Level_Head

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Death and the Legal Process: Terri Schiavo
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level_head
I, too, have been looking into this.

I have now read several hundred pages of court transcripts, read a variety of moving papers from Governor Bush's legal citation of precedent in "Alice in Wonderland" (amusing) to the Guardian Ad Litem Dr. Wolfson's statement that she should not be helped because people would still argue about what her improved condition meant.

Medical reports, affidavits, videos, some news coverage -- I've looked at a bunch. 

This timeline with links is very helpful.

UPDATE: Apprently, it has not been made clear: The Court has ordered her to die -- she is NOT to be fed, even by hand -- she is NOT to be kept alive even if she can swallow food and water on her own. (She evidently can.) The parents are ordered to let her die, and not help.

ADDITIONAL RESOURCES:

Another useful set of links.
Count transcripts.
My conversation with Zaimoni on the topic.

The conversation with Zaimoni has many additional references that he has compiled.

The understanding I have reached is rather different from some of my friends:

Physical condition:
1.  Terri Schiavo is not "brain dead".  She has greatly impaired muscle control, vision, and somewhat impaired hearing.
2.  She is able to vocalize, with difficulty, and is limited to a few words or sounds.
3.  She can and does laugh, cry, smiles at interaction with those close to her, and is (distantly) aware of her surroundings.
4.  Her brain is not "gone" -- and while the tissue is damaged particularly in some brain regions, it is still present.
5.  Medical testimony in the case indicated that someone with the level of damage shown on the scans would be expected to retain some awareness, and that she does retain that awareness.
6.  Terri Schiavo's movements are voluntary, though she does have occasional spasms.
7.  She is, essentially, severely retarded (at least in ability to express herself).
8.  She is not on life support.  She can swallow her own foods and water, with difficulty.
9.  She is not in a coma, though she was briefly in 1990 after the attack.

Cause:
1.  She has been described as having suffered a heart attack. 
2.  When admitted, she had unexplained bruises on her neck, and unexplained lack of oxygen.
3.  Michael Schiavo said she "fell", and that's how she got the bruises.  He "doesn't know" how she was deprived of oxygen.
4.  She seems to have had a shortage of potassium -- but there is conflicting information on this.
5.  The Guardian Ad Litem suggests that this might be from drinking too much iced tea. 
6.  (She drank about half the iced tea that I have done daily for eight years.)
7.  Because the hospital was told that she had lost a lot of weight (she had, over years had gone from 250 to 110) they suggested bulimia as a cause.
8.  There is apparently no other evidence for bulimia, and no reports of bulimic behavior.

Money:
1. She has not been a ward of the state in the medical sense.
2. Michael Schiavo (her husband) won a malpractice suit and settled another case, (about $1.6m total) and most of this was to be used to help her.
3. Instead, he has used much of it to hire lawyers to kill her.
4. Little of it is left, apparently, though he will not disclose his accounting.

Legal:
1. She's survived having the feeding tube pulled or shut off on multiple previous occasions.
2. The longest of these was a week or so, from October 15 to 21, 2003.
3. The original standard was "she must express a wish to die" and "she must be in a persistent vegetative state".
4. Michael remembered (years after the beginning of this affair) that she expressed this wish.
5. Michael was able to hire "experts" to testify that she was in a persistent vegetative state.
6. Other experts testified that she was, indeed, aware of her surroundings.
7. The current legal standard imposed on her is that physicians must show, by a preponderance of the evidence, that she can be cured.
8. With this new standard, made up for this case, they now can legally kill her.
9. The legal action has successfully blocked all attempts at therapy -- even no-cost therapy.
10.  Michael could easily obtain a divorce, but refuses.
11.  Michael has been offered (apparently) $10 million to let her live, but refuses.

The legal approach has been "therapy would likely help her, but there would still be a lawsuit so we cannot recommend the therapy."

Overall, the behavior and actions of husband Michael Schiavo have been utterly reprehensible.  If he catches someone doing something nice for Terri, he fires them.  He wants her to die, has said so frequently (including to Terri herself), and she is distraught after his visits.  When she develops an infection, he demands that she be given no antibiotic, hoping she'll die from it.  Nurses have helped her anyway, and several have paid for this with their jobs.

This is not "the experts all agree" -- this is Michael's experts against everyone not paid by Michael or the State.  And many paid by the State are on Terri's side.

Terri Schiavo is severely impaired, not brain-dead.  She is aware and interactive, not vegetative.  I don't like killing her because she is impaired, just because she is inconvenient (or threatening) to her husband.  I think that it is likely that if Terri Schiavo improves her ability to speak, Michael will spend the rest of his life in jail.

I hope it works out this way.

===|==============/ Level Head

If the feeding tube is removed, big deal. If her condition is as you describe it (which doesn't match what I've heard docs describe) then her parents can spoon feed her for the rest of her life. If she can eat, then this whole thing is much ado about nothing. If she can't eat then the tube is a form of artificial life support that she cannot survive without - it's quite different from giving her Gerbers and her swallowing it. If she can swallow, then there's nothing to stop mom and dad from feeding her.

It's a very sad case on all sides. I'm glad I'm not in the middle of it and I wish my representatives would keep their noses out of it as well. I feel for the parents, the husband and Terry herself. There but for the grace of God go I...

Your assessment agrees with mine, although I do not agree with the passing of laws which will not prevent ANYONE from being able to make that decision for themselves in Florida. My own wishes have been made plain; I would not want to wish as she does.

However, it's too late for that now. She can't tell anyone what she wanted and I don't think her husband should be allowed to kill her because she's inconvenient. I questioned the "persistent vegitative state" diagnosis when I saw video of her making hand and eye movements. She was clearly tracking something in the room. As I used to be a CNA and used to have care of the coma/PVS ward, I know that they are not capable of doing that. They rarely move; the eyes are in a fixed state and the muscles spasm rather than moving on their own.

Being able to do this also sets a terrible prescedent. I don't see much difference, even if she were PVS, between that and a coma. What's next, killing coma patients?

Is there one too many "nots" in your first sentence?

I have no problem with removing artificial life support from a brain-dead person. That, though, does not describe Ms. Schiavo's situation at all.

===|==============/ Level Head

thanks for the posting, and for the link.
if you have a set of online links you found particularly helpful in your studies would you post them?
tia.


Check the top of the post; I've added several.

===|==============/ Level Head

The biggest problem I have had with this case and still have with this case, is that her husband claims that "this is what Terri wanted." Well, if that is true, then he had an ethical responsibility to carry out those wishes from the beginning. He never should have placed her on that feeding tube. Period.

His actions have caused many people, myself included, to question his motives and credibility. At a minimum, if these were Terri's wishes and he refused to uphold them for some 8 years after the accident, then he should be charged with abuse and neglect.

He never should have placed her on that feeding tube.

I can see why he would have - after all, at the time he did it, the extent of the damage was still being determined. There is value in keeping a patient alive long enough to determine whether recovery is possible, had he not done that, I might give some creedence to LH's accusations.

Just found an autoauthoritative search engine for cross-checking licensed-to-practice in Florida. Note that it can fetch inactive registrations.

I'm going to leave the links to the affadavits this failed up — with annotation.

1. Terri Schiavo is not "brain dead". She has greatly impaired muscle control, vision, and somewhat impaired hearing.

She also has no cerebral cortex. While technically this doesn't make her brain dead - I think the legal/medical definition of "brain dead" is when the brain stem is gone, and Terri Schiavo's is intact - the cerebral cortex is the part of the brain largely responsible for higher brain functions, including sensation, voluntary muscle movement, thought, reasoning, and memory. In short, everything that made Terri Schiavo herself is gone, along with the ability to process what she feels or control her muscle movements. Some reflexes remain.

2. She is able to vocalize, with difficulty, and is limited to a few words or sounds.

Sounds, not words. I'm not surprised that her vocal cords can still operate, but she has no ability to speak. (I am told that her parents have interpreted non-verbal grunts as "words".)

3. She can and does laugh, cry, smiles at interaction with those close to her, and is (distantly) aware of her surroundings.

She cannot interact with her surroundings. She has no voluntary control over her muscles and there is nothing in her skull that would let her be aware of her surroundings or interact with anyone. This lie has been disseminated using an extremely edited videoclip of well over four hours of filming.

4. Her brain is not "gone" -- and while the tissue is damaged particularly in some brain regions, it is still present.

I don't know where you got this from. Parts of her brain are still there. The cerebral cortex is gone.

5. Medical testimony in the case indicated that someone with the level of damage shown on the scans would be expected to retain some awareness, and that she does retain that awareness.

Nope. Medical testimony in the case shows that the level of damage to her cerebral cortex (entirely, or almost entirely, necrotized: turned to liquid in her skull) means she has no awareness. Literally, physically, her awareness is gone.

6. Terri Schiavo's movements are voluntary, though she does have occasional spasms.

Her cerebral cortex is gone. This is the part of the brain that provides voluntary control over muscles. She has no ability to make voluntary movements, and no ability to think about making them, either.

7. She is, essentially, severely retarded (at least in ability to express herself).

This is true, in a severely understated sense. Kind of like saying that Stephen Hawking has a severe limp, or that Helen Keller had trouble seeing.

8. She is not on life support. She can swallow her own foods and water, with difficulty.

She cannot swallow. She has no swallow reflex. She was tested for a swallow reflex three times, and failed the test each time.

9. She is not in a coma, though she was briefly in 1990 after the attack.

Again, this is kind of true: "coma" implies the brain is still there and the patient might someday recover. Terri Schiavo's cerebral cortex is gone. Adult brain tissue does not regenerate. Terri is not in a coma, though that's a convenient way of expressing it: but she is gone. She is, as in the classic definition of coma, "incapable of sensing or responding to external stimuli and internal needs".

You'll find several useful links to informative posts about Terri Schiavo on my journal.

"She has no cerebral cortex."

Most of your conclusions are based on this assertino by Schiavo's attorneys. The doctors on the other side say this is false.

Terri, herself, demonstrates that it is false.

She was tested for a swallow reflex, and the test determined that it was too dangerous -- a decade ago. The Court has ordered that she not be tested again. Nevertheless, many nurses have fed her puddings and Jello without difficulty.

You have only to read the documents on the case to change your assertions utterly.

===|==============/ Level Head

The phrase "cruel and unusual punishment" comes to mind.

Thank you for illucidating this case. Prior to your explaination I could not see any reason for the governor or congress to be interfering in what seemed to be a legal guardianship matter.


You are welcome. The assertions that "everybody agrees she's brain dead" or "everybody agrees her cortex is completely gone" are just false. And they are still being made, elsewhere in this same entry, despite the evidence.

===|==============/ Level Head

Thanks for the elucidation on this. I've seen enough being said in the blogosphere and in other media that it's good to see some straight 'nuts 'n' bolts" coverage. What you've reported does concur with the impressions I'd gathered from the various conflicting reports. I'd really like to see a fully</i> indpendent evaluation of her condition made.

This article refers to Terri's injuries before her "heart attack".

http://www.villagevoice.com/news/0347,hentoff,48738,6.html

===|==============/ Level Head

The facts notwithstanding, I expect she will die in a few days.

I had become aware of this case in my legal reading a couple of years ago, and read up a bit then.

Thus, I was surprised at seeing the "facts" being promulgated, such as those here: that she is "brain dead" and "all doctors agree she has no cortex".

People can reach different opinions from the same facts. My interest here was to correct some falsehoods, provide access to facts, and thus allow decisions to be reached based on real information.

===|==============/ Level Head

(Nuts, my responce didn't post!)

Try again.

Thanks for evaluationg the situation, Level Head, I know I can trust you to evaluate the situation fairly and objectively.

I've been avoiding too much exposure to the case, as I tend to think it should be a private matter. Learning about it makes me feel rather uncomfortable.

I'm very glad I don't have to make any decisions about it.
However, I rather wish that the decisions weren't being made by lawyers and legislators either.

Re: A very sad situation

level_head

2005-03-23 06:04 pm (UTC)

In another large case that I am ... familiar with ... a judge misread a case, and made a rather large mistake. He misread "starting the statute of limitations on breach of contract" as "starting the statute of limitations on fraud". This is significant, as it changed the timeframe of the lawsuit from four years to three, and the suit had been filed three and a half years after the events.

The judge made a mistake. He was just wrong. But having done this, he made a series of four other major rulings in the case to back up his original mistake, rather than admit it. This was very costly.

My reading of the records here shows the same pattern. A number of rulings are being made to support an original error, which will not be admitted. Jeb Bush's citing of the sentence-before-trial in "Alice in Wonderland" was funny -- but it was to the point.

===|=================/ Level Head

I have never seen people fight so hard in order to insure the death of the disabled. I hope they are proud of themselves.

I have never seen people lie so extensively and so cruelly to parents of someone in PVS, who has no hope of recovery. Unfortunately, I suspect they are proud of themselves.

On the news tonight, even the commentator noted that suffering animals are even treated more humane, and that unless she is suffering or a criminal, it is worse than the state even condemns people on death row, to kill someone by starvation.

Here is the relevant AMA ethical note about removal of feeding tube. A lot of hysteria has been whipped up about this without any actual experience of the situation.

(Even Terri Schiavo's parents don't claim that she's experiencing any distress.)

Whoa? What happened to the response?

Short story -- this article has been debunked thoroughly above.

===|==============/ Level Head

I've been thinking about this, topic, or thinking around it, and not really sure what I want to say about it. About living wills, for that matter.

If I were in a persistent vegetative state, I wouldn't want to be kept alive. And I wouldn't want to be killed, either. That's how I feel about it: I wouldn't care. This isn't like being, say, disabled and in great pain, or even like the protagonist of "Johnny Got His Gun", where the victim is unable to do anything but still capable of normal thought (which would be, in my opinion, much more harrowing than PVS.) In PVS, the subject isn't thinking or feeling anything. I literatlly don't care what's done with my body in this state. If it were worth my parents' or my husband's or my friends' time and energy and money to them to keep me alive, that'd be fine with me. If it weren't, I'd have no interest in making my unfeeling self a burden to them.

I don't know how close or far from a persistent vegetative state Mrs. Schiavo is. It seems likely that she's fairly close to one. Even if she does have occassional flashes of consciousness, she's still very unresponsive and has suffered from massive brain damage (even if not complete destruction of the cerebral cortex).

But I guess the thing that bugs me is how intent Mr. Schiavo is on seeing her dead. If she really is in a PSV, what she wants can't possibly matter, because she's not capable of wanting ANYTHING. So why not let her parents take care of her, if that's what THEY want? Why care so much about seeing her, not merely out of his life or out of his care, but dead? So what if they're wrong, and the doctors and caregivers who've supported them ar wrong? So what if they're deluded? It's their delusion, their money, their time. Why is it important that they not spend it?

Why do so many other people think that it's important that they not spend it?

Part of me feels like what's being done to Mrs. Schiavo isn't nearly as bad as what's being done to her parents.

I have to agree with you: the tragedy happening to the Schindlers is much worse than what is happening to Ms Schiavo. You probably know my considered theological opinion that Ms Schiavo is already in the afterlife. So I'm not worked up about justice for Ms Schiavo. [Mr. Schiavo...worst-case is pretty bad, best-case is yet another awful tragedy.]

My current attitude on what would I want my relatives to do, on cruise-control, if I went into PVS is: do the doctors know what the etiology is? If not, do keep me on life support. (This is a diagnosis of elimination, they just might not have done enough work eliminating it.) If the doctors do know the etiology, it then becomes a calculated risk. My immediate parents are vehemently pro-life, and know that I have a fairly high pain-of-existence tolerance. I can trust them to go for the almost-no-chance, but cut their losses at no chance whatsoever.

Thanks for putting so much together in one place.

I hope you don't mind but I passed this link along to Brad's board for anyone there who might want to read it.

Have the best

You're welcome -- and no problem.

===|==============/ Level Head

Interesting food for thought. I still think that the defining interest for most of the politicians who have gotten involved has been what they thought they could get out of taking a stance, rather than being motivated out of genuine concern for Terri Schaivo's welfare.

But all of that has been very recent; I've been tracking on this one for a couple of years, and it's been going on long before that. I am suspicious of the media's involvement here, but that's a different issue.

Also, I note that political cartoons consistently say "Republicans" on this, but that the supporters seem to be a majority of both parties, even some rather radical liberals.

I do not think she was living a "quality life"; she is dimly aware of her surroundings at best and her brain is significantly damaged. But that "quality of life" argument could be made for many others as well, and don't believe that it's the government's role to decide to kill them for this.

===|==============/ Level Head

I hope you're planning to update this - or at least publicly acknowledge that the autopsy has rather conclusively proved you wrong.

1. Terri Schiavo is not "brain dead". She has greatly impaired muscle control, vision, and somewhat impaired hearing. - Brain rotted to 50% of normal adult weight: cerebral cortex gone so completely that she was both blind and deaf.
2. She is able to vocalize, with difficulty, and is limited to a few words or sounds. - Cerebral cortex gone so completely that whatever noises she made were random.
3. She can and does laugh, cry, smiles at interaction with those close to her, and is (distantly) aware of her surroundings. - Cerebral cortex gone so completely that she had no awareness of her surroundings, even conceding the idea that there was still an "I" there to be aware.
4. Her brain is not "gone" -- and while the tissue is damaged particularly in some brain regions, it is still present. 50% of her brain lost: the remainder severely damaged.
5. Medical testimony in the case indicated that someone with the level of damage shown on the scans would be expected to retain some awareness, and that she does retain that awareness. Some medical testimony, mostly from doctors who hadn't examined her: all but two of the doctors who had examined her agreed with the final and conclusive testimony of the autopsy report.
6. Terri Schiavo's movements are voluntary, though she does have occasional spasms. Cerebral cortex gone so completely that she could have had no voluntary movements.
7. She is, essentially, severely retarded (at least in ability to express herself). Essentially, this isn't wrong - at least if you accept "Mount Everest is a rather big hill" as a factually accurate statement.
8. She is not on life support. She can swallow her own foods and water, with difficulty. Autopsy shows that the area of her brain that controlled her swallow reflex was gone: any attempt to feed her solid food or water without a feeding tube could (and perhaps did) give her pneumonia.
9. She is not in a coma, though she was briefly in 1990 after the attack. Autopsy shows that she was - as all but two of the doctors who examined her agreed - certainly in a PVS, which is rather different from a coma, agreed.

You are taking a peculiar approach.

You are suggesting that the autopsy, which is widely reported as "proving" that she was "blind", overrides the obvious fact that she could see as demonstrated by hours of videotape.

The autopsy cannot "prove" or show conclusively the things you attribute to it. Science doesn't work that way.

The autopsy can offer evidence in support of one hypothesis or another. It is inappropriate to indicate that the autopsy proves that she could not do something she obviously did.

===|==============/ Level Head

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