Terri Schiavo case

Teresa Marie "Terri" Schiavo
Born	December 3, 1963(1963-12-03) Lower Moreland Township, Montgomery County, Pennsylvania
Died	March 31, 2005(2005-03-31) (aged 41) Pinellas Park, Florida
Occupation	Insurance clerk
Spouse	Michael Schiavo
Parents	Robert and Mary Schindler

The Terri Schiavo case ( /ˈʃaɪvoʊ/) was a legal battle in the United States between the legal guardians and the parents of Teresa Marie "Terri" Schiavo that lasted from 1998 to 2005. At issue was whether the husband's granted motions and later court findings to forgo further life-prolonging procedures or life support treatment for Terri, who was diagnosed by doctors as being in a persistent vegetative state, would be carried out. The highly publicized and prolonged series of legal challenges presented by the parents and by state and federal legislative intervention effected in total a seven-year delay before life support finally was terminated.

Terri Schiavo collapsed in her St. Petersburg, Florida home in full cardiac arrest on February 25, 1990. She suffered massive brain damage due to lack of oxygen and, after two and a half months in a coma, her diagnosis was elevated to vegetative state. For the next few years doctors attempted physical therapy and other experimental therapy, hoping to return Terri to a state of awareness. In 1998 Schiavo's husband, Michael, petitioned the Sixth Circuit Court of Florida (Pinellas County), to remove her feeding tube pursuant to Florida Statutes Section 765.401(3).^[1] He was opposed by Terri's parents, Robert and Mary Schindler, who argued that she was conscious. The court determined that she would not wish to continue life-prolonging measures,^[2] and on April 24, 2001 Terri's feeding tube was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included U.S. President George W. Bush returning to Washington D.C. to sign legislation designed to keep her alive. After all attempts at appeals through the federal court system upheld the original decision to remove the feeding tube, staff at the Pinellas Park hospice facility where Terri was being cared for disconnected the feeding tube on March 18, 2005 and she died on March 31.

In all, the Schiavo case involved 14 appeals and numerous motions, petitions, and hearings in the Florida courts; five suits in federal district court; Florida legislation struck down by the Supreme Court of Florida; federal legislation (the Palm Sunday Compromise); and four denials of certiorari from the Supreme Court of the United States.^[3] The case also spurred highly visible activism from the pro-life movement and disability rights groups.^[4]

Background

Early life

Terri Schiavo was born Teresa Marie Schindler on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania, a suburb of Philadelphia. She attended Bucks County Community College, where she met Michael Schiavo in 1982. The two began dating and were married on November 10, 1984. They moved to Florida in 1986, following Terri's parents. Michael worked as a restaurant manager, while Terri took up a job with an insurance company.^[5]

Initial medical crisis – 1990

In the early morning of February 25, 1990 Terri collapsed in a hallway of her St. Petersburg, Florida, apartment. Firefighters and paramedics arriving in response to 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. There, she was intubated and ventilated.^[6]

Initial medical assessments

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."^{[citation needed]} Upon admission to the hospital, her serum potassium level was noted to be very low, at 2.0 mEq/L; the normal range for adults is 3.5–5.0 mEq/L. Her sodium and calcium levels were normal.^[7] Electrolyte imbalance is often caused by drinking excessive fluids. A serious consequence of low potassium levels can be heart rhythm abnormalities, including sudden arrhythmia death syndrome.^[8] Vomiting, a self-induced act for many bulimic patients, is another cause of low potassium levels. Terri's husband, Michael, later filed and won a malpractice suit against her obstetrician on the basis that he failed to diagnose bulimia as the cause of her infertility.^[9] She was eventually switched from being fed by a nasogastric feeding tube to a percutaneous endoscopic gastrostomy (PEG) feeding tube.^[10][11]

Dr. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, who previously treated Terri, cared for Terri during her initial admission to Humana; both he and Dr. Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state (PVS) within approximately one year after Terri's sudden cardiac arrest.

Rehabilitation efforts – 1990-1993

In November, Michael took her to the University of California, San Francisco for experimental nerve stimulation – the Thalamic stimulator. The treatment took several months but was unsuccessful. Michael returned to Florida with her in January 1991 and admitted her as an inpatient to the Mediplex Rehabilitation Center in Bradenton, Florida. While there, he later said that he often took "her to parks and public places in hopes of sparking some recovery". On July 19, 1991, Terri was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy until 1994.^[12][13] In mid 1993, Michael requested a do not resuscitate order for Terri after she contracted a urinary tract infection. The court appointed guardian ad litem, Jay Wolfson,^[14] later wrote a report stating that Michael's decision was "predicated on his reasoned belief that there was no longer any hope for Terri's recovery."^[6]

From 1990 to 1993, Michael and the Schindlers enjoyed an amicable relationship.^[15] The Schindlers even allowed Michael to live rent-free in their condominium for several months. During this time, the Schindlers actively encouraged Michael to "get on with his life". He was encouraged by the Schindlers to date, and he introduced his in-law family to women he was dating. On June 18, 1990, the court appointed Michael Schiavo as Terri's legal guardian; this appointment was not disputed by the Schindlers at the time.^[6]

Legal cases 1998-2002

Petition to remove feeding tube

In May 1998, Terri's husband, Michael, filed a petition to remove Terri'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. Jeffrey Karp'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 Dr. Vincent Gambone's diagnosis of PVS that Schiavo was legally in a persistent vegetative state as defined by Florida Statutes,^[16] Title XLIV, Chapter 765, §101(12). This includes the "absence of voluntary action" and an "inability to communicate or interact purposefully."^[17][18]

Pearse found that there was no possibility of improvement but that Michael's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate. 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 they prevailed, they would have inherited the remainder of Mrs. Schiavo's estate upon her death.^[17]

Schiavo I: end-of-life wishes

Given the lack of a living will, a trial was held during the week of January 24, 2000, to determine what Terri's wishes would have been regarding life-prolonging procedures. Testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes was heard. Michael claimed that Terri 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 George Greer issued his order granting Michael's petition for authorization to discontinue artificial life support for his wife in February 2000. In this decision, the court found that Terri was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed.^[19] This decision was upheld by the Florida Second District Court of Appeal^[20] (2nd DCA) and came to be known by the court as Schiavo I in its later rulings.^[21]

Oral feeding and the Second Guardianship Challenge

In March 2000, the Schindlers filed a motion to permit oral feeding of Terri, which is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri was not responsive to swallowing tests and required a feeding tube,^[6] Judge Greer ruled that Terri was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request.^[22] The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed.^[23]

In 2000, the Schindlers again challenged Michael's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri to Pinellas Park, Florida hospice "after it was clear that she was not 'terminal' within Medicare guidelines" for hospices. By this time, while still legally married to Terri Schiavo, Michael was in a relationship with Jodi Centonze, and had fathered their first child. Michael said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (not to be kept alive in a PVS) were carried out. The court denied the motion to remove the guardian, allowing that the evidence was not sufficient and in some instances, not relevant. It set April 24, 2001 as the date on which the tube was to be removed.^[24]

Schiavo II

In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure.^[25] The Second District Court of Appeal upheld Greer's decision but remanded the issue in order to give the Schindlers an opportunity to file a new motion. On April 24, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against removal of feeding tube until this was settled. The feeding tube was reinserted on April 26. On appeal by Michael, the Second District Court of Appeal reversed Judge Quesada's order. In the same time frame, Michael filed a motion to enforce the mandate of the guardianship court (that the feeding tube be removed). The Second District Court of Appeal denied the motion. (These three decisions, all published in a single order by Florida's Second District Court of Appeal,^[26] came to be known by the court as Schiavo II in its later rulings.)

Schiavo III & IV: PVS diagnosis challenge

Left: CT scan of normal brain; Right: Schiavo's 2002 CT scan provided by Ronald Cranford, showing loss of brain tissue. The black area is liquid, indicating hydrocephalus ex vacuo.^[27] The small white piece in the right image is the Thalamic stimulator implanted in her brain.

On August 10, 2001, on remand from the Florida Second District Court of Appeal, Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability such that Terri herself would be able to decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the Second District Court of Appeals. On October 17, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Terri's wishes back to the trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Michael could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri's condition. (These decisions, all published in a single order by the Florida Second District Court of Appeal,^[28] came to be known by the court as Schiavo III in its later rulings.) In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer's court to determine whether new therapy treatments could help Terri restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan) was performed, which showed severe cerebral atrophy. An EEG showed no measurable brain activity. The five physicians chosen were Dr. William Maxfield, a radiologist, and four neurologists: Dr. William Hammesfahr, Dr. Ronald Cranford, Dr. Melvin Greer and Dr. Peter Bambakidis.^[29]

The five doctors examined Terri's medical records, brain scans, the videos, and Terri herself. Drs. Cranford, Greer, and Bambakidis testified that Terri was in a persistent vegetative state. Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state. As part of the court-ordered medical exam, six hours of video of Terri were taped and filed at the Pinellas County courthouse. The tape included Terri with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Terri "clearly does not consistently respond to her mother". From that six hours of video, the Schindlers and their supporters produced six clips showing reactions and emotions, totaling less than six minutes, and released those clips to public websites.^[30] Judge Greer ruled that Terri was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr's testimony, which claimed positive results in similar cases by use of vasodilation therapy, the success of which is unsupported in the medical literature.^[31] This ruling was later affirmed by Florida's Second District Court of Appeal, which stated that "this court has closely examined all of the evidence in the record," and "we have... carefully observed the video tapes in their entirety." The court concluded that "...if we were called upon to review the guardianship court's decision de novo, we would still affirm it." (This decision by the Second District Court of Appeals^[32] came to be known as Schiavo IV in later rulings.)

Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. They selected pro-life activist Randall Terry as their spokesman but continued to pursue their available legal options. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube to provide for "eight weeks' therapy". Accompanying the petition were four affidavits from members of the Schindler family and one from Dr. Alexander T. Gimon. At the hearing, the Schindlers' counsel read into the record additional affidavits from three speech professionals and two nurses. Nurse Carla Sauer lyer asserted that she was able to feed Terri Schiavo orally but that Michael characterized any such interaction as "therapy" and ordered her not to do so. Iyer claimed in her affidavit that her initial training in 1996 consisted solely of the instruction, "Do what Michael Schiavo tells you or you're terminated," and that standing orders were not to contact the Schindler family, but that she "would call them anyway". She also claimed that Michael said, "When is that bitch gonna die?" According to Iyer, on five different occasions she tested Terri's blood sugar levels after Michael visited and found that Terri's blood sugar levels were so low they wouldn't even register. She claims that she eventually called the police and was fired the next day.^[33] Despite her claims that she called the Schindlers multiple times in 1996, there is no evidence the Schindlers did anything at the time to demand that the nursing home or police investigate the supposed incidents. Nor did they subpoena Iyer during their 2000 court battle with Michael.

On September 17, Judge George Greer denied the petition, and wrote that "the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them clearly demonstrate this to be true." Regarding (Nurse) Iyer's^[33] statements,^[34][35][36] Greer wrote that they were "incredible to say the least" and that "Ms. Iyer details what amounts to a 15-month cover-up April 1995 through July 1996 which include the staff of Palm Garden of Largo Convalescent Center, the Guardian of the Person, the guardian ad litem, the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler... It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had Iyer contacted them in 1996 as her affidavit alleges".^[37]

Terri's Law and other government delays

Main article: Government involvement in the Terri Schiavo case

On October 15, 2003, Schiavo's feeding tube was removed. Within a week, when the Schindlers' final appeal was exhausted, State Rep. Frank Attkisson and the Florida Legislature hastily passed "Terri's Law," giving Governor Jeb Bush the authority to intervene in the case. Governor Bush immediately ordered the feeding tube reinserted. Governor Bush sent the Florida Department of Law Enforcement to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted.^[38] She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem (GAL), Dr. Jay Wolfson, to "deduce and represent the best wishes and best interests" of Schiavo, and report them to Governor Bush. Wolfson's report did not change Michael's role as her legal guardian and did not otherwise obstruct him legally.^[6]

Michael Schiavo opposed the Governor's intervention in Schiavo's case, and was represented, in part, by the American Civil Liberties Union (ACLU). At the same time, Robert and Mary Schindler, her parents, attempted to intervene and participate in the "Terri's Law" case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida Sixth Circuit, the same circuit as for Judge George W. Greer. They appealed, and, on February 13, the Florida Second District Court of Appeal (Second District Court of Appeals) reversed Baird's ruling, allowing them to participate. On March 17, Baird denied the Schindlers the right to intervene a second time,^[39] and the Schindlers, represented by the conservative American Center for Law and Justice (ACLJ), appealed the right to participate in the "Terri's Law" case, with the court scheduling an oral argument date for June 14.^[40] The Schindlers' other attorney, Pat Anderson, was concurrently challenging Michael Schiavo's right to be her guardian, and, on June 16, she made a petition for writ of Quo Warranto.

On May 5, 2004, Baird found "Terri's Law" unconstitutional, and struck it down.^[41] Bush appealed this order to the Second District Court of Appeals, but, on May 12, they issued an "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution."^[42] The Second District Court of Appeals, in sending it directly to the Florida's Supreme Court, invoked "pass through" jurisdiction.^[43]

The Florida Supreme Court then overturned the law as unconstitutional.^[44]

Final feeding tube removal and federal involvement

Early 2005 motions

On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations.^[45] The Schindlers wanted Schiavo to be tested with an fMRI and given a swallowing therapy called VitalStim. The motion was accompanied by thirty-three affidavits from doctors in several specialties, speech-language pathologists and therapists, and a few neuropsychologists, all urging that new tests be undertaken.^[46][47] Patricia Fields Anderson, the Schindler family attorney, still held out hope "that Terri might be able to take nourishment orally, despite past findings that she is incapable."^[48] Judge Greer formally denied the motion and ordered the "removal of nutrition and hydration from the ward" and set the time and date for the removal of the feeding tube as, "1:00 p.m. on Friday, March 18, 2005."^[49]

On February 28, the Schindlers filed a motion, asking for permission to attempt to provide Schiavo with "Food and Water by Natural Means." This second motion asked for permission to "attempt to feed" Schiavo by mouth.^[50] Judge Greer denied the second motion on March 8, saying "it has become clear that the second motion is part and parcel of the previous motion on medical evaluations. The same declarations are being used for both motions and the motion appears to be an alternative pleading to the previous motion. Both are asking for an experimental procedure."^[51] The following day, Greer denied the first motion as well, citing that an affiant doctor for Michael cautioned that fMRI was an experimental procedure that should be conducted in an academic setting, because Schiavo had already undergone swallowing tests and failed, and because VitalStim had only been performed on patients who were not in a PVS. Greer noted that "most of the doctor affidavits submitted are based on their understanding of Schiavo's condition from news reports or video clips they have seen. Many are obviously not aware of the medical exams undertaken for the 2002 trial..."^[46]

Following Greer's order on March 18, 2005 to remove the feeding tube, Republicans in the United States Congress subpoenaed both Michael and Terri Schiavo to testify at a congressional hearing.^[52] Greer told congressional attorneys, "I have had no cogent reason why the (congressional) committee should intervene." He also stated that last-minute action by Congress does not invalidate years of court rulings.^[53][54]

Palm Sunday Compromise

Main article: Palm Sunday Compromise

President Bush and Congressional Republicans anticipated Greer's adverse ruling well before it was delivered and worked on a daily basis to find an alternative means of overturning the legal process by utilizing the authority of the United States Congress. On March 20, 2005, the Senate, by unanimous consent, passed their version of a relief bill; since the vote was taken by voice vote, there was no official tally of those voting in favor and those opposed. Soon after Senate approval, the House of Representatives passed an identical version of the bill S.686, which came to be called the "Palm Sunday Compromise" and transferred jurisdiction of the Schiavo case to the federal courts. The bill passed the House on March 21 at 12:41 a.m. (UTC-5). U.S. President George W. Bush flew to Washington, D.C. from his vacation in Texas in order to sign the bill into law at 1:11 a.m. As in the state courts, all of the Schindlers' federal petitions and appeals were denied, and the U.S. Supreme Court declined to grant certiorari, effectively ending the Schindlers' judicial options.

At the same time, the so-called Schiavo memo surfaced, causing a political firestorm. The memo was written by Brian Darling, the legal counsel to Florida Republican senator Mel Martinez. It suggested the Schiavo case offered "a great political issue" that would appeal to the party's base (core supporters) and could be used against Senator Bill Nelson, a Democrat from Florida, because he had refused to co-sponsor the bill.^[55] Nelson easily won re-election in 2006.

Final local motions, death and autopsy

On March 24, 2005, Judge Greer denied a petition for intervention by the Department of Children & Families (DCF) and signed an order forbidding the department from "taking possession of Theresa Marie Schiavo or removing her" from the hospice and directed "each and every and singular sheriff of the state of Florida" to enforce his order. The order was appealed to the Second District Court of Appeals the following day, which resulted in an automatic stay under state law. While the stay was in effect, Florida Department of Law Enforcement personnel prepared to take custody of Terri and transfer her to a local hospital for reinsertion of the feeding tube. Once Greer was made aware of the stay, he ordered it lifted and all parties stood down. Governor Bush decided to obey the court order despite enormous pressure from the political right. If Bush (or the Florida Legislature) had ignored Greer's order by attempting to remove her from the hospice, a confrontation between the Pinellas Park Police Department and the FDLE agents could have ensued. In jest, one official said local police discussed "... whether we had enough officers to hold off the National Guard."^[56]

Schiavo died at a Pinellas Park hospice on March 31, 2005. Although there was concern that Schiavo would experience significant symptoms from dehydration with the removal of the feeding tube, studies have shown that patients who have their feeding tubes removed, such as the case of Schiavo, usually have a peaceful death.^[57][58]

After her death, Schiavo's body was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Fla. The autopsy occurred on April 1, 2005. It revealed extensive brain damage. The manner of death was certified as "undetermined". The autopsy was led by Chief Medical Examiner Jon R. Thogmartin, M.D. In addition to consultation with a neuropathologist (Stephen J. Nelson, M.D.), Dr. Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report^[23] was released on June 15, 2005. In addition to studying Terri's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. Examination of Schiavo’s nervous system by neuropathologist Stephen J. Nelson, M.D., revealed extensive injury. The brain itself weighed only 615 g, only half the weight expected for a female of her age, height, and weight, an effect caused by the loss of a massive amount of neurons. Microscopic examination revealed extensive damage to nearly all brain regions, including the cerebral cortex, the thalami, the basal ganglia, the hippocampus, the cerebellum, and the midbrain. The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout the cerebral cortex, the large pyramidal neurons that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, is also typical. There was marked damage to important relay circuits deep in the brain (the thalami) – another common pathologic finding in cases of PVS. The damage was, in the words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons."^[59]

The cardiac pathologist who studied Schiavo's heart found it and the coronary vessels to be healthy, which excludes the possibility that her initial collapse was the result of myocardial infarction, although there was a localized area of healed inflammation (opening the possibility of myocarditis). Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." Regarding the possibility of strangulation or domestic violence as a cause of Schiavo's initial collapse, the report states: "No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in the months after her initial collapse. Indeed, within an hour of her initial hospital admission, radiographic examination of her cervical spine was negative. Specifically, external signs of strangulation including cutaneous or deep neck injury, facial/conjunctival petechiae, and other blunt trauma were not observed or recorded during her initial hospital admission. Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings."

Regarding the cause and manner of Schiavo’s death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined."^[23]

"We were not surprised the medical examiner said Terri's brain was damaged," said Bobby Schindler, Jr., her brother, in an interview hours after the autopsy report was released. "The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions."^[60]

Public opinion and activism

Main article: Public opinion and activism in the Terri Schiavo case

Due to media attention there was a great deal of public opinion and activism in the case, including many polls, and frequent fractious protests some even leading to arrests. Two polls showed that a large majority of Americans believed that Michael Schiavo should have had the authority to make decisions on behalf of his wife, Terri Schiavo, and that the United States Congress overstepped its bounds with its intervention in the case.^[61] However, other polls seemed to favor the Schindler family's position, and questions were raised about the wording of all the polls.^[62][63] Various organizations and protesters demanded that Schiavo's feeding tube be reinserted. Most of these groups were affiliated with the Christian right.^[64]

References

1. ^ "§ 765.401 of Florida Statutes – Health Care Advance Directives – The proxy.". State of Florida. 2006-11-22. http://law.onecle.com/florida/civil-rights/765.401.html. Retrieved 2007-01-01. 
2. ^ William R. Levesque (2003-11-08). "Schiavo's wishes recalled in records". St. Petersburg Times Online. http://www.sptimes.com/2003/11/08/Tampabay/Schiavo_s_wishes_reca.shtml. Retrieved 2006-01-05. 
3. ^ Felos, George J., Esq. (2005-03-24). ""Respondent Michael Schiavo's opposition to application for injunction," Case No.: 04A-825". Blue Dolphin Publishing. http://news.findlaw.com/hdocs/docs/schiavo/32405acluopp.pdf. Retrieved 2006-01-15.  p. 9
4. ^ Nina Easton (2005-03-23). "Rights groups for disabled join in fight". Boston Globe. http://www.boston.com/news/nation/washington/articles/2005/03/23/rights_groups_for_disabled_join_in_fight/. Retrieved 2006-01-10. 
5. ^ Frey, Jennifer (25 March 2005). "Terri Schiavo's Unstudied Life". Washington Post. http://www.washingtonpost.com/wp-dyn/articles/A64459-2005Mar24.html. Retrieved 30 July 2010. 
6. ^ ^{a b c d e} Wolfson, Jay, DrPH, JD. (2003-12-01). "A report to Governor Jeb Bush and the Sixth Judicial Circuit in the matter of Theresa Marie Schiavo". abstractappeal.com. http://abstractappeal.com/schiavo/WolfsonReport.pdf. Retrieved 2011-09-21.  pp. 2 , 8, 10
7. ^ Mark Fuhrman (2005-06-28). Silent Witness. William Morrow. ISBN 0060853379.  p67
8. ^ Meyer J, et al. Sudden Arrhythmia Death Syndrome: Importance of the Long QT Syndrome Am Fam Physician. 2003 Aug 1;68(3):483-488.[1] Retrieved 2011-7-26
9. ^ Greer, George W., Circuit Judge. "IN RE: THE GUARDIANSHIP OF THERESA MARIE SCHIAVO, Incapacitated," File No. 90-2908GD-003, Fla. 6th Judicial Circuit, February 11, 2000
10. ^ Carey Goldberg (2005-07-05). "After a coma: Comebacks are slow and patchy, and almost never miraculous". Boston Globe. http://www.boston.com/news/globe/health_science/articles/2005/07/05/after_a_coma/. Retrieved 2009-02-22. 
11. ^ "Terri Schiavo biography and timeline". Bay News 9. 2007-03-27. Archived from the original on May 10, 2006. http://web.archive.org/web/20060510065536/http://www.baynews9.com/content/36/2005/3/31/76457.html. Retrieved 2008-02-03. 
12. ^ "Sabal Palms Health Care Center (Largo, FL) Detailed Hospital Profile". http://www.hospital-data.com/hospitals/SABAL-PALMS-HEALTH-CARE-CENTER-LARGO.html. Retrieved 2007-07-25. 
13. ^ "The Terri Schiavo Information Page". abstractappeal.com. http://abstractappeal.com/schiavo/infopage.html. Retrieved 2009-04-01. 
14. ^ "Jay Wolfson, Dr.P.H., J.D.". Archived from the original on August 30, 2006. http://web.archive.org/web/20060830121828/http://hsc.usf.edu/publichealth/eoh/jwolfson/. Retrieved 2007-07-25. ^{[dead link]}
15. ^ 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 link
16. ^ "State of Florida. Florida Statutes, Accessible State Law on the Official State of Florida Website link". State of Florida. 2005-05-01. http://flsenate.gov/statutes/. Retrieved 2006-02-05. 
17. ^ ^{a b} Pearse, Richard L., Jr., P.A., Guardian Ad Litem. (1998-12-29). "Report of guardian ad litem," for "In re: the guardianship of Theresa Schiavo, an incapacitated person, Case No. 90-2908GD-003". Hospice Patients Alliance. http://www.hospicepatients.org/richard-pearse-jr-12-29-98-report-of-guardianadlitem-re-terri-schiavo.pdf. Retrieved 2006-02-01.  pp. 2 , 8-11
18. ^ "State of Florida. Florida Statutes, Citation of Law, §765.101(12), Florida Statutes". State of Florida. 2005-06-01. http://flsenate.gov/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0765/SEC101.HTM. Retrieved 2006-02-03. 
19. ^ Greer, George W., Circuit Judge (2000-02-11). "In re: the guardianship of Theresa Marie Schiavo, Incapacitated," File No. 90-2908GD-003". Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder02-00.pdf. Retrieved 2006-01-08.  pp. 9-10
20. ^ Altenbernd, Chris W. (for The Court) (2001-01-24). "In re Guardianship of Theresa Marie Schiavo, Incapacitated. Robert Schindler and Mary Schindler, Appellants, v. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Appellee, Case Number: 2D00-1269". Florida Second District Court of Appeal. http://abstractappeal.com/schiavo/2dcaorder01-01.txt. Retrieved 2006-02-06. 
21. ^ See, for instance p. 6 of US District Court Case No. 8:05-CV-530-T-27TBM p. 6
22. ^ Greer, George W., Circuit Judge. (2000-03-07). "In re: the guardianship of Theresa Marie Schiavo, Incapacitated, File No. 90-2908GD-003". Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder0300.pdf. Retrieved 2006-02-09. 
23. ^ ^{a b c} Thogmartin, Jon R., M.D. (2005-06-13). ""Report of Autopsy" for Theresa Schiavo, Case #5050439". http://www.abstractappeal.com/schiavo/autopsyreport.pdf. Retrieved 2006-02-10.  p. 34
24. ^ Anderson, Patricia F., Esq. (2003-01-01). "Second amended petition to remove guardian". libertytothecaptives.net. http://www.libertytothecaptives.net/petitiontoremoveguardian_amended.html. Retrieved 2006-02-10.  p. 14
25. ^ "Florida Rules of Civil Procedure". The Florida Bar. 2005-12-01. http://floridacivpro.com/rules/2009/11/1540-relief-from-judgment-decr.php. Retrieved 2006-02-07. ^{[dead link]} (page 65)
26. ^ Altenbernd, Chris W., Judge (for The Court) (2001-07-11). ""In re Guardianship of Theresa Marie Schiavo, Incapacitated. Robert Schindler and Mary Schindler, Appellants, v. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Appellee," and "Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Appellant, v. Robert Schindler and Mary Schindler, Appellees," Case Numbers: 2D00-1269, 2D01-1836, and 2D01-1891,". Florida Second District Court of Appeal. http://abstractappeal.com/schiavo/2dcaorder07-01.txt. Retrieved 2006-02-11. 
27. ^ Fins, Joseph; Nicholas Schiff (2005-09-01). "In Brief: The Afterlife of Terri Schiavo". The Hastings Center Report (The Hastings Center) 35 (4): 8. http://www.medscape.com/viewarticle/511647. Retrieved 2005-10-01.  Quote: "She had developed hydrocephalus ex vacuo, a condition marked by enlarged ventricles filled with cerebrospinal fluid, because of this profound loss of cortical volume."
28. ^ Altenbernd, Chris W., Judge (for The Court) (2001-10-17). "In re: Guardianship of Theresa Marie Schiavo, Incapacitated. Robert Schindler and Mary Schindler, Appellants, v. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Appellee, Case Number: 2D01-3626". Florida Second District Court of Appeal. http://www.2dca.org/opinion/October%2017,%202001/2d01-3626.pdf. Retrieved 2006-02-22.  p. 12
29. ^ Nohlgren, Stephen (2003-11-10). "Schiavo tapes: snippets, then not much". St. Petersburg Times. http://www.sptimes.com/2003/11/10/Tampabay/Schiavo_tapes__snippe.shtml. Retrieved 2008-04-05. 
30. ^ Smith, Brad (2005-03-20). "Schiavo Videotapes Offer Powerful But Misleading Evidence". Tampa Tribune. http://news.tbo.com/news/MGBQ67CTI6E.html. Retrieved 2006-02-17. 
31. ^ Greer, George W., Circuit Judge. (2002-11-22). "In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908-GB-003". Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder11-02.txt. Retrieved 2006-02-04. 
32. ^ Altenbernd, Chris W., Judge (for The Court) (2003-06-06). ""In re: Guardianship of Theresa Marie Schiavo, Incapacitated. Robert Schindler and Mary Schindler, Appellants, v. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Appellee," Case Number: 2D02-5394". Florida Second District Court of Appeal. Archived from the original on 2008-06-26. http://web.archive.org/web/20080626171350/http://www.2dca.org/opinion/June+06,+2003/2D02-5394.pdf. Retrieved 2006-02-22.  pp. 9-10
33. ^ ^{a b} "Fox interview of Carla Sauer Iyer". Fox News via American Patriot Friends Network (APFN). 2005-03-25. http://treyjackson.typepad.com/junction/2005/03/carla_sauer_i_w.html. Retrieved 2007-07-25. ^{[dead link]}
34. ^ Carla Sauer Iyer (2005-03-02). "Affidavit". http://www.apfn.org/Schiavo/CIyerAffidavit090203.htm. Retrieved 2007-07-25. 
35. ^ Breed, Allen G. (2005-03-25). "Michael Schiavo's character is mixed portrait". Orange County Register. http://www.ocregister.com/ocr/sections/news/news/article_456712.php. Retrieved 2009-03-01. ^{[dead link]}
36. ^ Heidi Law (2002-01-01). "Heidi Law Affidavit". self. http://www.hospicepatients.org/heidi-law-09-03-affidavit-re-terri-schiavo-michael.html. Retrieved 2007-01-01. 
37. ^ Greer, George W., Circuit Judge. (2003-09-17) (PDF). In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908GD-003. Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder0903.pdf. Retrieved 2007-07-25.  Direct quote from pages 5 & 6 of this 9-page Order
38. ^ Bury, Chris (2005-03-15). "Transcript: Michael Schiavo on 'Nightline': Husband at the Heart of the 'Right to Die' Case Speaks to Chris Bury,". ABC News. http://abcnews.go.com/Nightline/story?id=584124&page=1. Retrieved 2006-02-21. 
39. ^ Reynolds, Dave (2004-03-17). "Judge Baird Again Denies Schindlers' Request To Intervene In "Terri's Law" Case". Inclusion Daily Express , Fla. Minnesota Governor's Council on Developmental Disabilities. http://www.mncdd.org/news/inclusion-daily/2004/03/031704fladvschiavo.htm. Retrieved 2006-03-01. 
40. ^ "State of Florida "Case Docket," Case Number: 2D04-1528". Florida Second District Court of Appeal. 2004-01-01. http://199.242.69.70/pls/ds/ds_docket?p_caseyear=2004&p_casenumber=1528&psCourt=2&psSearchType=. Retrieved 2006-03-02. 
41. ^ Baird, W. Douglas, Circuit Judge. (2005-05-05). "Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Petitioner, v. Jeb Bush, Governor of the State of Florida, and Charlie Crist, Attorney General of the State of Florida, Respondents, Case No. 03-008212-CI-20". Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder05-04.txt. Retrieved 2006-02-03. 
42. ^ Birkhold, James, Clerk (for The Court) (2004-05-12). "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution," Case Number: 2D04-2045". Florida Second District Court of Appeal. http://www.floridasupremecourt.org/pub_info/summaries/briefs/04/04-925/Filed_06-04-2004_SchiavoOpposition.pdf. Retrieved 2006-04-01.  (Pages 6 & 7)
43. ^ Conigliaro, Matt, Esq. (2004-06-10). "Schiavo News". abstractappeal.com. http://abstractappeal.com/schiavo/schiavoposts2004.html. Retrieved 2006-04-07. 
44. ^ Pariente, Barbara, Chief Justice (for The Court). (2004-09-23). "Jeb Bush, Governor of Florida, et al., Appellants, vs. Michael Schiavo, Guardian of Theresa Schiavo, Appellee, Case Number: SC04-925". Florida Supreme Court. http://www.floridasupremecourt.org/pub_info/summaries/briefs/04/04-925/Filed_09-23-2004_Opinion.pdf. Retrieved 2006-04-15. 
45. ^ Gibbs, David C., III, Esq. (2005-02-23). ""Resondents' Fla.R.Civ.P.1.540(b)(5) Motion for relief from judgment pending contemporary medical/psychiatric/rehabilitative evaluation of Theresa Marie Schiavo," File Number: 90-2908GD-003". http://floridasky.us/terri/022305med.pdf. Retrieved 2006-05-01. 
46. ^ ^{a b} Greer, George W., Circuit Judge (2005-03-09). "In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, as Guardian of the person of Theresa Marie Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908-GD-003". Florida Sixth Judicial Circuit]. http://abstractappeal.com/schiavo/trialctorder030905.pdf. Retrieved 2006-05-28.  p. 2
47. ^ Unsigned (2005-03-28). "On Face the Nation, Family Research Council's Perkins misrepresented Schindler family's 33 affidavits calling for more medical treatment for Terri Schiavo". Media Matters for America. http://mediamatters.org/research/200503280008. Retrieved 2006-05-03. 
48. ^ Troxler, Howard (2003-09-15). "Too thin a line between life, death for Schiavo". Saint Petersburg Times. http://www.sptimes.com/2003/09/15/Columns/Too_thin_a_line_betwe.shtml. Retrieved 2006-03-08. 
49. ^ Greer, George W., Circuit Judge (2005-02-25). "In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908-GD-003". Florida Sixth Judicial Circuit]. http://abstractappeal.com/schiavo/trialctorder02-05.pdf. Retrieved 2006-06-26.  p. 3
50. ^ Gibbs, David C., III, Esq. (2005-02-27). "Emergency expedited motion for permission to provide Theresa Schiavo with food and water by natural means, File Number: 90-2908GD-003". http://floridasky.us/terri/022805EmMotionNaturalFeeding.pdf. Retrieved 2006-03-25.  p. 1
51. ^ Greer, George W., Circuit Judge. (2005-03-08). "In re: The guardianship of Theresa Marie Schiavo, Incapacitated. Michael Schiavo, Petitioner, v. Robert Schindler and Mary Schindler, Respondents, File No. 90-2908-GD-003". Florida Sixth Judicial Circuit. http://abstractappeal.com/schiavo/trialctorder030805.pdf. Retrieved 2006-03-25. 
52. ^ Davis, Tom, Chairman, (for The Committee) (2005-03-18). ""Subpoena," Committee on Government Reform, U.S. House of Representatives". http://abstractappeal.com/schiavo/HouseSubpoenas.pdf. Retrieved 2005-09-01. 
53. ^ Unsigned (2005-03-18). "Schiavo's feeding tube removed despite congressional intervention". USA Today. Associated Press. http://www.usatoday.com/news/washington/2005-03-18-congress-schiavo_x.htm. Retrieved 2006-02-24. 
54. ^ Unsigned (2005-03-18). "Schiavo's Feeding Tube Removed". Associated Press. http://news.tbo.com/news/MGBLXWESG6E.html. Retrieved 2005-10-01. 
55. ^ Unsigned (2005-04-04). "GOP memo says issue offers political rewards". The Washington Post. http://seattletimes.nwsource.com/html/nationworld/2002213728_memo20.html. Retrieved 2006-03-02. 
56. ^ "Report : State Tried Schiavo Grab". CBS News. Associated Press. 2005-03-26. http://www.cbsnews.com/stories/2005/03/26/national/main683300.shtml. Retrieved 2006-02-23. 
57. ^ Lallanilla, Marc (March 18, 2005). "Death from Dehydration Is Usually Serene". ABC News. http://abcnews.go.com/Health/Schiavo/story?id=531907&page=1. Retrieved 16 July 2011. 
58. ^ Hook CC, Mueller PS (November 2005). "The Terri Schiavo saga: the making of a tragedy and lessons learned". Mayo Clin. Proc. 80 (11): 1449–60. PMID 16295025. 
59. ^ Phillips, Rich, Producer. (2005-06-07). "Autopsy: No sign Schiavo was abused: Findings show woman's brain 'profoundly atrophied'". CNN. http://www.cnn.com/2005/HEALTH/06/15/schiavo.autopsy. Retrieved 2006-05-03. 
60. ^ Joni B. Hannigan (2005-06-15). "Terri Schiavo autopsy reports 'undetermined' cause of death; indicates no eating disorder, heart attack or trauma in 1990". Florida Baptist Witness. http://www.floridabaptistwitness.com/4471.article. Retrieved 2006-03-15. 
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63. ^ unsigned (2005-04-06). "80%: Non-Terminal Patients Should Not be Denied Food, Water; Three-to-One: Feeding Tube Should Stay in Place When Wishes Unknown; Americans Divided on Intervention by Elected Officials". Zogby International. http://www.zogby.com/news/2005/04/06/80-non-terminal-patients-should-not-be-denied-food-water-three-to-one-feeding-tube-should-stay-in-pl/. Retrieved 2011-7-24. 
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Further reading

• Terri's Story: The Court-Ordered Death of an American Woman by Diana Lynne (2005) ISBN 1-58182-488-2
• Silent Witness: The Untold Story of Terri Schiavo's Death by Mark Fuhrman (2005) ISBN 0-06-085337-9
• A Life That Matters: The Legacy of Terri Schiavo — A Lesson For Us All by Mary and Robert Schindler (2005) ISBN 0-446-57987-4
• Remembering Terri Schiavo: Reflections of a Health Care Warrior by Audrey Ignatoff (2005) ISBN 1-4116-3220-6
• Terri: The Truth by Michael Schiavo, Michael Hirsh (2006) ISBN 0-525-94946-1
• "Terri Schiavo: When Does Personhood End?" in The Elements of Bioethics, Gregory Pence, ISBN 978-0-07-313277-8
• The Case of Terri Schiavo: Ethics at the End of Life edited by Arthur L. Caplan, James J. McCartney, and Dominic A. Sisti, ISBN 159102398X
• Fighting for Dear Life: The Untold Story of Terri Schiavo and What It Means for All of Us by David C.Gibbs, III (2006) ISBN 076420243X

External links

Florida portal

Compilations

These are compilations of legal documents relating to the Schiavo case:

• Findlaw's compilation
• Tampa Bay Online's compilation^{[dead link]}
• The University of Miami Ethics Programs' compilation

Information sites

• Conigliaro, Matt, Esq., Editor of "Abstract Appeal" Legal Blog. (2005). The Terri Schiavo Information Page Retrieved August 31, 2005
• Hospice Patients Alliance Retrieved August 30, 2005. Includes the initial 1999 Police Report

Persondata
Name	Schiavo, Terri
Alternative names
Short description
Date of birth	1963-12-03
Place of birth	Lower Moreland Township, Montgomery County, Pennsylvania
Date of death	2005-03-31
Place of death	Pinellas Park, Florida