Terri Schiavo case
Encyclopedia
The Terri Schiavo case (icon) was a legal battle in the United States
between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the husband's granted motions and later court findings to forgo further life-prolonging procedures or life support treatment for Terri, who was diagnosed by doctors as being in a persistent vegetative state
, would be carried out. The highly publicized and prolonged series of legal challenges presented by the parents and by state and federal legislative intervention effected in total a seven-year delay before life support finally was terminated.
Terri Schiavo collapsed in her St. Petersburg, Florida
home in full cardiac arrest
on February 25, 1990. She suffered massive brain damage
due to lack of oxygen
and, after two and a half months in a coma
, her diagnosis was elevated to vegetative state
. For the next few years doctors attempted physical therapy and other experimental therapy, hoping to return Terri to a state of awareness. In 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida
(Pinellas County
), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). He was opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The court determined that she would not wish to continue life-prolonging measures, and on April 24, 2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included U.S. President
George W. Bush
returning to Washington D.C. to sign legislation designed to keep her alive. After all attempts at appeals through the federal court system upheld the original decision to remove the feeding tube, staff at the Pinellas Park
hospice facility where Terri was being cared for disconnected the feeding tube on March 18, 2005 and she died on March 31.
In all, the Schiavo case involved 14 appeals and numerous motions
, petitions, and hearings in the Florida courts; five suits in federal district court
; Florida legislation struck down by the Supreme Court of Florida; federal legislation (the Palm Sunday Compromise
); and four denials of certiorari
from the Supreme Court of the United States
. The case also spurred highly visible activism from the pro-life movement and disability rights groups.
, where she met Michael Schiavo in 1982. The two began dating and were 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 job with an insurance company.
, apartment
. Firefighters and paramedics arriving in response to 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. There, she was intubated
and ventilated.
." Upon admission to the hospital, her serum potassium
level was noted to be very low
, at 2.0 mEq
/L
; the normal range for adults is 3.5–5.0 mEq/L. Her sodium and calcium levels were normal. Electrolyte imbalance
is often caused by drinking excessive fluids
. A serious consequence of low potassium levels
can be heart rhythm abnormalities, including sudden arrhythmia death syndrome. Vomiting, a self-induced act for many bulimic patients, is another cause of low potassium levels. Terri's husband, Michael, later filed and won a malpractice
suit against her obstetrician on the basis that he failed to diagnose bulimia as the cause of her infertility. She was eventually switched from being fed by a nasogastric feeding tube
to a percutaneous endoscopic gastrostomy
(PEG) feeding tube.
Dr. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, who previously treated Terri, cared for Terri during her initial admission to Humana; both he and Dr. Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state
(PVS) within approximately one year after Terri's sudden cardiac arrest.
for experimental nerve stimulationthe Thalamic stimulator
. The treatment took several months but was unsuccessful. Michael returned to Florida with her in January 1991 and admitted her as an inpatient to the Mediplex Rehabilitation Center in Bradenton, Florida
. While there, he later said that he often took "her to parks and public places in hopes of sparking some recovery". On July 19, 1991, Terri was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy
until 1994.
In mid 1993, Michael requested a do not resuscitate
order for Terri after she contracted a urinary tract infection. The court appointed guardian ad litem, Jay Wolfson, later wrote a report stating that Michael's decision was "predicated on his reasoned belief that there was no longer any hope for Terri's recovery."
From 1990 to 1993, Michael and the Schindlers enjoyed an amicable relationship. The Schindlers even allowed Michael to live rent-free in their condominium for several months. During this time, the Schindlers actively encouraged Michael to "get on with his life". He was encouraged by the Schindlers to date, and he introduced his in-law family to women he was dating. On June 18, 1990, the court appointed Michael Schiavo as Terri's legal guardian; this appointment was not disputed by the Schindlers at the time.
Pearse found that there was no possibility of improvement but that Michael's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate. 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 they prevailed, they would have inherited the remainder of Mrs. Schiavo's estate upon her death.
, a trial was held during the week of January 24, 2000, to determine what Terri's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Terri 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 George Greer
issued his order granting Michael's petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the court found that Terri was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal
(2nd DCA) and came to be known by the court as Schiavo I in its later rulings.
In 2000, the Schindlers again challenged Michael's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri to 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 was in a relationship with Jodi Centonze, and had fathered their first child. Michael 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.
On August 10, 2001, on remand from the Florida Second District Court of Appeal
, Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability such that Terri herself would be able to decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the Second District Court of Appeals. On October 17, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Terri's wishes back to the trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Michael could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri's condition. (These decisions, all published in a single order by the Florida Second District Court of Appeal, came to be known by the court as Schiavo III in its later rulings.) In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer's court to determine whether new therapy treatments could help Terri restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan) was performed, which showed severe cerebral atrophy
. An EEG
showed no measurable brain activity. The five physicians chosen were Dr. William Maxfield, a radiologist
, and four neurologist
s: Dr. William Hammesfahr
, Dr. Ronald Cranford, Dr. Melvin Greer and Dr. Peter Bambakidis.
The five doctors examined Terri's medical records, brain scans, the videos, and Terri herself. Drs. Cranford, Greer, and Bambakidis testified that Terri was in a persistent vegetative state. Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state
. As part of the court-ordered medical exam, six hours of video of Terri were taped and filed at the Pinellas County courthouse. The tape included Terri with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Terri "clearly does not consistently respond to her mother". From that six hours of video, the Schindlers and their supporters produced six clips showing reactions and emotions, totaling less than six minutes, and released those clips to public websites. Judge Greer ruled that Terri was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr's testimony, which claimed positive results in similar cases by use of vasodilation
therapy, the success of which is unsupported in the medical literature. This ruling was later affirmed by Florida's Second District Court of Appeal, which stated that "this court has closely examined all of the evidence in the record," and "we have... carefully observed the video tapes in their entirety." The court concluded that "...if we were called upon to review the guardianship court's decision de novo
, we would still affirm it." (This decision by the Second District Court of Appeals came to be known as Schiavo IV in later rulings.)
Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. They selected pro-life activist Randall Terry
as their spokesman but continued to pursue their available legal options. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube to provide for "eight weeks' therapy". Accompanying the petition were four affidavits from members of the Schindler family and one from Dr. Alexander T. Gimon. At the hearing, the Schindlers' counsel read into the record additional affidavits from three speech professionals and two nurses. Nurse Carla Sauer lyer asserted that she was able to feed Terri Schiavo orally but that Michael characterized any such interaction as "therapy" and ordered her not to do so. Iyer claimed in her affidavit that her initial training in 1996 consisted solely of the instruction, "Do what Michael Schiavo tells you or you're terminated," and that standing orders were not to contact the Schindler family, but that she "would call them anyway". She also claimed that Michael said, "When is that bitch gonna die?" According to Iyer, on five different occasions she tested Terri's blood sugar
levels after Michael visited and found that Terri's blood sugar levels were so low they wouldn't even register. She claims that she eventually called the police and was fired the next day. Despite her claims that she called the Schindlers multiple times in 1996, there is no evidence the Schindlers did anything at the time to demand that the nursing home or police investigate the supposed incidents. Nor did they subpoena
Iyer during their 2000 court battle with Michael.
On September 17, Judge George Greer
denied the petition, and wrote that "the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them clearly demonstrate this to be true." Regarding (Nurse) Iyer's statements, Greer wrote that they were "incredible to say the least" and that "Ms. Iyer details what amounts to a 15-month cover-up April 1995 through July 1996 which include the staff of Palm Garden of Largo 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... It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had Iyer contacted them in 1996 as her affidavit alleges".
and the Florida Legislature
hastily passed "Terri's Law," giving Governor Jeb Bush
the authority to intervene in the case. Governor Bush immediately ordered the feeding tube reinserted. Governor Bush sent the Florida Department of Law Enforcement
to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted. She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem (GAL), Dr. Jay Wolfson, to "deduce and represent the best wishes and best interests" of Schiavo, and report them to Governor Bush. Wolfson's report did not change Michael's role as her legal guardian and did not otherwise obstruct him legally.
Michael Schiavo opposed the Governor's intervention in Schiavo's case, and was represented, in part, by the American Civil Liberties Union
(ACLU). At the same time, Robert and Mary Schindler, her parents, attempted to intervene and participate in the "Terri's Law" case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida Sixth Circuit, the same circuit as for Judge George W. Greer. They appealed, and, on February 13, the Florida Second District Court of Appeal
(Second District Court of Appeals) reversed Baird's ruling, allowing them to participate. On March 17, Baird denied the Schindlers the right to intervene a second time, and the Schindlers, represented by the conservative American Center for Law and Justice
(ACLJ), appealed the right to participate in the "Terri's Law" case, with the court scheduling an oral argument
date for June 14. The Schindlers' other attorney, Pat Anderson, was concurrently challenging Michael Schiavo's right to be her guardian, and, on June 16, she made a petition for writ of Quo Warranto
.
On May 5, 2004, Baird found "Terri's Law" unconstitutional
, and struck it down. Bush appealed this order to the Second District Court of Appeals, but, on May 12, they issued an "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution." The Second District Court of Appeals, in sending it directly to the Florida's Supreme Court, invoked "pass through" jurisdiction.
The Florida Supreme Court then overturned the law as unconstitutional.
On February 28, 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. 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." 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..."
Following Greer's order on March 18, 2005 to remove the feeding tube, Republicans in the United States Congress
subpoena
ed both Michael and Terri Schiavo to testify at a congressional hearing. 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.
. On March 20, 2005, the Senate, by unanimous consent
, passed their version of a relief bill; since the vote was taken by voice vote, there was no official tally of those voting in favor and those opposed. Soon after Senate approval, the House of Representatives passed an identical version of the bill S.686, which came to be called the "Palm Sunday Compromise
" and transferred jurisdiction of the Schiavo case to the federal courts. The bill passed the House on March 21 at 12:41 a.m. (UTC-5
). U.S. President
George W. Bush
flew to Washington, D.C.
from his vacation in Texas
in order to sign the bill into law at 1:11 a.m. As in the state courts, all of the Schindlers' federal petitions and appeals were denied, and the U.S. Supreme Court declined to grant certiorari
, effectively ending the Schindlers' judicial options.
At the same time, the so-called Schiavo memo
surfaced, causing a political firestorm. The memo was written by Brian Darling
, the legal counsel to Florida Republican senator Mel Martinez
. It suggested the Schiavo case offered "a great political issue" that would appeal to the party's base
(core supporters) and could be used against Senator Bill Nelson, a Democrat
from Florida
, because he had refused to co-sponsor the bill. Nelson easily won re-election in 2006.
Schiavo died at a Pinellas Park
hospice
on March 31, 2005. Although there was concern that Schiavo would experience significant symptoms from dehydration
with the removal of the feeding tube, studies have shown that patients who have their feeding tubes removed, such as the case of Schiavo, usually have a peaceful death.
After her death, Schiavo's body was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Fla. The autopsy
occurred on April 1, 2005. It revealed extensive brain damage. The manner of death was certified as "undetermined". The autopsy was led by Chief Medical Examiner Jon R. Thogmartin, M.D. In addition to consultation with a neuropathologist (Stephen J. Nelson, M.D.), Dr. Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report was released on June 15, 2005. In addition to studying Terri's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. Examination of Schiavo’s nervous system by neuropathologist Stephen J. Nelson, M.D., revealed extensive injury. The brain
itself weighed only 615 g, only half the weight expected for a female of her age, height, and weight, an effect caused by the loss of a massive amount of neurons. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex
, the thalami
, the basal ganglia
, the hippocampus
, the cerebellum
, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neuron
s that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, is also typical. There was marked damage to important relay circuits deep in the brain (the thalami) – another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."
The cardiac pathologist who studied Schiavo's heart found it and the coronary vessels
to be healthy, which excludes the possibility that her initial collapse was the result of myocardial infarction
, although there was a localized area of healed inflammation (opening the possibility of myocarditis
). Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." Regarding the possibility of strangulation or domestic violence as a cause of Schiavo's initial collapse, the report states: "No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in the months after her initial collapse. Indeed, within an hour of her initial hospital admission, radiographic examination of her cervical spine was negative. Specifically, external signs of strangulation including cutaneous or deep neck injury, facial/conjunctival petechiae, and other blunt trauma were not observed or recorded during her initial hospital admission. Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings."
Regarding the cause and manner of Schiavo’s death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined."
"We were not surprised the medical examiner said Terri's brain was damaged," said Bobby Schindler, Jr., her brother, in an interview hours after the autopsy report was released. "The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions."
showed that a large majority of Americans
believed that Michael Schiavo should have had the authority to make decisions on behalf of his wife, Terri Schiavo, and that the United States Congress
overstepped its bounds with its intervention in the case. However, other polls seemed to favor the Schindler family's position, and questions were raised about the wording of all the polls. Various organizations and protesters demanded that Schiavo's feeding tube be reinserted. Most of these groups were affiliated with the Christian right
.
These are compilations of legal documents relating to the Schiavo case:
Information sites
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the husband's granted motions and later court findings to forgo further life-prolonging procedures or life support treatment for Terri, who was diagnosed by doctors as being in a persistent vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
, would be carried out. The highly publicized and prolonged series of legal challenges presented by the parents and by state and federal legislative intervention effected in total a seven-year delay before life support finally was terminated.
Terri Schiavo collapsed in her St. Petersburg, Florida
St. Petersburg, Florida
St. Petersburg is a city in Pinellas County, Florida, United States. It is known as a vacation destination for both American and foreign tourists. As of 2008, the population estimate by the U.S. Census Bureau is 245,314, making St...
home in full cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
on February 25, 1990. She suffered massive brain damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...
due to lack of oxygen
Hypoxia (medical)
Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...
and, after two and a half months in a coma
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
, her diagnosis was elevated to vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
. For the next few years doctors attempted physical therapy and other experimental therapy, hoping to return Terri to a state of awareness. In 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida
Florida Circuit Courts
The Florida Circuit Courts are state courts. They are trial courts of original jurisdiction for most controversies. In Florida, the circuit courts are one of four types of courts created by the Florida Constitution .The Circuit Courts primarily handle civil cases where...
(Pinellas County
Pinellas County, Florida
Pinellas County is a county located in the state of Florida. Its county seat is Clearwater, Florida, and its largest city is St. Petersburg. This county is contained entirely within the telephone area code 727, except for some sections of Oldsmar, which have the area code 813...
), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3). He was opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The court determined that she would not wish to continue life-prolonging measures, and on April 24, 2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included U.S. President
President of the United States
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....
George W. Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
returning to Washington D.C. to sign legislation designed to keep her alive. After all attempts at appeals through the federal court system upheld the original decision to remove the feeding tube, staff at the Pinellas Park
Pinellas Park, Florida
Pinellas Park is a city located in central Pinellas County, Florida. The population was 45,658 at the 2000 census. As of 2004, the population estimated by the U.S. Census Bureau is 47,166 . The city was founded by Philadelphia publisher, F. A...
hospice facility where Terri was being cared for disconnected the feeding tube on March 18, 2005 and she died on March 31.
In all, the Schiavo case involved 14 appeals and numerous motions
Motion (legal)
In law, a motion is a procedural device to bring a limited, contested issue before a court for decision. A motion may be thought of as a request to the judge to make a decision about the case. Motions may be made at any point in administrative, criminal or civil proceedings, although that right is...
, petitions, and hearings in the Florida courts; five suits in federal district court
United States district court
The United States district courts are the general trial courts of the United States federal court system. Both civil and criminal cases are filed in the district court, which is a court of law, equity, and admiralty. There is a United States bankruptcy court associated with each United States...
; Florida legislation struck down by the Supreme Court of Florida; federal legislation (the Palm Sunday Compromise
Palm Sunday Compromise
The Palm Sunday Compromise, formally known as the Act for the relief of the parents of Theresa Marie Schiavo, is an Act of Congress passed on March 21, 2005, to allow the case of Terri Schiavo to be moved into a federal court...
); and four denials of certiorari
Certiorari
Certiorari is a type of writ seeking judicial review, recognized in U.S., Roman, English, Philippine, and other law. Certiorari is the present passive infinitive of the Latin certiorare...
from the Supreme Court of the United States
Supreme Court of the United States
The Supreme Court of the United States is the highest court in the United States. It has ultimate appellate jurisdiction over all state and federal courts, and original jurisdiction over a small range of cases...
. The case also spurred highly visible activism from the pro-life movement and disability rights groups.
Early life
Terri Schiavo was born Teresa Marie Schindler on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania, a suburb of Philadelphia. She attended Bucks County Community CollegeBucks County Community College
Bucks County Community College is a two-year community college located in Bucks County, Pennsylvania, near Philadelphia. Founded in 1964, Bucks has three campuses and online courses: a main campus in Newtown, an "Upper County" campus in the town of Perkasie, and a "Lower County" campus in the...
, where she met Michael Schiavo in 1982. The two began dating and were married on November 10, 1984. They moved to Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
in 1986, following Terri's parents. Michael worked as a restaurant manager, while Terri took up a job with an insurance company.
Initial medical crisis1990
In the early morning of February 25, 1990 Terri collapsed in a hallway of her St. Petersburg, FloridaSt. Petersburg, Florida
St. Petersburg is a city in Pinellas County, Florida, United States. It is known as a vacation destination for both American and foreign tourists. As of 2008, the population estimate by the U.S. Census Bureau is 245,314, making St...
, apartment
Apartment
An apartment or flat is a self-contained housing unit that occupies only part of a building...
. Firefighters and paramedics arriving in response to Michael's 9-1-1
9-1-1
9-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...
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. There, she was intubated
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
and ventilated.
Initial medical assessments
Her medical chart contained a note that "she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day and drinking about 10–15 glasses of iced teaIced tea
Iced tea is a form of cold tea, often served in a glass with ice. It may or may not be sweetened. Iced tea is also a popular packaged drink. It can be mixed with flavored syrup, with common flavors including lemon, peach, raspberry, lime, passion fruit, and cherry...
." Upon admission to the hospital, her serum potassium
Potassium
Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
level was noted to be very low
Hypokalemia
Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low...
, at 2.0 mEq
Equivalent (chemistry)
The equivalent , sometimes termed the molar equivalent, is a unit of amount of substance used in chemistry and the biological sciences.The equivalent is formally defined as the amount of a substance which will either:...
/L
Litre
pic|200px|right|thumb|One litre is equivalent to this cubeEach side is 10 cm1 litre water = 1 kilogram water The litre is a metric system unit of volume equal to 1 cubic decimetre , to 1,000 cubic centimetres , and to 1/1,000 cubic metre...
; the normal range for adults is 3.5–5.0 mEq/L. Her sodium and calcium levels were normal. Electrolyte imbalance
Electrolyte disturbance
Electrolytes play a vital role in maintaining homeostasis within the body. They help to regulate myocardial and neurological function, fluid balance, oxygen delivery, acid-base balance and much more. Electrolyte imbalances can develop by the following mechanisms: excessive ingestion; diminished...
is often caused by drinking excessive fluids
Water intoxication
Water intoxication, also known as water poisoning, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside of safe limits by over-consumption of water....
. A serious consequence of low potassium levels
Hypokalemia
Hypokalemia or hypokalaemia , also hypopotassemia or hypopotassaemia , refers to the condition in which the concentration of potassium in the blood is low...
can be heart rhythm abnormalities, including sudden arrhythmia death syndrome. Vomiting, a self-induced act for many bulimic patients, is another cause of low potassium levels. Terri's husband, Michael, later filed and won a malpractice
Malpractice
In law, malpractice is a type of negligence in, which the professional under a duty to act, fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm...
suit against her obstetrician on the basis that he failed to diagnose bulimia as the cause of her infertility. She was eventually switched from being fed by a nasogastric feeding tube
Nasogastric intubation
Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.-Uses:...
to a percutaneous endoscopic gastrostomy
Percutaneous endoscopic gastrostomy
Percutaneous endoscopic gastrostomy is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and...
(PEG) feeding tube.
Dr. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, who previously treated Terri, cared for Terri during her initial admission to Humana; both he and Dr. Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
(PVS) within approximately one year after Terri's sudden cardiac arrest.
Rehabilitation efforts1990-1993
In November, Michael took her to the University of California, San FranciscoUniversity of California, San Francisco
The University of California, San Francisco is one of the world's leading centers of health sciences research, patient care, and education. UCSF's medical, pharmacy, dentistry, nursing, and graduate schools are among the top health science professional schools in the world...
for experimental nerve stimulationthe Thalamic stimulator
Thalamic stimulator
A thalamic stimulator is a relatively new medical device that can suppress tremors, such as those caused by Parkinson's Disease or essential tremor. It was approved for use by the Food and Drug Administration on August 4, 1997. Installation is invasive, so it is typically only used when the...
. The treatment took several months but was unsuccessful. Michael returned to Florida with her in January 1991 and admitted her as an inpatient to the Mediplex Rehabilitation Center in Bradenton, Florida
Bradenton, Florida
Bradenton is a city in Manatee County, Florida, United States. The U.S. Census Bureau estimated the city's 2007 population to be 53,471. Bradenton is the largest Principal City of the Bradenton-Sarasota-Venice, Florida Metropolitan Statistical Area, which had a 2007 estimated population of 682,833...
. While there, he later said that he often took "her to parks and public places in hopes of sparking some recovery". On July 19, 1991, Terri was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
until 1994.
In mid 1993, Michael requested a do not resuscitate
Do not resuscitate
In medicine, a "do not resuscitate" or "DNR" is a legal order written either in the hospital or on a legal form to respect the wishes of a patient to not undergo CPR or advanced cardiac life support if their heart were to stop or they were to stop breathing...
order for Terri after she contracted a urinary tract infection. The court appointed guardian ad litem, Jay Wolfson, later wrote a report stating that Michael's decision was "predicated on his reasoned belief that there was no longer any hope for Terri's recovery."
From 1990 to 1993, Michael and the Schindlers enjoyed an amicable relationship. The Schindlers even allowed Michael to live rent-free in their condominium for several months. During this time, the Schindlers actively encouraged Michael to "get on with his life". He was encouraged by the Schindlers to date, and he introduced his in-law family to women he was dating. On June 18, 1990, the court appointed Michael Schiavo as Terri's legal guardian; this appointment was not disputed by the Schindlers at the time.
Petition to remove feeding tube
In May 1998, Terri's husband, Michael, filed a petition to remove Terri'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 Dr. Vincent Gambone's diagnosis of PVS 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."Pearse found that there was no possibility of improvement but that Michael's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate. Due to a lack of a living will
Living will
An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or...
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 they prevailed, they would have inherited the remainder of Mrs. Schiavo's estate upon her death.
Schiavo I: end-of-life wishes
Given the lack of a living willLiving will
An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or...
, a trial was held during the week of January 24, 2000, to determine what Terri's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Terri 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
Roman Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the world's largest Christian church, with over a billion members. Led by the Pope, it defines its mission as spreading the gospel of Jesus Christ, administering the sacraments and exercising charity...
who would not wish to violate the Church's teachings on euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
by refusing nutrition and hydration." Judge George Greer
George Greer
George W. Greer was an American judge serving in the Pinellas-Pasco County Circuit Court, family law division, in Clearwater, Florida, who received national attention when he presided over the Terri Schiavo case....
issued his order granting Michael's petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the court found that Terri was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal
Florida Second District Court of Appeal
The Florida Second District Court of Appeal is headquartered in Lakeland, Florida and has a branch in Tampa.-History:The initial territorial jurisdiction of the Second District, with its headquarters in Lakeland, encompassed twenty-eight counties, ranging from Lake County in the north, to Collier...
(2nd DCA) and came to be known by the court as Schiavo I in its later rulings.
Oral feeding and the Second Guardianship Challenge
In March 2000, the Schindlers filed a motion to permit oral feeding of Terri, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri was not responsive to swallowing tests and required a feeding tube, Judge Greer ruled that Terri was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request. The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed.In 2000, the Schindlers again challenged Michael's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri to Pinellas Park, Florida
Pinellas Park, Florida
Pinellas Park is a city located in central Pinellas County, Florida. The population was 45,658 at the 2000 census. As of 2004, the population estimated by the U.S. Census Bureau is 47,166 . The city was founded by Philadelphia publisher, F. A...
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 was in a relationship with Jodi Centonze, and had fathered their first child. Michael 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.
Schiavo II
In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure. 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, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against removal of feeding tube until this was settled. The feeding tube was reinserted on April 26. On appeal by Michael, the Second District Court of Appeal reversed Judge Quesada's order. In the same time frame, Michael 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, came to be known by the court as Schiavo II in its later rulings.)Schiavo III & IV: PVS diagnosis challenge
Florida Second District Court of Appeal
The Florida Second District Court of Appeal is headquartered in Lakeland, Florida and has a branch in Tampa.-History:The initial territorial jurisdiction of the Second District, with its headquarters in Lakeland, encompassed twenty-eight counties, ranging from Lake County in the north, to Collier...
, Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability such that Terri herself would be able to decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the Second District Court of Appeals. On October 17, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Terri's wishes back to the trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Michael could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri's condition. (These decisions, all published in a single order by the Florida Second District Court of Appeal, came to be known by the court as Schiavo III in its later rulings.) In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer's court to determine whether new therapy treatments could help Terri restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan) was performed, which showed severe cerebral atrophy
Cerebral atrophy
Cerebral atrophy is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means loss of cells. In brain tissue, atrophy describes a loss of neurons and the connections between them...
. An EEG
Electroencephalography
Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
showed no measurable brain activity. The five physicians chosen were Dr. William Maxfield, a radiologist
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
, and four neurologist
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
s: Dr. William Hammesfahr
William Hammesfahr
William Hammesfahr is an American neurologist practicing in Clearwater, Florida, who specializes in treating stroke victims. He is best known for his involvement in the Terri Schiavo case, during which he examined Schiavo and testified on behalf of her parents....
, Dr. Ronald Cranford, Dr. Melvin Greer and Dr. Peter Bambakidis.
The five doctors examined Terri's medical records, brain scans, the videos, and Terri herself. Drs. Cranford, Greer, and Bambakidis testified that Terri was in a persistent vegetative state. Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state
Minimally conscious state
Minimally Conscious State is a disorder of consciousness distinct from Persistent vegetative state and Locked-in syndrome. Unlike persistent vegetative state, patients with MCS have partial preservation of conscious awareness. MCS is a relatively new category of disorders of consciousness. The...
. As part of the court-ordered medical exam, six hours of video of Terri were taped and filed at the Pinellas County courthouse. The tape included Terri with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Terri "clearly does not consistently respond to her mother". From that six hours of video, the Schindlers and their supporters produced six clips showing reactions and emotions, totaling less than six minutes, and released those clips to public websites. Judge Greer ruled that Terri was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr's testimony, which claimed positive results in similar cases by use of vasodilation
Vasodilation
Vasodilation refers to the widening of blood vessels resulting from relaxation of smooth muscle cells within the vessel walls, particularly in the large arteries, smaller arterioles and large veins. The process is essentially the opposite of vasoconstriction, or the narrowing of blood vessels. When...
therapy, the success of which is unsupported in the medical literature. This ruling was later affirmed by Florida's Second District Court of Appeal, which stated that "this court has closely examined all of the evidence in the record," and "we have... carefully observed the video tapes in their entirety." The court concluded that "...if we were called upon to review the guardianship court's decision de novo
Trial de novo
In law, the expression trial de novo means a "new trial" by a different tribunal...
, we would still affirm it." (This decision by the Second District Court of Appeals came to be known as Schiavo IV in later rulings.)
Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. They selected pro-life activist Randall Terry
Randall Terry
Randall Almira Terry is an American pro-life activist and candidate for the Democratic Party's nomination for President in 2012. Terry founded the pro-life organization Operation Rescue. The group became particularly prominent beginning in 1987 for blockading the entrances to abortion clinics;...
as their spokesman but continued to pursue their available legal options. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube to provide for "eight weeks' therapy". Accompanying the petition were four affidavits from members of the Schindler family and one from Dr. Alexander T. Gimon. At the hearing, the Schindlers' counsel read into the record additional affidavits from three speech professionals and two nurses. Nurse Carla Sauer lyer asserted that she was able to feed Terri Schiavo orally but that Michael characterized any such interaction as "therapy" and ordered her not to do so. Iyer claimed in her affidavit that her initial training in 1996 consisted solely of the instruction, "Do what Michael Schiavo tells you or you're terminated," and that standing orders were not to contact the Schindler family, but that she "would call them anyway". She also claimed that Michael said, "When is that bitch gonna die?" According to Iyer, on five different occasions she tested Terri's blood sugar
Blood sugar
The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
levels after Michael visited and found that Terri's blood sugar levels were so low they wouldn't even register. She claims that she eventually called the police and was fired the next day. Despite her claims that she called the Schindlers multiple times in 1996, there is no evidence the Schindlers did anything at the time to demand that the nursing home or police investigate the supposed incidents. Nor did they subpoena
Subpoena
A subpoena is a writ by a government agency, most often a court, that has authority to compel testimony by a witness or production of evidence under a penalty for failure. There are two common types of subpoena:...
Iyer during their 2000 court battle with Michael.
On September 17, Judge George Greer
George Greer
George W. Greer was an American judge serving in the Pinellas-Pasco County Circuit Court, family law division, in Clearwater, Florida, who received national attention when he presided over the Terri Schiavo case....
denied the petition, and wrote that "the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them clearly demonstrate this to be true." Regarding (Nurse) Iyer's statements, Greer wrote that they were "incredible to say the least" and that "Ms. Iyer details what amounts to a 15-month cover-up April 1995 through July 1996 which include the staff of Palm Garden of Largo 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... It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had Iyer contacted them in 1996 as her affidavit alleges".
Terri's Law and other government delays
On October 15, 2003, Schiavo's feeding tube was removed. Within a week, when the Schindlers' final appeal was exhausted, State Rep. Frank AttkissonFrank Attkisson
Frank C. Attkisson is a Florida politician. He served in the Florida House of Representatives from 2000 to 2008 and as the mayor of Kissimmee, Florida from 1996 to 2000. Attkisson has begun his campaign for County Commission for Osceola County in 2010.-Early life and education:Attkisson was born...
and the Florida Legislature
Florida Legislature
The Florida State Legislature is the term often used to refer to the two houses that act as the state legislature of the U.S. state of Florida. The Florida Constitution states that "The legislative power of the state shall be vested in a legislature of the State of Florida," composed of a Senate...
hastily passed "Terri's Law," giving Governor Jeb Bush
Jeb Bush
John Ellis "Jeb" Bush is an American politician who served as the 43rd Governor of Florida from 1999 to 2007. He is a prominent member of the Bush family: the second son of former President George H. W. Bush and former First Lady Barbara Bush; the younger brother of former President George W...
the authority to intervene in the case. Governor Bush immediately ordered the feeding tube reinserted. Governor Bush sent the Florida Department of Law Enforcement
Florida Department of Law Enforcement
The Florida Department of Law Enforcement is a Florida government agency. FDLE is composed of five programs: Executive Direction and Business Support, Criminal Investigations and Forensic Science, Criminal Justice Information, Criminal Justice Professionalism, and the Florida Capitol Police...
to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted. She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem (GAL), Dr. Jay Wolfson, to "deduce and represent the best wishes and best interests" of Schiavo, and report them to Governor Bush. Wolfson's report did not change Michael's role as her legal guardian and did not otherwise obstruct him legally.
Michael Schiavo opposed the Governor's intervention in Schiavo's case, and was represented, in part, by the American Civil Liberties Union
American Civil Liberties Union
The American Civil Liberties Union is a U.S. non-profit organization whose stated mission is "to defend and preserve the individual rights and liberties guaranteed to every person in this country by the Constitution and laws of the United States." It works through litigation, legislation, and...
(ACLU). At the same time, Robert and Mary Schindler, her parents, attempted to intervene and participate in the "Terri's Law" case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida Sixth Circuit, the same circuit as for Judge George W. Greer. They appealed, and, on February 13, the Florida Second District Court of Appeal
Florida District Courts of Appeal
The Florida District Courts of Appeal are the intermediate appellate courts of the Florida state court system. There are five DCAs:*The First District Court of Appeal is headquartered in Tallahassee...
(Second District Court of Appeals) reversed Baird's ruling, allowing them to participate. On March 17, Baird denied the Schindlers the right to intervene a second time, and the Schindlers, represented by the conservative American Center for Law and Justice
American Center for Law and Justice
The American Center for Law & Justice is a conservative Christian, pro-life group that was founded in 1990 by evangelical Pat Robertson.-History:...
(ACLJ), appealed the right to participate in the "Terri's Law" case, with the court scheduling an oral argument
Oral argument
Oral arguments are spoken presentations to a judge or appellate court by a lawyer of the legal reasons why they should prevail. Oral argument at the appellate level accompanies written briefs, which also advance the argument of each party in the legal dispute...
date for June 14. The Schindlers' other attorney, Pat Anderson, was concurrently challenging Michael Schiavo's right to be her guardian, and, on June 16, she made a petition for writ of Quo Warranto
Quo warranto
Quo warranto is a prerogative writ requiring the person to whom it is directed to show what authority they have for exercising some right or power they claim to hold.-History:...
.
On May 5, 2004, Baird found "Terri's Law" unconstitutional
Constitutionality
Constitutionality is the condition of acting in accordance with an applicable constitution. Acts that are not in accordance with the rules laid down in the constitution are deemed to be ultra vires.-See also:*ultra vires*Company law*Constitutional law...
, and struck it down. Bush appealed this order to the Second District Court of Appeals, but, on May 12, they issued an "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution." The Second District Court of Appeals, in sending it directly to the Florida's Supreme Court, invoked "pass through" jurisdiction.
The Florida Supreme Court then overturned the law as unconstitutional.
Early 2005 motions
On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations. 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. 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." 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."On February 28, 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. 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." 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..."
Following Greer's order on March 18, 2005 to remove the feeding tube, Republicans in the United States Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
subpoena
Subpoena
A subpoena is a writ by a government agency, most often a court, that has authority to compel testimony by a witness or production of evidence under a penalty for failure. There are two common types of subpoena:...
ed both Michael and Terri Schiavo to testify at a congressional hearing. 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.
Palm Sunday Compromise
President Bush and Congressional Republicans anticipated Greer's adverse ruling well before it was delivered and worked on a daily basis to find an alternative means of overturning the legal process by utilizing the authority of the United States CongressUnited States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
. On March 20, 2005, the Senate, by unanimous consent
Standing Rules of the United States Senate
The Standing Rules of the Senate are the rules of order adopted by the United States Senate that govern its procedure. The Senate's power to establish rules derives from Article One, Section 5 of the United States Constitution: "Each House may determine the rules of its proceedings..."There are...
, passed their version of a relief bill; since the vote was taken by voice vote, there was no official tally of those voting in favor and those opposed. Soon after Senate approval, the House of Representatives passed an identical version of the bill S.686, which came to be called the "Palm Sunday Compromise
Palm Sunday Compromise
The Palm Sunday Compromise, formally known as the Act for the relief of the parents of Theresa Marie Schiavo, is an Act of Congress passed on March 21, 2005, to allow the case of Terri Schiavo to be moved into a federal court...
" and transferred jurisdiction of the Schiavo case to the federal courts. The bill passed the House on March 21 at 12:41 a.m. (UTC-5
UTC-5
UTC−05:00 is an identifier for a time offset from UTC of −05.This offset is used in the Eastern Time Zone during standard time and in the Central Time Zone during Daylight Saving Time ....
). U.S. President
President of the United States
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....
George W. Bush
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
flew to Washington, D.C.
Washington, D.C.
Washington, D.C., formally the District of Columbia and commonly referred to as Washington, "the District", or simply D.C., is the capital of the United States. On July 16, 1790, the United States Congress approved the creation of a permanent national capital as permitted by the U.S. Constitution....
from his vacation in Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
in order to sign the bill into law at 1:11 a.m. As in the state courts, all of the Schindlers' federal petitions and appeals were denied, and the U.S. Supreme Court declined to grant certiorari
Certiorari
Certiorari is a type of writ seeking judicial review, recognized in U.S., Roman, English, Philippine, and other law. Certiorari is the present passive infinitive of the Latin certiorare...
, effectively ending the Schindlers' judicial options.
At the same time, the so-called Schiavo memo
Schiavo memo
During the Terri Schiavo controversy in March 2005, a talking points memo on the controversy was written by Brian Darling, the legal counsel to Republican Senator Mel Martinez of Florida...
surfaced, causing a political firestorm. The memo was written by Brian Darling
Brian Darling
Brian Darling is a senior fellow in government studies at The Heritage Foundation, a conservative think-tank based in Washington, D.C. Darling has been involved in U.S. politics since the early 1990s, in roles as a congressional aide, lobbyist and legal counsel...
, the legal counsel to Florida Republican senator Mel Martinez
Mel Martinez
Melquíades Rafael Martínez Ruiz, usually known as Mel Martinez , is a former United States Senator from Florida and served as Chairman of the Republican Party from November 2006 until October 19, 2007, the first Latino to serve as chairman of a major party...
. It suggested the Schiavo case offered "a great political issue" that would appeal to the party's base
Base (politics)
In politics, the term base refers to a group of voters who almost always support a single party's candidates for elected office. Base voters are very unlikely to vote for the candidate of an opposing party, regardless of the specific views each candidate holds...
(core supporters) and could be used against Senator Bill Nelson, a Democrat
Democratic Party (United States)
The Democratic Party is one of two major contemporary political parties in the United States, along with the Republican Party. The party's socially liberal and progressive platform is largely considered center-left in the U.S. political spectrum. The party has the lengthiest record of continuous...
from Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
, because he had refused to co-sponsor the bill. Nelson easily won re-election in 2006.
Final local motions, death and autopsy
On March 24, 2005, Judge Greer denied a petition for intervention by the Department of Children & Families (DCF) and signed an order forbidding the department from "taking possession of Theresa Marie Schiavo or removing her" from the hospice and directed "each and every and singular sheriff of the state of Florida" to enforce his order. The order was appealed to the Second District Court of Appeals the following day, which resulted in an automatic stay under state law. While the stay was in effect, Florida Department of Law Enforcement personnel prepared to take custody of Terri and transfer her to a local hospital for reinsertion of the feeding tube. Once Greer was made aware of the stay, he ordered it lifted and all parties stood down. Governor Bush decided to obey the court order despite enormous pressure from the political right. If Bush (or the Florida Legislature) had ignored Greer's order by attempting to remove her from the hospice, a confrontation between the Pinellas Park Police Department and the FDLE agents could have ensued. In jest, one official said local police discussed "... whether we had enough officers to hold off the National Guard."Schiavo died at a Pinellas Park
Pinellas Park, Florida
Pinellas Park is a city located in central Pinellas County, Florida. The population was 45,658 at the 2000 census. As of 2004, the population estimated by the U.S. Census Bureau is 47,166 . The city was founded by Philadelphia publisher, F. A...
hospice
Palliative care
Palliative care is a specialized area of healthcare that focuses on relieving and preventing the suffering of patients...
on March 31, 2005. Although there was concern that Schiavo would experience significant symptoms from dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
with the removal of the feeding tube, studies have shown that patients who have their feeding tubes removed, such as the case of Schiavo, usually have a peaceful death.
After her death, Schiavo's body was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Fla. The autopsy
Autopsy
An autopsy—also known as a post-mortem examination, necropsy , autopsia cadaverum, or obduction—is a highly specialized surgical procedure that consists of a thorough examination of a corpse to determine the cause and manner of death and to evaluate any disease or injury that may be present...
occurred on April 1, 2005. It revealed extensive brain damage. The manner of death was certified as "undetermined". The autopsy was led by Chief Medical Examiner Jon R. Thogmartin, M.D. In addition to consultation with a neuropathologist (Stephen J. Nelson, M.D.), Dr. Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report was released on June 15, 2005. In addition to studying Terri's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. Examination of Schiavo’s nervous system by neuropathologist Stephen J. Nelson, M.D., revealed extensive injury. The brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
itself weighed only 615 g, only half the weight expected for a female of her age, height, and weight, an effect caused by the loss of a massive amount of neurons. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex
Cerebral cortex
The cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
, the thalami
Thalamus
The thalamus is a midline paired symmetrical structure within the brains of vertebrates, including humans. It is situated between the cerebral cortex and midbrain, both in terms of location and neurological connections...
, the basal ganglia
Basal ganglia
The basal ganglia are a group of nuclei of varied origin in the brains of vertebrates that act as a cohesive functional unit. They are situated at the base of the forebrain and are strongly connected with the cerebral cortex, thalamus and other brain areas...
, the hippocampus
Hippocampus
The hippocampus is a major component of the brains of humans and other vertebrates. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. Humans and other mammals have two hippocampi, one in...
, the cerebellum
Cerebellum
The cerebellum is a region of the brain that plays an important role in motor control. It may also be involved in some cognitive functions such as attention and language, and in regulating fear and pleasure responses, but its movement-related functions are the most solidly established...
, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neuron
Betz cell
Betz cells are pyramidal cell neurons located within the fifth layer of the grey matter in the primary motor cortex, M1. They are named after Vladimir Alekseyevich Betz, who described them in his work published in 1874. These neurons are the largest in the central nervous system, sometimes reaching...
s that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, is also typical. There was marked damage to important relay circuits deep in the brain (the thalami) – another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."
The cardiac pathologist who studied Schiavo's heart found it and the coronary vessels
Coronary circulation
Coronary circulation is the circulation of blood in the blood vessels of the heart muscle . The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries...
to be healthy, which excludes the possibility that her initial collapse was the result of myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
, although there was a localized area of healed inflammation (opening the possibility of myocarditis
Myocarditis
Myocarditis is inflammation of heart muscle . It resembles a heart attack but coronary arteries are not blocked.Myocarditis is most often due to infection by common viruses, such as parvovirus B19, less commonly non-viral pathogens such as Borrelia burgdorferi or Trypanosoma cruzi, or as a...
). Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." Regarding the possibility of strangulation or domestic violence as a cause of Schiavo's initial collapse, the report states: "No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in the months after her initial collapse. Indeed, within an hour of her initial hospital admission, radiographic examination of her cervical spine was negative. Specifically, external signs of strangulation including cutaneous or deep neck injury, facial/conjunctival petechiae, and other blunt trauma were not observed or recorded during her initial hospital admission. Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings."
Regarding the cause and manner of Schiavo’s death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined."
"We were not surprised the medical examiner said Terri's brain was damaged," said Bobby Schindler, Jr., her brother, in an interview hours after the autopsy report was released. "The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions."
Public opinion and activism
Due to media attention there was a great deal of public opinion and activism in the case, including many polls, and frequent fractious protests some even leading to arrests. Two pollsOpinion poll
An opinion poll, sometimes simply referred to as a poll is a survey of public opinion from a particular sample. Opinion polls are usually designed to represent the opinions of a population by conducting a series of questions and then extrapolating generalities in ratio or within confidence...
showed that a large majority of Americans
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
believed that Michael Schiavo should have had the authority to make decisions on behalf of his wife, Terri Schiavo, and that the United States Congress
United States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
overstepped its bounds with its intervention in the case. However, other polls seemed to favor the Schindler family's position, and questions were raised about the wording of all the polls. Various organizations and protesters demanded that Schiavo's feeding tube be reinserted. Most of these groups were affiliated with the Christian right
Christian right
Christian right is a term used predominantly in the United States to describe "right-wing" Christian political groups that are characterized by their strong support of socially conservative policies...
.
Further reading
- Terri's Story: The Court-Ordered Death of an American Woman by Diana Lynne (2005) ISBN 1-58182-488-2
- Silent Witness: The Untold Story of Terri Schiavo's Death by Mark FuhrmanMark FuhrmanMark Fuhrman is a former detective of the Los Angeles Police Department , known for his part in the investigation of the murders of Nicole Brown Simpson and Ronald Goldman and his subsequent felony conviction for perjury...
(2005) ISBN 0-06-085337-9 - A Life That Matters: The Legacy of Terri Schiavo — A Lesson For Us All by Mary and Robert Schindler (2005) ISBN 0-446-57987-4
- Remembering Terri Schiavo: Reflections of a Health Care Warrior by Audrey Ignatoff (2005) ISBN 1-4116-3220-6
- Terri: The Truth by Michael Schiavo, Michael Hirsh (2006) ISBN 0-525-94946-1
- "Terri Schiavo: When Does Personhood End?" in The Elements of Bioethics, Gregory Pence, ISBN 978-0-07-313277-8
- The Case of Terri Schiavo: Ethics at the End of Life edited by Arthur L. Caplan, James J. McCartney, and Dominic A. Sisti, ISBN 159102398X
- Fighting for Dear Life: The Untold Story of Terri Schiavo and What It Means for All of Us by David C.Gibbs, III (2006) ISBN 076420243X
External links
CompilationsThese are compilations of legal documents relating to the Schiavo case:
- Findlaw's compilation
- Tampa Bay Online
' s compilation - The University of Miami Ethics Programs' compilation
Information sites
- Conigliaro, Matt, Esq., Editor of "Abstract Appeal" Legal Blog. (2005). The Terri Schiavo Information Page Retrieved August 31, 2005
- Hospice Patients Alliance Retrieved August 30, 2005. Includes the initial 1999 Police Report