Euthanasia and Terri Schiavo

Results of the autopsy
Follow-up and afterthoughts

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Results of the autopsy:

An autopsy was performed on the body of Terri Schiavo on 2005-APR-01. This was one day after she died. Results were released on JUN-13. As expected, they raised more questions than they answered.

Jon R. Thogmartin, the Medical Examiner of District Six, Florida, commented on the Terri Schiavo's brain:

"Brain weight is an important index of its pathological state....The decedent's brain was grossly abnormal and weighted only 615 grams (1.35 lbs.). That weight is less than half of the expected tabular weight for a decedent of her adult age of 41 years, 3 months....By way of comparison, the brain of Karen Ann Quinlan weighed 835 grams at the time of her death, after 10 years in a similar persistent vegetative state." _1,2

Stephen J. Nelson, the Chief Medical Examiner of the 10^th Judicial Court of Florida concluded:

"Neuropathologic examination alone of the decedent's brain -- or any brain, for that matter -- cannot prove or disprove a diagnosis of persistent vegetative state or minimally conscious state." ₃

A diagnosis of either state can only be determined after an extensive examination by a qualified specialist while the patient is alive and can be tested. This was done on Terri Schiavo by a number of court appointed neurologists. They unanimously agreed that Terri was in a persistent vegetative state. She was also casually viewed by a few physicians, either directly or by watching carefully edited videotapes. Some of the latter believe that she was in a minimally conscious state.

Jon R. Thogmartin, the Medical Examiner of District Six, Florida, was unable to determine the cause of her collapse in 1990:

	There is no evidence from the observations of her family or friends that she suffered from an eating disorder. However, her serum potassium level was abnormally low when she was first admitted to hospital after her collapse. At the time, physicians assumed that the low potassium level was caused by an eating disorder during the weeks prior to her collapse. Dr. Thogmartin believes that the level might have been caused by her heart having being in ventricular fibrillation, the administering of the drug epinephrine, and the administration of fluids, at the time of or following her collapse.
	There is no evidence that she suffered a myocardial infarction (heart attack). Her heart "was anatomically normal without any areas of recent or remote myocardial infarction."
	Extensive physical exams and radiographs were performed on Terri by hospital personnel, starting shortly after her collapse. There was no indication that Terri had been strangled. She had no traumatic injuries to her body. If she had, "contusions, abrasions, recent fractures and...healing fractures" would have been detected by medical personnel at the time.
	A bone scan was performed in 1991. The request form mentioned a "closed head injury." The report stated that "the patient has a history of trauma." However, these comments appear to be erroneous.
	She had a compression fracture of the spine which is commonly found in persons, like Terri, who have osteoporosis.
	"Mrs. Schiavo would not have been able to consume sustenance safely and/or in sufficient quantity by mouth." Any attempt to do so would have resulted in aspiration of food into her lungs -- a very dangerous situation.
	There were allegations in the media that Mr. Schiavo was being drugged with morphine in order to expedite the dying process. Morphine suppresses breathing and hastens death. She received two morphine suppositories -- one on 2005-MAR-19 and one on MAR-26 -- 12 and 5 days before her death. There was no trace of morphine in her body when she died.
	There was no evidence of injury to the brain. However, the there was "massive cerebral atrophy. Her brain weight was approximately half of the expected weight." She was blind, as evidenced by damage and neuronal loss in the occipital lobes of her brain.
	Terri did not starve to death. She died of dehydration.

The cause of her collapse in 1990 is impossible to determine with the available evidence.

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Statement by Terri Schiavo's parents:

Terri Schiavo's parents issued a statement on 2005-JUN-16 via the Christian Communication Network. It said, in part:

	"First, the IME's report confirms Terri's physical condition and disability. We all knew Terri was seriously brain-injured before the IME report. This is nothing new. The IME's report also confirms that TERRI WAS NOT TERMINAL. THAT TERRI HAD NO LIVING WILL, THAT TERRI HAD A STRONG HEART, and THAT TERRI WAS BRUTALLY DEHYDRATED TO DEATH."
	"Second, our family would encourage the media to remember that this case was allegedly about "Terri's choice." There is absolutely no evidence that Terri wanted to die of dehydration, or that she believed that that the level of one's disability gives anyone the moral and legal right to end another's life."
	"Third, the IME said clearly that dehydration, not her brain injury, was the cause of her death. Terri was dehydrated to death before our eyes The moral shame of what happened is not erased because of Terri's level of disability. No one would say that "blind people" or "brain-injured" people should be put to death. That would be an irresponsible and heartless position to take. Tragically, that is what happened to Terri. As a society, it seems that we have lost our compassion for the disabled."

They also mentioned that:

	Terri was not terminally ill at the time that her feeding tube was removed. The IME predicted that her body would not have died on its own for perhaps another decade, if she continued to receive the type of quality care and nourishment which she had been given in the past.
	The IME determined that her collapse in 1990 was not caused by bulimia or a heart attack.
	They believe that Terri was not blind; they believe that she became blind only after the feeding tube was removed.
	Terri must have felt pain as she was dehydrated. Otherwise, there would have been no reason why she would have been given morphine.

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Activity by Governor Jeb Bush:

Governor Bush discussed the autopsy results with Dr. Thogmartin in private before they were released. Governor Bush said: "What he [Thogmartin] did say to me that was troubling ... was that there was some doubt about when she collapsed and how long it took for a phone call to be made to 911. I think that is worthy of some investigation."

According to the St. Petersburg Times, "Refusing to give up on the Terri Schiavo case, Gov. Jeb Bush has asked Pinellas prosecutors to sort out time discrepancies Michael Schiavo has provided regarding the hour he found his wife unconscious 15 years ago."

Michael Schiavo recalls that Terri collapsed at about 4:30 AM. He said that he called 911 immediately. But telephone records show that 911 was not called until 5:40 AM.

	David Gibbs III, the attorney for Terri's parents, commented on 2005-JUN-15 that: "I think this is a very troubling gap in time. Michael Schiavo needs to step forward and explain."
	George Felos, the attorney for Michael Schiavo attributes the discrepancy to a simple mistake, based on attempting to recall details of the timing of an extremely upsetting event over 15 years ago. Felos said: "I think it's preposterous and ludicrous that if Michael did say 4:30 or 5 or something like that, that there's any issue. The opponents of Terri Schiavo's wishes are intent on creating a controversy in this case where none exists." He suggested that if Michael Schiavo had waited 70 minutes before calling 911, that "She would have been dead before they (paramedics) got there."
	Dr. Amyn M. Rojiani, a pathology professor at the University of South Florida College of Medicine, said that he didn't think it would be possible for Terri's heart to stop about 4:30 and be restarted by paramedics at 6:32 -- two hours later.
	George Felos commented on the intervention by Governor Bush: "I think it's sad and disgusting given the governor's continuing unwarranted meddling in this case. The extent to which he will prostitute himself to right-wing constituents for his future political gain I think is just pitiful."

Bruce Bartlett, assistant to the State Attorney Bernie McCabe, said on JUN-16: "We are going to look into the circumstances surrounding the times. The governor has expressed concern over that aspect of the case."

McCabe reported back to Governor Bush in early July. He concluded that there was no wrongdoing in the case. He determined that Michael Schiavo had contacted 911 at about 5:50 AM, very shortly after Terri collapsed. The gap in the record was apparently caused by Michael's difficulty in reconstructing the events fifteen years previously.

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Follow-up and afterthoughts:

	2006-JAN-21: Michael Schiavo married Jodi Centonze on in the Roman Catholic Church of Espiritu Santo in Florida. While his former wife was in a persistent vegetative state Michael had lived with Jodi; together they had two children.
	2006-JAN-21: LifeSiteNews.com reported that on the same day:

"...Terri Schiavo�s sister Suzanne Vitadamo spoke out against the Catholic bishops of Florida, saying Terri may not have been killed if the bishops would have supported the fight to protect her life."

"Speaking at a 'Stand Up for Life' rally in South Carolina, Ms. Vitadamo said if the Florida bishops had stepped forward and denounced what was taking place 'there would have been such an enormous outcry of support from parishioners in our diocese and from Catholics around the world that my sister could very well be alive today'." ₆

2006-JAN-29: Senate Majority Leader Bill Frist (R-TN) indicated on NBC's "Meet the Press" that he had also had second thoughts about his involvement in the Schiavo case. He said:

"Well, I�ll tell you what I learned from it, which is obvious. The American people don�t want you involved in these decisions....I didn�t make the diagnosis. I raised the question of whether or not she was in a persistent vegetative state.....When you�re taking innocent life, with parents who want that life preserved, you�ve got to make sure, and therefore stepping in to say, let�s take one more review, that�s what we did. I accept the outcome. I don�t agree with the moral sense of it." ₇

2006-FEB-13: Senator Mel Martinez (R-FL) had promoted a bill in Congress that would have given federal courts jurisdiction to reinstate Terri Schiavo's feeding tubes. In an interview for a Florida TV program "Political Connections" he said:

"If I had to take one lesson away, it's perhaps decisions of this nature really belong in state courts, not federal courts. Perhaps this was not in the realm of federal concern. It may have been better left to state courts to deal with it." ₈

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References used:

"Report of Autopsy," Medical Examiner, District Six, 2005-APR-01, Page 16, at: http://www.earnedmedia.org/
H.C. Kinney et al., "Neuropathological findings in the brain of Karen Ann Quinlan...," The New England Journal of Medicine, 1994; 330: 1468-1475.
Op Cit, "Report of Autopsy," Page 28.
"Schindler Family's Statement on Medical Examiner's Report," Christian Communication Network, 2005-JUN-16, at: http://www.earnedmedia.org/
Cris Tisch & Joni James, "Schiavo timeline troubles governor. The state attorney will review discrepancies concerning Terri Schiavo's unexplained collapse," St. Petersburg Times, 2005-JUN-17, at: http://www.sptimes.com/
Gudrun Schultz, "Terri Schiavo�s Husband Re-Married in Catholic Church," LifeSiteNews.com, 2006-JAN-23, at: http://www.lifesite.net/
"Frist says Schiavo case taught him a lesson. Senate majority leader: Americans don�t want gov�t involved in such choices," Meet the Press, 2006-JAN-29, at: http://msnbc.msn.com/
"Sen. Martinez says he was mistaken on Schiavo debate," Associated Press, 2006-FEB-13, at: http://www.terripac.com/news.html