political firestorm. The memo was written by Brian Darling, the legal counsel to Florida Republican senator Mel Martinez. It suggested 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.

On March 24 2005, Greer denied a petition for intervention by the Department of Children & Families (DCF) and signed an order forbidding the department from "taking possession of Theresa Marie Schiavo or removing her" from the hospice and directed "each and every and singular sheriff of the state of Florida" to enforce his order. The order was appealed to the 2nd DCA the following day, which resulted in an automatic stay under state law. While the stay was in effect, Florida Department of Law Enforcement personnel prepared to take custody of Terri and transfer her to a local hospital for reinsertion of the feeding tube. Once Greer was made aware of the stay, he ordered it lifted and all parties stood down. Governor Bush decided to obey the court order despite enormous pressure from the political right. If Bush (or the Florida Legislature) had ignored Greer's order by attempting to remove Schiavo from the hospice, a confrontation between the Pinellas Park Police Department and the FDLE agents could have ensued. In jest, one official said local police discussed "...whether we had enough officers to hold off the National Guard."

Last Rites

On March 26, 2005, Bob and Mary Schindler announced that their legal options had been exhausted. The next day, Schiavo was given the Anointing of the Sick ("Last Rites"). In accordance with the Catholic ritual of Viaticum, she received the Eucharist for the last time; it had been administered to her once through her feeding tube just before it was removed. The Eucharist, according to the teaching of the Catholic Church, can be received under the consecrated species of either bread (referred to as the host) or wine. As her tongue was too dry to receive a small piece of the host, she received under the species of wine, one drop being placed on her tongue.

On the day of her death, Terri's brother, Bobby Schindler, and his sister, Suzanne Vitadamo, had been in the room visiting their sibling for about an hour and 45 minutes when a hospice administrator notified Michael Schiavo that his wife was in her final stages. At Michael Schiavo's request, hospice staff asked Terri's siblings to leave the room.

Terri Schiavo died at 9:05 a.m. EST on Thursday, March 31, 2005, with her husband Michael at her side. According to their spokesman, Schiavo's parents had not been allowed into her room during her last hours. When notified that their daughter had died, the couple hurriedly came to the hospice. The Schindler family was not allowed into the room while Michael Schiavo was there, and was allowed in once he left.

Autopsy

After her death, Schiavo's body was taken to the office of the medical examiner for Pinellas and Pasco counties. The autopsy occurred on April 1 2005. It revealed extensive brain damage. The manner of death was certified as "undetermined".

Autopsy details

The autopsy was led by Dr. Jon Thogmartin. Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report was released on June 15, 2005. In addition to studying Ms. Schiavo's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties.

Examination of Schiavo’s nervous system revealed extensive injury. The brain itself weighed 615 g, only half the weight expected for a female of her age, height, and weight. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex, the thalami, the basal ganglia, the hippocampus, the cerebellum, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neurons that comprise some 70 percent of cortical cells—critical to the functioning of the cortex—were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, is also typical. There was marked damage to important relay circuits deep in the brain (the thalami)—another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons." Dr. Stephen J. Nelson, P.A., cautioned that "[n]europathologic examination alone of the decedent’s brain – or any brain for that matter – cannot prove or disprove a diagnosis of persistent vegetative state or minimally conscious state." The vegetative state is a behaviorally defined syndrome of complete unawareness, to self and to environment, that occurs in a person who nevertheless experiences wakefulness. As the condition is defined in clinical terms, it can therefore only be diagnosed in persons who, at some point, are shown to meet those clinical terms. Ancillary investigations, such as CT scans, MRI, EEGs, and lately fMRI and PET scanning, may only provide support for the clinical impression—as might the pathologic findings, after death. In the case of Terri Schiavo, seven of the eight neurologists who examined her in her final years stated that she met the clinical criteria for PVS; the serial CT scans, EEGs, the one MRI, and finally, the pathologic findings, were consistent with that diagnosis.

Aside from a localized, healed inflammation, the cardiac pathologist who studied Schiavo's heart found it and the coronary vessels to be healthy. Her initial collapse was not the result of myocardial infarction, commonly known as a heart attack.

Although the basis of Michael Schiavo's $1 million medical malpractice judgment was his claim that Terri Schiavo suffered from an eating disorder (bulimia) that caused a serious electrolyte disturbance, stopping her heart, Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." The main piece of evidence cited for an eating disorder — the low levels of potassium in her blood in 1990 — could have been caused by the emergency treatment she received at the time, Thogmartin said. While she had lost more than 100 pounds since high school, Schiavo never confessed to an eating disorder, she did not take diet pills and no one had ever witnessed her purging food.

Regarding the possibility of strangulation or domestic violence as a cause of Terri's initial collapse, the report states: "Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings."

Regarding the cause and manner of Schiavo’s death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which [sic] cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined."

“We weren’t surprised the medical examiner said Terri’s brain was damaged,” said Bobby Schindler, Jr., Terri’s brother, in an interview hours after the autopsy report was released. “The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions.”

Following death

Schiavo's gravemarker.

Schiavo's body was cremated following the autopsy. Her parents offered a memorial Mass for her at the Holy Name of Jesus Catholic Church in Gulfport on April 5. Father Frank Pavone, an activist with Priests for Life, delivered the main homily (Audio: MP3 Format).

On May 7, Schiavo's parents made public a complaint that they hadn't been informed of when and where the ashes of their daughter had been (or were to be) buried by Michael Schiavo. He was under court order to provide this information to them.

On June 20, the cremated remains of Terri Schiavo were buried. The Schindlers' attorney stated that the family was notified by fax only after the memorial service; by then, the family had already started getting calls from reporters. The ashes were interred at Sylvan Abbey Memorial Park in Clearwater, Florida. The epitaph, shown at right, reads:

Schiavo / Theresa Marie / Beloved Wife

Born December 3, 1963

Departed this earth / February 25, 1990

At peace March 31, 2005

I kept my promise

On January 23, 2006, Michael Schiavo married his long-term fiancée, Jodi Centonze, whom he met in a dentist's office in 1995.

Disputed opinions

David Gibbs III, the lead lawyer for Terri Schiavo’s parents, supported Vatican statements which condemned her treatment as euthanasia. Pope John Paul II stated that health care providers are morally bound to provide food and water to patients in persistent vegetative states. This led to a challenge by Schiavo's parents, who requested a new trial about whether their daughter, as a devout Catholic, would wish to go against the Church's teaching. Judge Greer rejected their request.

Schiavo's husband insisted that she had expressed her wishes not to be kept on life support with no hope for improvement. During a trial in 2000, testimony was heard from witnesses on both sides to establish Schiavo's wishes regarding life support. The court determined that she had made "credible and reliable" statements that she wouldn't want to be "kept alive on a machine," based on expert testimony, finding that Americans don't want to live "with no hope of improvement," and that her condition in a persistent vegetative state had "long since satisfied" the requirement that there be no hope of improvement.

In 2003, guardian ad litem Dr. Jay Wolfson was appointed by Florida legislature to "deduce and represent the best wishes and bests interests of Theresa Schiavo." He reported to Governor Jeb Bush that "the evidence that served as the basis for the decisions regarding Theresa Schiavo were firmly grounded within Florida statutory and case law, which clearly and unequivocally provide for the removal of artificial nutrition in cases of persistent vegetative states," and that the evidence regarding Schiavo's medical condition and intentions had been "deemed, by the trier of fact to be clear and convincing." and "The reasonable degree of medical certainty associated with her diagnosis and prognosis is very high."

Public opinion and activism

Main article: Public opinion and activism in the Terri Schiavo case

The Terri Schiavo case held the attention of both American and international audiences and had major political ramifications. A number of opinion polls were carried out, particularly on the question of federal involvement in the Terri Schiavo case, with conflicting results. The case drew notable figures on both sides of the debate, as well as many pressure groups and public protesters. Although the vast majority of protests were nonviolent, two of the more extreme acts included death threats aimed towards Michael Schiavo. The Schindlers' legal fight was funded by a variety of sources on the political right. Michael's legal fight was funded by Terri's trust fund.

On March 11, 2005, media tycoon Robert Herring (who believes that stem cell research could have cured Schiavo's condition) offered $1 million (USD) to Michael Schiavo if he agreed to cede his guardianship to his wife's parents. The offer was rejected; George Felos, attorney for Michael Schiavo, described it as offensive, adding that Michael had rejected other monetary offers, including one of $10 million (USD).

During the final stages of the court battle in March 2005, around 30 individuals made a variety of complaints to the DCF, alleging various abuses. These included Terri being in pain from recent dental work, Terri not having had any dental work for years prior to that, and the blinds in her room not being open wide enough. DCF investigators found the claims to be groundless, stating that there were "no indicators" of abuse in any of the cases and concluding that "[t]he preponderance of the evidence shows that Michael Schiavo followed doctors' orders [regarding] Ms. Schiavo's diagnosis of being in a persistent vegetative state and that he provided her with appropriate care."

Perhaps the greatest effect that Schiavo has had on the American psyche is to remind citizens to consider drawing up a living will while they are still mentally alert. The rate of living will creation in America has increased since Terri Schiavo died.

See also

• Cause célèbre
• Terri Schiavo timeline
• Texas Futile Care Law
• Tirhas Habtegiris (a terminally ill patient removed from a ventilator against the wishes of her family in December 2005)
• Karen Ann Quinlan
• List of people who became famous through being terminally ill

Further reading

• Fighting for Dear Life: Inside the Terri Schiavo Story and What it Means for All of Us by David Gibbs and Bob DeMoss (2006) ISBN 0-7642-0243-X
• The Right to Die: Terri Schiavo (2003) ISBN 0-7365-8883-3 (video)
• Silent Witness: The Untold Story of Terri Schiavo's Death by Mark Fuhrman (2005) ISBN 0-06-085337-9
• Using Terri: The Religious Right's Conspiracy to Take Away Our Rights by Jon B. Eisenberg (2005) ISBN 0-06-087732-4
• A Life That Matters: The Legacy of Terri Schiavo—A Lesson For Us All by Mary and Robert Schindler (2005) ISBN 0-446-57987-4
• Remembering Terri Schiavo: Reflections of a Health Care Warrior by Audrey Ignatoff (2005) ISBN 1-4116-3220-6
• Terri's Story: The Court-Ordered Death of an American Woman by Diana Lynne (2005) ISBN 1-58182-488-2
• The Case of Terri Schiavo: Ethics at the End of Life. Arthur Caplan, James J. McCartney, Dominic Sisti, editors (2006) ISBN 159102398 Template:Invalid isbnBook web site
• Terri : The Truth by Michael Schiavo, Michael Hirsh (2006) ISBN 0-525-94946-1
• "Terri Schiavo: When Does Personhood End?" The Elements of Bioethics, Gregory Pence, ISBN 978-0-07-313277-8 Template:Invalid isbn
• A Terri Schiavo reading list

External links

Compilations

(legal documents relating to the Schiavo case)

• Findlaw's compilation
• Tampa Bay Online's compilation
• Abstract Appeal's compilation
• The University of Miami Ethics Programs' compilation

Information sites

• The Partnership for Medical Ethics Reform PMER Non-Profit Educational Partnership for Consumers and Patients Retrieved March 15 2006
• American Center for Law and Justice. ACLJ National "Civil Rights" law firm. Retrieved August 30 2005
• Liberty to the Captives. Compilation of testimonies, interviews and information on the case. Retrieved December 18 2005
• American Civil Liberty Union. ACLU National "Civil Rights" law firm. Retrieved August 30 2005
• Amicus National, Inc. (2005). Legal docs, Living Wills. Site providing free living will forms on a state-by-state basis. Retrieved April 16 2005
• Conigliaro, Matt, Esq., Editor of "Abstract Appeal" Legal Blog. (2005). THE TERRI SCHIAVO INFORMATION PAGE Retrieved August 31 2005
• End-of-Life Choices (2005). Advance Health Care Directives: End-of-Life Choices—Make Your Wishes Known! Retrieved August 30 2005
• Hospice Patients Alliance Retrieved August 30 2005. Includes the initial 1999 Police Report
• Zorn, Eric (2005). For your reference - the Schiavo case. Eric Zorn's Notebook, Chicago Tribune. Retrieved March 31 2005
• Template:SourceWatch
• The Legacy of the Terri Schiavo Case: Why is it so hard to die in America? The University of Pennsylvania Center for Bioethics 10th Anniversary Symposium, April 30- May 1, 2006, Philadelphia, PA.See link
• How to pronounce Terri Schiavo

Articles, advocacy and commentary

This information is available on the Public opinion and activism in the Terri Schiavo case article.