A Terri Schiavo FAQ

Ken AshfordAssisited Suicide/Schiavo, Courts/Law, Health CareLeave a Comment


Confused about the differing stories in the Schiavo case? Wondering about who to believe? Here’s some answers to common questions. I strongly recommend Abstract Appeal’s Terry Schiavo’s Information Page as an unbiased source of information from a Florida lawyer who has been blogging the case since mid-2003.

Why should anyone be allowed to kill Terri Schiavo?

If Terri Schiavo is "killed" by the removal of feeding tubes, then Florida law and many other state laws allow "killing", and people are "killed" by the state every day. Many people do believe that removal of nutrition is murder, which is a perfectly legitimate belief. But Terri Schiavo’s case is no different from numerous other cases of patients who are removed from artificial nutrition every year–many times at the request of guardians who stand to benefit financially from the patient’s death.

Why will Terri Schiavo be allowed to die by dehydration?

It’s not a pleasant thought, but it’s Florida law.

In 1999, in response to a Florida Supreme Court ruling, the Florida legislature updated its "end of life" statutes, which were first put into place in 1990. The House and Senate voted unanimously in support of a number of changes to the text. One of those changes added to the list of "life-prolonging procedure": including artificially provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. (Cite in Florida Supreme Court ruling, 1999 changes here.)

Governor Jeb Bush signed the bill in June of that year.

So in 1999, the entire Florida legislative and executive branch voted for a law that authorized the withdrawal of sustenance to a PVS patient at the request of an appointed guardian or a licensed social worker, in the event that no interested relative was available.

The 1999 bill wasn’t unusual in any way and is consistent with many other states–in fact, it is considered a model for state law. Withdrawing sustenance is standard procedure for PVS and comatose patients, even though they can’t speak for themselves. The St. Petersburg Times covered a few local cases that occurred in March alone.

Shouldn’t Terri Schiavo be entitled to due process?

Terri Schiavo has received far more due process than any other PVS patient in history.

Her guardian’s performance has been reviewed three times. A full trial was held to determine her end-of-life wishes, and the ruling upheld by the appellate court. A full trial was held on whether or not she was in a persistent vegetative state, and whether or not any treatment would improve her condition; the judge ruled that she was in a persistent vegetative state and that no treatment held out a reasonable hope of recovery. The appellate court reviewed all the evidence (viewing all the video footage) and stated that if it held a de novo trial it would come to the same conclusion, and upheld the ruling. The Florida Supreme Court has denied review on both trials.

The federal courts have been petitioned since 2004, and have consistently refused involvement, up to and including the Supreme Court.

Why is Michael Schiavo allowed to order the removal of his wife’s feeding tube?

Michael Schiavo didn’t order the removal of his wife’s feeding tube. From the Second District Court of Appeals decision:

In this case, however, Michael Schiavo has not been allowed to make a decision to disconnect life-support. The Schindlers have not been allowed to make a decision to maintain life-support. Each party in this case, absent their disagreement, might have been a suitable surrogate decision-maker for Theresa. Because Michael Schiavo and the Schindlers could not agree on the proper decision and the inheritance issue created the appearance of conflict, Michael Schiavo, as the guardian of Theresa, invoked the trial court’s jurisdiction to allow the trial court to serve as the surrogate decision-maker.

Judge Greer’s February 22 decision ordered Michael Schiavo to cause his wife’s feeding tube to be removed.

Michael Schiavo certainly set this process in motion by asking the court to decide what Terri would have wanted and testifying that she told him she wouldn’t want to live in these circumstances. But he is not the one making the decision. (See Abstract Appeal for another take.)

Doesn’t Michael Schiavo have a financial interest in his wife’s death?

At the time of the petition, a little over $700,000 remained in Terri Schiavo’s trust. Reports from both sides vary on the amount left, but everyone agrees that the amount is minimal, most of it spent on authorized legal expenses. Michael Schiavo had no control over the trust fund.

Moreover, guardians are usually close relatives, and often stand to benefit from the death of their ward. Judge Greer addressed this fact in his original decision, pointing out that the Schindlers had the same financial interest in removing him as ward, since the $700,000 would then come to them. They would be under no obligation to keep Terri alive once they had control. So either one of the parties could have been acting out of financial motives. Or, as is more likely the case, neither are.

Michael Schiavo offered to give the $700,000 to charity to assure the parents that he wasn’t acting out of financial motives. The parents turned it down. He has also turned down at least one offer of $1 million to turn over guardianship to Terri Schiavo’s parents (his lawyers put other offers as high as $10 million). Any suggestion that Michael Schiavo is acting out of greed seems unlikely in light of these facts. (See Abstract Appeal for another take.)

Why is Michael Schiavo denying his wife care?

Three guardians ad litem, Richard Pearse, Jay Wolfson and John Pecarek, have reported on Terri Schiavo’s care. (Pecarek’s report is not available online; Pearse’s report; Wolfson’s report)

Pecarek reviewed Michael Schiavo’s guardianship in 1994 when the Schindlers attempted to remove Terri from Schiavo’s care. Pecarek found no reason to do so. Wolfson on Pecarek’s report:

"His report, issued 1 March 1994, found no inappropriate actions and indicated that Michael had been very attentive to Theresa."

Wolfson on the guardian hearing in general:

"Proceedings concluded that there was no basis for the removal of Michael Schiavo. Further, it was determined that he had been very aggressive and attentive in the care of Theresa. His demanding concern for her well-being and meticulous care by the nursing home earned him the characterization by the administrator as ‘a nursing home administrator’s nightmare’. It is notable that through more than thirteen years after Theresa’s collapse, she has never had a bedsore."

In 1998, Pearse confirmed that Terri Schiavo was well cared for, also mentioning that she "received regular therapy."

What about Michael Schiavo’s failure to treat Terri’s urinary tract infection?

From Jay Wolfson’s report:

"…Michael, in consultation with Theresa’s treating physician, elected not to treat the infection and simultaneously imposed a ‘do not resuscitate’ order should Theresa experience cardiac arrest. When the nursing facility initiated an intervention to challenge this decision, Michael cancelled the orders. Following the incident involving the infection, Theresa was transferred to another skilled nursing facility."

"Michael’s decision not to treat was based on discussions and consultation with Theresa’s doctor, and was predicated on his reasoned believe that there was no longer any hope for Theresa’s recovery."

Recall that Michael Schiavo’s guardianship was reviewed three times after this decision not to treat, and all three reviews concluded that his care was exemplary.

Shouldn’t an MRI be done to confirm the diagnosis?

Five physicians, including one independent expert and two physicians selected by the Schindlers, examined Terri Schiavo in 2002. If an MRI had been necessary, the two Schindler physicians could have ordered one. An MRI was only requested in one of the last appeals, basing it on a new Neurology article, fMRI reveals large-scale network activation in minimally conscious patients and the 17 doctor affidavits (see below).

Judge Greer’s response categorically lists all the problems with the request. To summarize, the Neurology article involves "minimally conscious" patients, whereas Terri Schiavo is in a persistent vegetative state, the 17 doctors based their opinion on the video shorts (see below), and Terri Schiavo has implants that would have to be removed by brain surgery before an MRI could be performed.

In reading the 17 affidavits (before they were taken offline at Terri’s Fight), I noted that those who recommended an MRI said only that it "might" be helpful. Not one expressed surprise that an MRI had not been performed or asserted that this was standard medical practice.

Is there some doubt as to her diagnosis?

Her two guardians ad litem, Richard Pearse and Jay Wolfson, have said unequivocally, after hours of evaluation and discussion with medical experts, that Terri Schiavo is in a persistent vegetative state.

In 2002, the Schindlers had their chance to prove in court that Terri was not in a persistent vegetative state. While the appellate court had only ordered Judge Greer to determine if new treatment methods would work, he also chose to reaffirm the PVS diagnosis. The Schindlers chose two doctors; Michael Schiavo chose two. The judge appointed a fifth.

The independent doctor agreed with Schiavo’s two doctors that Terri Schiavo was in a persistent vegetative state. The Schindler doctors asserted that she was not. They based this finding on Terri Schiavo’s interaction with her mother, her ability to track a balloon, and so on. Judge Greer’s opinion indicates that he "carefully viewed" all the videotapes. He counted up the times that Dr. Hammesfahr (one of the Schindler doctors) gave Terri Schiavo a command (105), asked her a question (61), how many times her mother gave her a command (6), or asked a question (11). In all these cases, he observed: "The court saw few actions that could be considered responsive to either those commands or those questions. " The appellate court confirmed this by viewing the tapes again.

The two Schindler doctors proposed their own therapeutic treatment that could possibly improve Terri’s chances. They could point to no case studies documenting their success, and they agreed that current science didn’t offer much hope. In both cases, their suggested treatment plans were, to put it kindly, experimental.

In other words, when the Schindlers had their best shot to challenge Terri Schiavo’s diagnosis and rehabilitation, they offered two unproven, experimental therapies. Either they couldn’t get any better, or they wasted an important opportunity.

What about the videotape?

The videotape segments that stirred up so much attention, the ones that are on TV all the time, show Terri Schiavo talking to her mother and apparently responding. These clips were culled and edited from four hours of videotaped footage of Terri Schiavo. The judge and the appellate court viewed all the footage; see the question above for the results.

No one has challenged the statement that the clips were edited from a much longer tape, and no one has challenged Judge Greer’s assessment of the longer tape.

What about the 17 doctors who say she should be retested?

The doctors who wrote affidavits, by their own admission, have not examined Terri Schiavo and base their opinion on the short videotape. Most of them have not examined her records. Some of them are plugging their own new therapy; at least two are plugging the same therapy that the two Schindler physicians suggested and that the judge rejected as insufficient.

What about the nurse who says that Michael Schiavo tried to kill her with insulin, neglected her, and denied her all care?

Carla Iyer’s affidavit states that Terri Schiavo spoke regularly, laughed and expressed pain, that her chart comments to this effect were whited out by other staff members, that she called the Schindlers to give them progress reports that Michael forbade, that Michael Schiavo was eager for his wife to die and poisoned her with insulin, that a nurse at the facility was complicit in Schiavo’s abuse, and that she reported this activity to the police and was fired for her pains.

She came forward to report this in late 2003; the Schindlers tried to get a new trial based in part on her affidavit. Judge Greer’s response to her charges:

"Ms. Iyer details what amounts to a 15-month cover-up which would include the staff of [the] 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. Her affidavit clearly states that she would ‘call them (Mr. and Mrs. Schindler) anyway because I thought they should know about their daughter’…..Neither in the testimony nor in the medical records is there support for these affidavits as they purport to detail activities and responses of Terri Schiavo. It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had she contacted them as she alleges."

How can the judge take Michael Schiavo’s word for Terri Schiavo’s wishes?

He didn’t just take Michael Schiavo’s word for it. Judge Greer accepted Richard Pearse’s GAL recommendation that Michael Schiavo’s unsupported word would not be enough to establish clear and convincing evidence. He accepted two other witnesses (both Schiavo siblings) who recalled Terri Schiavo’s comments on the Nancy Cruzan case. Two of Terri Schiavo’s friends reported Terri’s opinion about Karen Quinlan, but the judge rejected one as not credible (testimony changed between deposition and trial) and both as irrelevant, as Terri made the observations when she was a teenager.

Judges accept a spouse’s word in these situations all the time, often with no other support.

Why did Judge Greer dismiss the GALs?

Richard Pearse, the first GAL, determined that Michael Schiavo’s "credibility is adversely affected by the obvious financial benefit to him of being the ward’s sole heir at law in the event of her death while still married to him".

Michael Schiavo asked that Pearse be dismissed for bias because he failed to mention that Schiavo had committed to donate all his inheritance to charity, or observe that the Schindlers had a similar financial bias. Jay Wolfson’s report noted that it was a "well-pleaded case for bias".

The judge discharged Mr. Pearse but did not disregard his findings. Judge Greer does mention that "Mr. Pearse readily agreed that he has feelings and viewpoints regarding the withdrawal of feeding and hydration tubes and that he did not so advise the court prior to his appointment", which suggests that Pearse had other conflicts.

He dismissed Jay Wolfson, according to Wolfson himself, because " once the Florida Supreme Court struck down Terri’s Law his efforts were moot. "

Why is Michael Schiavo still allowed to make decisions for his wife when he abused her/hasn’t been faithful to her?

Judge Greer ruled that the abuse issue was irrelevant, and there’s no definitive ruling on whether or not Michael Schiavo abused his wife. As to whether or the abuse caused Terri Schiavo’s condition, most experts think it most likely that she had a heart attack brought on by her bulimia. Matt at Abstract Appeal reminds everyone of the malpractice lawsuit:

"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."

Michael Schiavo has had relationships with other women, and is engaged to a woman with whom he had two children. However, all the investigators have uniformly praised Michael Schiavo’s care of his wife. From Judge Greer’s original opinion ruling that Terri Schiavo’s feeding tube must be removed:

"It is also interesting to note that Mr. Chiavo continues to be the most regular visitor to his wife even though he is criticized for wanting to remove her life support. Dr. Gambone even noted that close attention to detail has resulted in her excellent physical condition and that Petitioner is very involved."

So you’re on Michael Schiavo’s side?

I’m on the side of the law. The law defines a procedure. Michael Schiavo, the Schindlers, and the courts all followed that procedure. I don’t support intervention because the Schindlers and others didn’t get the outcome they wanted. I wouldn’t support Michael Schiavo if the positions were reversed.

For the record, I’m agnostic on the right to die. My public policy position is that many people clearly want the option, and the states should ensure that they have that right, while still protecting those who can’t speak for themselves. My personal position is that my family can make whatever decision they think best, should I not be able to decide for myself. I don’t know that I could ever withdraw nutrition from a loved one, and can’t imagine promising to do so.

To determine your position, I offer up a few hypotheticals:

  1. Assume all facts are the same, but Michael Schiavo and the Schindlers agree that the feeding tube should be removed.
  2. Assume all facts are the same, the Schindlers oppose the feeding tube removal, but Terri Schiavo left a detailed living will that specified she would want the feeding tube removed if she were in a persistent vegetative state.
  3. Assume that Michael Schiavo has remained completely faithful to his wife all these years, but still testifies that she told him she would want to die in these circumstances, and the Schindlers still oppose him.

If your opinion switches from opposition to support in these hypotheticals, then your opposition is based on the circumstances in this case. So ask yourself: do you really think that you know more about the case from the media coverage and court documents than the judges who actually reviewed all the evidence? It’s one thing to acknowledge that the judicial system has the occasional flaw; it’s quite another to say that over a dozen judges have actively ignored evidence that proves Michael Schiavo wants to end his wife’s life on a whim.

If you still oppose the removal of the feeding tube in these hypotheticals, then you presumably oppose all decisions of this nature. However, the courts have applied the law as it is currently written. Why not work to change the laws, rather than believe, despite all the review, that Terri Schiavo has been denied due process or is the victim of activist pro-death judges?

Congress has chosen to spend a huge amount of time intervening in one case, thus implicitly devaluing every other person who has died in these identical circumstances, and for no other reason than they don’t like the Florida court’s decision.