March 18, 2005: Terri Schiavo's Tube Removed


WHAT HAPPENED?


Terri Schiavo, after experiencing a cardiac arrest in her home in 1990, spent the rest of her life in a persistent vegetative state. Her case became a right-to-die legal case when her husband argued that she would not have wanted to live the rest of her life as she was, with no possibility to recover. He wanted to remove her feeding tube, but her parents argued in favor of keeping it, hoping that she would recover.


Though Schiavo was successfully resuscitated after her cardiac arrest, the lack of oxygen left her with permanent brain damage. Two and a half months passed with no improvement, and it was confirmed that she was in a persistent vegetative state. For the next 2 years, therapies continued including occupational, speech, physical, and other experimental therapies, but none were successful.


Her husband, Michael, began petitioning to remove her feeding tube in 1998, and her parents, Robert and Mary, opposed him. Her feeding tube was removed once in 2001, but reinserted a few days later.


The case was highly publicized as her husband and parents battled it out, and involved state and federal politicians, and even President George W. Bush. Ultimately, her feeding tube was removed on March 18, 2005, and she died nearly 2 weeks later on March 31.


The case spurred a lot of conversations and activism around the pro-life movement, the right-to-die movement, and within disability rights groups.

THE EVENT THAT STARTED IT ALL


Terri Schiavo was born on December 3, 1963. She had struggled with obesity in her younger years, and lost a significant amount of weight. She met Michael while attending Bucks County Community College in 1982, and the couple married in 1984. They followed Terri's parents and moved to Florida in 1986. Michael was a restaurant manager, and Terri was a bookkeeper with an insurance company.


On February 25, 1990, Terry collapsed in her St. Petersburg apartment, and her husband immediately called 911. She was face down, unconscious, and had no pulse. Firefighters and paramedics arrived and attempted to resuscitate her. She was intubated and ventilated by the paramedics.


In her initial medical assessment, she was determined to have suffered a cardiac arrest, with notes in her charts saying that she was trying to keep her weight down by drinking liquids all day, and this excessive fluid drinking may have lead to an electrolyte imbalance.


In November of the same year, Michael took Terri to the University of California, San Francisco for experimental nerve stimulation treatments, which took several months and was unsuccessful. They returned to Florida where she received testing and therapy through 1994. In 1993, Michael signed a do not resuscitate order.


In 1992, Michael filed a medical malpractice suit against Terri's obstetrician. The 2 were trying to have a child and though they went to the OB to learn why they were struggling, the doctor failed to diagnose bulimia as the cause. Had the doctor reviewed her medical history, he likely would have known.


During the case, Terri's friend testified that she knew that she was bulimic, and Michael ultimately won the case, being awarded $6.8 million. This was later reduced to $2 million, as Terri was considered at fault for her condition. Following attorney and other legal fees, Michael received $750,000 for Terri's medical care, and $300,000 for himself, money that Michael claimed in 2003 that Terri's parents demanded he share.

THE FIGHT TO DIE


In 1990, the court appointed Michael as Terri's legal guardian. Her parents did not dispute this: At the time, they got along very well, Michael even lived with them rent-free.


But in 1998, Michael filed a petition to remove Terri's feeding tube. Though Richard Pearse, the court-appointed second guardian ad litem, believed that there was no possibility for Terri to improve, and believed that she met the criteria for a persistent vegetative state, he also believed that Michael's decision may be influenced by the estate he would inherit upon her death. Because Terri lacked a living will, Pearse recommended denying the petition.


Because of the lack of living will, a trial was held to determine what Terri would want in this situation. Michael's attorney, George Felos, won a landmark right-to-die case before in Florida in 1990.


18 witness testified to her medical condition and speculation on her end-of-life wishes. Michael claimed that his wife would not want to live the rest of her life kept alive only by machines. Her parents claimed that she was a devout Roman Catholic, and would not violate the church's beliefs on refusing nutrition and hydration as a form of euthanasia. In this case, later called Schiavo I, the judge issued an order granting the petition to for authorization to discontinue artificial life support for Terri.


But a few months later, in March 2000, her parents filed a motion to permit assisted feeding of Terri. In Florida, this is not considered a life-prolonging procedure. However, a judge denied the request. The same year, her parents tried to contest Michael's guardianship of their daughter. At the time, he had started a new relationship with a new woman, and had a child with her. (I will remind you at this point that 10 years had passed since the incident.) Despite this, he did not want to divorce her because it would relinquish guardianship to her parents, and he knew that she did not want to live like this. The court again denied their request, and April 21, 2001, was set for her tube removal.


But that month, her parents filed another motion, saying that they had new evidence of her wishes. The judge denied their motion, but remanded the issue so they could file a new one. On April 24, 2001, Terri's feeding tube was removed for the first time.


Terri's parents filed a civil suit against Michael, alleging perjury, and the judge in that case issued an injunction for the removal of the feeding tube, which was reinserted 2 days later on April 26, 2001. All of these subsequent cases, including Michael's demand to enforce the original ruling which was denied, became known as Schiavo II.


On August 10, 2001, the judge heard from Terri's parents again, who claimed that a new medical treatment could restore enough cognitive ability that she could weigh in on her fate. They also, again, requested Michael be removed as her guardian. The judge denied these motions, and they appealed, where the denial was affirmed.


The Court of Appeals remanded the question of Terri's wishes back to a trial court for an evidentiary hearing, where 5 board certified neurologists were to testify. Her parents were allowed to choose 2 doctors, Michael could choose 2 doctors, and the court itself would appoint 1 independent physician to evaluate. (This became Schiavo III)


The hearing was held in October of 2002. The 5 doctors, William Maxfield, William Hammesfahr, Ronald Cranford, Melvin Greer and Peter Bambakidis all examined Terri's medical records, brain scans, videos, and Terri herself. 3 physicians, Cranford, Greer and Bambakidis, all testified that she was in a persistent vegetative state, where as Maxfield and Hammesfahr testified that she was in a minimally conscious state.


6 hours of video was taped of Terri, and examined by the doctors. In that 6 hours, Terri's parents and those who supported them found 6 clips, totaling under 6 minutes, where she may have been showing reactions or emotions. They released those clips to the public. The judge ruled that she was in PVS, and there was no hope for significant improvement. The testimony of Hammesfahr was heavily criticized, as he claimed using Vasodilation therapy may help, which is not supported by medical literature.


The court supported that she was in PVS, and this became known as Schiavo IV.


In 2003, after Terri had been entirely unconscious for 13 years, her parents began lobbying more publicly to keep their daughter alive. They chose a pro-life activist named Randy Terry as their spokesperson. On September 11, 2003, they petitioned the court again to stall the removal of her feeding tube, providing 4 affidavits from family members, and a doctor. They also had a nurse who claimed that she was able to feed Terri orally, but Michael considered that "therapy" and she was ordered not to do so.


The petition was once again denied, the Judge writing that it was "not even a veiled or disguised attempt" to re-litigate the entire case. The judge claimed that the nurse, Carla Sauer Iyer's, testimony was not credible and that, had they known that this happened in 1996 like the affidavit alleged, that they absolutely would have used it in earlier hearings.


On October 15, 2003, for the second time, Terri's feeding tube was removed. Her parents tried again to appeal, but exhausted all attempts. But, within a week, State Rep. Frank Attkisson passed "Terri's Law" in an emergency session, that gave Governor Jeb Bush the authority to intervene. He did, and ordered the tube reinserted. Michael opposed this, and the American Civil Liberties Union (ACLU) represented him. Her parents attempted to participate in the case, but were denied. They appealed, and were allowed. And then they were denied again.


On May 5, 2004, "Terri's Law" was found unconstitutional. Bush appealed, but it was ultimately overturned and officially unconstitutional.

THE RIGHT TO DIE


On February 23, Terri's parents filed yet another motion, this time to be retested and given new swallowing therapy. The motion was accompanied by 33 affidavits from doctors, pathologists and therapists. The judge denied the motion. She ordered the removal of Terri's feeding tube for March 18, 2005, 15 years ago today, and 15 years after she had been conscious for the last time.


On February 28, her parents filed another motion asking for permission to provide Terri with food and water by natural means, which was denied again. The judge claimed that this motion, and the previous one, were all based on understanding of Terri's condition from news reports and videos, but not her actual medical state, or from the extensive medical exams done for her trials.


Following the order for the tube to be removed on March 18, Republicans in congress subpoenaed Michael and Terri to testify at confessional hearings, to which the judge said "I have no cogent reason why the committee should intervene." President George W. Bush anticipated that the judge would rule adversely, and worked to find alternative means to overturn the ruling. On March 20, 2005, the Senate unanimously passed their version of a relief bill. It was passed by the house and Bush flew to the White House from vacation to sign the bill into law. The bill was called "The Palm Sunday Compromise", which allowed the case to be moved to federal court.


As they had so many times before in the state courts, the parents' petitions and appeals were denied, and they were effectively out of options.


On March 24, 2005, the judge denied yet another intervention, this time from the Department of Children & Families. He signed an order forbidding the department from taking possession of Terri and that every sheriff in the state should enforce this order. Unsurprisingly, it was appealed. Though the motion forbade the movement of Terri, the Florida Department of Law Enforcement prepared to take her to have the tube reinserted. But the judge got involved, and Jeb Bush obeyed the court, despite enormous pressure from republicans.


On March 31, 2005, Terri died. Despite concerns hat she would be uncomfortable or in pain from dehydration, studies have shown that patients die quite peacefully after feeding tube removal. During the autopsy, it was determined that the damage to her brain was irreversible. Though interestingly, a heart attack and bulimia were ruled out. Foul play was ruled out, too. Her death was officially certified as undetermined.


Michael and Terri's parents continued to clash after her death. Michael wanted to bury her in her home state of Pennsylvania, and her parents wanted to bury her in Florida. Ultimately, her ashes were buried in Florida, but Michael included the phrase "I kept my promise", regarding his promise to not keep her alive artificially, on the head stone, angering her parents.


They both continued to fight for their different beliefs, and both wrote books on their sides of the debate.


Despite your beliefs on the situation, or what Terri would have wanted, you have to believe that what she didn't want was for her husband and parents to spend the rest of their lives at odds with one another. I think everyone can agree on that.


But, as for my personal beliefs, I simply can't imagine believing that someone really, truly, wanted to live like that. I can understand someone, while healthy, claiming they would want to be kept alive by any means necessary. And I can absolutely understand parents and family not wanting to let their loved one go. But to genuinely believe that someone's dying wish would be to be kept alive by machines, unable to eat or breathe on their own, for fifteen years is unfathomable to me. I understand what some religions say about it, and I can understand using your faith to make your own decision, but I cannot believe anyone of any faith would want to be alive under those circumstances.


Though I think Michael ruffled feathers more than needed, even after her death, I commend him for fighting for so many years for what he truly believed his wife would want, even when remarried. You can quote me on this: If I'm ever 15 years into a clinically diagnosed permanent vegetative state, let me go.


Terri Schiavo's case is a landmark case in the right-to-die argument, but also a reminder to have a living will, or at the very least, have conversations with those who could ultimately be making decisions for you about what you'd want. I know being in a vegetative state is not something anybody wants to think about, but being clear about your wishes could avoid trial after trial, motion after motion, to ultimately get where you wanted to go.


REFERENCES:

1. https://en.wikipedia.org/wiki/Terri_Schiavo_case

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