I don't blame the parents at all for what they are doing, it's natural for them to hang on as long as they can. What bothers me are the 10,000 other people sticking their nose into it and making up wild stories about the people involved.
Also the judge in the case happens to be a personal friend of mine and all the abuse he is getting ticks me off.
Here is a good summation of the actual facts of the case:
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.
Also, though he has said little to the public about this case, Michael has stated that he believes he is fulfilling Terri's wishes and that she would not want to live like this.
"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 chose 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.
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