Euthanasia and Terri Schiavo

An overview

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Overview:

Terri Schiavo was a 41-year-old severely disabled woman in Florida who was the focus of two massive religious, judicial and legislative efforts: one to keep her alive, the other to allow her to die. Her feeding tube was removed on 2005-MAR-19. She died at about 9:05 ET on MAR-31.

History:

As a teenager, Terri was quite overweight. In the late 1980s, she had lost 65 pounds and became very concerned that she might regain her excess weight. During early 1990, she suffered from bulimia, an eating disorder. She regularly purged her body of sustenance. This created a potassium imbalance in her body which induced a heart attack, which in turn temporarily starved her brain of oxygen. Courts and doctors appointed by the courts ruled that she was in a persistent vegetative state. "Patients in a persistent vegetative state lack integrated function of the cerebral cortex while retaining involuntary brain stem reflexes that regulate heart rate, digestive, circulatory, sleep and other involuntary bodily functions. Their behaviors are automatic, non-purposeful, uninhibited reflexes no longer under voluntary control by higher brain centers." ₁ Unlike patients in a coma, patients in a persistent vegetative state can never recover.

Medical assessment:

Leon Prockop, a professor of neurology at the University of Southern Florida, has studied Terri's CAT scans. He believes that Terri's life effectively ceased fifteen years ago. He said that "She has approximately 20% of her [total] brain tissue left inside her skull and the remaining tissue is damaged. The tissue that controls the higher brain functions is gone. It's disappeared." He continued: "Her death occurred some time ago. That's my opinion....She has lost all frontal lobe functions. In her case, there is a severe absence of brain tissue. This is not guesswork.....Her CAT scan shows a greater degree of brain damage than I have ever seen in a living person. That brain tissue cannot come back. It never has, and it never will." His view "coincides with the vast preponderance of expert medical opinion..." ₉

On the other hand, Terri's family, and supporting lawyers, spiritual advisors and a very few physicians disagree. They believe that Terri is responsive to external stimuli, is conscious, and is aware of her surroundings. William Cheshire, a neurologist on the staff of the Mayo Clinic in Jacksonville, FL supports this view. He observed Terri in person and has reviewed her medical history. However, he did not perform "a comprehensive neurological examination" which the Mayo Clinic declares is "the standard procedure for the evaluation of a comatose patient..." ₉

Columnist Oakland Ross suggests "...it often seems the two sides are talking about two different women. Yet they are both talking about the same Terri Schiavo." ₉

CitizenLink stated that: "Pinellas-Pasco County Medical Examiner Jon Thogmartin also said he found no evidence to contradict the diagnosis that Schiavo was in a persistent vegetative state after her 1990 collapse."

Developments leading up to her death:

Brain scans showed that the part of Schiavo's brain that controlled thought and voluntary movements had atrophied. Her brain stem, which regulates the body's automatic functions such as the heart beat, blood pressure, breathing, kidney function, eye blinking, etc. remained intact and functioning. ₂ CAT scans showed that almost 90% of her cerebrum the "largest and most complex part of [the] brain [which is] involved in consciousness, thinking, speech and emotions" had been replaced by spinal fluid. Her cerebellum which "regulates muscular co-ordination, smooth movements, balance, posture," etc. was "severely degenerated."

Her husband, sister in law and brother in law recall her stated wish on two occasions that she be allowed to die, if she were ever in this situation. The courts have accepted this position. Her parents reject the assessment that she is in a persistent vegetative state or that she ever expressed such end-of-life beliefs. They feel that she was in a "minimally conscious state" i.e. Terri was aware of her environment, of other persons, and of her own bodily pain. She was capable of thinking, although she was unable to communicate the thoughts to others. Further, her parents believe that she could have regained some of her mental and physical functioning through therapy.

Terri was unable to eat or drink on her own. She had been supplied nourishment through a feeding tube that connects directly to her stomach. On three occasions in the past, her husband has obtained court approval to remove the tube and allow her to die by dehydration. By late 2005-MAR, the family, Florida courts, the U.S. Supreme Court, and Congress had been active in her case. Almost all legal approaches to require the re-insertion of the feeding tube appear to have been exhausted by the time of her death on MAR-31. Appeals as high as the U.S. Supreme Court were possible, but would undoubtedly have been unsuccessful.

Events from 2005-MAR-18 onward: