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Rev. Robert Johansen

Killing Terri Schiavo

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A hospice in Pinellas County, Florida, has become the front line of the battle to defend the dignity of human life. Inside the hospice is Terri Schindler Schiavo, whose collapse in 1990 and subsequent brain injury has left her severely disabled. A feeding tube provides her nutrition and hydration. Otherwise, she is in fairly good health, with no other serious diseases or disorders. Her husband, Michael Schiavo, has sought since 1998 to have her feeding tube removed in order to cause her death by starvation and dehydration. He contends that Terri expressed the wish that she would not want to be kept alive in her condition.

But Terri's parents, Bob and Mary Schindler, say that isn't true. And they have been engaged in a decade-long legal battle to keep Terri alive.

On October 15, 2003, it seemed as though the Schindlers had lost the fight. After numerous hearings and appeals, Florida Circuit Court Judge George Greer ordered Terri's feeding tube removed, and Terri began to die. Her impending death mobilized the pro-life community to a degree that has rarely been seen. A crowd of people gathered outside the hospice where Terri lay, praying, singing hymns, and carrying picket signs. And many more people lobbied their state legislators and Florida Governor Jeb Bush to take action to save her life.

Governor Bush expressed his support for Terri's right to live but had no power under Florida law to intervene. However, on October 21, six days after the feeding tube was removed, the legislature enacted "Terri's Law," giving the governor the legal authority to issue in cases like Terri's a onetime stay of an order to withdraw nutrition and hydration. Governor Bush signed the bill into law and issued a stay the same day.

Terri's feeding tube was restored, and she is, for the moment, alive and safe. But her husband and his attorney, George Felos, have vowed that they will not give up. Felos has filed suit to have "Terri's Law" overturned as unconstitutional. The question of the law's constitutionality has only begun to be adjudicated and is unlikely to be resolved in the near future.

Terri's plight has evoked heated debate over fundamental moral, medical, and legal issues. Those in favor of removing Terri's feeding tube have tried to frame the debate as a "right-to-die" case. Those fighting to save her argue that removing her feeding tube is tantamount to murder. But before one can weigh the moral and legal concerns, it is first necessary to understand Terri's true condition, and the sad situation that brought things to where they are today.

Questionable Medical Evidence

Doctors testifying on behalf of Michael Schiavo say that Terri is in a persistent vegetative state (PVS), with no hope of recovery. A patient in a PVS is unaware of himself or his environment and does not respond to the world around him. He continues breathing on his own, maintains a stable heart rate, and may even have eye movements that mimic normal sleep. However, he has, for all intents and purposes, no higher brain functions that we would associate with "consciousness." Judge Greer's order to remove Terri's feeding tube was based largely on his finding that no course of treatment could improve her "quality of life" and that she had no function in her cerebral cortex.

The ruling and judgment are sweeping, including such statements that there was "no such testimony" to establish any hope of recovery and that "the credible evidence overwhelmingly supports the view that Terry Schiavo remains in a persistent vegetative state." Given such confident pronouncements, one might expect to find the evidence behind them all but impervious to refutation.

But that isn't the case. What you find when you examine the medical data and listen to the experiences of those who have spent the most time with Terri over the last decade is that a great deal of evidence belies the contention that Terri is in a PVS. Terri's parents, brother, sister, and numerous other family members and friends who visit her regularly do not believe for a moment that Terri is unaware of her environment or unresponsive. At a press conference organized by the Schindlers on October 24, Terri's mother, father, and eight others all gave accounts of how they see Terri consistently respond to people: She smiles, frowns, or acts sullenly depending on who the person is and what he or she does or says. She reacts quite markedly to music, particularly piano music, which she always especially enjoyed. A certified speech therapist asserted that Terri does attempt to verbalize and has been heard saying "yes," "no," "Mommy," and possibly even "Help me."

Even more powerful is the testimony of the numerous doctors who emphatically deny that Terri is in a PVS. The most convincing medical testimony comes from Dr. William Hammesfahr, a neurologist specializing in the treatment of brain injuries, who has spent approximately twelve hours examining Terri. At the October 24 press conference, Hammesfahr explained that Terri is able to respond to commands: She can raise and lower her limbs, although her range of motion is limited by severe muscular contractures from a lack of physical therapy for more than a decade. Doctors testifying for Michael Schiavo have dismissed such responses as reflexes. But what is most telling is Hammesfahr's description of Terri's response to a standard strength test: In this test he asked Terri to lift up her leg while he pressed down on it with his hand. He instructed her to keep lifting it in spite of his pressure. Hammesfahr explained how he could feel Terri pressing up against his hand with the same degree of force with which he was pressing down, so as to keep her leg in the same relative position. Such a response, Hammesfahr explained, is simply not reducible to a "reflex."

Hammesfahr has even observed her move her head and limbs into positions that clearly cause her discomfort and maintain them in order to carry out instructions he gave her. Such behavior, Hammesfahr said, cannot be reflexive: "Reflexes are designed to avoid injury. They are there to prevent pain." One has to overcome reflexes in order to perform a task in spite of discomfort or pain.

Many have seen the now-famous videotape that the Schindlers distributed to the press in their effort to show the world that Terri is not a vegetable. In this video, Terri gives every appearance of looking directly at those speaking to her, reacting to her mother's embrace, and following (with her eyes) a balloon around the room. While many who saw the video found it compelling evidence that Terri is in fact conscious, Judge Greer did not.

Although he had to be asked twice to look at his monitor and to put his glasses back on so he could see it clearly, he did not find the video evidence sufficiently "consistent and reproducible." He opined that "cognitive function would manifest itself in a constant response to stimuli." Pat Anderson, the Schindlers' attorney, explained in a World Net Daily article that Judge Greer, in evaluating the video, used a "scorecard" approach that "stacked the deck no matter how Terri responded. If she always responded--it was just primitive brain-stem activity. If she randomly responded--it was not repetitive enough." Interestingly, Judge Greer and Felos have sought to suppress the video, and Judge Greer ordered the Schindlers not to photograph or videotape Terri in the future, under threat of legal sanction.

Where Judge Greer derived the medical theory that "cognitive function would manifest itself in a constant response to stimuli" is hard to discern. It was not a matter of evidence introduced in the medical testimony in either the 1998 or 2000 legal proceedings. Furthermore, it's a matter of common sense that people don't respond to the same stimulus in exactly the same way every time with 100 percent predictability or repeatability. Indeed, if Terri did respond in such a rote manner, it's likely that such a response would have been dismissed as "reflexive." But the evidence of the videos and the testimony of the numerous family members and doctors overwhelmingly show that Terri does respond "consistently" to numerous stimuli. According to Hammesfahr, any of these responses, let alone all of them, should rule out a finding of PVS. "By definition," he said, "if there is any response to the outside world, the patient isn't in a PVS."

The Euthanasia Connection

But Judge Greer accepted the medical testimony presented by Michael Schiavo that Terri is in a PVS and will not recover. That conclusion becomes even more dubious when you examine Felos's well-known ties to the euthanasia movement and the background and testimony of Michael Schiavo's principal medical witness, Dr. Ronald Cranford.

Felos has been a member of the infamous Hemlock Society. Amazon.com, on the Web page for Felos's book Litigation as Spiritual Practice, describes him as "spearheading a social revolution to enable death with dignity in the state of Florida." He certainly spearheaded the effort to bring about Estelle Browning's death, spurred on by his belief that he can spiritually commune with those in a PVS. Although she couldn't speak, he claimed that he detected her soul crying out to his soul, asking, "Why am I still here?"

In light of Felos's association with the euthanasia movement, it's hard to imagine that his choice of Cranford is coincidental, as Cranford is perhaps the leading medical exponent of the pro-death movement.

Cranford jokingly refers to himself as "Dr. Death" and, for a fee, will come to a trial and testify that the person whose life the plaintiff wants to end is in a PVS. He was the leading medical voice calling for the deaths of Paul Brophy, Nancy Jobes, Nancy Cruzan, and Christine Busalucci, all of whom were brain-damaged but not dying. Nonetheless, he advocated death for all by dehydration/starvation, just as he has for Terri.

Nancy Cruzan--one of his "patients"--required no skilled nursing, no care but food and fluids, hygiene, and turning to prevent bedsores. She didn't even need tube feeding, but Cranford testified that he would even consider spoon-feeding "medical treatment." Cranford wrote in the summer 1998 issue of Concern for Dying that he foresees "that there may be extreme situations, and in the future increasingly common situations, where physician-assisted suicide may not only be permissible, but encouraged." In a 1997 op-ed for the Minneapolis--St. Paul Star Tribune, Cranford advocated the starvation of Alzheimer's patients.

In contrast to the twelve hours Hammesfahr spent examining Terri, Cranford spent approximately 45 minutes. Rus Cooper-Dowda, who has endured neurologic exams himself, upon seeing the videotape of Cranford's exam described it as "physically brutal." He said that Cranford "clumsily poked, prodded, thumped, shoved, and pinched her." Although Cranford admitted that Terri pulled away from him when he approached her, he did not deem that a voluntary response. When Terri moaned after he "thunked her hard between the eyebrows," Cranford told the court that it wasn't a response to pain.

Cranford prides himself on the fact that he was very influential in the development of the criteria used in diagnosing PVS. But in 1996, Dr. Keith Andrews, the medical director of the Royal Hospital for Neurodisability in London, along with several other staff members, published an article titled "Misdiagnosis of the Vegetative State" in the British Medical Journal. In that article, they revealed that 43 percent of patients sent to that hospital with the diagnosis of PVS--some of whom had been presumed to be in a PVS for more than a year--were not in a vegetative state at all. They found that the misdiagnosed patients had severe communication problems as a result of their disabilities, but with the proper clinical measures, "nearly all were able to communicate...some to a high level." They concluded that:

The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment [emphasis mine].... Recognition of awareness is essential...to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

The growing awareness of the difficulty in diagnosing PVS, and the widespread errors in making the diagnosis, have led many leading hospitals, such as the Northwestern University Rehabilitation Institute, to routinely reassess patients referred to them as PVS.

Cranford has testified that patients in a PVS have "no hope of recovery," but this is simply untrue. A number of people found to be "unrecoverable" have, in fact, recovered. Cranford himself diagnosed Sergeant Richard Mack, a police officer shot in the line of duty, as "definitely...in a persistent vegetative state...never to regain cognitive, sapient functioning." Almost two years later, Mack "woke up." He eventually regained almost all his mental abilities.

Kate Adamson, who appeared on Fox News's O'Reilly Factor on November 6, recounted her own chilling story. She had also been diagnosed as in a PVS, and doctors removed her feeding tube.

I could see and hear everything going on around me, and I had no way...of communicating with anyone.... I was completely paralyzed.... When the feeding tube was turned off for eight days, I was--thought I was--going insane. I was screaming out [in her mind], "Don't you know I need to eat?" ...Michael [Schiavo] on national TV had mentioned last week that it's a pretty painless thing to have the feeding tube removed. It is the exact opposite. It was sheer torture...

Thanks to the persistence of her husband, Adamson's feeding tube was restored, and the doctors reluctantly began to treat her. Her recovery suggests that the untreatability of PVS isn't as absolute as some would like to suppose.

Hammesfahr is one of the doctors challenging medical orthodoxy regarding PVS patients. He has had promising results in treating stroke and other brain-injured patients. The effectiveness of his treatment program has been confirmed by Medicare, which, by law, is not permitted to pay for treatments that are experimental or not demonstrated to be medically effective. In a 2001 decision, after review of more than 700 patients and the medical literature, Medicare ruled that Hammesfahr's therapy is "medically reasonable and necessary."

Hammesfahr believes not only that Terri Schiavo is not in a PVS, but that she is treatable and could recover at least some of her former faculties. He believes, for example, that with proper therapy, Terri could once again swallow normally and take solid food by mouth. He has repeatedly advocated that Terri be given this therapy, but Michael Schiavo, who has complete control over Terri's medical care, has steadfastly refused to allow it. The evidence for his contention, Hammesfahr explained, is that Terri does not drool. "The average human being produces one-and-a-half to two pints of saliva a day. If you can't swallow it, you drool," he said. "Terri can swallow that amount of her own saliva, which means that she can swallow liquids." If Terri can swallow liquids, he reasons, it is quite likely that she can learn to swallow solid food again, which, of course, means she would no longer require tube feeding.

A Husband With an Agenda

The immediate cause of Terri's brain damage was cardiac arrest, which caused her brain to be deprived of oxygen for more than five minutes. In January 1993, Michael Schiavo won a malpractice award of $1.6 million from the hospital that treated Terri. He was also personally awarded $600,000 for loss of consortium. In his testimony, Michael spoke of his love for his wife and his intentions to honor his wedding vows for the rest of his life and to use the award money for Terri's care and rehabilitation. Indeed, Michael repeatedly assured Bob and Mary Schindler that he would seek rehabilitation therapy for Terri once he had obtained a settlement.

A month after Michael received the money, the Schindlers approached their son-in-law to remind him of his promise. This led to a heated argument, with Bob and Michael yelling in the hall outside Terri's room. Michael stormed off and vowed that he was going to see his lawyer and that Bob and Mary would "never see [their] daughter again."

A month after this incident, the Schindlers were informed that Michael had cut off their access to Terri's medical information. As her husband, Michael was granted guardianship over Terri and had the legal authority to issue the order, which remains in place to this day. Terri's doctors and nurses were not to discuss her medical condition with the Schindlers. Bob and Mary later learned that shortly after, Michael gave a "Do Not Resuscitate" order for Terri, even though she was in no danger of death.

The staff of Terri's nursing home was sympathetic to the Schindlers and frequently gave them information in spite of Michael's medical "gag order." Later that year, Bob and Mary learned that Terri had a serious urinary tract infection and that Michael had ordered the nursing home not to give her treatment, which would have consisted of a simple course of antibiotics. They were informed by the nursing home staff (going against the gag order), not Michael, as he himself admitted in this exchange with the attorney for the Schindlers in the 1993 guardianship hearing:

Attorney: When you made the decision that you were not going to treat Terri's infection and you were, in effect, going to allow her to die, did you think that you had any obligation to tell her parents?

Michael: To answer that question, I probably would have let them know sooner or later.

Attorney: You never did let them know, though, did you?

Michael: No.

Left untreated, the infection would eventually have caused sepsis and Terri's death. Fortunately the nursing home eventually gave Terri the antibiotics anyway, and she recovered.

At this point, Bob and Mary made their first attempt to have Michael removed as guardian. In his deposition for this proceeding, Michael admitted that he had ordered the nursing home to deny Terri treatment for the infection and that he knew the infection, left untreated, would have caused Terri's death. When asked in the deposition if he would do it again, he said he couldn't "because evidently there's a law out there that says I can't do it." When asked why he did it, he responded that "[he] was making a decision about what Terri would want." The judge (at this point, it was not Judge Greer) denied the Schindlers' petition to have Michael removed as guardian. In 1996, they tried again but were again refused.

In 1998, Michael petitioned the court to remove Terri's feeding tube. He argued that there was no hope for her recovery and that Terri had expressed the wish to him that she would not want to be kept alive in her condition. This was the first time that Michael had ever claimed such a wish on Terri's part. Terri's parents and several of her close friends--who found his assertion totally out of character with what they knew of Terri--vigorously disputed the claim.

The judge then appointed a guardian ad litem, Richard Pearse, to investigate Michael's fitness as guardian and to make a recommendation about Terri's feeding tube. Pearse interviewed the various parties, including doctors, and issued his report in December 1998 recommending against Michael's fitness as guardian and against removing Terri's feeding tube.

After February 1993, Mr. Schiavo's attitude concerning treatment for the ward apparently changed. [In January 1993 he received the $1.6 million award].... It is apparent to me that he has reached a point that he has no hope of the ward's recovery and wants to get on with his own life. [Michael] admitted to the guardian ad litem that he had at least two romantic involvements after Terri's collapse. [Schiavo was already living with his current girlfriend, with whom he has two children.]

That Michael wanted to "move on" with his life was evident long before Pearse interviewed Michael. In the 1993 guardianship hearing, Michael testified regarding his disposition of some of Terri's property:

Attorney: What did you do with your wife's jewelry?

Michael: My wife's jewelry?

Attorney: Yeah.

Michael: Um, I think I took her engagement ring and her...what do they call it...diamond wedding band and made a ring for myself.

Attorney: What did you do with her cats?

Michael: Her cats were put to sleep on the advice of my mother-in-law.

The veterinarian who euthanized Terri's pets came forward to say there was never any suggestion from Terri's mother that this be done, and that it was done only at Michael Schiavo's insistence.

Pearse also found that Michael's claim that Terri wouldn't want to live in her condition wasn't credible and noted that Michael stood to inherit about $800,000:

[H]is credibility is necessarily adversely affected by the obvious financial benefit to him of being the ward's sole heir at law in the event of her death while still married to him. Her death also permits him to get on with his own life.

In February 1999, Felos filed a "suggestion of bias" against Pearse and demanded he be removed as guardian ad litem. The judge then hearing the case, Bruce Boyer, took no action on Felos's "suggestion of bias" or on Pearse's report. In April of that year, Pearse filed a request that he either be given further instructions or discharged. He reiterated his concerns about Michael's guardianship and also noted that there would be due process difficulties if the case proceeded to trial without Terri having an independent guardian ad litem. Judge Boyer discharged Pearse without appointing a successor.

The case then proceeded to trial before Judge Greer, who also refused to appoint a new guardian ad litem to represent Terri's interests in the case.

The Questionable Judge

But that wasn't the first unusual thing Judge Greer did in the trial. At the time of Pearse's report, the only evidence that Terri had expressed a wish not to go on living was Michael's assertion. Pearse had mentioned that Michael's story would be "more credible if it were corroborated." It's strangely coincidental then that at the last minute before the trial, Felos produced two witnesses who corroborated Michael's claim: his brother and sister-in-law. Felos delayed producing his witness list until two days before the trial, preventing the Schindlers' attorney from deposing them. Nevertheless, Judge Greer permitted their testimony to be entered into evidence, and the Schindlers' attorney, who was not an experienced trial lawyer, didn't contest his decision.

The evidence Michael presented of Terri's putative wish not to be kept alive on a feeding tube was derived from a conversation that he and his brother and sister-in-law supposedly had with Terri while watching a televised movie about a person who was in a coma and on a ventilator. Terri allegedly said, "I wouldn't want to live like that." Anderson argues that even if Terri really had said that, the statement still "wouldn't be relevant to Terri's situation. The context of the conversation was about someone on a ventilator." In many states, Anderson explained, such a com- ment is considered a "sympathetic anecdotal statement regarding the plight of others" and is not admissible. In order to be relevant, the person making such a statement has to "specifically apply the circumstances of the utterance to himself." In other states, like New York, oral statements regarding these matters are simply inadmissible.

But Judge Greer allowed these statements into evidence ignoring the contravening testimony from the Schindlers and others that such statements would be completely out of character for her. Two of Terri's best friends, Jackie Rhoades and Diane Meyer, testified about a conversation they had with Terri about Karen Ann Quinlan, whose parents fought in court to allow her to be removed from a respirator. They eventually won, but Karen went on to live for eight more years, breathing on her own after the respirator was removed. Diane had said, "Who would want to live like that?" Both Jackie and Diane recounted how Terri got very angry, saying, "How do they know what she wants? Why don't they just leave her alone?" They and the Schindlers also testified that Terri regularly visited a nursing home, spending time with people in the last stages of life. Terri never once declared that she "wouldn't want to live like them."

Anderson finds it beyond belief that Terri, a devout Catholic girl who went to Catholic school, attended Mass regularly, and volunteered at a nursing home, would adopt such a sentiment. Given the fact that Terri's supposed wish was brought up years after her injury, that its corroboration is highly questionable, and that there's ample contravening testimony, it's hard to imagine any reasonable, unbiased person being persuaded by it. Yet Judge Greer was, describing Michael's testimony as "clear and convincing"--the highest standard of proof in a civil trial.

On the Front Lines

My own involvement with the fight to save Terri Schiavo's life began a few months ago. After learning of Terri's plight, I became convinced that a terrible injustice was being perpetrated. I began writing about her situation on my weblog, Thrown Back (http://ThrownBack.blogspot.com). This eventually led to me getting to know some of the people involved with Terri's fight, including the Schindlers themselves. After Terri's feeding tube was withdrawn, for several days, Michael Schiavo denied Terri's pastoral care by refusing to let a priest visit her. At that point the Schindlers and the priest who has been closest to them, Monsignor Thaddeus Malanowski, asked me to come to Florida to be of assistance. Fortunately, my bishop, James Murray of Kalamazoo, graciously granted his permission for me to go.

The Schindlers have been portrayed, by Michael Schiavo, his attorneys, and by the unsympathetic media, as everything from religious fanatics to pathetic simpletons. Even some of the local clergy in Tampa have characterized the Schindlers as in denial concerning their daughter's sad state, blinded by their emotional attachment to her. But when I went to St. Petersburg and met the Schindlers, I found nothing of the sort. They are level-headed, reasonable, calm people. Furthermore, they're realistic about Terri's condition: She's severely brain damaged and will almost certainly never enjoy anything close to a full recovery.

But unlike Felos, Cranford, and Judge Greer, they don't see Terri's humanity as reduced or negated by her disability. They realize that the person they know and love as Terri is still there. And they cannot understand why her disability constitutes grounds for ending her life.

Some have urged the Schindlers to "let Terri go." But that comfortable euphemism covers over the reality that they're being asked to acquiesce to their daughter's painful death. And unlike those insulated by ideology or agenda, their love refuses to let that happen.

Rev. Robert Johansen is a priest of the Diocese of Kalamazoo, Michigan. He has written for Adoremus Bulletin and Culture Wars.

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Posted: 22-Mar-05



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