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The Terri Schiavo Case

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Video Clips of Terri Schiavo

Time Magazine, April 4, 2005 (Vol. 165, Issue 14, p. 23)

Daniel Eisenberg

Lessons of the Schiavo Battle

Copyright Time Incorporated Apr 4, 2005
What the bitter fight over a woman's right to live or die tells us about politics, religion, the courts and life itself

PAT ROBERTSON CALLED THE REMOVAL OF HER FEEDING TUBE "Judicial murder," and House majority leader Tom DeLay described it as an "act of medical terrorism." Representative Christopher Shays of Connecticut, one of only five House Republicans to vote against Congress's emergency legislation throwing the Terri Schiavo case into the federal courts, declared that "this Republican Party of Lincoln has become a party of theocracy." Operation Rescue founder Randall Terry, acting as spokesman for the parents of the severely brain damaged woman and making even his counterparts on the conservative right wince in embarrassment, inveighed in a mass e-mailing that Florida State Circuit Court Judge George Greer, who approved the request by Schiavo's husband to let her die, "has shown more courage in trying to kill Terri Schiavo than Governor [Jeb] Bush has shown in trying to save her." Just a few days before Easter, Brother Paul O'Donnell, a Franciscan monk and spiritual adviser to Robert and Mary Schindler, Schiavo's parents, said, "We pray that this modern-day crucifixion will not happen."

With Schiavo's life hanging in the balance, and people on both sides of the case holding strong beliefs about her right to live or die, passions were understandably running high. But as the endless barrage of inflammatory rhetoric and sometimes blatant posturing continued, the Florida woman at the center of the bitterly fought case seemed to have become a sideshow. "This is not about Terri Schiavo," says George Annas, chairman of the health law department at Boston University School of Public Health. "I think this is about abortion and stem cells. Congress wants to say that we need pro-life judges because the judiciary is out of control and favors death over life." Most Americans disapproved of the congressional action-and showed little faith in the stated, high-minded motives behind it. In a TIME poll conducted last week, fully three-quarters of respondents (including 68% of Republicans) said it was wrong for Congress to intervene, and two-thirds said they believed that Washington's action was more rooted in politics than principles.

Having conspicuously interrupted a vacation to return to Washington to sign Congress's bill in the wee hours of the morning-although he could have approved it from his ranch in Texas-President George W. Bush did not escape the public's displeasure. In TIME'S poll, 70% disapproved of his role in the drama. As federal and Florida state courts continued to reject appeals from Schiavo's parents to reinsert her feeding tube, Washington may have started to get the message. Bush, DeLay and Senator Bill Frist of Tennessee were suddenly as quiet as the Democrats had been all along; the Republican congressional leaders declined opportunities to speak about Schiavo on the Sunday-morning talk shows. "The winners of this are going to be the people who stop talking about it," said a senior Republican strategist.

TO MANY AMERICANS, THE IDEA THAT THERE could be any winners in this ugly and tragic family spectacle, filled with accusations of greed, abuse and adultery, must have been hard to believe. Beyond the heart-wrenching specifics of the case, the Schiavo controversy raised alarms for many about the federal government encroaching on states' rights, individual rights and the judiciary, not to mention the role religion should play in politics and the legal system. Most of all, though, it got people thinking seriously about what it means to be alive or dead, and how they might prepare for their own death. Suddenly, couples gathered around the dinner table or getting ready for bed were discussing how they would want to be treated near the end of their life and making plans to draft a living will and appoint a health-care proxy. Almost 70% of the people polled by TIME said they would want their feeding tube pulled if they were in Schiavo's situation, and some went to lengths to ensure they didn't end up in the same predicament. One Florida attorney told friends he had just drafted a new living will that included the words "I really, really, really mean this," and a Democratic political consultant says without joking that her new living will is going to include the words "Congress cannot overturn this by any legislation." Of course, having a living will doesn't guarantee it won't be contested. In a Bucks County, Pa., court this week, a daughter hopes to prevent her mother from having a feeding tube put into her Alzheimer's-afflicted father against the express wishes of his living will.

MORE THAN 15 YEARS AFTER SHE SUFFERED cardiac arrest (from a potassium imbalance that may have been caused by an eating disorder), which deprived her brain of oxygen and left her in what most doctors have diagnosed as a persistent vegetative state, Schiavo has become a cause célčbre for the right-to-life movement. Already mentioned in all sorts of fund-raising literature, Schiavo is a symbol not just for those fighting the right-to-die movement but also in the battle over abortion, stem-cell research and judicial activism. "We're replacing the sanctity of life with the quality of life in this country," laments Ken Connor, Florida Governor Jeb Bush's counsel in the Schiavo case.

Over the course of the nasty seven-year legal battle between Schiavo's parents and her husband and legal guardian Michael, he has insisted that his wife, who did not have a living will, had previously made clear her wishes not to be kept alive in such an incapacitated state. She has been dependent on a feeding tube, though not a ventilator, and according to most medical experts, lacks a consciously functioning brain. Although Michael Schiavo and the Schindlers were initially united in seeking extensive treatment for Terri's condition, the two sides have been estranged since February 1993, when they apparently had a falling out over the $300,000 malpractice settlement that Michael won from Schiavo's gynecologist, who failed to detect the potassium imbalance that led to her collapse. (An additional $750,000 from the case was put into trust for Terri's care, although Michael Schiavo's lawyers claim almost all of it has been used for medical and legal bills.)

Since then, Schiavo's parents exhausted every legal avenue to keep their daughter alive; their unsuccessful appeal to the U.S. Supreme Court last week was their fifth. Along the way, they have made a number of arguments, and all were rejected: that because of his relationship and two children with another woman, Michael should be removed as guardian-although, according to court documents, the Schindlers originally encouraged him to see other women; that as a devout Catholic, Terri would want to live-although they have also acknowledged in court that they might have disregarded her wish to die even if stated in a living will; that Michael was abusing Terri, charges he has vehemently denied; and that her condition has been misdiagnosed, that she actually has a minimal level of consciousness and, with more therapy, could get better.

Even a bill signed by Governor Bush in 2003 to allow the tube to be reinserted ultimately didn't help, since the measure, dubbed Terri's Law, was declared unconstitutional. By the time they were able to persuade Congress to give them another chance to be heard in the federal courts, her parents were arguing that Terri was being denied due process, contending that her rights under the Americans with Disabilities Act were being violated and even claiming that Terri had recently communicated that she still wants to live. While the Schindlers and their supporters charged that Terri was being starved to death, her husband maintained that Terri was in absolutely no pain.

ALMOST FROM THE MOMENT THAT DELAY first came up with the idea of subpoenaing Schiavo as a way to prevent the removal of her feeding tube, the saga has had elements of a political circus. There was Congress, convening a special session during the Easter recess to pass a bill crafted just for one family, giving Schiavo's parents a final avenue of appeal. There was President Bush, for the first time cutting short a rest at his ranch to sign a bill. Top Republican staffers on Capitol Hill told TIME that it took some lobbying by congressional Republican leaders, who Bush needs for his controversial Social Security reform and budget cuts, for the President to return on short notice in such a visible role. There were members of Congress, including some physicians like Senate majority leader Frist, earning the derision of the medical community by voicing their own views of Schiavo's condition based on little more than court transcripts and some grainy, heavily edited three-year-old videotapes. ("We're not doctors," Democratic Representative Barney Frank quipped. "We just play them on C-SPAN")

There were protesters suggesting that Governor Bush should, in an eerie echo of the Elián González snatching that took place five years ago, forcibly remove Schiavo from her hospice to make her a ward of the state-with the help of the Florida National Guard if necessary. At one point, they almost got their wish. Agents from Florida's Department of Children & Families actually did begin to head over to Schiavo's hospice, but local police at the scene made it clear that they would not allow them in without an order from Judge Greer, who had previously enjoined the state from taking such a drastic action. In the end, Governor Bush, a devout Catholic who scored valuable points with the religious right with his dogged work on the case, reluctantly admitted that "my powers are not as expansive as people would want them to be."

On the Internet, conservative bloggers questioned whether an anonymous G.O.P. talking-points memo calling the Schiavo case "a great political issue" was in fact a fake cooked up by Democrats. And DeLay, for whom the Schiavo case served as a well-timed media distraction in the midst of his growing ethical scandals, told a private gathering of the conservative Family Research Council that "this is more than just Terri Schiavo. This is exactly the kind of issue that is going on in America ... attacks against the conservative movement, against me and others, to destroy everything we believe in."

MANY VOTERS REACTED NEGATIVELY TO such bluster. In the TIME poll, 54% of respondents said they would be more likely to vote against their congressional representative if he or she voted for the recent Schiavo bill. Still, for all the speculation that Republicans may have overreached with their control of Congress, it is hard to imagine that many voters, especially moderate Republicans, will punish legislators for, in effect, trying to prolong Schiavo's life.

"All we did was allow Terri's parents to have the same privileges as an individual sentenced to death-an appeal to the federal courts," says Thomas Price, a Republican Representative from Georgia. That comparison is debatable, but there is no denying that the action will resonate with a small minority of committed members of the religious right. "For people for whom this is murder by the state in a grotesque and inhumane way, this will deepen and harden their energy and activism in ways that will last a lifetime," says former Speaker of the House Newt Gingrich, who while personally conflicted over the issue, thinks Congress did the right thing. "But for everyone else, it will be a memory."

That surely was one of the political calculations the Republicans made when deciding to get so involved in the Schiavo case, which was first discussed in the halls of Congress late last year. At a time when G.O.P. leaders in Congress have been unable to gain much traction on issues like abortion and gay rights-which are near and dear to Christian conservatives-this was a no-lose opportunity to burnish their credentials with their most demanding and important supporters. Still, many Republicans reject the notion that anything but deep moral conviction motivated the extraordinary legislative measure. "It's hard to say it's politics when you get that kind of consensus in a divided U.S. Senate," says Republican Senator Chuck Grassley of Iowa.

The move contradicted the G.O.R'S longstanding support of states' rights, generating concern from a few independent-minded members of the party, like Virginia Senator John Warner. As the only Republican Senator to take to the floor to speak against the emergency legislation, Warner declared in the Congressional Record that "I fear the door has opened, and Congress, which by constitutional mandate is entrusted to pass laws for the nation, will again and again be petitioned to deal with personal situations which are the responsibility of the several states." Even so, the idea of a meaningful split emerging in the Republican ranks seems to be overblown. The people who deliver votes and mobilize constituencies are still on the same page, and that means doing what they can to make social conservatives happy.

Some on the religious right think the Schiavo case shows that their agenda is more realistic than ever. "When I heard that Senate minority leader Harry Reid was with us, I thought I had died and gone to heaven," says the Rev. Louis Sheldon, chairman of the Traditional Values Coalition. "[This] says that being pro-life is respectable and has political credibility. The issue is broadening; it isn't just abortion."

If people like Sheldon get their way, it will be about almost everything that encompasses the so-called culture-of-life movement, including restricting stem-cell research and assisted suicide. Social conservatives are almost certain to use the Schiavo case as another weapon in the coming war against what they castigate as judicial activism, the practice of creating new rights from the bench. As Frist contemplates the so-called nuclear option of trying to take away congressional Democrats' ability to filibuster President Bush's controversial judicial nominees, Schiavo is sure to be a rallying cry. In particular, critics fervently believe that the federal courts that heard the Schindlers' appeals largely ignored Congress's will by not following the bill's order to conduct a thorough re-examination of the case, formally called a de novo review. "In this instance, judges have essentially made themselves the supreme political power and simply aren't willing to listen to other branches of government," says Don Feder, communications director of Vision America, a Texas-based Christian conservative group.

Some Democrats tried to make political hay out of the fact that Republicans were rallying to the defense of Schiavo, much of whose care has been paid for by a malpractice settlement along with Medicaid, just when the G.O.P. was trying to limit such awards and cut Medicaid spending. Even if that doesn't help their case on specific issues, some Democrats believe the Schiavo episode may change voters' general perception of the two parties. "This is a cold, bracing slap in the face for a lot of Americans, as to the degree they want these very personal issues debated upon in a political forum," says Democratic political consultant David Axelrod.

Although they insist that the Schiavo saga was an extreme example, Republicans aren't giving up on the issue of end-of-life care. The Senate Health Committee is set to hold a hearing this week on end-of-life issues, and there is talk among some members of introducing a federal version of Terri's Law, which would give other people in similar right-to-die cases access to federal courts. Members only have to look at their state counterparts to get other ideas: a conservative Democratic lawmaker in Michigan has introduced a bill that would bar spouses caught in adultery from blocking measures that would keep a husband or wife alive, while a Georgia state senator has authored legislation that would bar the removal of a feeding tube from patients able to breathe on their own unless they had left a living will specifying otherwise. Certain social conservatives don't believe in any kind of right to die, even if someone has asked for death in a living will. In their minds, ending any life-sustaining medical treatment is tantamount to murder or assisted suicide. The G.O.P. probably would never go that far. Still, as an aide to the House leadership puts it, "the fight is not over." And with that kind of language, the battle over Terri Schiavo's legacy isn't likely to simmer down anytime soon. -Reported by Perry Bacon Jr., John F. Dickerson and Karen Tumulty/Washington; Amanda Bower/New York; Dee Gill and Wendy Malloy/Tampa; Tim Padgett and Siobhan Morrissey/Miami; and David Thigpen and Eric Ferkenhoff/Chicago, with other bureaus

Schiavo Autopsy Results

Copyright 2005 The New York Times Company
The New York Times
June 16, 2005 Thursday
Late Edition - Final

SECTION: Section A; Column 1; National Desk; Pg. 1

LENGTH: 1264 words

HEADLINE: Schiavo Autopsy Says Brain, Withered, Was Untreatable

BYLINE: By ABBY GOODNOUGH; Lynn Waddell contributed reporting from Largo, Fla., for this article.


An exhaustive autopsy found that Terri Schiavo's brain had withered to half the normal size since her collapse in 1990 and that no treatment could have remotely improved her condition, medical examiners said on Wednesday.

The autopsy results, released almost three months after Ms. Schiavo died after the court-ordered removal of her feeding tube, effectively quashed allegations by her parents that she had been abused by her husband. Yet the findings also questioned the prevailing theory that an eating disorder had prompted Ms. Schiavo's collapse, stating there was not enough hard evidence.

The report generally supported the contention of Ms. Schiavo's husband, Michael, accepted by judges in six courts over the years, that she was unaware and incapable of recovering. And it countered arguments by her family, who badly wanted to win custody of Ms. Schiavo, that she was responsive and could improve with therapy.

In the last months of her life, the fight over Ms. Schiavo produced a searing national debate about the rights of incapacitated people and when their lives should end if they left no specific instructions. The question of whether Mr. Schiavo should bring about his wife's death by removing her feeding tube, or whether he should cede custody to her parents, went on for seven years, reaching the Vatican, the White House, Congress and finally the United States Supreme Court, which declined to hear the case.

But the autopsy left unresolved the mystery, which haunted not just her husband and parents but ultimately much of the nation, of why Ms. Schiavo's heart stopped beating late one night when she was 26. The ensuing brain damage left her able to breathe on her own but not, most doctors said, to think or to have emotions.

''The only diagnosis that I know for sure is that her brain went without oxygen,'' said Dr. Jon R. Thogmartin, the medical examiner who led the autopsy in Pinellas County, where Ms. Schiavo had spent her final years in a hospice. ''Why? That is undetermined.''

The autopsy also found that the brain deterioration had left her blind. That finding, along with the determination that the brain damage was irreversible, caused some Republicans in Washington, who had pushed so hard for federal intervention in her case, to have second thoughts. And Democrats cited the autopsy results as proof that critics of the federal intervention had been vindicated. [Page A24.]

At a news conference in Largo, near Tampa, Dr. Thogmartin said the condition of Ms. Schiavo's body was ''consistent'' with earlier medical findings that she was in a persistent vegetative state. Her parents, who believed she might some day eat and drink on her own or even speak, had rejected that diagnosis. But the courts accepted testimony from Ms. Schiavo's husband, Michael, that she would not want to stay alive in her condition.

''This damage was irreversible,'' Dr. Thogmartin said of Ms. Schiavo's brain. ''No amount of therapy or treatment would have regenerated the massive loss of neurons.''

Yet a lawyer for Ms. Schiavo's parents, Robert and Mary Schindler, said they still believed their daughter had responded to their voices and touch. The lawyer, David Gibbs, said the parents, who were traveling in Minnesota on Wednesday, also doubted the finding that Ms. Schiavo was blind. The Schindlers had released videos showing their daughter appearing to smile at her mother and track a balloon with her eyes.

''She had a life that was worth saving,'' Mr. Gibbs said.

Dr. Thogmartin said that in addition to studying Ms. Schiavo's remains, he had scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. A specialist in Michigan separately studied Ms. Schiavo's heart tissue, and a laboratory in Connecticut determined that she did not have a genetic mutation that might have caused her heart to stop.

Ms. Schiavo had lost more than 100 pounds between her teenage years and the time of her collapse, and some doctors had theorized that her heart had stopped due to bulimia. Her husband even won a malpractice lawsuit on that premise, persuading a jury to award $1 million in damages on the grounds that Ms. Schiavo's obstetrician had failed to diagnose bulimia.

But Dr. Thogmartin stopped short of that conclusion. He said that while Ms. Schiavo had a low potassium level after her collapse, a symptom of an eating disorder, there was no evidence of her taking diet pills or laxatives or binging and purging.

''You end up with a 26-year-old that used to be heavy, that now lost the weight, is reveling in her thinness now, enjoying her life, and doesn't want to gain the weight back,'' Dr. Thogmartin said. ''And if that's a bulimic, there's a lot of bulimics out there. It's just not enough.''

He added that Ms. Schiavo's potassium level could possibly have dropped immediately after her heart stopped, perhaps during resuscitation efforts. Or, he said, Ms. Schiavo's habit of drinking excessive amounts of caffeinated tea might have even caused the deficiency. But unless new evidence comes to light, he said, no one will ever know for sure.

Though Ms. Schiavo went almost two weeks without her gastric feeding tube before dying on March 31, Dr. Thogmartin said she technically died of ''marked dehydration,'' not starvation.

The autopsy also ruled out heart attack or physical abuse causing Ms. Schiavo's collapse. Dr. Thogmartin said drug overdose was unlikely, though the toxicology tests performed immediately afterward would not have detected an overdose of diet pills or caffeine.

''I don't think drugs were sufficiently ruled out,'' he said.

Ms. Schiavo's parents had accused Mr. Schiavo of abusing their daughter and had even produced bone scans that they said showed damage to her spine, ribs and knees. But Dr. Thogmartin said he found only one fracture on a vertebra, which he said was likely caused by osteoporosis.

Dr. Michael Baden, a forensic pathologist who used to be New York City's chief medical examiner, said the autopsy was more thorough than most and should lay to rest all rumors of foul play.

''The politicians said that if she were treated differently she might have had a different outcome,'' said Dr. Baden, who was not involved in the autopsy but read the report. ''This shows that no matter how you treated her, there wouldn't have been a different outcome.''

He added, ''This doesn't close the book on the cause of this in the first place. But we know it wasn't trauma or spousal abuse. Whatever the cause, it was a natural one rather than a suspicious one.''

Shortly before Ms. Schiavo's death, President Bush cut short a Texas vacation and returned to the White House late one night to sign a law allowing her parents to seek a federal court review of the case. His brother, Gov. Jeb Bush of Florida, also intervened on the Schindlers' behalf, even getting the State Legislature to pass a law in 2003 empowering him to order Ms. Schiavo's feeding tube reinserted after doctors had removed it. But the law was ruled unconstitutional, and Governor Bush eventually declared himself out of options.

On Wednesday, Governor Bush praised Dr. Thogmartin and his staff for their ''careful review'' and added that he would ''continue to strive to protect our most vulnerable citizens.''

Michael Schiavo's lawyer, George Felos, said his client felt vindicated by the results.

''For years he feels that he's been talking in the wind,'' Mr. Felos said. ''Mr. Schiavo was pleased to hear the hard science and evidence of those findings.''

Video Clips of Terri Schiavo

These videos were shown to the Florida legislature and reportedly were instrumental in prompting them to intervene legally in the case.

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