Terri Schiavo

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Terri Schiavo before her injury

Terri Schiavo (Dec. 3, 1963 – Mar. 31, 2005) was a coma victim whose plight came to national attention during the Bush Administration. The legal issues split the country as much as the abortion issue.

While on a weight-loss diet, Schiavo consumed too little potassium. On February 25, 1990, Schiavo suffered a cardiac arrest, possibly due to a undiagnosed weight-loss related potassium deficiency. By the time paramedics arrived, Mrs. Schiavo's heart had not pumped for around 10 minutes, doctors found. [1] The lack of blood flow to the brain resulted in a condition diagnosed as a persistent vegetative state. Her husband and her parents became locked in a lengthy legal battle over whether to keep her alive. Florida Governor Jeb Bush and his brother President Bush sided with the parents, who believed their daughter was responsive. Despite a special law passed to prevent her death, the courts finally upheld the Guardianship Court's authorization of Michael Schiavo's decision to terminate her life support on March 18, 2005, and she died of starvation and dehydration within two weeks.


Contents

Controversy

The case struck raw nerves on both sides of the liberal-conservative divide, pitting largely atheistic and materialistic supporters of euthanasia and "right-to-die" against predominantly religious supporters of "right to life" and human rights. Libertarians fell somewhere in the middle, disagreeing with Michael Schiavo's decision, but ultimately disagreeing with the governments intrusion into an incredibly personal decision.

Keep her alive

Many patients observed to be in a brain-damaged state like Terri's have surprisingly recovered, including several highly publicized cases shortly after Terri died from dehydration.[2][3] During this time, one of Terri's nurses states that Terri frequently spoke (saying "help me" and "Mommy") and recognized familiar people. Yet she was forced to die by dehydration over the objections of her parents, her brother and sister, her church, and millions of Americans.

Let her die

George Felos, an attorney prominent in the right-to-die movement and described as "pro-death"[4] represented Mr. Schiavo and applied to the Pinellas County-Pasco County Circuit probate court for the right to remove Terri's feeding tube. A judge ordered her death despite objections by everyone in Terri's own family and several medical professionals.[5] His order not only required removal of Terri's feeding tube, but ordered the arrest of people who peacefully attempted to give drinking water to Terri rather than let her die of dehydration.[6]

Terri Schiavo was not terminally ill, but she was determined to be in a "persistent vegetative state". This conclusion was reached by neurologists hired on the side seeking her death, but disputed by neurologists hired by Terri’s parents. Her parents were given the right to a comprehensive examination of Terri by order of the Florida 6th Judicial Circuit court. Two neurologists selected by Michael Schiavo, one radiologist and one neurologist selected by Terri’s parents, and one neurologist selected by the court examined Terri and her medical history thoroughly. The judge declared that Terri was in a persistent vegetative state with no hope of improvement.[1]

Role of The Husband: Michael Schiavo

While still married to Terri, Michael Schiavo started a new family with another woman, whom he eventually married after Terri's death, while insisting on retaining legal authority over Terri despite the objections of her parents and siblings.[7] Generally, in the absence of an advanced directive, health care decisions are authorized to be made by surrogates in the following order: (1) the spouse, unless legally separated; (2) an adult child; (3) a parent; or (4) an adult brother or sister. [8] Michael Schiavo had the legal authority to make the health care decision, but he had to show by clear and convincing evidence that Theresa Schiavo was in a persistent vegetative state and that Theresa would elect to cease life-prolonging procedures if she were competent to make her own decision. [9] After ten years in a persistent vegetative state that robbed Theresa Schiavo of most of her cerebrum and all but the most instinctive of neurological functions, Michael Schiavo petitioned the Guardianship Court to authorize the termination of life-prolonging procedures. [10]

Legal dispute

The legal dispute over Schiavo's death lasted seven years, beginning with the filing of a petition in 1998 with the Pinellas County (Florida) Circuit Court for permission to remove her feeding tube, and ending with her death in 2005. During the same time, Mr. Schiavo increasingly came under the influence of attorney George Felos, who is prominent in the right-to-die movement. A nurse suggested misconduct by Mr. Schiavo during his visits, alleging evidence that Mr. Schiavo may have been harming Terri.[11] Following Terri's death, the county coroner refused to allow an independent autopsy or even an independent review of its autopsy, and claimed without independent verification that Terri's brain had half the normal mass for a woman her age. Her body was then quickly cremated, destroying any possible exculpatory evidence.

Leading up to Terri's death in 2003, a court ordered the removal of Schiavo's feeding tube. This prompted the Florida legislature to pass 'Terri's Law' in under a week, authorizing the personal involvement of Governor Jeb Bush to overrule the finding of the court. The governor immediately ordered the reinsertion of the feeding tube. Terri's Law was later ruled unconstitutional by the Florida Supreme Court, finding that state and federal constitutions prohibit the interference of the governor or legislature within a specific judicial case.

Neither an act of the Florida legislature nor any federal court reversed the initial decision of the Guardianship Court to authorize Michael Schiavo's decision to cease life-prolonging procedures which ultimately resulted in Terri's death by dehydration. [12]

Autopsy

The State and Schiavo's estranged husband refused to allow an independent autopsy, and Schiavo was cremated after her death. The State did perform its own autopsy and reported these results that lack independent verification:[13] [14]

  1. “Neuropathologic examination alone of the decedent’s brain—or any brain, for that matter—cannot prove or disprove a diagnosis of persistent vegetative state.”
  2. The changes in the cortex were most severe in the occipital lobes, “with relative preservation of the frontal and temporal lobes.”
  3. Oral feedings, based on autopsy findings and past medical records, were “potentially harmful or, at least, extremely dangerous to Mrs. Schiavo’s health and welfare” because of the risk of aspiration.
  4. The only evidence for an eating disorder was the initial low serum potassium, which could have resulted from the fluid load and epinephrine administered during her resuscitation.
  5. The autopsy showed no signs of remote trauma to neck structures, but with 15 years delay, “even bony anomalies would have likely resolved.” External signs of trauma should have been apparent on her hospital admission just after her collapse. “Subtle trauma related to commotio cordis or nontraumatic asphyxia is also possible,” as are “drugs/toxins not typically detected by hospital toxicologic screening.”
  6. Severe, irreversible brain damage that left that organ discolored and scarred, shriveled to half its normal size, and damaged in nearly all its regions, including the one responsible for vision.
  7. Brain damage "was irreversible . . . no amount of treatment or rehabilitation would have reversed" it.

Similar cases

  • Nancy Cruzan. An American woman left in allegedly vegetative state after a car accident.
  • Sue Rodriguez. A Canadian woman with a terminal illness who desired an assisted suicide.
  • Spiro Nikolouzos. An American whose life support the hospital wished to end. His family fought this, claiming that the hospital wished to end his life purely because his Medicare coverage was running out. Under the Texas Futile Care Law, the Texas hospital could legally override the will of a family if given approval by an ethics committee.
  • Haleigh Poutre. An American child beaten into a coma by a foster parent whom the Commonwealth of Massachusetts is attempting to remove from life support. [2]
  • Jessie Ramirez. An American man who suffered severe head trauma during a car accident, and was diagnosed as being a Persistent Vegetative State. Based on this diagnosis, his wife requested that life support be removed only 1 week after the accident. His parents fought to keep him on life support despite his wife's interference and an Arizona judge ordered his feeding tube replaced. He recovered 3 weeks after the accident. [3]

References

  1. With His Wife in Limbo, Husband Can't Move, N.Y. Times, Nov. 2, 2003 §1, at 18.
  2. http://news.bbc.co.uk/2/hi/americas/4511511.stm
  3. http://cornellsun.com/node/23962
  4. http://www.personal.psu.edu/glm7/m211.htm
  5. http://abstractappeal.com/schiavo/WolfsonReport.pdf
  6. http://www.lifesite.net/ldn/2005/mar/05032402.html
  7. http://www.sptimes.com/2005/03/26/Tampabay/She_s_the_other_woman.shtml]
  8. http://www.uniformlaws.org/shared/docs/health%20care%20decisions/uhcda_final_93.pdf
  9. Bush v. Schiavo, 885 So. 2d 321 (Fla. 2004).
  10. Schiavo I, 780 So. 2d at 177 (Fla. 2001).
  11. http://www.newsmax.com/archives/articles/2003/9/22/165543.shtml
  12. Bush v. Schiavo, 885 So. 2d 321 (Fla. 2004).
  13. http://www.aapsonline.org/nod/newsofday186.htm
  14. http://fl1.findlaw.com/news.findlaw.com/hdocs/docs/schiavo/61305autopsyrpt.pdf

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