Terri Shivo /part II: Final feeding tube removal and federal involvement

[NOTE: READ THE POST BELOW FIRST for a chronological account]

Early 2005 motions
From the start of 2005, publicity for the case again began to grow and it climaxed in the last half of March with Schiavo’s last days, dominating the national news through most of that month. Jesse Jackson went to Florida to support and argue on behalf of the Schindler family (What’s a controversy without Jesse Jackson?) The Schindlers filed two motions in an effort to forestall the removal of Schiavo’s feeding tube. No stay was granted by the appellate courts.

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 MRI 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”. Anderson argued that Greer did not specify “artificial nutrition and hydration” versus “oral nutrition and hydration” and stated that “the withholding of food and water…was not ordered by the Court but by Michael Schiavo.” In his order, Greer also set a time and date for the removal of the feeding tube: “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 MRI 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…”

Final removal and federal involvement
Following Greer’s order on March 18, 2005 to remove the feeding tube, Republicans in the United States Congress 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
Governor 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 Congress. 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. EST. President Bush flew to Washington D.C. from his vacation in Texas in order to sign the bill into law at 1:11 a.m. EST. 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. Qualified commentators at the time of the bill’s passage suggested that it was a bill of attainder. 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, because he had refused to co-sponsor the bill. Nelson won re-election in 2006.

Final local motions, death and autopsy
On March 24, 2005, 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 on March 31, 2005.
The parents objected to the pain of Terri’s death. Although Terri was not terminally ill, studies have shown that for terminally ill patients who choose to die, deaths by dehydration are generally peaceful, given appropriate palliative care.

The Facts
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 Mrs. Schiavo’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 neurons 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.”

Public opinion and activism and activism in the Terri Schiavo case
The Terri Schiavo case drew much public attention as the case rose to State and then Federal legislation. Right to life groups allied themselves with Terri’s parents but staged several protests of their own. Terri’s parents alleged that her husband was abusive and that this had led indirectly to her condition. The Florida Department of Children and Families rejected these allegations. Some have since maintained that her death constituted judicial murder.

Enter the Pope
In 2004, Pope John Paul II  stated that health care providers are morally bound to provide food and water to patients in persistent vegetative states. This led to a challenge in 2005 by Schiavo’s parents, who requested a new trial about whether their daughter, as a devout Catholic, would wish to go against the Church’s teaching. David Gibbs III, the lead lawyer for Terri Schiavo’s parents, supported Vatican statements which condemned her treatment as euthanasia. Judge Greer rejected their request. Coincidentally, the Pope himself died two days after Schiavo, replacing her story as front-page news. A similarly protracted case in Italy was that of Eluana Englaro, whose feeding tube was disconnected in February 2009. Another prolonged Italian case was that of Piergiorgio Welby.

On March 11, 2005, media tycoon Robert Herring  (who believes that stem cell research could have cured Schiavo’s condition) offered $1 million to Michael Schiavo if he agreed to cede his guardianship to his wife’s parents. He made the offer via Gloria Allred. The offer was rejected; George Felos, attorney for Michael Schiavo, described it as offensive, adding that Michael had rejected other monetary offers, including one of $10 million.

READ THE POST BELOW FIRST for a chronological account

for a quick bulletpointed account visit the NPR website. You can also listen to audio play on the topic on All Things Considered.