Killing Terri Schiavo
By Rev. Robert Johansen
hospice in Pinellas County, Florida, has become the front line
of the battle to defend the dignity of human life. Inside the
hospice is Terri Schindler Schiavo, whose collapse in 1990 and
subsequent brain injury has left her severely disabled. A feeding
tube provides her nutrition and hydration. Otherwise, she is
in fairly good health, with no other serious diseases or disorders.
Her husband, Michael Schiavo, has sought since 1998 to have
her feeding tube removed in order to cause her death by starvation
and dehydration. He contends that Terri expressed the wish that
she would not want to be kept alive in her condition.
But Terri’s parents, Bob and Mary Schindler, say
that isn’t true. And they have been engaged in a decade-long
legal battle to keep Terri alive.
On October 15, 2003, it seemed as though the Schindlers
had lost the fight. After numerous hearings and appeals, Florida
Circuit Court Judge George Greer ordered Terri’s feeding
tube removed, and Terri began to die. Her impending death mobilized
the pro-life community to a degree that has rarely been seen.
A crowd of people gathered outside the hospice where Terri lay,
praying, singing hymns, and carrying picket signs. And many
more people lobbied their state legislators and Florida Governor
Jeb Bush to take action to save her life.
Governor Bush expressed his support for Terri’s
right to live but had no power under Florida law to intervene.
However, on October 21, six days after the feeding tube was
removed, the legislature enacted “Terri’s Law,”
giving the governor the legal authority to issue in cases like
Terri’s a onetime stay of an order to withdraw nutrition
and hydration. Governor Bush signed the bill into law and issued
a stay the same day.
Terri’s feeding tube was restored, and she is,
for the moment, alive and safe. But her husband and his attorney,
George Felos, have vowed that they will not give up. Felos has
filed suit to have “Terri’s Law” overturned
as unconstitutional. The question of the law’s constitutionality
has only begun to be adjudicated and is unlikely to be resolved
in the near future.
Terri’s plight has evoked heated debate over fundamental
moral, medical, and legal issues. Those in favor of removing
Terri’s feeding tube have tried to frame the debate as
a “right-to-die” case. Those fighting to save her
argue that removing her feeding tube is tantamount to murder.
But before one can weigh the moral and legal concerns, it is
first necessary to understand Terri’s true condition,
and the sad situation that brought things to where they are
Questionable Medical Evidence
Doctors testifying on behalf of Michael Schiavo say
that Terri is in a persistent vegetative state (PVS), with no
hope of recovery. A patient in a PVS is unaware of himself or
his environment and does not respond to the world around him.
He continues breathing on his own, maintains a stable heart
rate, and may even have eye movements that mimic normal sleep.
However, he has, for all intents and purposes, no higher brain
functions that we would associate with “consciousness.”
Judge Greer’s order to remove Terri’s feeding tube
was based largely on his finding that no course of treatment
could improve her “quality of life” and that she
had no function in her cerebral cortex.
The ruling and judgment are sweeping, including such
statements that there was “no such testimony” to
establish any hope of recovery and that “the credible
evidence overwhelmingly supports the view that Terry Schiavo
remains in a persistent vegetative state.” Given such
confident pronouncements, one might expect to find the evidence
behind them all but impervious to refutation.
But that isn’t the case. What you find when you
examine the medical data and listen to the experiences of those
who have spent the most time with Terri over the last decade
is that a great deal of evidence belies the contention that
Terri is in a PVS. Terri’s parents, brother, sister, and
numerous other family members and friends who visit her regularly
do not believe for a moment that Terri is unaware of her environment
or unresponsive. At a press conference organized by the Schindlers
on October 24, Terri’s mother, father, and eight others
all gave accounts of how they see Terri consistently respond
to people: She smiles, frowns, or acts sullenly depending on
who the person is and what he or she does or says. She reacts
quite markedly to music, particularly piano music, which she
always especially enjoyed. A certified speech therapist asserted
that Terri does attempt to verbalize and has been heard
saying “yes,” “no,” “Mommy,”
and possibly even “Help me.”
Even more powerful is the testimony of the numerous
doctors who emphatically deny that Terri is in a PVS. The most
convincing medical testimony comes from Dr. William Hammesfahr,
a neurologist specializing in the treatment of brain injuries,
who has spent approximately twelve hours examining Terri. At
the October 24 press conference, Hammesfahr explained that Terri
is able to respond to commands: She can raise and lower her
limbs, although her range of motion is limited by severe muscular
contractures from a lack of physical therapy for more than a
decade. Doctors testifying for Michael Schiavo have dismissed
such responses as reflexes. But what is most telling is Hammesfahr’s
description of Terri’s response to a standard strength
test: In this test he asked Terri to lift up her leg while he
pressed down on it with his hand. He instructed her to keep
lifting it in spite of his pressure. Hammesfahr explained how
he could feel Terri pressing up against his hand with the
same degree of force with which he was pressing down, so
as to keep her leg in the same relative position. Such a response,
Hammesfahr explained, is simply not reducible to a “reflex.”
Hammesfahr has even observed her move her head and limbs
into positions that clearly cause her discomfort and maintain
them in order to carry out instructions he gave her.
Such behavior, Hammesfahr said, cannot be reflexive: “Reflexes
are designed to avoid injury. They are there to prevent pain.”
One has to overcome reflexes in order to perform a task
in spite of discomfort or pain.
Many have seen the now-famous videotape that the Schindlers
distributed to the press in their effort to show the world that
Terri is not a vegetable. In this video, Terri gives every appearance
of looking directly at those speaking to her, reacting to her
mother’s embrace, and following (with her eyes) a balloon
around the room. While many who saw the video found it compelling
evidence that Terri is in fact conscious, Judge Greer did not.
Although he had to be asked twice to look at his monitor
and to put his glasses back on so he could see it clearly, he
did not find the video evidence sufficiently “consistent
and reproducible.” He opined that “cognitive function
would manifest itself in a constant response to stimuli.”
Pat Anderson, the Schindlers’ attorney, explained in a
World Net Daily article that Judge Greer, in evaluating the
video, used a “scorecard” approach that “stacked
the deck no matter how Terri responded. If she always responded—it
was just primitive brain-stem activity. If she randomly responded—it
was not repetitive enough.” Interestingly, Judge Greer
and Felos have sought to suppress the video, and Judge Greer
ordered the Schindlers not to photograph or videotape Terri
in the future, under threat of legal sanction.
Where Judge Greer derived the medical theory that “cognitive
function would manifest itself in a constant response to stimuli”
is hard to discern. It was not a matter of evidence introduced
in the medical testimony in either the 1998 or 2000 legal proceedings.
Furthermore, it’s a matter of common sense that people
don’t respond to the same stimulus in exactly the same
way every time with 100 percent predictability or repeatability.
Indeed, if Terri did respond in such a rote manner, it’s
likely that such a response would have been dismissed as “reflexive.”
But the evidence of the videos and the testimony of the numerous
family members and doctors overwhelmingly show that Terri does
respond “consistently” to numerous stimuli. According
to Hammesfahr, any of these responses, let alone all of them,
should rule out a finding of PVS. “By definition,”
he said, “if there is any response to the outside world,
the patient isn’t in a PVS.”
The Euthanasia Connection
But Judge Greer accepted the medical testimony presented
by Michael Schiavo that Terri is in a PVS and will not recover.
That conclusion becomes even more dubious when you examine Felos’s
well-known ties to the euthanasia movement and the background
and testimony of Michael Schiavo’s principal medical witness,
Dr. Ronald Cranford.
Felos has been a member of the infamous Hemlock Society.
Amazon.com, on the Web page for Felos’s book Litigation
as Spiritual Practice, describes him as “spearheading
a social revolution to enable death with dignity in the state
of Florida.” He certainly spearheaded the effort to bring
about Estelle Browning’s death, spurred on by his belief
that he can spiritually commune with those in a PVS. Although
she couldn’t speak, he claimed that he detected her soul
crying out to his soul, asking, “Why am I still here?”
In light of Felos’s association with the euthanasia
movement, it’s hard to imagine that his choice of Cranford
is coincidental, as Cranford is perhaps the leading medical
exponent of the pro-death movement.
Cranford jokingly refers to himself as “Dr. Death”
and, for a fee, will come to a trial and testify that the person
whose life the plaintiff wants to end is in a PVS. He was the
leading medical voice calling for the deaths of Paul Brophy,
Nancy Jobes, Nancy Cruzan, and Christine Busalucci, all of whom
were brain-damaged but not dying. Nonetheless, he advocated
death for all by dehydration/starvation, just as he has for
Nancy Cruzan—one of his “patients”—required
no skilled nursing, no care but food and fluids, hygiene, and
turning to prevent bedsores. She didn’t even need tube
feeding, but Cranford testified that he would even consider
spoon-feeding “medical treatment.” Cranford wrote in
the summer 1998 issue of Concern for Dying that he foresees
“that there may be extreme situations, and in the future
increasingly common situations, where physician-assisted suicide
may not only be permissible, but encouraged.” In a 1997
op-ed for the Minneapolis–St. Paul Star Tribune,
Cranford advocated the starvation of Alzheimer’s patients.
contrast to the twelve hours Hammesfahr spent examining Terri,
Cranford spent approximately 45 minutes. Rus Cooper-Dowda, who
has endured neurologic exams himself, upon seeing the videotape
of Cranford’s exam described it as “physically brutal.”
He said that Cranford “clumsily poked, prodded, thumped,
shoved, and pinched her.” Although Cranford admitted that
Terri pulled away from him when he approached her, he did
not deem that a voluntary response. When Terri moaned after
he “thunked her hard between the eyebrows,” Cranford
told the court that it wasn’t a response to pain.
Cranford prides himself on the fact that he was very
influential in the development of the criteria used in diagnosing
PVS. But in 1996, Dr. Keith Andrews, the medical director of
the Royal Hospital for Neurodisability in London, along with
several other staff members, published an article titled “Misdiagnosis
of the Vegetative State” in the British Medical Journal.
In that article, they revealed that 43 percent of patients sent
to that hospital with the diagnosis of PVS—some of whom
had been presumed to be in a PVS for more than a year—were
not in a vegetative state at all. They found that the misdiagnosed
patients had severe communication problems as a result of their
disabilities, but with the proper clinical measures, “nearly
all were able to communicate...some to a high level.”
They concluded that:
The vegetative state needs considerable skill to diagnose,
requiring assessment over a period of time; diagnosis cannot
be made, even by the most experienced clinician, from a bedside
assessment [emphasis mine].... Recognition of awareness
is essential...to avoid inappropriate approaches to the courts
for a declaration for withdrawal of tube feeding.
The growing awareness of the difficulty in diagnosing
PVS, and the widespread errors in making the diagnosis, have
led many leading hospitals, such as the Northwestern University
Rehabilitation Institute, to routinely reassess patients referred
to them as PVS.
Cranford has testified that patients in a PVS have “no
hope of recovery,” but this is simply untrue. A number
of people found to be “unrecoverable” have, in fact,
recovered. Cranford himself diagnosed Sergeant Richard Mack,
a police officer shot in the line of duty, as “definitely...in
a persistent vegetative state...never to regain cognitive, sapient
functioning.” Almost two years later, Mack “woke
up.” He eventually regained almost all his mental abilities.
Kate Adamson, who appeared on Fox News’s O’Reilly
Factor on November 6, recounted her own chilling story.
She had also been diagnosed as in a PVS, and doctors removed
her feeding tube.
I could see and hear everything going on around me,
and I had no way...of communicating with anyone…. I was
completely paralyzed…. When the feeding tube was turned
off for eight days, I was—thought I was—going insane.
I was screaming out [in her mind], “Don’t you know
I need to eat?” ...Michael [Schiavo] on national TV had
mentioned last week that it’s a pretty painless thing
to have the feeding tube removed. It is the exact opposite.
It was sheer torture...
Thanks to the persistence of her husband, Adamson’s
feeding tube was restored, and the doctors reluctantly began
to treat her. Her recovery suggests that the untreatability
of PVS isn’t as absolute as some would like to suppose.
Hammesfahr is one of the doctors challenging medical
orthodoxy regarding PVS patients. He has had promising results
in treating stroke and other brain-injured patients. The effectiveness
of his treatment program has been confirmed by Medicare, which,
by law, is not permitted to pay for treatments that are experimental
or not demonstrated to be medically effective. In a 2001 decision,
after review of more than 700 patients and the medical literature,
Medicare ruled that Hammesfahr’s therapy is “medically
reasonable and necessary.”
Hammesfahr believes not only that Terri Schiavo is not
in a PVS, but that she is treatable and could recover at least
some of her former faculties. He believes, for example, that
with proper therapy, Terri could once again swallow normally
and take solid food by mouth. He has repeatedly advocated that
Terri be given this therapy, but Michael Schiavo, who has complete
control over Terri’s medical care, has steadfastly refused
to allow it. The evidence for his contention, Hammesfahr explained,
is that Terri does not drool. “The average human being
produces one-and-a-half to two pints of saliva a day. If you
can’t swallow it, you drool,” he said. “Terri
can swallow that amount of her own saliva, which means that
she can swallow liquids.” If Terri can swallow liquids,
he reasons, it is quite likely that she can learn to swallow
solid food again, which, of course, means she would no longer
require tube feeding.
A Husband With an Agenda
The immediate cause of Terri’s brain damage was
cardiac arrest, which caused her brain to be deprived of oxygen
for more than five minutes. In January 1993, Michael Schiavo
won a malpractice award of $1.6 million from the hospital that
treated Terri. He was also personally awarded $600,000 for loss
of consortium. In his testimony, Michael spoke of his love for
his wife and his intentions to honor his wedding vows for the
rest of his life and to use the award money for Terri’s
care and rehabilitation. Indeed, Michael repeatedly assured
Bob and Mary Schindler that he would seek rehabilitation therapy
for Terri once he had obtained a settlement.
A month after Michael received the money, the Schindlers
approached their son-in-law to remind him of his promise. This
led to a heated argument, with Bob and Michael yelling in the
hall outside Terri’s room. Michael stormed off and vowed
that he was going to see his lawyer and that Bob and Mary would
“never see [their] daughter again.”
A month after this incident, the Schindlers were informed
that Michael had cut off their access to Terri’s medical
information. As her husband, Michael was granted guardianship
over Terri and had the legal authority to issue the order, which
remains in place to this day. Terri’s doctors and nurses
were not to discuss her medical condition with the Schindlers.
Bob and Mary later learned that shortly after, Michael gave
a “Do Not Resuscitate” order for Terri, even though
she was in no danger of death.
The staff of Terri’s nursing home was sympathetic
to the Schindlers and frequently gave them information in spite
of Michael’s medical “gag order.” Later that
year, Bob and Mary learned that Terri had a serious urinary
tract infection and that Michael had ordered the nursing home
not to give her treatment, which would have consisted of a
simple course of antibiotics. They were informed by the nursing
home staff (going against the gag order), not Michael, as he
himself admitted in this exchange with the attorney for the
Schindlers in the 1993 guardianship hearing:
Attorney: When you made the decision that you were
not going to treat Terri’s infection and you were, in
effect, going to allow her to die, did you think that you had
any obligation to tell her parents?
Michael: To answer that question, I probably would
have let them know sooner or later.
Attorney: You never did let them know, though, did
Left untreated, the infection would eventually have
caused sepsis and Terri’s death. Fortunately the nursing
home eventually gave Terri the antibiotics anyway, and she recovered.
At this point, Bob and Mary made their first attempt
to have Michael removed as guardian. In his deposition for this
proceeding, Michael admitted that he had ordered the nursing
home to deny Terri treatment for the infection and that he knew
the infection, left untreated, would have caused Terri’s
death. When asked in the deposition if he would do it again,
he said he couldn’t “because evidently there’s
a law out there that says I can’t do it.” When asked
why he did it, he responded that “[he] was making a decision
about what Terri would want.” The judge (at this point,
it was not Judge Greer) denied the Schindlers’ petition
to have Michael removed as guardian. In 1996, they tried again
but were again refused.
In 1998, Michael petitioned the court to remove Terri’s
feeding tube. He argued that there was no hope for her recovery
and that Terri had expressed the wish to him that she would
not want to be kept alive in her condition. This was the first
time that Michael had ever claimed such a wish on Terri’s
part. Terri’s parents and several of her close friends—who
found his assertion totally out of character with what they
knew of Terri—vigorously disputed the claim.
The judge then appointed a guardian ad litem,
Richard Pearse, to investigate Michael’s fitness as guardian
and to make a recommendation about Terri’s feeding tube.
Pearse interviewed the various parties, including doctors, and
issued his report in December 1998 recommending against
Michael’s fitness as guardian and against removing
Terri’s feeding tube.
After February 1993, Mr. Schiavo’s attitude concerning
treatment for the ward apparently changed. [In January 1993
he received the $1.6 million award].... It is apparent to me
that he has reached a point that he has no hope of the ward’s
recovery and wants to get on with his own life. [Michael] admitted
to the guardian ad litem that he had at least two romantic
involvements after Terri’s collapse. [Schiavo was already
living with his current girlfriend, with whom he has two children.]
Michael wanted to “move on” with his life was evident
long before Pearse interviewed Michael. In the 1993 guardianship
hearing, Michael testified regarding his disposition of some
of Terri’s property:
Attorney: What did you do with your wife’s
Michael: My wife’s jewelry?
Michael: Um, I think I took her engagement ring
and her...what do they call it...diamond wedding band and made
a ring for myself.
Attorney: What did you do with her cats?
Michael: Her cats were put to sleep on the advice
of my mother-in-law.
The veterinarian who euthanized Terri’s pets came
forward to say there was never any suggestion from Terri’s
mother that this be done, and that it was done only at Michael
Pearse also found that Michael’s claim that Terri
wouldn’t want to live in her condition wasn’t credible
and noted that Michael stood to inherit about $800,000:
[H]is credibility is necessarily adversely affected
by the obvious financial benefit to him of being the ward’s
sole heir at law in the event of her death while still married
to him. Her death also permits him to get on with his own life.
In February 1999, Felos filed a “suggestion of
bias” against Pearse and demanded he be removed as guardian
ad litem. The judge then hearing the case, Bruce Boyer,
took no action on Felos’s “suggestion of bias”
or on Pearse’s report. In April of that year, Pearse filed
a request that he either be given further instructions or discharged.
He reiterated his concerns about Michael’s guardianship
and also noted that there would be due process difficulties
if the case proceeded to trial without Terri having an independent
guardian ad litem. Judge Boyer discharged Pearse without
appointing a successor.
The case then proceeded to trial before Judge Greer,
who also refused to appoint a new guardian ad litem to
represent Terri’s interests in the case.
The Questionable Judge
But that wasn’t the first unusual thing Judge
Greer did in the trial. At the time of Pearse’s report,
the only evidence that Terri had expressed a wish not
to go on living was Michael’s assertion. Pearse had mentioned
that Michael’s story would be “more credible if
it were corroborated.” It’s strangely coincidental
then that at the last minute before the trial, Felos produced
two witnesses who corroborated Michael’s claim: his brother
and sister-in-law. Felos delayed producing his witness list
until two days before the trial, preventing the Schindlers’
attorney from deposing them. Nevertheless, Judge Greer permitted
their testimony to be entered into evidence, and the Schindlers’
attorney, who was not an experienced trial lawyer, didn’t
contest his decision.
The evidence Michael presented of Terri’s putative
wish not to be kept alive on a feeding tube was derived from
a conversation that he and his brother and sister-in-law supposedly
had with Terri while watching a televised movie about a person
who was in a coma and on a ventilator. Terri allegedly said,
“I wouldn’t want to live like that.” Anderson
argues that even if Terri really had said that, the statement
still “wouldn’t be relevant to Terri’s situation.
The context of the conversation was about someone on a ventilator.”
In many states, Anderson explained, such a com- ment is considered
a “sympathetic anecdotal statement regarding the plight
of others” and is not admissible. In order to be relevant,
the person making such a statement has to “specifically
apply the circumstances of the utterance to himself.”
In other states, like New York, oral statements regarding these
matters are simply inadmissible.
But Judge Greer allowed these statements into evidence
ignoring the contravening testimony from the Schindlers and
others that such statements would be completely out of character
for her. Two of Terri’s best friends, Jackie Rhoades and
Diane Meyer, testified about a conversation they had with Terri
about Karen Ann Quinlan, whose parents fought in court to allow
her to be removed from a respirator. They eventually won, but
Karen went on to live for eight more years, breathing on her
own after the respirator was removed. Diane had said, “Who
would want to live like that?” Both Jackie and Diane recounted
how Terri got very angry, saying, “How do they know what
she wants? Why don’t they just leave her alone?”
They and the Schindlers also testified that Terri regularly
visited a nursing home, spending time with people in the last
stages of life. Terri never once declared that she “wouldn’t
want to live like them.”
Anderson finds it beyond belief that Terri, a devout
Catholic girl who went to Catholic school, attended Mass regularly,
and volunteered at a nursing home, would adopt such a sentiment.
Given the fact that Terri’s supposed wish was brought
up years after her injury, that its corroboration is
highly questionable, and that there’s ample contravening
testimony, it’s hard to imagine any reasonable, unbiased
person being persuaded by it. Yet Judge Greer was, describing
Michael’s testimony as “clear and convincing”—the
highest standard of proof in a civil trial.
On the Front Lines
My own involvement with the fight to save Terri Schiavo’s
life began a few months ago. After learning of Terri’s
plight, I became convinced that a terrible injustice was being
perpetrated. I began writing about her situation on my weblog,
Thrown Back (http://ThrownBack.blogspot.com). This eventually
led to me getting to know some of the people involved with Terri’s
fight, including the Schindlers themselves. After Terri’s
feeding tube was withdrawn, for several days, Michael Schiavo
denied Terri’s pastoral care by refusing to let a priest
visit her. At that point the Schindlers and the priest who has
been closest to them, Monsignor Thaddeus Malanowski, asked me
to come to Florida to be of assistance. Fortunately, my bishop,
James Murray of Kalamazoo, graciously granted his permission
for me to go.
The Schindlers have been portrayed, by Michael Schiavo,
his attorneys, and by the unsympathetic media, as everything
from religious fanatics to pathetic simpletons. Even some of
the local clergy in Tampa have characterized the Schindlers
as in denial concerning their daughter’s sad state, blinded
by their emotional attachment to her. But when I went to St.
Petersburg and met the Schindlers, I found nothing of the sort.
They are level-headed, reasonable, calm people. Furthermore,
they’re realistic about Terri’s condition: She’s
severely brain damaged and will almost certainly never enjoy
anything close to a full recovery.
But unlike Felos, Cranford, and Judge Greer, they don’t
see Terri’s humanity as reduced or negated by her disability.
They realize that the person they know and love as Terri is
still there. And they cannot understand why her disability constitutes
grounds for ending her life.
Some have urged the Schindlers to “let Terri go.”
But that comfortable euphemism covers over the reality that
they’re being asked to acquiesce to their daughter’s
painful death. And unlike those insulated by ideology or agenda,
their love refuses to let that happen.
Rev. Robert Johansen is a priest of the Diocese
of Kalamazoo, Michigan. He has written for Adoremus Bulletin
and Culture Wars.