Terri Schiavo case
The Terri Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo (née Schindler) (/ˈʃaɪvoʊ/; December 3, 1963 – March 31, 2005), a woman in an irreversible persistent vegetative state. Schiavo's husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without the prospect of recovery, and in 1998, he elected to remove her feeding tube. Schiavo's parents disputed her husband's assertions and challenged Schiavo's medical diagnosis, arguing in favor of continuing artificial nutrition and hydration.[1][2] The highly publicized and prolonged series of legal challenges presented by her parents, which ultimately involved state and federal politicians up to the level of George W. Bush, the then U.S. president, caused a seven-year (1998 to 2005) delay before Schiavo's feeding tube was ultimately removed.
Terri Schiavo
On February 25, 1990, at age 26, Schiavo went into cardiac arrest at her home in St. Petersburg, Florida. She was resuscitated, but had massive brain damage due to lack of oxygen to her brain and was left comatose. After two and a half months without improvement, her diagnosis was changed to that of a persistent vegetative state. For the next two years, doctors attempted occupational therapy, speech therapy, physical therapy and other experimental therapy, hoping to return her to a state of awareness, without success. In 1998, Schiavo's husband Michael Schiavo petitioned the Sixth Circuit Court of Florida to remove her feeding tube pursuant to Florida law.[3] He was opposed by Terri's parents, Robert and Mary Schindler. The court determined that Schiavo would not have wished to continue life-prolonging measures,[4] and on April 24, 2001, her feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge again ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included Bush returning to Washington, D.C., to sign legislation moving the case to the federal courts. After appeals through the federal court system that upheld the original decision to remove the feeding tube, staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005.[5]
The Schiavo case involved 14 appeals and numerous legal motions, petitions, and hearings in the Florida courts; five suits in federal district court; extensive political intervention at the levels of the Florida state legislature, Governor Jeb Bush, the U.S. Congress, and President George W. Bush; and four denials of certiorari from the Supreme Court of the United States.[6] The case also spurred highly visible activism from the United States anti-abortion movement, the right-to-die movement, and disability rights groups.[7] Since Schiavo's death, both her husband and her family have written books on their sides of the case, and both have also been involved in activism over related issues.[8][9][10]
Background[edit]
Early life[edit]
Terri Schiavo was born Theresa Marie Schindler to Mary (born 1941)[11] and Robert Schindler (1937–2009)[12] on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania, a suburb of Philadelphia. She was the oldest of three children. Her mother reported that, as a child, Terri would spend hours in her bedroom arranging her collection of stuffed animals.[13] As a teen, she enjoyed listening to John Denver and reading Danielle Steel romances.[14] She attended Bucks County Community College, where she met Michael Schiavo in 1982. The two began dating and married on November 10, 1984. They moved to Florida in 1986, following Terri's parents. Michael worked as a restaurant manager, while Terri took up a bookkeeping job with an insurance company.[15] She had naturally dark hair, but dyed it blonde.[16]
Initial medical crisis: 1990[edit]
In the early morning of February 25, 1990, Terri Schiavo collapsed in a hallway of her St. Petersburg, Florida apartment. Firefighters and paramedics, arriving in response to her husband Michael's 9-1-1 call, found her face-down and unconscious. She was not breathing and had no pulse. They attempted to resuscitate her and she was transported to the Humana Northside Hospital. Paramedics had her intubated and ventilated.[17]
Legal cases 1992–2005[edit]
Malpractice[edit]
In 1992, Michael filed a malpractice suit against Terri's gynecologist on the basis that he failed to diagnose bulimia as the cause of her infertility.[24] Terri had gone to the doctor because she had stopped menstruating but the doctor had failed to take her medical history into account which might have revealed an eating disorder. During the case, one of Terri's friends testified that she knew Schiavo was bulimic. In November 1992, Michael won the case and was awarded $6.8 million by the jury, later reduced to $2 million as Terri was found partly at fault for her condition.[19] After attorneys' fees and other expenses, Michael received $300,000 and $750,000 was put in a trust fund for Terri's medical care. According to Michael, in early 2003 the Schindlers demanded that he share the malpractice money with them.[2]
Petition to remove feeding tube[edit]
On June 18, 1990, the court appointed Michael Schiavo as Terri Schiavo's legal guardian; this appointment was not disputed by the Schindlers at the time.[17] In May 1998, Michael Schiavo filed a petition to remove Terri Schiavo's feeding tube, which her parents opposed. Richard Pearse was appointed by the court as a second guardian ad litem (GAL), and on December 29, 1998, reported "Dr. Jeffrey Karp's opinion of the ward's condition and prognosis is substantially shared among those physicians who have recently been involved in her treatment." Pearse concluded from Karp's and Vincent Gambone's diagnosis of Persistent Vegetative State that Schiavo was legally in a persistent vegetative state as defined by Florida Statutes, Title XLIV, Chapter 765, §101(12). This includes the "absence of voluntary action" and an "inability to communicate or interact purposefully".[23][25]
Pearse found that there was no possibility of improvement but that Michael Schiavo's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate as long as he remained married to her. Due to a lack of a living will and questions regarding Michael's credibility, Pearse recommended denying his petition to remove her feeding tube. Pearse reported that the issue of conflict of interest applied to the Schindlers as well since, had Michael divorced Terri as they wanted him to, they would have inherited the remainder of Terri Schiavo's estate upon her death.[23]
Schiavo end-of-life wishes[edit]
Given the lack of a living will, a trial was held before Pinellas County Judge George Greer during the week of January 24, 2000, to determine what Terri Schiavo's wishes would have been regarding life-prolonging procedures.[26] Michael Schiavo was represented by attorney George Felos, who had won a landmark right-to-die case before the Florida Supreme Court in 1990.[27][28]
The trial included testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes. Michael Schiavo claimed that his wife would not want to be kept on a machine where her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents "claimed that Terri was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration." Judge Greer issued his order granting the petition for authorization to discontinue artificial life support for Terri Schiavo in February 2000. In this decision, the court found that Terri Schiavo was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed.[26] This decision was upheld by the Florida Second District Court of Appeal[29] (2nd DCA) and came to be known by the court as Schiavo I in its later rulings.[30]
Oral feeding and the second guardianship challenge[edit]
In March 2000, the Schindlers filed a motion to permit assisted feeding of Terri, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri Schiavo was not responsive to swallowing tests and required a feeding tube,[17] Judge Greer ruled that she was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request.[31] The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed.[32]
In 2000, the Schindlers again challenged Michael Schiavo's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri Schiavo to a Pinellas Park, Florida, hospice "after it was clear that she was not 'terminal' within Medicare guidelines" for hospices. By this time, while still legally married to Terri Schiavo, Michael Schiavo was in a relationship with Jodi Centonze, and had fathered their first child. He said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (not to be kept alive in a PVS) were carried out. The court denied the motion to remove the guardian, allowing that the evidence was not sufficient and, in some instances, not relevant. It set April 24, 2001, as the date on which the tube was to be removed.[33]
Schiavo II[edit]
In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri Schiavo's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure.[34] The Second District Court of Appeal upheld Greer's decision but remanded the issue in order to give the Schindlers an opportunity to file a new motion. On April 24, 2001, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael Schiavo alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against the removal of feeding tube until this was settled. The feeding tube was reinserted on April 26, 2001. On appeal by Michael Schiavo, the Second District Court of Appeal reversed Judge Quesada's order. In the same time frame, Michael Schiavo filed a motion to enforce the mandate of the guardianship court (that the feeding tube be removed). The Second District Court of Appeal denied the motion. These three decisions, all published in a single order by Florida's Second District Court of Appeal,[35] came to be known by the court as Schiavo II in its later rulings.
Final feeding tube removal and federal involvement[edit]
Early 2005 motions[edit]
On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations.[54] The Schindlers wanted Schiavo to be tested with an fMRI and given a swallowing therapy called VitalStim. The motion was accompanied by thirty-three affidavits from doctors in several specialties, speech-language pathologists and therapists, and a few neuropsychologists, all urging that new tests be undertaken.[55][56] Patricia Fields Anderson, the Schindler family attorney, still held out hope "that Terri might be able to take nourishment orally, despite past findings that she is incapable".[57] Judge Greer formally denied the motion and ordered the "removal of nutrition and hydration from the ward" and set the time and date for the removal of the feeding tube as "1:00 p.m. on Friday, March 18, 2005".[58]
On February 28, 2005, the Schindlers filed a motion, asking for permission to attempt to provide Schiavo with "Food and Water by Natural Means". This second motion asked for permission to "attempt to feed" Schiavo by mouth.[59] Judge Greer denied the second motion on March 8, saying "it has become clear that the second motion is part and parcel of the previous motion on medical evaluations. The same declarations are being used for both motions and the motion appears to be an alternative pleading to the previous motion. Both are asking for an experimental procedure."[60] The following day, Greer denied the first motion as well, citing that an affiant doctor for Michael cautioned that fMRI was an experimental procedure that should be conducted in an academic setting, because Schiavo had already undergone swallowing tests and failed, and because VitalStim had only been performed on patients who were not in a PVS. Greer noted that "most of the doctor affidavits submitted are based on their understanding of Schiavo's condition from news reports or video clips they have seen. Many are obviously not aware of the medical exams undertaken for the 2002 trial."[55]
Following Greer's order on March 18, 2005, to remove the feeding tube, Republicans in the United States Congress subpoenaed both Michael and Terri Schiavo to testify at a congressional hearing.[61] Greer told congressional attorneys, "I have had no cogent reason why the (congressional) committee should intervene." He also stated that last-minute action by Congress does not invalidate years of court rulings.[62][63]
Ethical and legal issues[edit]
Right to die[edit]
The Schiavo case has been compared to the Karen Ann Quinlan case and Nancy Cruzan case, two landmark right-to-die cases.[74][75] Quinlan entered a persistent vegetative state in 1975, and her family was allowed to remove her from a ventilator in 1976 after a ruling by the New Jersey Supreme Court based on her right of privacy. She died of pneumonia in 1985.[76] Cruzan was diagnosed with PVS in 1983 and her legal case reached the Supreme Court, which ruled that "clear and convincing evidence" of her wishes to die under such circumstances was needed. Cruzan's family did not have enough evidence of that, but later produced more. She died after being removed from life support in 1990.[77]
The "Terri Schiavo case" actually refers to a series of cases. It differed from the Quinlan and Cruzan cases by involving settled law rather than breaking new legal ground on the right-to-die issue. In 2006, Professor Lois Shepherd, PhD JD, states it was "unclear" whether the Schiavo case represents a landmark decision.[78] The Terri Schiavo affair involved a dispute between family members and her legal guardian over her wishes when there is no documented desire. According to medical ethicist Matthew Stonecipher, "The movement to challenge the decisions made for Terri Schiavo threatened to destabilize end-of-life law that had developed over the last quarter of the 20th century, principally through the cases of Karen Ann Quinlan and Nancy Cruzan."[75] The outcome of the Schiavo case was also in part determined by a 1990 Florida case, Guardianship of Estelle Browning.[28][79] In that case, attorney George Felos, representing a Browning relative, successfully argued that Browning's feeding tube should be removed before the Florida Supreme Court. The elderly Browning had expressed, in a living will, her wish not to be kept alive by any artificial means, including receiving food and water "by a gastric tube or intravenously." At that time, it was common to remove people from ventilators, but the law in Florida was not clear on removing them from feeding tubes. In a landmark ruling, the Florida Supreme Court decided that Browning had "the constitutional right to choose or refuse medical treatment, and that right extends to all relevant decisions concerning one's health."[28]
Disability rights[edit]
During the years of legal proceedings, disability rights groups and activists closely monitored and involved themselves in the case. In March 2003, twelve disability rights groups, led by Not Dead Yet, along with four other amici filed an amicus curiae brief in which they opposed the removal of Schiavo's feeding tube.[80] They also used the Schiavo case to advocate for federal review in cases where third parties decide to withdraw life support from patients unable to give consent.[7][64] They argued that persistent vegetative state is frequently misdiagnosed, and that the reasons for withdrawal of life support from a patient should be scrutinized since even family member surrogates can have conflicts of interest. The Palm Sunday Compromise granted the federal review they sought, but it was limited to only the Schiavo case.[7]
These are compilations of legal documents relating to the Schiavo case: