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. The case ignited a national debate about medical ethics, end-of-life care, and the role of government in personal healthcare decisions. This article delves into the details of Terri Schiavo's life, her medical condition, the legal battles surrounding her care, and the broader implications of this landmark case.
Terri Schiavo's Early Life and Marriage
Terri Schiavo was born Theresa Marie Schindler on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania. She was the oldest of three children born to Mary and Robert Schindler. As a child, Terri enjoyed arranging her collection of stuffed animals and, 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. Following her parents, they moved to Florida in 1986. Terri worked at an insurance company during the day, and Michael managed a restaurant at night.
The Cardiac Arrest and Diagnosis
In the early morning of February 25, 1990, at age 26, Terri Schiavo collapsed in a hallway of her St. Petersburg, Florida apartment. Her husband, Michael, called 9-1-1, and firefighters and paramedics arrived to find her face-down and unconscious. She was not breathing and had no pulse. They resuscitated her, and she was transported to Humana Northside Hospital.
The cause of Schiavo's collapse was determined to be cardiac arrest, resulting in severe brain damage due to oxygen deprivation. After two and a half months without improvement, her diagnosis was changed to that of a persistent vegetative state (PVS). For the next two years, doctors attempted occupational therapy, speech therapy, physical therapy, and other experimental therapy, hoping to return her to a state of awareness, without success.
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Weight Loss and Potential Eating Disorder
Terri Schiavo had struggled with her weight since childhood. By the time she was 18, she weighed 250 pounds. In the years leading up to her collapse, she had lost a significant amount of weight. According to court papers, the couple wanted to have a baby, but even after consulting fertility doctors, failed to conceive. By that time, Terri had shed nearly 100 pounds.
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 is 3.5-5.0 mEq/L). Her sodium and calcium levels were normal.
Some doctors theorized that her heart had stopped due to bulimia. Her husband even won a malpractice lawsuit on that premise, persuading a jury to award $1 million in damages on the grounds that Schiavo's obstetrician had failed to diagnose bulimia.
However, the autopsy report stopped short of that conclusion. While Schiavo had a low potassium level after her collapse, a symptom of an eating disorder, there was no evidence of her taking diet pills or laxatives or binging and purging. The medical examiner suggested that Schiavo's habit of drinking excessive amounts of caffeinated tea might have even caused the deficiency.
The Legal Battle Begins
In June 1990, the court appointed Michael Schiavo as Terri Schiavo's legal guardian; this appointment was not disputed by the Schindlers at the time. 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.
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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. 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.
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). 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.
The Court's Decision and Appeals
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 March 2000, the Schindlers filed a motion to permit assisted feeding of Terri, which is not considered a life-prolonging procedure under Florida law. In 2000, the Schindlers again challenged Michael Schiavo's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri Schiavo to a 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 Schiavo was in a relationship with Jodi Centonze, and had fathered their first child. He 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.
In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri Schiavo's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of the Florida Rules of Civil Procedure. 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.
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On April 24, 2001, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael Schiavo alleging perjury, which was assigned to another court. The judge, Frank Quesada, issued an injunction against the removal of feeding tube until this was settled. The feeding tube was reinserted on April 26, 2001. On appeal by Michael Schiavo, the Second District Court of Appeal reversed Judge Quesada's order. In the same time frame, Michael Schiavo 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.
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 Schiavo herself would be able to decide to continue life-prolonging measures. The court also heard motions from the Schindlers to remove the guardian (Michael Schiavo) 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, 2001, 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 Schiavo'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 Schiavo could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri Schiavo's condition. These decisions, all published in a single order by the Florida Second District Court of Appeal, 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 Schiavo 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 doctors examined Terri Schiavo's medical records, brain scans, the videos, and Terri herself. Cranford, Greer, and Bambakidis testified that Terri Schiavo was in a persistent vegetative state (PVS). 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 Schiavo were taped and filed at the Pinellas County courthouse. The tape included Terri Schiavo 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". 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. 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 …
Political Intervention and "Terri's Law"
Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube in order 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. In particular, nurse Carla Sauer Iyer 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. On September 17, 2003, 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 Iyer's statements, Greer wrote that they were "incredible to say the least" and that "Ms. Iyer details what amounts to a 15-month cover-up from 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.
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 passed "Terri's Law" in an emergency session giving Governor Jeb Bush the authority to intervene in the case. Governor Bush immediately ordered the feeding tube be reinserted. Governor Bush sent the Florida Department of Law Enforcement (FDLE) to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted. She was then returned to the hospice.
Part of the legislation required the appointment of a guardian ad litem (GAL), Jay Wolfson, to "deduce and represent the best wishes and best interests" of Schiavo, and report them to Governor Bush. 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.
Final Appeals and Removal of the Feeding Tube
On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations. The Schindlers wanted Schiavo to be tested with an fMRI and given a swallowing therapy called VitalStim. On February 28, 2005, 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. 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 bo…
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. Congress, and President George W.
Terri Schiavo's feeding tube was removed, for the third time, during Easter week of 2005, in the midst of additional international drama over the death of Pope John Paul II. The Pope, some months earlier, had issued a non-encyclical statement admonishing against the removal of artificial nutrition. On the day that Ms Schiavo's feeding tube was removed, his was inserted.
Terri Schiavo's Death and Autopsy
Terri Schiavo died on March 31, 2005, in a Florida hospice, almost two weeks after her feeding tube was removed. She was 41 years old.
An exhaustive autopsy found that Terri Schiavo's brain had withered to half the normal size since her collapse in 1990 and that no treatment could have remotely improved her condition, medical examiners said Wednesday. The autopsy results, released almost three months after Schiavo died after the court-ordered removal of her feeding tube, effectively quashed allegations by her parents that she had been abused or even strangled.
The report generally supported the contention of Schiavo's husband, Michael, accepted by judges in six courts over the years, that she was unaware and incapable of recovering. And it countered arguments by her family, who badly wanted to win custody of Schiavo, that she was responsive and could improve with therapy.
The autopsy also found that the brain deterioration had left her blind. That finding, along with the determination that the brain damage was irreversible, caused some Republicans in Washington, who had pushed so hard for federal intervention in her case, to have second thoughts. And Democrats cited the autopsy results as proof that critics of federal intervention had been vindicated.
The medical examiner said the condition of Schiavo's body was ''consistent'' with earlier medical findings that she was in a persistent vegetative state. Her parents, who believed she might some day eat and drink on her own or even speak, had rejected that diagnosis. But the courts accepted testimony from Schiavo's husband, Michael, that she would not want to stay alive in her condition.
The autopsy ruled out heart attack or physical abuse causing Schiavo's collapse. The medical examiner said drug overdose was unlikely, though the toxicology tests performed immediately afterward would not have detected an overdose of diet pills or caffeine.
The Broader Implications and Lessons Learned
The Terri Schiavo case raised fundamental questions about the rights of incapacitated people, end-of-life decision-making, and the role of the legal and political systems in personal medical choices.
The case highlighted the importance of advance directives, such as living wills and healthcare surrogates, in ensuring that an individual's wishes are respected if they become unable to make decisions for themselves. Terri Schiavo did not have a formal, written, executed advance directive. She did not have a healthcare surrogate authorizing anybody to make decisions in her stead; and she did not have a living will articulating in writing her intentions regarding heroic measures, clinical interventions, or her wish with respect to being kept alive by artificial means if she were in a diagnosed persistent vegetative state.
The Schiavo case also underscored the challenges of determining a patient's wishes when there is conflicting evidence and disagreement among family members. In the absence of clear written instructions, courts must rely on testimony and other evidence to determine what the patient would have wanted.
The intervention of politicians in the Schiavo case raised concerns about the separation of powers and the potential for political considerations to influence medical decisions.
The case also sparked a broader debate about the ethical implications of providing or withholding artificial nutrition and hydration to patients in a persistent vegetative state.
The Dialogue About Eating Disorders
In the days since Terri Schiavo’s death, a dialogue has begun. It started small. A posting on an Internet bulletin board here, a Google for pertinent information there. Sometimes, even a consultation with a physician. But this dialogue hasn’t been about right to life. It hasn’t been about compassionate killing. It hasn’t been about whether Terri Schiavo’s husband or her family really knew what her living will wishes were before she suffered catastrophic brain damage from a heart attack that left her dependent on a feeding tube for 15 years. Instead, this dialogue has been about what hasn’t been a dialogue: eating disorders.
Even though some physicians say a side effect of bulimia is why Schiavo had the heart attack, why the oxygen supply was cut off from her brain, why she suffered horrible brain damage and why she had to have that feeding tube simply to live, few are talking about it.
While Schiavo’s family members told CNN earlier this year that they didn’t think Schiavo had a “real” eating disorder, the evolution of Schiavo’s body shape is startling. In her high school senior yearbook picture and at a weight of about 250 pounds, Schiavo is nothing short of voluptuous. In another picture, a few years later, she’s markedly thinner, smiling for the camera in front of a bedecked Christmas tree. In one of the final pictures of Schiavo before her heart attack, Schiavo looks like a different person. She’s a fraction of her high school size and tipping the scales at a mere 110 pounds. The straps of her tank top rest atop her now prominent clavicle bones. Weighing less than 120 pounds, Schiavo was deficient in more than body fat. She was deficient, dangerously so, in potassium. This is where the debate over whether Schiavo suffered from bulimia may have its footing.
Most compelling are the electrolyte imbalances, like Schiavo’s potassium imbalance, that can lead to heart failure, coma, or even death. In an online discussion last March, Dr. Jay Wolfson, professor of public health and medicine at the University of South Florida and legal guardian for Terri Schiavo in 2003, said Schiavo had been drinking between 15 and 20 glasses of iced tea a day, and may have been purging, as well. Her electrolyte imbalance was so profound, he said, it caused her heart attack.