FEU-NRMF

INSTITUTE OF MEDICINE • April 24, 2001

nd
Bioethics 2 - Terri’s feeding tube is removed, after the 2 District Court
of Appeal (DCA) upheld Greer’s decision and both the
CASE: TERRI SCHIAVO Florida Supreme Court and U.S. Supreme Court refused to
intervene
Historical Background • April 26, 2001
• Theresa “Terri” Marie Schindler - Two days later, the treatment resumed when the
• Born: December 3, 1963 in Pennsylvania Schindler’s file an emergency motion with Judge Greer.
• Parents: Robert and Mary Schindler - Presented a different trial court judge with 7 affidavits
• Early 1980’s from licensed physicians. Although none of the physicians
- Terri moved to Florida had physically examined Mrs. Schiavo, each contended
- She worked as an administrator in an insurance office that she was neither in a persistent vegetative state nor
• November 1984 beyond the aid of medical treatment
- She married Michael Schiavo, a restaurant manager - Former girlfriend of Michael Schiavo will testify that he lied
about Ms. Schiavo’s wishes
• February 25, 1990
- Schindlers file a new civil suit that claims that Michael
- At age 26, she collapsed in the hall of her apartment
Schiavo committed perjury himself when he testified that
- She experienced cardiac arrest and suffered brain damage
Ms. Schiavo had stated an aversion to remaining on life
due to lack of oxygen
support
- Cardiac arrest was attributed to an imbalance of blood
potassium, probably linked to an eating disorder (over 7-8 • April 30, 2001
years, her weight dropped from 250 lbs to 110 lbs) - Michael Schiavo files an emergency motion with the 2nd
DCA to allow the removal of Ms. Schiavo’s PEG tube
• After several weeks
- She emerged from a coma into a vegetative state requiring • July 2001
a percutaneous endoscopic gastrostomy (PEG) tube to - 2nd DCA informs the Schindler’s that they must address
provide her with nutrition and hydration but no assistance their desire to have new evidence heard and their perjury
in breathing claim against Michael Schiavo within the original
- She was transferred to a skilled care and rehabilitation guardianship proceeding
facility, and a court appointed Michael Schiavo as Terri’s - 2nd DCA instructs Judge Greer to weigh the Schindlers’
guardian without objection from her parents new evidence
- 2nd DCA denies Michael Schiavo’s request to discontinue
• November 1990
the PEG tube
- Michael Schiavo takes Ms. Schiavo to California for
experimental “brain stimulator” treatment, an • October 3, 2001
experimental “thalamic stimulator implant” in her brain - The court delays removal of feeding tube indefinitely
• July 19, 1991 • October 17, 2001
- Transferred to Sable Palms skilled care facility and receives - The court rules that five doctors can examine Terri to
continuing neurological testing, and regular and determine whether she has any hope of recovery
aggressive speech/occupational therapy • October 2002
• November 1992 - 3 doctors, including the one appointed by the court, testify
- Michael Schiavo engages in a legal feud with Terri’s that Terri is in a persistent, vegetative state with no hope
obstetrician in a malpractice suit of recovery
- Misdiagnosing his wife (eating disorder) before her heart - 2 doctors selected by the Schindlers say she can recover
stopped • November 2002
- Jury awards almost $1,000,000, most of which went to - Greer rules there is no evidence Terri has any hope of
financing the various cares she went through recovery
• July 1993 - Orders feeding tube to be removed on Jan. 3, 2003
- Terri’s parents had a dispute with Michael over the • September 17, 2003
malpractice suit money and Terri’s care - Judge Greer orders the removal of the PEG tube to take
- They filed a petition to have Michael removed as Terri’s place on October 15, 2003
guardian, but the case is later dismissed - Rejects the Schindlers’ request that Ms. Schiavo be given
• May 1998 therapy to learn how to eat without the tube
- Michael asked the court to authorize removal of Terri’s • October 14, 2003
hydration and feeding tube - The 2nd DCA refuses to block Judge Greer’s order to
- The Schindler’s opposed the request, insisting that their remove the PEG tube.
daughter would want to remain alive in this condition • October 15, 2003
• December 1998 - Ms. Schiavo’s PEG tube is once again removed
-
nd
Richard Pecarek (2 guardian) concludes that Ms. Schiavo - With Terri Schiavo’s “personalized decision” determined
is in a persistent vegetative state with no chance of at the 2000 trial and her medical condition conclusively
improvement confirmed at the 2002 hearing, artificial hydration and
• February 2000 nutrition were stopped for the second time, on 15 October
- Pinellas, Fla., Circuit Judge George Greer rules the feeding 2003, pursuant to court order.
tube can be removed
- According to doctors, it will cause her death in
approximately 7 to 14 days

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• October 19, 2003 blindness. There was also extensive loss of neurons in the
- The Advocacy Center for Persons with Disabilities, Inc. files basal ganglia and in the hippocampus, and loss of Purkinje
a federal court lawsuit that claims that the removal of Ms. cells in the cerebellum. In short, the findings from the
Schiavo’s PEG tube is abuse and neglect autopsy were fully consistent with the expectation of
• October 20, 2003 widespread, hypoxic–ischemic brain damage. "No amount
- The Florida House of Representatives passes a bill, “Terri’s of therapy or treatment would have regenerated the
Law” massive loss of neurons.".
• October 21, 2003 - In addition, the presence of an implanted thalamic
- Governor Bush issues an executive order directing stimulator explained why an MRI scan was never done
reinsertion of the PEG tube and appointing as guardian
- Ms. Schiavo’s PEG tube is reinserted Ethical Issues Raised
- This order was superseded 6 days later when the Florida • Autonomy
legislature passed and Governor Jeb Bush signed Terri’s - Terri Schiavo failed to decide for herself because of her
Law, which provided the governor unfettered discretion to vegetative state. Michael Schiavo, her husband, claimed
order resumption of Mrs. Schiavo’s medical treatment. that she would not want to be in that condition so he
• December 1, 2003 requested that she legally be allowed to die. On the other
- An independent guardian concludes there is "no side, her parents said that she would have wanted to live.
reasonable medical hope" that Terri will improve - Neither of them hold the decision of Terri in this situation.
• September 23, 2004 In this case, his husband has the right to decide. But the
- Florida's Supreme Court, unanimously affirming the trial husband became a poor surrogate decision maker because
court order, declares "Terri's Law" unconstitutional he's been living with his girlfriend and will be married after
- the Florida Supreme Court held Terri’s Law the death of Terri.
unconstitutional as a violation of separation of powers
(17), and a third date was set for removal of the PEG tube • Beneficence
• December 29, 2004 - It is never licit to suspend the ordinary means in patients
- The 2nd District Court of Appeal upholds Greer's decision even if the prognosis may be fatal.
not to grant a new trial - In Terri's case, removal of feeding tube and allowing her to
• January 24, 2005 die is unethical. Being deprived of nutrition and hydration
- The United States Supreme Court refused to grant review on the basis of a judgment that she probably wouldn't
of the case in which the Florida Supreme Court struck have wanted it, Terri was cruelly starved to death.
down “Terri’s Law” as unconstitutional
• February 22, 2005 • Non Maleficence
- The 2nd DCA clears the way for Michael Schiavo to remove - Purpose of medicine to protect health, alleviate pain and
Terri's feeding tube comfort the suffering always with due respect the freedom
- Pinellas Circuit Court Judge Greer issued an emergency and dignity of the person. Anything that goes against life
stay blocking removal of the feeding tube for until 5 p.m. itself is evil and undermines human civilization.
the next day - Ultimately, Judge Greer ruled that on Friday, March 18,
• February 23, 2005 2005, at 1:00 p.m., Michael Schiavo could have the PEG
- Greer again issues an emergency stay, blocking removal of tube removed.
the feeding tube for another two days, until 5 p.m. Feb. 25 - On Thursday, March 31, 2005, Terri Schiavo died, nearly
• February 25, 2005 thirteen days after removal of her PEG tube.
- Judge Greer denies the motion - Her brother, Bobby Schindler said Terri experienced
- He orders that, “absent a stay from the appellate courts, insufferable pain after almost two weeks without food and
the guardian, Michael Schiavo, shall cause the removal of water. Her sister's lip were cracked to the point where they
nutrition and hydration from the ward, Theresa Schiavo, at were blistering, her skin became markedly dehydrated
1 p.m. on Friday, March 18, 2005.” from the lack of water and her breathing became rapid and
• March 18, 2005 uncontrollable.
- For the third time, the PEG tube was removed in mid- - As the Terri Schiavo case demonstrates, the withholding or
afternoon in accordance with court orders withdrawing of hydration and feeding tubes can be most
- the tube was removed for the final time, and despite the divisive ethical decision. On the one hand, food and water
intervention of Congress and President George W. Bush are so basic to life. We may not deprive people of access
• March 31, 2005 to food and water; to do so constitutes abuse and, if they
- Terri Schiavo died at 9:05 a.m, nearly thirteen days after die as a consequence, does it not constitute murder?
removal of her PEG tube. Her body is transported to the
Pinellas Country Coroners’ Office for an autopsy • Stewardship
• April 1, 2005 - ”Life comes from God, and humans are "stewards"
- An autopsy was performed responsible for the care of the body.”

• June 15, 2005
- Autopsy report was released. • Double Effect
- revealing that Mrs. Schiavo’s brain was “grossly abnormal - if doing something morally good has a morally bad side-
and weighed only 615 grams”—less than half of the effect, it is ethically permissible providing that the bad
expected weight for an adult her age—and showing outcome was not intended
neuronal loss in her occipital lobes consistent with cortical

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• Right to Food and Water - It is considered as a “grave offense” to the Creator since
- Every person deserves food and water, regardless of their man is not the absolute owner of his life but to God.
physical circumstance. We affirm food and water as basic Earthly life is a gift and blessing from God, and that death
and ordinary care, and reject the dangerous classification is a path to God, to eternal life.
of food and water as as extraordinary medical treatment - Pope Pius XII denounced the false compassion that seeks
when delivered artificially. to justify euthanasia and deprives man of meritorious
- A patient is able to breathe and survive on his or her own suffering, purifying suffering, not by means of s charitable
often still requires food and water delivered by tube due and laudable alleviation, but by means of death itself.
to handicap or other impairment—sometimes lasting a - The value of pain and suffering is intended to purify and
short time, and other times lasting for a long time. identify themselves with Jesus Christ before commencing
- No one should ever be starved or dehydrated to the point the beatific vision heaven.
of death, and in no circumstance should the denial of food - By practicing euthanasia, a person is robbed of their
and water be treated as a legitimate medical practice purpose of being purified through pain and death which is
the absolute in life and the direct relationship they can
• Presumption of the Will to Live share with their Creator through the experience of a
- It's not uncommon for life and death decisions to be made natural death.
within minutes of a patient entering a hospital. Especially
when a patient cannot communicate, it is legitimate to Developments
presume a will to live on behalf of the patient. • In 1968, it was proposed that death be defined as the
- Even if Michael Schiavo's account of his conversation with irreversible loss of whole brain function. In remarkably short
Terri before her injury were credited, it is a mistake to order, states adopted the new medical and legal definition of
assume that people can make decisions in advance about death.
whether to have themselves starved to death if they • Concurrently, the U.S. Congress passed the Patient Self-
eventually find themselves disabled. Determination Act (PSDA), legislation encouraging people to
- That's why living wills have proven to be so often compose Advance Directives leaving clear and convincing
unreliable. One does not know how one will actually feel, evidence of their wishes for medical care and surrogate
or how one will feel about one's life and the prospect of decision makers in the event they are incapacitated.
death, or whether one will retain a desire to live despite a • The 1990 Patient Self Determination Act requires all healthcare
mental or physical disability, when one is not actually in professionals and institutions in the United States to provide
that condition and when one is envisaging it from the assistance in making an Advance Directive. Advance Directives,
perspective of more or less robust health. while potentially very helpful, are not cure-alls. To be effective,
they need to be shared with closest family and friends, and
• Protection from Euthanasia as a Form of Medicine reviewed regularly, particularly as life changes.
- Euthanasia is not medicine. • On October 20 and 21, 2003, a special session of the Florida
- Suicide, including physician-assisted suicide, is not Legislature passed a bill, “Terri’s Law” that allowed the
medicine. governor to issue a ‘’one-time stay in certain cases”.
- Every patient deserves protection from euthanasia being • In September 2004, the Supreme Court of Florida issued a 7-0
treated as a form of medicine. Wherever euthanasia is declaration that the Florida law was unconstitutional,
normalized as a form of medicine, it becomes one of a violating the separation of powers.
variety of options presented to patients and families facing • From October into March, an incredible series of lawsuits were
crisis. Yet physicians have historically never endorsed filed to continue Terri’s PEG tube.
consciously bringing about the death of a patient.
- And we believe no patient should be pressured into
making a decision where their choice of avoiding assisted
suicide could be frowned upon by a physician, hospital, or
insurance company that would prefer they take the less
costly route in the face of a potentially terminal diagnosis,
rather than spending every moment they can alive with
those they love, and who love them.

• Christian Morality
- Euthanasia, in the strict sense, is a gravely illicit sin
because it implies homicide. No reason (compassion,
humanitarianism, piety, mercy) can justify the act of
suppressing life.
- The fundamental principle is the absolute respect for
human life.
- Pope Paul VI recalled the same doctrine on the illicitness
of euthanasia: Euthanasia, with patient’s consent is
suicide; without it, homicide.
- It highlights the fact that no person or body can authorize
or impose the death of an innocent life because of the
fundamental right of every individual to life.

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