Terri Schiavo Case

A long slow death in Florida – Terri Schiavo was just 27 when she suffered “sudden cardiac death”. This was likely from a fatal cardiac arrhythmia and not enough blood was pumped to deliver oxygen to her brain. By the time her normal cardiac rhythm was restored in the ER her brain had suffered considerable and permanent damage.

The most metabolically active area of the brain and the first to be damaged when the supply of oxygen is interrupted for more than a few minutes is called the cebreal cortex. This is a thin layer of brain matter that is responsible for most of the higher brain functions including memory, sensory perception, planning, motivation, personality, and conscious thought. It is this layer that makes us who we are and it is this layer that has been almost completely destroyed in Terri Schiavo.

Matthew J. Conigliaro who writes the only blog about Florida law, has a Terri Schiavo Information Page and he quotes the June 2003 opinion of the Second District Court of the State of Florida;

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 At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid.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(emphasis added).

Terri’s husband Michael Schiavo filed petitions with Florida courts starting in 1998 and was successful in convincing the court that his wife had made statements to him as well as to other people (who testified as well) that she would not want to be kept alive in such a state. Terri’s patents opposed this petition and tried to convince the court that their daughter was in fact conscious but the court found the video tapes of Terri and the testimony of only two physicians unconvincing and early this month Terrie’s feeding tube was disconnected.

Despite what you hear in the press about Michael Schiavo (“he sued the doctors for a million dollars and now he is after her life insurance . . he doesn’t want her around anymore because he has a girlfriend a new child”) he remained by her side for eight years without getting a divorce and when it became clear that Terri’s condition was not going to improve and knowing what he did about her wishes he petitioned the court to act as surrogate to decide what to do.

Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate can petition a court to act as a ward’s surrogate and determine what the ward would decide to do. Michael took the position that, based on statements Terri made to him and others, 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.

But then it seemed as if every conservative and religious right-wing politico (most of whom had never heard of Terri Schiavo before this month) including the ultra conservative National Right to Life Coalition saw fit to intrude into what was previously a tragic, private family dispute in order to utilize this case to further their agendas. The Florida legislature passed a law allowing the Governor to have the power to order her feeding tube to be reconnected, which he did and it was. Now lawyers for Michael Schiavo are trying to convince the court that this new law is unconstitutional . . . . What a friggen mess!

The Medical Issues;
Most people seeing this case for the first time on the news have seen the video clips of Terri that her family has released. What you see is a smiling woman reaching for her mother. There is no possible way that this woman could be in a “persistently vegetative state” as the court and doctors say she is! Right? The problem here is that people are confusing the concept of “coma” where a patient is completely unresponsive to stimuli with “persistent vegetative state” where the patient has intact reflexes (such as movements and facial expressions) but no awareness or conscious thought. In hearing testimony from five physicians (two for Michael, two for Terri’s parents, and one independent), the court concluded that there was no convincing evidence that Terri was capable of any conscious thought;

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.

Even though there is no technical way to measure or evaluate conscious thought there is the additional evidence of the CAT scan of Terri’s brain that proves that the critical areas of the brain necessary for conscious thought (the cortex) is either gone or severely damaged. This scan is consistent with Terri’s clinical presentation. She has intact reflexes (purposeless movements, breathing, digestion, temperature regulation) that only require the most basic structures of the brain, the brain stem, and the spinal cord to be intact in order to function. Given the evidence of the clinical exam and the head scans and the fact that she has been in this state for over 10 years without any change, the likelihood that Terri has any self awareness or conscious thought to any extent is slim to none.

We don’t know for sure because there is no direct way of measuring this and conservatives and “right-to-life” proponents will cling to this uncertainty as their argument for keeping these patients alive. But this is a closed argument because it cannot be currently proven 100% that there is no “Terri” inside her body despite the large amount of evidence that makes this highly unlikely.

The Legal issues;
There are volumes of material that has been written about the moral and ethical dilemmas of people in persistent vegetative states and whether or not to allow them to die. This web site has a very good outline of the various arguments, most of which are beyond the scope of my single post. But no matter what you believe as to the ethical validity of discontinuing life support in these patients, one thing is clear. Individual cases need to be decided in the courts and not in legislatures. Part of the reason we have court systems is for this very purpose, to decide difficult cases.

Many conservatives fear that cases such as this will set a precedent that may lead to a slippery slope. They fear that we will be questioning whether to allow those patients such as the mentally retarded or those who have less brain damage than Terri to live or die (even though this has not happened since the first cases of withdrawing support from patients in a vegetative state appeared in the 1970s).

But what about the precedent that the Florida legislature sets? We could certainly see a slippery slope here! The next time the family of an elderly patient with end-stage Alzheimer’s disease who does little more than what Terri Schiavo does and must be fed through a tube decides to allow their loved one to die, what is to stop the legislature from stepping in and stopping it?!

What is to stop the legislature from stepping in and altering the medical care of patients in cases where the conservative majority finds it objectionable (late term abortions, sterilization, the discontinuing of treatment for terminal diseases)? What is to stop any single family member who disagrees with the rest of the family on the care of a loved one from going to his/her state legislator and asking them to sponsor a bill to force whatever treatment they want? The Florida state legislature has overstepped it’s authority in bypassing it’s own court system and forcing medical care on a single patient in a single case.

Besides, I find the conservative’s opinion in this case to be very disingenuous. Would such attention have been focused on Terri if she had been a homeless minority drug addict who had suffered a cardiac arrest as a result of smoking crack cocaine and who was now a ward of the state? It is also very ironic that the conservatives who claim that there might be a slight chance that Terri has conscious thought are the same group who are so quick to dismiss the possibility that any murderer on death row might in fact be innocent or that we as a country have executed innocent people! It would seem that for the conservatives at least, everyone has a “right-to-life” but some people have more of a right to life than others.

So now we are left with another “right-to-die” debate that should never have happened. This case is a very difficult one because Terri didn’t leave any written living will. However, all the legal steps and procedures that are in place to help decide such cases were followed and the court sided with Michael. As her husband, Michael has every right to act as surrogate and guardian for his wife and to make decisions based on what he believes she would want and what would be in her best interests. This is both a legal right and obligation that is included in the legal institution of marriage. Yet another irony is that these conservatives who are so opposed to “gay marriage” because it would threaten the validity of the institution of heterosexual marriage found it quite easy to interfere in this case and negate Michael’s rights and obligations as husband.

What about Terri’s right? Yes, what about her “right to die” and her right to decide how she would want to spend her life? In her current condition she is unable to express her wishes (if she in fact is capable of having wishes at all). The courts have already heard the arguments and have made a decision. It is a travesty that any government would step in to intervene on any single case. It’s a case of political bravado that makes any conservative legislator (and the Gov.) look good in the eyes of the voters but not a single politico will spend a second of their lives in Terri’s shoes nor caring for her daily and watching a horrendously slow death and decay as the years drag on. Thank God I don’t live in Florida where the government decides when and how it will allow people to die!