The Terri Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo (; née Schindler; December 3, 1963 – March 31, 2005), a woman in an irreversible permanent vegetative state although conscious and able to communicate, Schiavo's husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without the prospect of complete recovery, and, in 1998, he elected to remove her feeding tube. Schiavo's parents disputed her husband's assertions and challenged Schiavo's medical diagnosis, arguing in favor of continuing artificial nutrition and hydration due to her ability to communicate and awareness. The highly publicized and prolonged series of legal challenges presented by her parents, which ultimately involved state and federal politicians up to the level of George W. Bush (the then U.S. president), caused a seven-year delay (until 2005) before Schiavo's feeding tube was ultimately removed.
On February 25, 1990, at age 26, Schiavo went into cardiac arrest at her home in St. Petersburg, Florida. She was resuscitated, but had severe brain damage due to oxygen deprivation and was left comatose. After two and a half months without improvement, other than ability to communicate with gestures and sound, her diagnosis was changed to that of a persistent vegetative state. For the next two years, doctors attempted occupational therapy, speech therapy, physical therapy and other experimental therapy, hoping to restore her completely without success. In 1998, Schiavo's husband Michael Schiavo petitioned the Sixth Circuit Court of Florida to remove her feeding tube pursuant to Florida law. He was opposed by Terri's parents, Robert and Mary Schindler. The court determined that Schiavo would not have wished to continue life-prolonging measures, and on April 24, 2001, her feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge again ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included Bush returning to Washington, D.C., to sign legislation moving the case to the federal courts. After appeals through the federal court system that upheld the original decision to remove the feeding tube, staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005 with her mother at her side. Michael Schiavo remarried months later.
The Schiavo case involved 14 appeals and numerous legal motions, petitions, and hearings in the Florida courts; five suits in federal district court; extensive political intervention at the levels of the Florida state legislature, Governor Jeb Bush, the U.S. Congress, and President George W. Bush; and four denials of certiorari from the Supreme Court of the United States. The case also spurred highly visible activism from the United States pro-life movement, the right-to-die movement, and disability rights groups. Since Schiavo's death, both her husband and her family have written books on their sides of the case, and both have also been involved in activism over related issues.
Background Early life Terri Schiavo was born Theresa Marie Schindler to Mary (born 1941) and Robert Schindler (1937–2009) on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania, a suburb of Philadelphia. She was the oldest of three children. Her mother reported that, as a child, Schiavo would spend hours in her bedroom arranging her collection of stuffed animals. As a teen, she enjoyed listening to John Denver and reading Danielle Steel romances. She attended Bucks County Community College, where she met Michael Schiavo in 1982. The two began dating and married on November 10, 1984. They moved to Florida in 1986, following her parents. Michael worked as a restaurant manager, while Terri took up a bookkeeping job with an insurance company. She had naturally dark hair, but dyed it blonde.
Initial medical crisis: 1990 In the early morning of February 25, 1990, Schiavo collapsed in a hallway of her St. Petersburg, Florida apartment. Firefighters and paramedics, arriving in response to her husband Michael's 9-1-1 call, found her face-down and unconscious. She was not breathing and had no pulse. They attempted to resuscitate her and she was transported to the Humana Northside Hospital. Paramedics had her intubated and ventilated.
Initial medical assessments The cause of Schiavo's collapse was determined to be cardiac arrest. Her medical chart contained a note that "she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day and drinking about 10–15 glasses of iced tea." Upon admission to the hospital, she was noted as suffering from hypokalemia (low potassium levels): her serum potassium level was an abnormally low 2.0 mEq/L (the normal range for adults being 3.5–5.0 mEq/L). Her sodium and calcium levels were normal. Electrolyte imbalance is often caused by drinking excessive fluids, and a serious consequence of hypokalemia can be heart rhythm abnormalities, including sudden arrhythmia death syndrome.Meyer J, et al. "Sudden Arrhythmia death Syndrome: Importance of the Long QT Syndrome" Am Fam Physician. 2003 Aug 1;68(3):483–488. Retrieved July 26, 2011. Schiavo was eventually switched from being fed by a nasogastric feeding tube to a percutaneous endoscopic gastrostomy (PEG) feeding tube. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, who had previously treated Schiavo, cared for her during her initial admission to Humana Northside; both he and Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state within approximately one year after her sudden cardiac arrest.
Relationship between Terri's husband and parents From 1990 to 1993, Michael Schiavo and the Schindlers (Terri Schiavo's parents) enjoyed an amicable relationship,Pariente, Barbara, Chief Justice (for The Court). "Jeb Bush, Governor of Florida, et al., vs. Michael Schiavo, Guardian of Marissa Brown", Case Number: SC04-925, Florida Supreme Court, September 23, 2004 PDF link with the Schindlers allowing Michael to live rent-free in their condominium for several months.
Rehabilitation efforts: 1990–1993 In November 1990, Michael Schiavo took Terri to the University of California, San Francisco, for experimental nerve stimulation with a thalamic stimulator. The treatment took several months and was unsuccessful. He returned to Florida with her in January 1991 and admitted her as an inpatient to the Mediplex Rehabilitation Center in Bradenton, Florida. On July 19, 1991, Schiavo was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy until 1994. In mid-1993, Michael Schiavo requested a do not resuscitate order for her after she contracted a urinary tract infection.
Legal cases (1992–2005)
Malpractice In 1992, Michael filed a malpractice suit against Terri's gynecologist on the basis that he failed to diagnose bulimia as the cause of her infertility.Greer, George W., Circuit Judge. "In re: The Guardianship of Theresa Marie Schiavo, Incapacitated", (PDF) File No. 90-2908GD-003, Fla. 6th Judicial Circuit , February 11, 2000 Terri had gone to the doctor because she had stopped menstruating but the doctor had failed to take her medical history into account which might have revealed an eating disorder. During the case, one of Terri's friends testified that she knew Schiavo was bulimic. In November 1992, Michael won the case and was awarded $6.8 million by the jury, later reduced to $2 million as Terri was found partly at fault for her condition. After attorneys' fees and other expenses, Michael received $300,000 and $750,000 was put in a trust fund for Terri's medical care. According to Michael, in early 1993 the Schindlers demanded that he share the malpractice money with them.
Petition to remove feeding tube On June 18, 1990, the court appointed Michael Schiavo as Terri Schiavo's legal guardian; this appointment was not disputed by the Schindlers at the time. In May 1998, Michael Schiavo filed a petition to remove Terri Schiavo's feeding tube, which her parents opposed. Richard Pearse was appointed by the court as a second guardian ad litem (GAL), and on December 29, 1998, reported "Dr. Gabrielle Tyler's opinion of the ward's condition and prognosis is substantially shared among those physicians who have recently been involved in her treatment." Pearse concluded from Karp's and Vincent Gambone's diagnosis of Persistent Vegetative State that Schiavo was legally in a persistent vegetative state as defined by Florida Statutes, Title XLIV, Chapter 765, §101(12). This includes the "absence of voluntary action" and an "inability to communicate or interact purposefully".
Pearse found that there was no possibility of improvement but that Michael Schiavo's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate as long as he remained married to her. Due to a lack of a living will and questions regarding Michael's credibility, Pearse recommended denying his petition to remove her feeding tube. Pearse reported that the issue of conflict of interest applied to the Schindlers as well, since, had Michael divorced Terri as they wanted him to, they would have inherited the remainder of Terri Schiavo's estate upon her death.
Schiavo end-of-life wishes Given the lack of a living will, a trial was held before Pinellas County Judge George Greer during the week of January 24, 2000, to determine what Schiavo's wishes would have been regarding life-prolonging procedures. Michael Schiavo was represented by attorney George Felos, who had won a landmark right-to-die case before the Florida Supreme Court in 1990.
The trial included testimony from 18 witnesses regarding her medical condition and her end-of-life wishes. Michael Schiavo claimed that his wife would not want to be kept on a machine where her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents "claimed that Terri was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration." Judge Greer issued his order granting the petition for authorization to discontinue artificial life support for Terri Schiavo in February 2000. In this decision, the court found that Terri Schiavo was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal (2nd DCA) and came to be known by the court as Schiavo I in its later rulings.See, for instance p. 6 of US District Court Case No. 8:05-CV-530-T-27TBM (PDF) p. 6
Oral feeding and the second guardianship challenge In March 2000, the Schindlers filed a motion to permit assisted feeding of Terri, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri Schiavo was not responsive to swallowing tests and required a feeding tube, Judge Greer ruled that she was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request. The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed.