The Death of Terri Schiavo
Catholic World News : The Death of Terri Schiavo
The Death of Terri Schiavo
If the courts had reconsidered the facts, if doctors had followed procedures, if reporters had asked obvious questions, if bishops had spoken out boldly-a gross injustice might have been averted.
By Father Robert J. Johansen
May 2005 (CWR) - On March 31, shortly after 9 am, Terri Schindler-Schiavo died as the nation, and even the world, watched. She died in the hospice bed to which she had been confined for over five years. Her death has been hailed as a victory for the “right-to-die” movement, and denounced by others as “judicial homicide.”
As she lay dying, the media kept a grim countdown of the number of days she had been without food and water, and pundits opined on the cable news shows and in the newspapers about “death with dignity” and the sanctity of life. Her death, and the circumstances surrounding it, was commented upon more widely than most in modern history, and yet also probably one of the most misunderstood.
Terri's feeding tube was removed, as Florida Circuit Court Judge George Greer ordered, on March 18, shortly after 2 pm. Terri's family-her parents Bob and Mary, and her brother and sister Bobby and Suzanne-had been with Terri for most of the day. Terri had received her last feeding at about 11 am. The Schindlers were told by the police officers who maintained constant guard outside Terri's room that they would have to leave. At this point, medical personnel removed the percutaneous gastrostomy (PEG) tube that had been providing Terri's nutrition and hydration for some 15 years. From that moment on, Terri would receive no water or food, and thus began the “dying process” which would end 13 days later.
For the first few days, Terri appeared more or less “normal.” She continued to interact with her family and appeared alert. But after 3 or 4 days, the change in her condition became noticeable: Her skin started to appear dry and lifeless, and she became less responsive. By the seventh day, the Schindlers were telling me, in our daily telephone conversations, that Terri had become “lethargic,” and within a few more days, almost entirely unresponsive. Sometime around day 10 or 11 Terri suffered renal failure, which led swiftly to, and was the immediate cause of, her death.
THE LAST LEGAL BATTLES
In the weeks prior to the removal of Terri's feeding tube, and even while Terri lay dying, the Schindlers waged a legal battle to keep Terri alive. On February 25, Judge Greer ordered that Terri's feeding tube was to be removed three weeks hence. He also ruled that he would not hear any further motions or petitions from the Schindlers, except as they related to Terri's “dying process” and her final disposition. As the Associated Press reported:
The judge wrote that he was no longer comfortable granting delays in the family feud, which has been going on for nearly seven years and has been waged in every level of Florida's court system. He said the case must end.
“The court is no longer comfortable granting stays simply upon the filings of new motions,” Greer wrote. “There will always be 'new' issues.”
The Schindlers, in spite of Judge Greer's decision to refuse new motions, nonetheless filed several in the week following his setting of a new death date. Among these were petitions for new medical evaluations of Terri, a petition to allow Terri and her estranged husband Michael to be divorced, and a request to remove Michael as guardian.
Initially, Judge Greer held to his stated intent and dismissed these motions without hearing their merits. However, when threatened with the prospect of a successful appeal by the Schindlers on due-process grounds, Judge Greer relented and allowed most of the Schindlers' motions to be heard and argued. In the end, however, the hearings made no difference to the outcome of Judge Greer's decisions. During the week of March 7, Judge Greer:
o Denied the Schindlers' motion to compel Michael Schiavo's deposition in their case challenging his guardianship.
o Denied the Schindlers' motion for a divorce of Terri from Michael. The motion was denied on “Catch-22” grounds: Under the law, only spouses can request a divorce from each other. Since Terri could not speak for herself, she could not request a divorce. Only Michael, as guardian, could make such a request on Terri's behalf. Needless to say, Michael chose not to.
Then Judge Greer:
o Denied the Schindlers' motion to remove Michael as guardian.
o Denied the Schindlers' motion that attempts be made to feed Terri by mouth once the feeding tube was removed on March 18. George Felos, the attorney for Michael Schiavo, argued against this motion by asserting that if Terri was fed by mouth, she might aspirate the food and die an “extended, gruesome death.” This line of reasoning seemed bizarre, given that Felos was seeking Terri's death via starvation and dehydration over the course of a week to ten days.
o Denied the Schindlers' request that Terri be allowed to receive Viaticum (Holy Communion for the dying) by mouth. The judge ruled that if Terri was to be given Communion, it had to be done via her feeding tube.
o Denied the Schindlers' motion to allow their daughter to die at their home, noting the parents could visit the Pinellas Park hospice where she lived.
o Denied the Schindlers request to have Terri's intact body interred: He confirmed Michael's order that Terri was to be cremated upon her death. He also denied the Schindlers' motion to allow Terri to be buried in Florida. Michael intended to inter her cremated remains in Pennsylvania, where they are both from.
Judge Greer's ruling against the Schindlers on the matter of feeding by mouth seemed the most indicative of his frame of mind. By precluding attempts, as a “last ditch” measure, to feed her by mouth, the judge showed that his object was not merely to stop what he might (erroneously) argue is an “extraordinary” means of support, but to make certain that Terri died. One might make an analogy to someone on a respirator: frequently respirators are removed from patients, but sometimes they continue to breathe on their own without support. It is as though a judge were to order not only that a respirator be removed, but that the patient's mouth and nose be sealed with duct tape, just to make sure he couldn't get any air by any means.
TURNING TO LAWMAKERS
Following an unsuccessful round of appeals in the Florida and federal appellate courts, the Schindlers' efforts turned to obtaining legislative relief. The Schindlers lobbied the Florida legislature to pass a new version of “Terri's Law,” which had been struck down as unconstitutional by the Florida Supreme Court. But while the Florida bill seemed to stall, the Schindlers made more progress in the US Congress, where measures intended to grant a new review of Terri's case had been introduced in the House and Senate. The measure introduced in the House, the Incapacitated Persons Protection Act, was a broadly written bill that would have given the right to a federal hearing to a whole class of persons facing death by removal of nutrition and hydration. The Senate bill was more narrowly construed, providing relief to the Schindlers alone.
Americans were treated to a topsy-turvy public debate in which each side seemed at times to argue according to principles historically embraced by their opponents. Republicans such as House Majority Leader Tom De Lay decried the unaccountability and activism of our courts, while at the same time arguing for the passage of a bill which would bring Terri's case back before those same courts. Democrats, who have in the past defended intervention by federal courts in matters of state policy, found themselves arguing for States' rights, holding the decisions of the Florida courts sacrosanct.
The debate over the bills went on past the removal of Terri's feeding tube, and indeed, it seemed at points that no measure would be passed. Bobby Schindler went to Washington to lobby for the bills in the House and Senate, and met with every single member of both houses. Congressional sources described Bobby as “very persuasive” in his meetings with legislators. In one meeting, as he laid out the details of Terri's case, audible gasps were heard several times as the members were told of the string of injustices and errors which led to her judicially-ordered starvation.
In spite of the Republican support and Bobby Schindler's persuasiveness, there was formidable opposition to passing a law to save Terri. The ringleader of the opposition to the Senate bill, according to Bobby, was none other than Senator Ted Kennedy, the Catholic senior senator from Massachusetts. It struck me as ironic that Kennedy, whose opposition to the death penalty is passionate, led the opposition to a law that would have given Terri the same right to a hearing as condemned criminals. The opposition in the Senate led to the adoption of a compromise bill that gave relief to the Schindlers alone, and not the broader protection offered by the House bill.
In the early hours of March 21, the House passed Senate Bill 686, “For the Relief of the Parents of Theresa Marie Schiavo.” This bill provided for a de novo review of Terri's case, meaning that all of the issues and facts surrounding her case would have to be reconsidered.
This de novo review was essential: Although Terri's case had come before several state and federal courts numerous times, all of the courts' opinions were based on the same set of factual findings made by Judge Greer in his 1998 decision granting Michael the right to remove Terri's feeding tube. In that decision, Judge Greer ruled as a matter of fact that Terri was in a persistent vegetative state (PVS), and that Terri had indicated a wish not to go on living should she become dependent on artificial nutrition and hydration. As I have written before, both in CWR (November 2004) and in Crisis magazine (January 2004), these rulings were arrived at in a manner which rode roughshod over rules of civil trial procedure, and with what seemed to be a blind eye to the mountain of evidence contradicting them. The problem the Schindlers have faced, as I wrote in a recent article at National Review Online: …is that in our legal system, once a judge has ruled on a matter of fact, it is very difficult to revisit such a ruling. Lawyers have a rule of thumb that trial courts hear and rule on questions of fact, and appellate courts rule on questions of law. It is unusual for an appellate court to overturn a lower court's ruling based on errors regarding issues of fact.
And so, at every turn in this case, the Schindlers had to try to undo the faulty rulings of fact previously issued by Judge Greer. They had to go back before Judge Greer himself and try to convince him that he was wrong, and should undo his own rulings. Judge Greer proved unwilling to do so. Higher courts were unwilling to overturn a trial judge's rulings of fact and so, ruled against the Schindlers. The de novo review promised by the federal “Terri's Law” held out their only hope.
A PARTISAN STRUGGLE
That hope was never fulfilled, as the de novo review never materialized. It was well known that many jurists took offense at the passage of Terri's Law, which they interpreted as a congressional attempt to dictate how they should exercise jurisprudence. Speeches made by Rep. Tom De Lay and Senate Majority Leader Bill Frist decrying “activist judges” and an “out-of-control” judiciary solidified the impression that the battle over Terri Schiavo's life had become part of a political struggle: Those on the right saw Congress as trying to check the abuse of power by unaccountable judges. Those on the left saw the ability of judges to enact social change by the exercise of their legal authority imperiled by Terri's Law.
The reaction in the judiciary was evident from the outset. First, federal judges seemed completely to ignore the provision in the new law to grant the de novo review. The “fresh look” at all of the facts and issues of Terri's case simply did not happen. Instead the judges confined themselves to re-examining the issues of law, just as they would have done if the federal legislation had never passed. But the direction that events would take was indicated by remarks made by a federal judge at the conclusion of the first hearing held after the passage of the federal law. Federal Circuit Judge James Whittemore declined to rule immediately on the Schindlers' request to re-insert Terri's feeding tube, pending new litigation. In a comment that seemed motivated more by pique than any legal considerations, Judge Whittemore declined also to indicate when he would issue a ruling. He said “I will not tell you when, how, or how long it will take.”
As it turned out, Judge Whittemore declined altogether the Schindlers' motion, and declined to allow the re-insertion of her feeding tube in light of further appeals. This act set the tone for the judicial decisions to come. In several forays up and down the federal court system, the Schindlers were rebuffed at every turn. The Schindlers' attorney, David Gibbs, announced on March 28 that their legal remedies were exhausted, and they would file no further motions or appeals.
ERRORS OF FACT
Terri's fate can be seen, ultimately, as the result of Judge Greer's dubious findings of fact at the 2002 evidentiary hearings, at which he concluded that Terri was in a PVS, and that she would not want to live in her disabled condition. The facts were crucial in deciding Terri's fate, as the result of Judge Greer's factual errors was fatal for Terri. These errors filtered into the public debate as well. There can be little doubt that much of the press coverage and commentary simply did not get the facts right concerning Terri's case, and this stream of misinformation weakened pubic support for Terri's cause.
In my 2004 CWR article “Saving Terri's Life” I described how the mainstream media was often content, during the 2003 conflict over the removal of Terri's feeding tube, simply to parrot the characterizations of Terri's case presented by Michael Schiavo and his attorneys, rather than actually to question their assertions and dig more deeply into the issues. Unfortunately, in this last round of debate and controversy, little changed. Some news outlets, such as Fox News, did a reasonable job of covering the issues fairly, and giving the pro-life position a fair hearing. Some commentators and pundits, such as Fox's Sean Hannity, took on Terri's cause as their own, and became powerful champions for her life. However, most media outlets were content merely to repeat or even amplify the “memes” about Terri's case.
(A “meme,” in popular parlance, is an idea that may have little foundation in actual fact-being the product of rumor, innuendo, or gossip. However, because the idea is in some way convenient or useful, it is picked up and spread casually without investigation, and gradually acquires a patina of truthfulness, simply because it has been repeated so often. Memes become pervasive ideas, and frequently have the power to change public attitudes and perceptions.)
There were a number of memes circulated regarding Terri's case and repeated unquestioningly by the mainstream media. Among these were the assertion, frequently heard on cable talk shows, that “12 (or 16 or 19) judges have heard the case and ruled against the Schindlers.” This assertion was offered as an argument for accepting the decision to remove Terri's feeding tube as one arrived at responsibly. But of course the number of judges who agree with a decision is irrelevant if all those judges' rulings are based on the same factual errors-which was precisely the case regarding Terri Schiavo. Again, all of the subsequent rulings on Terri's case were based on the same fact-findings made by Judge Greer; those findings were never re-examined.
Another meme frequently asserted was that “Terri was bulimic.” Bulimia is an eating disorder characterized by “bingeing and purging,” and can cause serious health problems. This meme is interesting in that it was often introduced as a way of “blaming the victim”-the idea being that somehow Terri brought her situation on herself, and therefore deserved her fate. It is also is interesting in that it simply has no foundation in actual fact or evidence. The “Terri was bulimic” meme was the product of speculation offered by Michael Schiavo and his attorneys as to the cause of the cardiac arrest that led to Terri's brain damage. However, there was no talk of Terri suffering from bulimia or other eating disorders among Terri's family or friends before her injury. The assertion did not surface until well after Terri's collapse. Furthermore, there is no actual medical evidence of such a condition, unless you credit the circular reasoning employed by advocates of Terri's death. Their argument begins with the acknowledged fact that bulimia is a known cause of electrolyte imbalance of the sort that caused Terri's cardiac arrest; then the fact that Terri suffered an electrolyte imbalance is adduced as evidence that she was bulimic.
Far more damaging, however, were the memes circulated regarding Terri's medical care and diagnosis. I frequently encountered assertions that all medical options had been exhausted in Terri's case, and that Terri had had the best of care. Both assertions were simply false.
The fact is that Michael Schiavo, as Terri's guardian, had allowed no therapy or attempts at rehabilitation since 1992. He also forbade the physical therapy that might minimize contractures and muscle atrophy-a form of care that is commonly provided even for bedridden patients in a coma.
Furthermore, the idea that Terri has had the “best of care” is belied by the fact that, for the last five years of her life, Terri was at a hospice rather than at a nursing home or hospital. Hospice care is intended for patients who are recognized as terminal; only basic nursing and palliative care is provided. Therapeutic measures aimed at improving a patient's condition are not offered by hospice.
AN IRRESPONSIBLE DIAGNOSIS?
The most misleading memes surrounded Terri's diagnosis and medical condition. Readers and viewers of the mainstream media were barraged with reports that Terri was in a PVS, frequently without even the mention that this diagnosis had been challenged and was doubted by responsible doctors. I frequently encountered statements such as “all the doctors” who had examined Terri concluded that she was PVS, or a cleverer version that gave at least a nod to reality: “all the reputable doctors who examined Terri found that she was PVS.”
But such assertions ignore a disturbing set of facts which I discovered in the course of my research for the National Review Online article mentioned above. In my discussion with a number of board-certified neurologists, some of whom are professors of neurology at major medical schools, I learned that the diagnoses of the neurologists who appeared in court for Michael Schiavo, and the one appointed by Judge Greer, were arrived at in a manner inconsistent with sound neurological practice-a manner which did not live up to the guidelines established by the American Academy of Neurology.
First, although the doctors who examined Terri on behalf of the Schindlers asked for Terri to be given an MRI (Magnetic Resonance Imaging) scan, Judge Greer refused it, as the “star” medical witness for Michael Schiavo, Dr. Ronald Cranford, said that an MRI was unnecessary. Lower-quality CT (computer-aided tomography) scans were done instead. And who made the decision regarding which medical tests Terri was to have? Judge Greer did. According to Patricia Anderson, the attorney for Bob and Mary Schindler, until the fall of 2004, Judge Greer went down the list of tests requested by the doctors and himself “checked off” which ones Terri would receive. Judge Greer's method led Anderson to comment that the judge “practiced quite a bit of medicine in this case.”
As the facts about Terri's diagnosis came out in the weeks before and after the removal of her feeding tube, many neurologists expressed dismay with the lack of advanced imaging procedures. Indeed, nearly 50 neurologists-all of them board-certified and many of them leaders in the discipline-came forward and either offered, or expressed a willingness to offer, affidavits calling on the court to allow new neurological exams of Terri, including advanced imaging tests such as MRI.
The neurologists I have interviewed all acknowledge that the diagnosis of PVS is primarily “clinical”-that is, arrived at mainly on the basis of examination rather than from tests. However, many also asserted that they would themselves order an MRI in a case like Terri's, when life and death are at stake. As one of them, Dr. Peter Morin, explained, an MRI is very useful in “determining the extent of brain injury,” and in assessing the likelihood of the patient's improvement or recovery. Dr. Kalarickal Oomen, a professor of neurology at Oklahoma University Medical School, added that “MRI in many cases gives much better anatomic detail than CT, and is far superior” to the CT scans which were done on Terri in 2002. The value of MRI in assessing brain-injured patients such as Terri led several neurologists to go so far as to characterize a decision deliberately to forego one (as was done with Terri) as “not responsible.”
The guidelines laid down by the American Academy of Neurology for diagnosing patients suspected of being vegetative remark that the diagnosis of PVS can require months to establish. These guidelines also call for careful, repeated examinations of the patient. Neurologists explained that these repeated visits need to be conducted at varying times and under different circumstances. Thus Dr. William Bell, a professor of neurology at Wake Forest University Medical School, explained that brain-injured patients have severely disrupted sleep/wake cycles, and that a doctor can examine such a patient on one day and find him seemingly unresponsive, but return at a different time the next day and find the patient quite alert and aware of his environment. A 1996 article published in the British Medical Journal, which reported a 43 percent error rate in diagnoses of PVS, also cautioned that a “bedside assessment” alone was “inadequate” to make a diagnosis of PVS.
But the exams conducted by the three doctors retained by Michael Schiavo and the court were in fact nothing but the kind of “bedside assessments” deemed “inadequate” in the British Medical Journal study. Each doctor examined Terri for no more than 45 minutes, on only one occasion. Neurologists I interviewed did not object to the length of the exams, saying that a neurological exam could be conducted in 30 to 45 minutes. However, all of them expressed dismay at the lack of repeat exams. Dr. Mouhammed Kabbani, of the University of Missouri Medical School, said: “A single exam for 45 minutes is not enough. There should be continuous observation over a few days to make sure there is, or there is not, meaningful and reproducible response.”
The claims regarding the reliability of Terri's diagnosis of PVS turn out, on further examination, to be as groundless or exaggerated as the many other memes propagated by the media. Dr. Bernardine Healy, former director of the National Institutes of Health and medical columnist for US News and World Report, lamented that the medical procedures followed in Terri's case were simply “not good enough” for a situation “when life-and death-are on the line.” While some reporters and commentators, such as Dr. Healy, attempted to stem the tide of misinformation, they appear to have been drowned out. This lack of diligence by the press, and, in many cases, seemingly willing cooperation with the pro-death agenda, led Nat Hentoff, the acknowledged leftist and avowed atheist writer for The Village Voice, to describe the coverage of Terri's case as “disgracefully ignorant.”
THE PRO-LIFE PRESENCE
The opposition to Terri's starvation and dehydration was spearheaded by the pro-life movement, including many Catholics. Father Frank Pavone, the national director of Priests for Life, was frequently with the Schindlers visiting Terri, and joined those keeping vigil outside Terri's hospice. He also appeared frequently on television, speaking out for Terri's right to life. Father Thomas J. Euteneuer of Human Life International also came to Florida to lend support to the Schindlers, and made several media appearances on their behalf.
As I remarked in my CWR article last November, the movement to save Terri brought Catholics and Protestants together in a remarkable display of ecumenism in its best and truest form. Indeed not only Catholics and Protestants, but large numbers of Jews and Muslims also gave witness to the dignity and sanctity of human life. There were a number of prominent Protestants who provided leadership in mobilizing support for Terri's cause, and presented the case for Terri's life to the public. Perhaps the most passionate and eloquent of these was Dr. James Dobson of Focus on the Family. Dr. Dobson's stature among conservative Protestants is perhaps unmatched, and he became the de facto Evangelical voice for Terri in the media.
Unfortunately, the public case for the dignity of life was weakened by the lack of a strong and uncompromised witness from the Catholic hierarchy in the US. Some individual bishops, such as Cardinal Justin Rigali of Philadelphia, Bishop Thomas Wenski of Orlando, and Archbishop Raymond Burke of St. Louis, spoke out admirably on behalf of Terri's right to life. Cardinal William Keeler of Baltimore, chairman of the US bishops' Committee for Pro-Life Activities, in a March 9 statement, urged that Terri should “continue to receive all treatments and care that will be of benefit to her.” He cited the words of Pope John Paul II (bio - news), reminding us that even people in a coma “retain their human dignity in all its fullness.” The cardinal added that “deliberately to remove [food and water] in order to hasten a patient's death … would be a form of euthanasia, which is gravely wrong.” In spite of that statement, though, there seemed to be little movement at the national level to make a coordinated effort, in the name of the American bishops, in Terri's case.
On the contrary, “progressive” moral theologians such as Father John Paris of Boston College and Father Kevin O'Rourke of Loyola University in Chicago made the rounds of the talk shows presenting their view that the starvation and dehydration of Terri Schiavo was consistent with Catholic teaching. Rarely mentioned was Pope John Paul II's March 2004 statement that food and water are the presumptive right of every patient and must be provided. When it was mentioned, Fathers Paris and O'Rourke dismissed the Pontiff's pronouncement as his “personal opinion,” or otherwise indicated that it could safely be ignored.
As Catholic progressives rushed to defend Terri's starvation and dehydration, and Evangelical leaders such as Dobson presented a powerful case for life from that perspective, a question arose in the minds of many Catholics: Where was the voice of the hierarchy? Where was the Catholic equivalent of a James Dobson-someone of high stature and authority who would go on the talk shows and refute the Parises and O'Rourkes? Where was a Catholic spokesman to present authentic Catholic teaching with episcopal authority to the public at large?
There was none. As the Catholic writer Amy Welborn wrote at her popular web log, “Open Book,” a “teachable moment,” a great opportunity for the American hierarchy to present the Catholic vision and teaching on human life to the nation, was lost through inaction.
Glossary Terms: Viaticum
THE BISHOP'S ABSENCE
Bishop Robert Lynch heads the St. Petersburg, Florida, diocese, in which Terri resided. Readers may recall that, in my November 2004 CWR article on Terri's case, I documented his inadequate, and indeed arguably counterproductive, statements during the October 2003 removal of Terri's feeding tube. He refused, in spite of numerous requests by the Schindlers in the months leading up to October 2003, to make any public gesture showing support for their efforts to save Terri's life. Neither did the Diocese of St. Petersburg sponsor any events or activities to encourage support for Terri's cause among priests or laity.
Unfortunately, in the weeks leading up to and after the removal of her feeding tube in 2005, Bishop Lynch did not seem to deviate from his pattern of non-engagement in Terri's cause. He was virtually invisible.
On February 28, the bishop issued a statement in which he acknowledged that the Schindlers felt “they are outside of the decision-making process” and that “they are in great pain and suffering mightily.” He devoted most of the statement to urging “both sides” to “allow some mediation” so that Terri's legacy was “a heroic moment of concern for the feelings of each other, guided by moral and ethical considerations, with a single focus of achieving the best result for Terri.” Nowhere in the statement did Bishop Lynch address the substantive issues or acknowledge that Terri had a right to life. He referred to normal “end-of-life” cases, where families know that “they have done all they possibly might to provide alternatives to death,” and have attempted “every possible treatment protocol which might be helpful.” But he did not seem to recognize that such had not been done regarding Terri. By his use of language about “decisions made within families,” and of “both sides” coming together, he showed that he still understood the case as a family dispute, and not as a grave injustice being perpetrated on one of his flock.
The closest thing to a collaborative effort of Catholic bishops speaking out on Terri's behalf came from the Florida Conference of Bishops. On February 28, they issued a statement titled “Continued Concerns for Terri Schiavo.” While not as strong as it might have been, the statement was unequivocal in asserting Terri's right to continue receiving food and water, saying “As long as they effectively provide nourishment and help provide comfort, we should see them [food and water] as part of what we owe to all who are helpless and in our care.” Furthermore, the bishop quoted Pope John Paul II's address to the International Congress on the Vegetative State:
I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. [emphasis added]
The bishops' use of Pope John Paul's statement indicates that they understood him to be authoritatively presenting Church teaching. They understood that Terri's case was not about “end-of-life” issues or the “right-to-die,” but was about providing the most basic human care to someone in need.
The Holy See itself also spoke out on behalf of Terri's right to live. On February 24, Cardinal Renato Martino, the president of the Pontifical Council for Justice and Peace, said on Vatican Radio, “If Mr. Schiavo succeeds legally in causing the death of his wife, this not only would be tragic in itself, but would be a grave step toward the legal approval of euthanasia in the United States.” He concluded his remarks by noting that “No one can be the arbiter of life except God himself.” Less than a week later, on March 7, Cardinal Martino issued an even stronger statement. After saying that Terri would have death “inflicted on her over a number of terrible days, even weeks,” the cardinal went on to observe that “the state of Florida has many laws on its books which protect animals,” and that such animals received a greater protection under the law than did Terri. He demanded that “It must stop here and now,” and concluded by saying that:
Society must realize that we can never inflict this sort of death on a human being, on any other creature, without each and every one of us and society as a whole suffering a terrible fate.
In what seemed to be a response to the progressive Catholic moralists who supported the removal of Terri's feeding tube, the Vatican's top bioethicist, Bishop Elio Sgreccia, president of the Pontifical Academy for Life, said on March 3 that removal of Terri's feeding tube would be “direct euthanasia,” adding that “withdrawing Schiavo's gastric tube would not be a matter of allowing her to die, but would inflict death.” The bishop explained that the academy usually does not comment on specific cases before courts, but “silence in this case could be interpreted as approval.” Going further than other churchmen had up to that point, Bishop Sgreccia denounced the rulings of the courts, saying:
As far as we are concerned, denying someone access to food and water is a cruel way of killing someone... Taking into account only medical and anthropological considerations, we feel an obligation to affirm that such a decision violates the rights of Terri Schiavo and, therefore, constitutes an abuse of judicial authority.
THE “EXIT PROTOCOL”
In spite of the lobbying of the Schindlers, the untiring work of friends and volunteers on their behalf, the protests and witness of those praying for and defending Terri's right to life, and the courageous witness of some bishops and the Holy See, the efforts to save Terri failed. While her death was reported and lamented worldwide, few suspected beforehand that the circumstances of her death would be subject to the cruelty, distortions, and media “spin” that had characterized so much of the coverage of the struggle over her life.
One of the memes continually appearing in media was that Terri was dying a “peaceful,” “quiet” death. Michael Schiavo and his attorney George Felos appeared on television numerous times and told viewers that Terri was going simply to “slip away.” Some defenders of removing her feeding tube went so far as to describe death by dehydration and starvation as “euphoric.” Such fanciful characterizations of Terri's death defied not only what many would regard as common sense, but medical evidence supplied by the very hospice in which Terri's death occurred.
Last fall Cheryl Ford, RN, a nurse from Tampa who has been very active in the efforts to save Terri's life, undertook a review on behalf of the Schindlers of medical records from when Terri was first admitted to Woodside Hospice. Woodside Hospice is run by Hospice of the Florida Suncoast. It is of interest to note that Michael Schiavo's attorney, George Felos, was a member of the Board of Directors of Hospice of the Florida Suncoast until the Terri Schiavo case began to attract widespread public attention a few years ago.
In her research, Cheryl Ford found in Terri's file a document titled “Exit Protocol.” The document is on Hospice of the Florida Suncoast “Patient Care Notes” stationery, and “Symptom Management Orders” stationery. It is dated April 19 & 20, 2001. The documents are signed by Lisa Miller, a clinical pharmacist on the staff of Hospice of the Florida Suncoast, and Dr. Victor Gambone, a physician affiliated with the hospice. The documents include the clinical pharmacist's notes of her conversation with Dr. Gambone, and the order for medications signed by Dr. Gambone. The document was produced in anticipation of the first time Terri's feeding tube was removed, in 2001. It lays out, in clinical detail, the procedures to be followed in bringing about Terri's death by starvation and dehydration. It is too lengthy to be reproduced here in its entirety. However, a verbatim transcription is available at the March 24 post of my web log, “Thrown Back” [http://ThrownBack.blogspot.com], and the scans of the documents themselves are also available there for download.
Several parts of the “Exit Protocol” are worth summarizing here. After describing how Terri's nutrition and hydration, including daily vitamins, are to be discontinued, the document has the following note:
3. Monitor symptoms of pain/discomfort. If noted, medicate with Naproxen rectal suppository 375 mg Q8* prn. [“Q8* prn” is shorthand for “every 8 hours as needed.” Naproxen is a pain-reliever, available in its over-the-counter version as Aleve.]
We were told repeatedly that dying by denial of nutrition and hydration was, as Michael said on the “Larry King Live” program, “painless and probably the most natural way to die.” But if it is painless, then why was it necessary to “monitor symptoms of pain/discomfort,” and why would medication be needed for that pain and discomfort?
Another section of the document deals with the breakdown in skin integrity that occurs in the “peaceful” death Terri endured:
4. Signs of compromised skin integrity-continue vigilant skin care, provide moistener to lips, consult wound-care specialist if needed.
As the body dehydrates, the skin loses its tone and dries out. Left untreated, this will lead to cracking and bleeding. The lips are even more sensitive in this respect. “Vigilant skin care” is the liberal use of lotions and moisteners to mask these symptoms. The lips must be continually swabbed with special moisteners, and have lip balm applied to them. In the last stages, though, in spite of such measures, skin breakdown often occurs. Because of the body's debilitated state, normal healing mechanisms do not function. Hence the need to consult wound-care specialists to deal with ulcers and open sores.
Another aspect of “slipping away” by starvation and dehydration is “terminal agitation”:
7. Multifocal myoclonus or terminal agitation (sometimes caused by electrolyte imbalance). Consider diazepam rectal administration 5-10 mg. May repeat in 4 hours if not resolved then daily-twice daily as needed.
Myoclonus is twitching or spasm of the muscles. Multifocal means “occurring in many different parts of the body.” This is usually the result of imbalance in electrolytes, the chemicals, such as salt, potassium, and calcium, which make the body's internal electrical “batteries” work. Nerve impulses and muscle contractions are governed by electro-chemical reactions utilizing these chemicals. Dehydration causes these chemicals to be out of balance, interfering with normal nerve and muscle function. This can result in nerves and muscles “firing off” uncontrollably, causing spasm. The patient will writhe and become extremely agitated. The experience is similar to muscle cramps resulting from strenuous exercise (especially when one has sweated profusely), but in this case occurring repeatedly all over the body. Diazepam (more commonly known as Valium) is a muscle relaxant.
In Dr. Gambone's medical orders, under the heading of “Pain,” the doctor orders morphine:
Morphine (MSIR) 5-10 mg IM [IM = intra-muscular; that is, injected into a large muscle such as the buttocks] or by rectal suppository.
If no relief after reaching upper range, repeat dose in 1 hour and increase subsequent doses by 50% q 3 hour prn [every 3 hours as needed].
The use of morphine for pain requires little explanation. Here morphine is specifically prescribed for the pain Terri isn't supposed to be feeling. George Felos, under questioning from the press, admitted on March 29 that Terri had in fact been given morphine. In spite of this fact, and the descriptions by the Schindlers and others of Terri's “emaciated” condition, Felos said he “saw no evidence of any bodily discomfort whatsoever.”
Terri's “peaceful,” “quiet” death required the use of pain-relieving suppositories, muscle relaxants, constant swabbing of her mouth, and injections of morphine. Most of the so-called “treatment” given under Terri's “Exit Protocol” was in fact not treatment at all. It was a regimen of medication intended to mask the symptoms of dying by starvation and dehydration, in order to perpetrate an illusion: the illusion that she was peacefully “slipping away,” when in fact she was dying in a painful and brutal way.
THE HUSBAND WHO WASN'T THERE
Terri's “quiet” death was not the only illusion created by George Felos and his accomplices in the mainstream media. Felos worked very hard to overcome Michael Schiavo's cold persona, seeking to portray him as a caring, sympathetic husband. This took some doing, as Michael's long-standing adulterous relationship with a live-in lover naturally cast doubt on his motivations and interests regarding Terri. But the illusions that were created while Terri was alive carried over into the descriptions of Terri's death.
The first indication of how Terri's death would be spun by George Felos and Michael's sympathizers appeared on March 28, 4 days before Terri died. CBS News erroneously ran an obituary of Terri on its web site. While the television network quickly realized its error and removed the obituary, it was nonetheless up long enough to be reported by talk-show host Glenn Beck and read by thousands of internet visitors. After observing that Terri died “surrounded by stuffed animals and medical equipment,” the obituary said that Michael Schiavo “was at the bedside of his wife Terri when she died.”
Pre-written obituaries are not unusual. News organizations keep obituaries of many public figures on file, for immediate release upon their death. But Terri's is unusual in two respects.
First, it is inaccurate. Among other things, Terri was not “surrounded” by very much “medical equipment” at all. After all, she was being starved and dehydrated to death. She was receiving no life-support, and in fact no care aside from the measures, enumerated above, designed to mask the true nature of her death. But even more problematic is the description of Michael being “at the bedside” of Terri as she died. How could the writer of the obituary possibly know that Michael would be at her bedside at Terri's death four days beforehand?
Careful reading of the news stories from the days leading up to Terri's death uncovers more evidence of how Terri's death story took shape. After Terri's death, many media sources reported that Michael had been staying at the hospice, either “in a spare room,” or “down the hall” from Terri during the days leading up to her death. At least one report described Michael as having stayed at the hospice for the entire 13 days between the removal of the feeding tube and Terri's death. But the earliest story I found mentioning Michael's supposed bedside vigil with Terri comes from March 26, only five days before she died. Furthermore, Schiavo attorney George Felos, when questioned by the media on March 28, “would not say” whether his client was “staying full time at Hospice.” Why would Felos refrain from saying something that would so obviously make his client appear sympathetic? The simplest explanation is that it wasn't true, and a good attorney like Felos would be very careful not to actually state an easily verified untruth on the record.
However, by the evening of March 31, the day Terri died, Felos was telling CNN that Michael Schiavo had been staying at the hospice for the previous two weeks “in a room just down the hall” from her. Again, if that was true, why wasn't Felos willing to say so 4 days earlier? It is interesting to note that in the 8 days between the removal of the feeding tube on March 18, and the first questions about Michael's presence on March 27, the press took no notice of either Michael's presence, or his arrivals or departures. Given the small army of reporters and the large crowd of vigil-keepers constantly present at the hospice, it strains credibility to suppose that Michael could have come and gone from the premises entirely unnoticed over the course of two weeks. It also strains credibility to propose that Michael could have remained sequestered at the hospice for two weeks straight: taking his meals there, being separated from his girlfriend and their children, not even going home for a change of clothing during the entire period. An Agence France-Presse story of March 27 also seemed to notice the difficulty in substantiating Michael's presence, remarking that “no one knows the exact whereabouts of the husband right now,” and that “no one knows how he gets to and from the hospice.”
The Schindlers and Father Pavone also noted that, in all of the time they spent with Terri (twice or three times daily totaling several hours a day) during those final weeks, they never once saw Michael at the hospice, nor did they see any evidence that he was there. Bobby Schindler remarked that on several occasions, he and his family were asked by the police to leave Terri's room, so that Michael could visit, but they never saw him. “We saw [George] Felos, we saw Deborah Bushnell [another Schiavo attorney], but we never saw Michael there,” Bobby said.
Most disturbing is the strong possibility that George Felos' description of the scene at Terri's death was also a product of meme-making. Recall that the erroneous CBS obituary placed Michael at Terri's bedside at the time of her death, which had not yet happened. After Terri died, George Felos stated that Michael had been present at her death, and had “cradled her head” in his arms at the moment she died. While no one but Michael Schiavo and George Felos know for sure what really transpired in that room, the Schindlers are skeptical: Bobby Schindler explained that, on the morning Terri died, he and his sister Suzanne had been with Terri most of the night. One of the three police officers stationed outside of Terri's room then came in and told Bobby and Suzanne that they would have to leave, so that Terri's “condition could be evaluated.” They knew Terri was close to death, and wanted to remain. Bobby argued with the police, but “they were told in no uncertain terms that they had to leave,” Father Pavone told CNN.
Michael Schiavo, according to the Schindlers, had ordered that the Schindlers could not be present when Terri died. Bobby told me that an interval of 5 to 10 minutes elapsed while he was arguing with the police and waiting outside Terri's room. During this period, he saw no sign of Michael, nor heard any indication that he was coming. “For all I know, Father, my sister died alone in that room,” he said. He and Suzanne were ushered away. The next thing they were told was that Terri had died. After another 15-20 minutes, they were allowed back into Terri's room. Again, there was no sign of Michael.
Father Pavone, at the press conference he and Schindler attorney David Gibbs gave after Terri's death, also remarked on Michael's absence. He related, in answer to a reporter's query, that his “first question, as I went in the room after it was first announced that Terri had died, was 'Where's Michael?'” He added, “He was nowhere to be seen.”
It would seem that the CBS obituary represented a “script” of sorts for Terri's death, and that George Felos saw to it that the script was played out. Bobby Schindler says he was “disgusted” by how Michael Schiavo and George Felos misrepresented Terri's death: “The whole thing was staged, Father,” he told me.
A LEGACY OF LIFE
While Michael Schiavo may have won the battle to end his wife's life, and George Felos may have won the test case he wanted, and had the script of Terri's death played out in the desired manner, the Schindlers are not despairing or ready to give up. They are grieving deeply, as might be expected of anyone who lost a daughter or sister. Their grief is compounded by the fact that Michael Schiavo refused to allow Terri's remains to be given a funeral Mass or Catholic burial. As of this writing, Michael has still not disclosed to the Schindlers where Terri's cremated remains will be interred, or when he intends to inter them.
But the Schindlers vow to continue their fight. At a memorial Mass held for Terri in the Southampton, Pennsylvania, parish where she grew up, Bob told me that he intends to see to it that some good is brought out of his daughter's death. He said he wants “to make sure nothing like this ever happens to anyone else again.” Bobby told me that he intends to give up his teaching career, and work full time to educate and inform the public about the truth of his sister's case and the dignity of life of those who are disabled or otherwise regarded as “unworthy of life.” He said he wants to see to it that his sister's legacy “is a legacy of life, not of death.”
At the reception following that memorial Mass for Terri, Father Pavone spoke powerfully about Terri's cause, the danger which her death poses for our society, and our duty to protect the lives of those who are weak and helpless. Terri Schiavo, though she could not speak, gave witness to the inherent and incalculable worth of every person. Father Pavone concluded his remarks by saying that Terri's death “is not the end of Terri's fight, it is the beginning of a new chapter! Death will not have the last word!”
[AUTHOR ID] Father Robert J. Johansen is a priest of the Diocese of Kalamazoo, Michigan.