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For a copy of Terri Schiavo's autopsy report, look here.

For updates regarding the autopsy report, check the Abstract Appeal Home Page.



Info Page Last Updated May 1, 2005






THE TERRI SCHIAVO INFORMATION PAGE

As a Florida law blogger, I have created this page to help people understand the legal circumstances surrounding the Terri Schiavo saga. In my view, there continues to be a need for an objective look at the matter. There is an unbelievable amount of misinformation being circulated.

To be clear at the outset, I have no interest in taking any "side" in this dispute. Remarkably, I've been accused of being biased in favor of each side at one point or another. I'm not. I have never met, spoken with, or even seen anyone in the Schiavo or Schindler families. I use first names on this web log simply for convenience, and my interest is simply as someone who enjoys Florida law and wishes to add some clarity to the events here. Pick a given month's archives (linked on the right) since I started this web log and you'll see what I mean.

Finally, and without unnecessary elaboration, I’ll point out that I sympathize with everyone involved. The circumstances here are tragic.



INFORMATION PAGE CONTENTS (LINKS)

Initial Thoughts
Overview
Rough Timeline and Decisions
Questions & Answers
More Information




INITIAL THOUGHTS

Before delving into the details of this case, I have two overarching sets of thoughts to share.

The first concerns a perception. Over the past 18 months, I suppose I've received thousands of emails concerning the Schiavo case. I've also read various message boards, and I've caught various talk radio and television news discussions, all discussing this case. One thing I've observed repeatedly is a sense of complete bewilderment by the public. How can this be happening, they say. This all just doesn't make any sense, they say. What are the Florida courts thinking, they say.

I have a simple suggestion to anyone whose information about this case just leaves them befuddled about how "this" could be happening or how everyone involved could be ignoring or overlooking "so much":

Keep looking for more information.

The facts of this case are terribly sad, but they are not hard to understand. There's really nothing to be confused about, and as best I can tell, nothing's been overlooked by anyone. Terri's situation has arguably received more judicial attention, more medical attention, more executive attention, and more "due process," than any other guardianship case in history. Terri's family has had the benefit of excellent legal representation as well as the Governor's own top-notch attorneys, all of whom have scoured the case for ways to assist the effort to keep Terri's feeding tube in place.


My second thought concerns the nature of trials. As you probably know (or will learn if you read the material below), Judge Greer held a full trial in this case to determine how Terri would choose to exercise her privacy rights. Michael was on one side; Terri's parents were on the other. Both sides brought witnesses and experts. In the end, the judge ruled that Terri would not wish to continue receiving nurishment and hydration through a surgically implanted tube.

Trials like this, where someone's life may literally be on the line, are held every day in courtrooms across the state and around the country. Most involve crimes, but not all. In every case, lawyers marshal witnesses, present evidence, and make arguments to further their clients' interests. The decisions made by the judge or jury may affect whether someone lives or dies, whether someone spends his or her life in prison, or whether someone will have to pay another debilitating sums of money.

Whether as a party, a witness, or a juror, those who have the opportunity to participate in trials should take their roles seriously, offering their best efforts to further the search for truth. At the same time, the public should realize that once a trial is over, the decision is made, and it was made based on the evidence. Appeals are almost always available, but if the judgment is affirmed, only very rarely will there be an opportunity to get a new decision based on evidence not previously presented.


OVERVIEW

In updating this page recently, I decided to include a summary about the case's events. After some efforts, it occurred to me that I should simply reproduce an email and my response that I recently blogged. They seem to make for a good summary. Here's the email:

Hi Matt,

I stumbled across your site and quickly became immersed. I have been an avid follower of Terri Schiavo as I feel quite passionately about the case as explained in the letter I wrote to the Rocky Mountain News which was recently published (see below). So far, no amount of legal jargon has been able to quench my desperate desire to understand this case. I have been searching for answers for so very long, that I felt some sense of relief when finding your site. I would really love to hear your opinion as to whether or not there is any hope whatsoever to save Terri at this point, or is this it? Thank you so much in advance for your time and for listening. And also, for this site. Have a great day!
I left the reader's attached letter out. Here was my response:

Thanks for the kind words and the sincere thoughts.

This is a very tough situation for all involved -- and mind you I'm not at all involved. I just discuss the case as part of what seems to be my running commentary on Florida law.

I appreciate that you wish to understand more. Ultimately, Terri's case is understandable, though painfully so. If you take away the "evil" allegations that have been leveled against everyone, it's easy to see what you're left with.

You're left with a woman who suffered a heart attack 15 years ago, who essentially died but was resuscitated, though not entirely. Her brain had suffered enormous damage from the heart attack. As time passed, her brain further deteriorated -- to the point where much if not most of her cerebral cortex (the portion of the brain that controls conscious thought, among other things) was literally gone, replaced by spinal fluid. Doctors hired by Terri's husband say the deterioration of Terri's brain left her without thoughts or feelings, that the damage is irreversible, and that Terri's life-like appearance is merely the result of brain stem activity -- basically involuntary reflexes we all have. An independent doctor hired by the court reached the same conclusions. Doctors hired by Terri's parents did not dispute the physical damage done to Terri, but they claim there are new therapies that could improve her condition. In two separate trials, the trial court found such claims of potential improvement to be without merit. Terri's body continues to function without her cerebral cortex. She is sustained by a feeding tube surgically inserted into her stomach. She cannot eat through her mouth without a strong likelihood of choking to death.

You're left with a husband who lived with his in-laws following Terri's heart attack, who apparently provided care and therapy for years but who later came to believe Terri would never recover. He believes she would not have wanted to be kept alive in this brain-degenerated condition by a surgically implanted tube. He is apparently willing to continue his fight to achieve what he believes Terri would want despite ridicule, hatred, expense, and threats.

You're left with parents who were once allied with Terri's husband in an effort to care for Terri and restore her but, unlike Terri's husband, they never lost hope. They believe Terri reacts to them and has conscious thoughts. They believe Terri would not want, and does not want, her feeding tube removed, and that some cognitive function could be restored through new therapies. Terri's parents are willing to continue their fight to achieve what they believe Terri would want despite ridicule, hatred, expense, and threats.

You're left with judges who have been placed in the utterly thankless position of applying Florida law to this impassioned situation. Florida law calls for the trial court to determine what Terri would choose to do in this situation, and after a trial hard fought by Terri's husband and her family, where each side was given the opportunity to present its best case about what Terri would do, the court determined the evidence was clear and convincing that Terri would choose not to continue living by the affirmative intervention of modern medicine -- that she would choose to have her feeding tube disconnected. In a second trial, brought about by Terri's family's claims new therapies could restore her and that the existence of such a therapy would make her "change her mind," the trial court again heard evidence from all sides and determined that no new therapy presented any reasonable chance of restoring Terri's brain function. The propriety of these decisions -- from the sufficiency of the evidence to the appropriateness of the procedures used -- has been unanimously upheld on appeal each time.

You're left with a public that is much confused. Some see video clips of Terri moving, appearing to make eye contact, and making sounds, and they assume such are the product of conscious thought -- that Terri's "in there." Some believe Terri's husband has been motivated by money. Some believe that no heart attack occurred -- instead, Terri's husband beat her nearly to death and has been trying to end her life ever since. Some believe he is a bad person because he has taken up with another woman and has children with her. Some believe Florida's judiciary is corrupt or inept, to the point where death threats have been made against the trial judge. Some are sad that families would fight like this. Some believe that removing Terri's feeding tube would cause her pain and is inhumane (I'm no doctor, but the medical information I've seen on this subject uniformly says the opposite.) Some are disappointed that the law does not allow someone in Terri's condition to be kept alive perpetually if a family member is willing to care for him or her. Some believe no life should be permitted to reach an unnecessary end unless irrefutable proof, or at least written proof, shows the person wanted things that way.

All of these positions are understandable in some sense, though if you've read my posts over the years you know I am particularly sensitive to the judiciary's position of following the law correctly and yet being so horrifically misunderstood by many.

Is there hope? Well, if you mean hope to keep Terri alive any longer, there is some. Terri's family continues to launch new legal battles, and to appeal old ones, in hopes a court somewhere will give them another chance to prove Terri would not want to discontinue her feeding tube, or in hopes they can win the authority to care for Terri themselves. There is a new legislative measure under consideration that could prove to be a repeat of 2003's "Terri's Law." How long can these efforts forestall the tube's removal? Can they stop it altogether? I can't say. But I don't think anyone with knowledge of how the legal system works would have foreseen several years ago that Terri would be with us in 2005, yet here she is.

I continue to hope that when this saga ends it will be the ending that Terri would have wanted.


ROUGH TIMELINE AND DECISIONS

I encourage anyone interested in this case to read the judicial decisions that have been entered. Most informative, from a factual point of view, are Judge Greer's orders and the Second District's decisions. The December 2003 guardian ad litem report to Governor Bush provides perhaps the most detailed factual chronology available.

December 1963… Terri's birth date
November 1984… Terri & Michael marry
February 1990…Terri suffers cardiac arrest and a severe loss of oxygen to her brain
May 1990…Terri leaves hospital and is brought to a rehabiliation center for aggressive therapy
July 1990…Terri is brought to the home where her husband and parents live; after a few weeks, she is brought back to the rehabilitation center
November 1990…Terri is taken to California for experimental therapies
January 1991…Terri is returned to Florida and placed at a rehabilitation center in Brandon
July 1991…Terri is transfered to a skilled nursing facility where she receives aggressive physical therapy and speech therapy
May 1992…Michael and the Schindlers stop living together
January 1993…Michael recovers $1 million settlement for medical malpractice claim involving Terri's care; jury had ruled in Michael's favor on allegations Terri's doctors failed to diagnose her bulimia, which led to her heart failure; case settled while on appeal
March 1994…Terri is transferred to a Largo nursing home
May 1998…Michael files petition for court to determine whether Terri's feeding tube should be removed; Michael takes position that Terri would choose to remove the tube; Terri's parents take position that Terri would choose not to remove the tube
February 2000…Following trial, Judge Greer rules that clear and convincing evidence shows Terri would choose not to receive life-prolonging medical care under her current circumstances (i.e., that she would choose to have the tube removed) [READ]
March 2000…Judge Greer denies petition for more swallowing tests, finds it uncontested Terri cannot swallow sufficiently to live [READ]
April 2000…Terri is transferred to a Hospice facility
January 2001…Second District Court of Appeal affirms the trial court's decision regarding Terri's wishes [READ]
April 23, 2001…Florida Supreme Court denies review of the Second District's decision [READ]
April 23 or 24, 2001…Trial court orders feeding tube removed
April 24, 2001…Terri's feeding tube is removed for the first time
April 26, 2001…Terri's parents file motion asserting they have new evidence regarding Terri's wishes
April 26, 2001…Trial court denies Terri's parents' motion as untimely
April 26, 2001…Terri's parents file new legal action against Michael Schiavo and request that the removal of Terri's feeding tube be enjoined; the case is randomly assigned to Judge Quesada
April 26, 2001…Judge Quesada grants the temporary injunction, orders Terri's feeding tube restored
July 2001…Second District rules that Judge Greer erred in denying the motion alleging new evidence and, in essence, orders the trial court to consider whether new circumstances make enforcement of the original order inequitable; Second District also reverses the temporary injunction and orders dismissal of much of the new action filed before Judge Quesada [READ]
(uncertain)…Terri's parents detail their reasons why enforcement is inequitable: (1) new witnesses have new information regarding Terri's wishes, and (2) new medical treatment could sufficiently restore Terri's cognitive functioning such that Terri would decide that, under those circumstances, she would continue life-prolonging measures; Terri's parents also move to disqualify Judge Greer
(uncertain)…Trial court denies both motions as insufficient
October 2001…Second District affirms the denial of the motion to disqualify and the motion regarding the new witnesses; the appellate court reverses the order with regard to potential new medical treatments and orders a trial on that question with doctors testifying for both sides and a court-appointed independent doctor [READ]
March 2002…Florida Supreme Court denies review of the Second District's decision [READ]
October 2002…Judge Greer holds a trial on the new medical treatment issue, hearing from doctors for both sides and a court-appointed independent doctor; Terri's parents also assert that Terri is not in a persistent vegetative state
Schindlers file emergency motion for relief from judgment based on a 1991 bone scan report indicating Terri's body had previously been subjected to trauma
November 22, 2002…Following trial, Judge Greer denies Schindlers' motion for relief (new medical evidence motion), rules that no new treatment offers sufficient promise of improving Terri's cognitive functioning and that Terri is, in fact, in a persistent vegetative state [READ]
November 22, 2002…On this same day, Judge Greer denies Schindlers' emergency motion related to the 1991 bone scan [READ]
June 2003…Second District affirms the trial court's decision denying Schindlers' motion for relief from judgment [READ]
August 22, 2003…Florida Supreme Court denies review of the Second District's decision [READ]
August 30, 2003…Terri's parents file federal action challenging Florida's laws on life-prolonging procedures as unconstitutional
September 17, 2003…Judge Greer denies Schindlers' motion to provide additional therapy, finding it an effort to retry the issues that were previously tried [READ]
October 10, 2003…Federal court dismisses Schindlers' case
October 15, 2003…Terri's feeding tube is removed for the second time
October 20, 2003…Florida House passes a bill to permit the Governor to issue a stay in cases like Terri's and restore her feeding tube
October 21, 2003…Federal court rejects injunction request
October 21, 2003…Florida House and Senate pass a bill known informally as "Terri's Law" to permit the Governor to issue a stay in cases like Terri's and restore her feeding tube [READ]; Governor signs the bill into law and immediately orders a stay; Terri is briefly hospitalized while her feeding tube is restored
October 21, 2003…Michael brings suit against the Governor, asking to enjoin the Governor's stay on grounds "Terri's Law" is unconstitutional; Judge Baird rejects Michael's request for an immediate injunction, allowing the tube to be restored, and requests briefs on the constitutional arguments involving the new law
November 7, 2003…Judge Baird rejects Governor's motion to dismiss Michael's suit and have case litigated in Tallahassee
November 20, 2003…Judge Baird rejects Governor's request for the judge to recuse himself
December 1, 2003…Guardian ad litem appointed under "Terri's Law" to advise Governor submits report to Governor [READ]
December 10, 2003…Second District rejects Governor's effort to have Judge Baird disqualified
April 2004…Second District affirms Judge Baird's decision denying Governor's motion to dismiss and have case litigated in Tallahassee [READ]
May 2004…Judge Baird declares "Terri's Law" unconstitutional on numerous grounds [READ]
June 2004…Second District certifies "Terri's Law" case directly to the Florida Supreme Court
July 2004…Schindlers file new motion for relief from judgment based on Pope John Paul II speech
September 2004…Florida Supreme Court affirms Judge Baird's ruling that "Terri's Law" is unconstitutional [READ]
October 2004…Judge Greer denies Schindlers' most recent motion for relief from judgment (motion based on Pope John Paul II speech) [READ]
December 1, 2004…Governor asks U.S. Supreme Court to review Florida Supreme Court's decision declaring "Terri's Law" unconstitutional
December 29, 2004…Second District affirms (without written opinion) Judge Greer's ruling denying Schindlers' most recent motion for relief from judgment
January 6, 2005…Schindlers file new motion for relief from judgment, alleging Terri never had her own attorney, that the trial court impermissibly applied the law retroactively, and that the original trial on Terri's wishes violated separation of powers principles
January 24, 2005…U.S. Supreme Court declines review in "Terri's Law" case
February 11, 2005…Judge Greer denies Schindlers' latest motion for relief from judgment (motion raising various due process challenges) [READ]
February 23, 2005…Florida's Department of Children and Families asks to intervene and for 60-day stay to permit investigation of alleged abuse [READ]
February 23, 2005…Schindlers file motion requesting new tests to determine Terri's status [READ]
February 25, 2005…Judge Greer rules motions appear endless, he will grant no further stays; sets March 18 date for removal of feeding tube [READ]
February 28, 2005…Schindlers file motion requesting that Terri be fed orally [READ]
March 2, 2005…Schindlers file new motion for relief from judgment, arguing factual error in original judgment [READ]
March 8, 2005…Judge Greer denies Schindlers' motion to feed Terri orally [READ]
March 9, 2005…Judge Greer denies Schindlers' motion requesting new tests [READ]
March 9, 2005…Judge Greer denies Schindlers' most recent motion for relief from judgment (motion based on factual error) [READ]
March 10, 2005…Judge Greer denies Department of Children and Families request to intervene and for stay, finds agency is free to investigate [READ]
March 16, 2005…Second District affirms Judge Greer's denial of Schindlers' motion raising various due process challenges, emphasizes law has been followed in this case [READ]
March 18, 2005…Schindlers file new federal action arguing due process violations in original trial; case assigned to Judge Moody [READ]
March 18, 2005…Judge Moody denies new federal claim, citing lack of jurisdiction [READ]
March 18, 2005…Congressional committee issues subpoenas for Michael, Terri, and Terri's caregivers to appear at hearing to be held at the hospice where Terri has stayed [READ]
March 18, 2005…Congressional committee files motion to intervene and modify order requiring the removal of Terri's feeding tube
March 18, 2005…Judge Greer denies congressional committee motion, ruling no grounds exist for intervention
March 18, 2005…Congressional committee requests Florida Supreme Court and Second District stay the feeding tube's removal [READ]
March 18, 2005…Terri's feeding tube removed for the third time
March 18, 2005…Florida Supreme Court denies congressional committee request, citing lack of jurisdiction [READ]
March 18, 2005…Second District denies congressional committee request as without merit
March 21, 2005…Congress enacts Terri's Law II, authorizing Terri's parents to seek federal court review of whether Terri's federal rights have been protected [READ]
March 21, 2005…Schindlers file new action in federal court based on new law, claiming Terri's federal rights have been violated [READ]
March 22, 2005…Judge Whittemore denies Schindlers' request to have Terri's feeding tube reinserted, finding no substantial likelihood the Schindlers will succeed with their claims [READ]
March 22, 2005…Schindlers file amended complaint in federal court, adding five new claims [READ]
March 23, 2005…In a 2-1 decision, Eleventh Circuit affirms Judge Whittemore's decision not to restore Terri's feeding tube [READ]
March 23, 2005…Eleventh Circuit denies the Schindlers' motion for the entire court to rehear the panel's decision; two judges dissent [READ]
March 23, 2005…Florida Senate rejects an effort to create a statute prohibiting the removal of feeding tubes except to comply with written instructions from the patient
March 23, 2005…Department of Children & Families petitions for intervention, to stay the tube's removal, based on alleged abuse [READ]
March 23, 2005…Schindlers file stay request with the U.S. Supreme Court regarding the Eleventh Circuit's decision [READ]
March 24, 2005…U.S. Supreme Court denies Schindlers' request [READ]
March 24, 2005…Judge Greer denies petition for intervention by the Department of Children & Families
March 25, 2005…Judge Whittemore denies renewed request to have Terri's feeding tube reinserted [READ]
March 25, 2005…Schindlers file final motion with Judge Greer for relief from judgment, alleging Terri tried to speak just before her feeding tube was removed [READ]
March 26, 2005…Judge Greer denies Schindlers' final motion for relief from judgment [READ]
March 26, 2005…Schindlers file petition asking the Florida Supreme Court to order the tube reinserted [READ]
March 26, 2005…Florida Supreme Court denies petition for lack of jurisdiction [READ]
March 30, 2005…Eleventh Circuit unanimously affirms Judge Whittemore's denial of Schindlers' renewed request to have Terri's feeding tube reinserted [READ]
March 30, 2005…Eleventh Circuit again denies the Schindlers' motion for rehearing by the entire court; three judges write concurrences, two dissent [READ]
March 30, 2005…U.S. Supreme Court again denies the Schindlers' motion to stay [READ]
March 31, 2005…Terri passes





QUESTIONS AND ANSWERS

What follows are some questions about the history of the Terri Schiavo case as well as the best answers known to me. My focus on this case has always been from a legal perspective, though I've recently updated this section to address some questions I am repeatedly asked. In each answer, I try to indicate my source.


What happened to Terri?

The Second District's opinion in the first appeal in this case explains:

On February 25, 1990, . . . Theresa, age 27, suffered a cardiac arrest as a result of a potassium imbalance. Michael called 911, and Theresa was rushed to the hospital. She never regained consciousness.

I've heard Michael beat or strangled her nearly to death and that he wants her to die to cover up his abuse. What really happened?

I do not know this family and will not comment on whether any abuse occurred. I can, however, look to the case's history and point out some items that might be relevant to anyone considering this issue.

First, "Terri's Law" required the chief judge of the local circuit court to appoint a guardian ad litem (GAL) to examine Terri's case and advise the Governor. The chief judge appointed Dr. Jay Wolfson from the University of South Florida. Dr. Wolfson's December 2003 report to Governor Bush included this bit of factual history:

The cause of the cardiac arrest was adduced to a dramatically reduced potassium level in Theresa's body. Sodium and potassium maintain a vital, chemical balance in the human body that helps define the electrolyte levels. The cause of the imbalance was not clearly identified, but may be linked, in theory, to her drinking 10-15 glasses of iced tea each day. While no formal proof emerged, the medical records note that the combination of [Theresa's] aggressive weight loss, diet control and excessive hydration raised questions about Theresa from Bulimia, an eating disorder, more common among women than men, in which purging through vomiting, laxatives and other methods of diet control become obsessive.
Also relevant to questions about the cause of Terri's collapse is the lawsuit that Michael brought on Terri's behalf against Terri's doctors. The premise of that early 1990s lawsuit was that the doctors committed malpractice by failing to diagnose Terri's bulimia and that her bulimia led to her cardiac arrest. The case was tried to a jury, which ruled in Michael's favor, finding that Terri had bulimia, that her bulimia caused her cardiac arrest, and that the doctors were negligent in failing to diagnose the situation. The verdict was appealed, and before the appellate court could rule, the parties settled, with Michael recovering approximately $750,000 for Terri and $300,000 for himself.

After this case gained national attention in 2003, Gary Fox, the lawyer who represented Terri and Michael in that suit, wrote a stirring column concerning Terri's bulimia and how the tragic effects of that disease have been lost in the hoopla surrounding this case. The St. Pete Times still has that column online, and you can read it here.

The significance of the medical malpractice lawsuit can be seen in a few ways. A jury agreed that bulimia caused Terri's collapse. The defendants were her doctors -- one might think that they, of all people, would have been able to show that Terri had been beaten or strangled if that was what had occurred. Also, to believe that Michael caused Terri's collapse by beating her is to believe that Michael initiated a lawsuit against someone else for causing her collapse, opening the whole matter to serious inquiry and greatly increasing the risk that someone would discover his role.

Finally, I am not aware that anyone -- not the paramedics, doctors, nurses, family members, friends, or anyone else -- who saw Terri in the hours, weeks, and months after her collapse ever suggested at the time that Terri had been beaten or strangled.

As I said above, I am not commenting on whether any abuse actually occurred. I don't know.


But isn't there a bone scan that shows Terri was beaten?

I honestly don't know. What I understand is that a bone scan was taken in 1991 and that the doctor who read it saw on it evidence of past trauma at various places on Terri's body. Some consider that evidence of a severe beating by her husband, others consider it evidence consistent with bulimia, a fall, and CPR by paramedics. Whether trauma really happened, or what kind, or when, are all unclear.

The bone scan was not raised in the original trial regarding Terri's wishes. The issue was raised by the Schindlers in a November 2002 emergency motion. Judge Greer rejected the matter as being irrelevant to the issue of Terri's wishes. See the order linked in the timeline above.


What's happened to Terri since her collapse?

The Second District's first opinion in this case explained:

Since 1990, Theresa has lived in nursing homes with constant care. She is fed and hydrated by tubes. The staff changes her diapers regularly. She has had numerous health problems, but none have been life threatening.

Over the span of this last decade, Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Theresa will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs.
In a later opinion in the same case, the Second District further explained:

Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.

Did she have a living will?

No. If she had, this case would probably never have generated much controversy. The one sure lesson to be taken from all of this is that each of us should have a living will. Florida law permits living wills and defines how and when they may be effective.


Terri is given food and water through tubes. Is disconnecting a feeding tube the same as ending life support?

Yes, under Florida law, which governs the ability of each person to determine, or to appoint someone to determine, whether each of us should receive what the Legislature terms "life-prolonging medical procedures." The Legislature has explained:

The Legislature recognizes that for some the administration of life-prolonging medical procedures may result in only a precarious and burdensome existence. In order to ensure that the rights and intentions of a person may be respected even after he or she is no longer able to participate actively in decisions concerning himself or herself, and to encourage communication among such patient, his or her family, and his or her physician, the Legislature declares that the laws of this state recognize the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures, or to designate another to make the treatment decision for him or her in the event that such person should become incapacitated and unable to personally direct his or her medical care.
§ 765.102(3), Florida Statutes.

The Legislature has also defined what is a "life-prolonging procedure":

"Life-prolonging procedure" means any medical procedure, treatment, or intervention, including artificially provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term does not include the administration of medication or performance of medical procedure, when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain.
§ 765.101(10), Florida Statutes (italics added by me).



Why did Terri’s husband get to make the decision about whether she should live or die?

Michael Schiavo did not make the decision to discontinue life-prolonging measures for Terri.

As Terri's husband, Michael has been her guardian and her surrogate decision-maker. By 1998, though -- eight years after the trauma that produced Terri's situation -- Michael and Terri's parents disagreed over the proper course for her.

Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate such as Michael can petition a court, asking the court to act as the ward's surrogate and determine what the ward would decide to do. Michael did this, and based on statements Terri made to him and others, he took the position that Terri would not wish to continue life-prolonging measures. The Schindlers took the position that Terri would continue life-prolonging measures. Under this procedure, the trial court becomes the surrogate decision-maker, and that is what happened in this case.

The trial court in this case held a trial on the dispute. Both sides were given opportunities to present their views and the evidence supporting those views. Afterwards, the trial court determined that, even applying the "clear and convincing evidence" standard -- the highest burden of proof used in civil cases -- the evidence showed that Terri would not wish to continue life-prolonging measures.



Why didn’t the court appoint a guardian other than Terri’s husband to speak for her?

The trial judge could have utilized a guardian ad litem as a neutral party to speak for Terri, but in the end the trial judge did not do so. The Second District affirmed this decision and explained its rationale in this way:

Under these circumstances, the two parties, as adversaries, present their evidence to the trial court. The trial court determines whether the evidence is sufficient to allow it to make the decision for the ward to discontinue life support. In this context, the trial court essentially serves as the ward's guardian. Although we do not rule out the occasional need for a guardian in this type of proceeding, a guardian ad litem would tend to duplicate the function of the judge, would add little of value to this process, and might cause the process to be influenced by hearsay or matters outside the record. Accordingly, we affirm the trial court's discretionary decision in this case to proceed without a guardian ad litem.


Why didn’t Terri’s parents get a chance to prove that Terri wouldn’t want her feeding tube to be removed?

They did. As explained above, the trial judge held a trial on this issue and determined that the evidence clearly and convincingly showed that Terri would not want to continue life-prolonging measures in her current state.



Can't the parents appeal the trial judge's decision, and shouldn't conflicting evidence be judged in favor of continuing life?

The Schindlers did appeal, and the Second District determined that while a surrogate decision-maker should err on the side of life, the trial judge had sufficiently clear and convincing evidence to determine that Terri would not wish to continue the life-prolonging measures she needs to live. The appellate court explained:

[T]he Schindlers argue that the testimony, which was conflicting, was insufficient to support the trial court's decision by clear and convincing evidence. We have reviewed that testimony and conclude that the trial court had sufficient evidence to make this decision. The clear and convincing standard of proof, while very high, permits a decision in the face of inconsistent or conflicting evidence. See In re Guardianship of Browning, 543 So. 2d at 273.

In Browning, we stated:

In making this difficult decision, a surrogate decisionmaker should err on the side of life… In cases of doubt, we must assume that a patient would choose to defend life in exercising his or her right of privacy.
In re Guardianship of Browning, 543 So.2d at 273. We reconfirm today that a court's default position must favor life.

The testimony in this case establishes that Theresa was very young and very healthy when this tragedy struck. Like many young people without children, she had not prepared a will, much less a living will. She had been raised in the Catholic faith, but did not regularly attend mass or have a religious advisor who could assist the court in weighing her religious attitudes about life-support methods. Her statements to her friends and family about the dying process were few and they were oral. Nevertheless, those statements, along with other evidence about Theresa, gave the trial court a sufficient basis to make this decision for her.

In the final analysis, the difficult question that faced the trial court was whether Theresa Marie Schindler Schiavo, not after a few weeks in a coma, but after ten years in a persistent vegetative state that has robbed her of most of her cerebrum and all but the most instinctive of neurological functions, with no hope of a medical cure but with sufficient money and strength of body to live indefinitely, would choose to continue the constant nursing care and the supporting tubes in hopes that a miracle would somehow recreate her missing brain tissue, or whether she would wish to permit a natural death process to take its course and for her family members and loved ones to be free to continue their lives. After due consideration, we conclude that the trial judge had clear and convincing evidence to answer this question as he did.


Was Michael the only person who testified about Terri's supposed statements on her views about living on life support?

No, others did as well, and when making the decision in the case, the trial judge took into account all of that testimony and additional evidence. As the Second District explained:

We note that the guardianship court's original order expressly relied upon and found credible the testimony of witnesses other than Mr. Schiavo or the Schindlers. We recognize that Mrs. Schiavo's earlier oral statements were important evidence when deciding whether she would choose in February 2000 to withdraw life-prolonging procedures. See § 765.401(3), Fla. Stat. (2000); In re Guardianship of Browning, 568 So. 2d 4, 16. Nevertheless, the trial judge, acting as her proxy, also properly considered evidence of Mrs. Schiavo's values, personality, and her own decision-making process.


Did the trial judge reach the right decision?

The "right" decision would be whatever decision Terri would make. I did not attend the trial, and I have not even reviewed the trial record. I do not pretend to know what the "right" decision would be.


Why has this case become such a controversy?

This case has become such a controversy because of Terri's parents' insistence that their daughter would not wish to die under these circumstances and their claim that Terri is conscious and responsive to stimulation.

The case has also become controversial because, for years, Terri's parents have publicly questioned Michael's motives for wanting to discontinue Terri's life support. Specifically, they have charged that Michael remains Terri's husband and is working to end her life so he can inherit whatever money remains from a $1 million 1993 medical malpractice settlement Michael recovered on behalf of himself and Terri. Presumably, if Michael divorced Terri, then he would not have access to Terri's portion of the money, and upon her death her parents would inherit it. News reports also indicate that Michael is engaged to another woman.


Is Michael really just looking for money?

I have no way to know. I know what the Schindlers say to reporters, but then I know that the Second District's first decision in the case used these words to describe Michael's care for Terri:

Theresa has been blessed with loving parents and a loving husband. Many patients in this condition would have been abandoned by friends and family within the first year. Michael has continued to care for her and to visit her all these years. He has never divorced her. He has become a professional respiratory therapist and works in a nearby hospital. As a guardian, he has always attempted to provide optimum treatment for his wife. He has been a diligent watch guard of Theresa's care, never hesitating to annoy the nursing staff in order to assure that she receives the proper treatment.
Recently, Michael received an offer of $1 million, and perhaps a second offer of $10 million, to walk away from this case and permit Terri's parents to care for her. These offers, assuming there were two, were based on a misunderstanding of the situation here. Michael lacks the power to undo the court order determining Terri's wishes and requiring the removal of her feeding tube. He did not make the decision and cannot unmake it. The court made the decision on Terri's behalf. Nonetheless, Michael apparently rejected each offer.


What about the Schindlers' claims that Terri is conscious and responds to stimulation?

When the Second District first reviewed the trial court's decision that Terri would choose not to live under her present circumstances, the appellate court expressed no reservations when it explained that Terri was and "will always remain in an unconscious, reflexive state, totally dependent upon others…" In October, 2002, as a result of Terri's parents' claims that treatment options offered promise to restore some of Terri's cognitive functioning, the Second District ordered the trial court to hold a trial on that issue. The trial court did so, and in the course of that trial the parties litigated whether Terri is in a persistent vegetative state.

The trial court heard testimony from five experts: two selected by Michael, two selected by the Schindlers, and one independent expert selected by the trial court. The two experts selected by Michael and the independent expert agreed that Terri was in a persistent vegetative state and that her actions were limited to mere reflexes. The two experts chosen by the Schindlers disagreed, but the trial court found their positions not credible. For instance, the trial court explained:

At first blush, the video of Terry Schiavo appearing to smile and look lovingly at her mother seemed to represent cognition. This was also true for how she followed the Mickey Mouse balloon held by her father. The court has carefully viewed the videotapes as requested by counsel and does find that these actions were neither consistent nor reproducible. For instance, Terry Schiavo appeared to have the same look on her face when Dr. Cranford rubbed her neck. Dr. Greer testified she had a smile during his (non-videoed) examination. Also, Mr. Schindler tried several more times to have her eyes follow the Mickey Mouse balloon but without success. Also, she clearly does not consistently respond to her mother. The court finds that based on the credible evidence, cognitive function would manifest itself in a constant response to stimuli.
The experts also disagreed about whether any treatment could improve Terri's condition. The two experts selected by the Schindlers each proposed a potential therapy method, but the trial court rejected both of them based on "the total absence of supporting case studies or medical literature."

Affirming those decisions, the Second District explained that it, too, reviewed the videotapes of Terri in their entirety as well as Terri's brain scans. The appellate court explained that it not only affirmed the decision but that, were it to review the evidence and make its own decision, the court would reach the same result reached by the trial court.


Were the Schindlers' doctors given an opportunity to examine Terri?

Yes. As the Second District explained:

Through the assistance of Mrs. Schiavo's treating physician, Dr. Victor Gambone, the physicians obtained current medical information about Theresa Schiavo including high-quality brain scans. Each physician reviewed her medical records and personally conducted a neurological examination of Mrs. Schiavo. Lengthy videotapes of some of the medical examinations were created and introduced into evidence. Thus, the quality of the evidence presented to the guardianship court was very high, and each side had ample opportunity to present detailed medical evidence, all of which was subjected to thorough cross-examination. It is likely that no guardianship court has ever received as much high-quality medical evidence in such a proceeding.
What about the video clips that show Terri reacting to her mother?

The court opinions indicate that similar videos were viewed in their entirety by the trial court, which found that Terri's actions were no more than reflexive and could not be reproduced with any consistency. The Second District affirmed that decision.





MORE INFORMATION

I have been following this case since I started the Abstract Appeal web log, and I have consistently posted thoughts and updates on the saga on the blog's main page. To help anyone interested in reviewing those posts together, I have created the following additional pages on this site:

Collection of Abstract Appeal's 2003 Schiavo-related Posts

Collection of Abstract Appeal's 2004 Schiavo-related Posts

Collection of Abstract Appeal's 2005 Schiavo-related Posts

Links To Popular Posts Regarding the Schiavo Saga














 
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