I intend for this to be my last post about the sad affair of Terri Schiavo, and our national obsession with it. Thankfully, the media seems to have dropped the matter, with the exception of a few outlets controlled by the religious right. I think this is a wonderful opportunity for us to put the whole thing to rest, and put it behind us.

I still feel a little bit angry at the American public - including myself - for insinuating ourselves voyeuristically into the private lives and disputes of the Schindler and Schiavo families. I feel especially angry toward those who uncritically accepted and perpetuated the constant, ugly attacks and insinuations against Michael Schiavo. As if he wasn't faced with enough burdens already, between his wife's collapse, her years of constant care for her, a weighty decision to talk to the court about her final wishes and the ensuing bloody, litigious dispute with her parents and brothers, and finally the death of his wife's body. Why would the rest of us pile on someone who already had so many burdens? Where is our compassion? To those of you who may be tempted to answer: "where was Michael's compassion?", I say only that you don't know his heart, and that I hope you will read on and realize that he deserves a big ol' chunk of benefit of the doubt - not the cruel slander of which he has receieved so much to date.

While I'm angry at the American public for holding our debate about feeding tubes in Terri Schiavo's hospice room, and I'm angry at many of us for having such a contemptible attitude toward her husband, I reserve most of my anger for those who manipulated the media to encourage these attitudes, and for the media itsself. In recent years, the media has abdicated its role as an outlet for trustworthy news, choosing simplistic "he-said, she-said" stories that favor whichever group is best able to generate the most public interest (or outrage) about their message instead of producing objective presentations of what happened, even when it requires consumers and reporters to sort through difficult facts in order to properly understand.

To understand where we all went wrong, we have to first admit that we were wrong in the first place. That means taking some serious time and print to talk about some facts and perspectives on the controversies that were aired in this case. Since that's a big job, I'm putting it in the extended entry....

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1.) Is there any reason to suspect that violence on Michael Schiavo's part caused Terri's collapse, or that he abused her before her collapse?

The answer is an emphatic "no". There were plenty of allegations and insinuations to the effect that he did, but never did any of these surface until after the the disagreement between Michael and the parents had arisen. The campaign against Michael lingered longer than the other controversies. After the autopsy, when the "Save Terri" faction ran out of anything else to feed to the media, the Governor of Florida, citing the fact that the autopsy didn't provide evidence to conclusively prove the belief that Terri was a victim of complications from an eating disorder (as was previously thought), along with a very minor discrepancy between Michael Schiavo's remembered timeline of events and the recorded time of his 911 call, to keep the heat on Michael by having his "possible role" in her death re-investigated. Most anyone who is still interested has read media accounts of the Attorney General's inquiry, to the effect that "there is not enough evidence to warrant a criminal investigation". But, the AG's report included quite a bit more than that, most of which never made it into the news (news organizations instead favoring a "balancing" quote from Bobby Schindler, offerring his sly suspicions about why there would be no criminal investigation). Much of what was in the AG's report was already known to people who had delved more deeply than what was presented by the mainstream media and conservative advocacy groups. But for the average newswatcher, there seems to be little awareness of these facts.

I challenge everyone who still maintains a position on this issue to read the Guardian Ad Litem's report (.pdf) in full, but in addition, I ask anyone who gives credence to allegations of violence on Michael Schiavo's part to read the Attorney General's report to Governor Bush. Although the autopsy results and the evidence from x-rays and other diagnostic tools applied shortly after Terri's collapse show no evidence the collapse was brought on by a criminal act, there are many hold-outs who insist that Michael did cause the collapse violently, by some means that would would not leave physical evidence of trauma. The AG's report reminds us just how unbelievable this idea is:

While Dr. Thogmartin's report indicated that non-traumatic asphyxia was not impossible, I do not believe that this can be constructed to mean that it represents a plausible explanation or one that is equally or more likely than the possible non-criminal explanations for Mrs. Schiavo's collapse. Asphyxiation occurs when the brain is deprived of oxygen and can be accomplished by cutting off the air to the lungs or the flow of oxygenated (arterial) blood to the brain. While not impossible, it would be exceedingly difficult to accomplish this without leaving evidence of a struggle in a surviving victim. (*See Footnote 1 below)

Cutting off the air supply through suffocation would have to continue for approximately four to five minutes before brain damage ensues. The victim will remain conscious for a significant portion of this time. Common sense suggests and experience has confirmed that victims struggle violently when unable to breath, flailing out at their attacker and whatever is preventing them from breathing and necessitating in turn that the assailant increase the amount of force against a moving, struggling victim. These factors make it virtually inevitable that observable injury will result. It is also possible to cause rapid unconsciousness with simultaneous bilateral compression of the carotid arteries. Based upon our experience, however, it would be virtually impossible for someone without considerable practice in using the technique to incapacitate a struggling victim, who is later resuscitated and survives, without causing visible injury.

Dr. Thogmartin's report also could not eliminate the possibility of subtle trauma in the form of "commotio cordis", a phenomenon that is most commonly seen in young athletes who are struck in the chest directly over the heart with an object such as a baseball. If the chest is sufficiently flexible and the impact occurs precisely during the 20 millisecond interval of the heart's cycle in which the ventricular muscles are repolarizing, ventricular fibrillation (rapid, unsynchronized contractions) can occur. Resuscitation efforts are rarely successful unless the person is defibrillated within two to three minutes. The timing of the impact as well as the hardness of the object, age of the subject and speed of impact are significant variables; it is unknown how often this type of blow to an unprotected chest can cause fibrillation without leaving any identifiable injury in a surviving adult victim. It seems very unlikely, however, that in the course of a domestic argument where one party is intentionally trying to harm the other, they will direct a single blow to the cardiac silhouette that is of sufficient force to cause ventricular fibrillation but not the intended injury.

Dr. Thogmartin also could not exclude the possibility of toxins or drugs being involved. Terri's described condition and the fact that paramedics were able to resuscitate her despite the twelve minute interval between her collapse and their arrival are not inconsistent with the possibility of an opiate overdose. The police officer who responded to the emergency did find a small number of medications in the residence, but did not feel that the drugs he found were relevant to Terri's collapse and did not record what they were. While there is some indication in the discovery materials from the malpractice suit that a prescription bottle of percocet may have been in the residence, Dr. Thogmartin indicated that the drug screen done at the ER would likely have detected the acetaminophen that is combined with oxycodone in that medication. There is of course no affirmative evidence that Terri ingested toxic amounts of any substance or medication and absolutely no basis to conclude they were forcibly or surreptitiously fed to her.
[...]
Footnote 1:

Decomposition of the body can sometimes hide some of the more subtle signs of assault, including petechial hemorrhages. Also, the bruising process effectively ends when the heart ceases to pump blood. This would not be an issue where the victim is resuscitated and survives.

In short, the theory that Michael smothered her, or otherwise attacked her without leaving physical evidence is very dubious.

Although the autopsy fails to prove it conclusively, the Attorney General's report makes clear that an eating disorder was the most likely cause of Terri's collapse:

The hypothesis that Terri's low potassium level was a factitious result of medication and fluid administered during her resuscitation is not new but first surfaced in the 1992 malpractice trial. The basis of the 1992 malpractice suit against Terri's gynecologist was that she had eating and nutritional disorders which he failed to detect and which allegedly led to her cardiac arrest causing profound and irreversible brain damage. Terri had sought this doctor's help in 1989 because of difficulty in getting pregnant and up until the time of her death was under treatment for amenorrhea (abnormally infrequent menstrual periods), a well documented result of eating disorders in young women. Terri had lost as much as 100 pounds since adolescence and had lost 20 pounds since her marriage. The suit alleged that her doctor failed to take a nutritional history and to diagnose and treat the eating disorders and nutritional deficiencies that were not only the cause of her menstrual problems but had ultimately led to her collapse.

Three physicians testifying on Terri's behalf concluded - based upon the medical records as well as interviews and statements of family members and co-workers - that Terri had an eating disorder or nutritional deficiency which had contributed to her cardiac arrest. The testimony suggested, without contradiction, this was the consensus opinion of all the doctors who had been involved in Terri's treatment.

The plaintiff did not attempt to specify the eating disorder but suggested that there was evidence to support bulimia and psychogenic polydipsia and that a combination of diet, excessive intake of fluids and compensatory purging behavior had caused both her amenorrhea and her extremely low level of potassium and that the latter condition led to her cardiac arrest. The defendant doctor had admitted that Terri's eating disorder was probably a factor in the amenorrhea for which he was treating her. He acknowledged that, while there are a number of other possible causes, eating and nutritional disorders are known to cause this condition. Additionally, the defense called a psychiatrist who specialized in the treatment of eating disorders; he testified that based upon reviewing the statements of family members, the medical records, the depositions of eleven physicians and the statements of four of her co-workers that Terri suffered from bulimia. This expert did not concede that the eating disorder was responsible for her cardiac arrest. He noted, as does Dr. Thogmartin, that the resuscitation efforts and administration of medication and fluids could explain her low serum potassium after the incident and that this reading did not necessarily reflect electrolyte levels at the time of her collapse. He suggested, however, that Terri's condition was sufficiently severe and at an early enough stage in the disease process that she would carefully conceal her behavior, would not have acknowledged the problem and was not yet amenable to treatment.

Dr. Thogmartin understandably concluded that currently available evidence was insufficient to either definitively rule out the existence of an eating or nutritional disorder or to conclude with reasonable certainty that it was the cause of her collapse. However, all experts in the 1992 proceedings - relying on all available contemporary records and witness recollections - opined that Terri suffered from an eating disorder and the jury unanimously agreed.

As I mentioned before, allegations of abuse against Michael began to surface after the disagreement between him and the parents began. The AG's report not only pounds this home, but reminds us that some people, including Terri's mother previous to their disagreement, have testified to quite the opposite view of Michael:

Family members and others who disagreed with Mr. Schiavo's decision to seek court approval to have his wife's feeding tube removed have made repeated attacks on his credibility and accused him of mistreatment of his wife. At least some of these accusations have been shown to be baseless by the autopsy conclusions. We should note, however, that we have also received unsolicited comments praising his honesty, sincerity and devotion to his wife's care. Also, when asked about her son-in-law during the 1992 malpractice trial, Mary Schindler testified, "He's there every day. She (Terri) does not want for anything. He is loving, caring. I don't know of any young boy that would be as attentive. He is ... he's just unbelievable, and I know without him there is no way I would have survived this."

What of Governor Bush's "new information" about the seeming time discrepancy? Well, if one isn't viewing this question through the lens of a great deal of prejudice already, then the Attorney General's report isn't needed to figure out that an hour discrepancy in remembered events during a traumatic episode like this one is hardly evidence of intentional deception or wrong-doing. The mere fact that Bush pressed his AG for such an inquiry on this basis proves well enough that Bush is not using any kind of objective or critical thinking to choose his course. Nevertheless, the AG does address those issues and makes the common-sense points that anyone should have thought of before asking for an investigation:

Absent proof that a crime has occurred, neither Michael Schiavo's credibility nor the consistency of his statements would become a critical and material concern. Nonetheless, the discrepancy between his recollection of the time of the incident and the time that paramedics and police recorded receiving the call hardly constitutes new information. Schiavo testified in the 1992 malpractice deposition and trial that he heard a noise around five a.m. and found his wife collapsed near the bathroom door. In a 2003 interview on Larry King Live he indicated this occurred at 4:30 a.m., a time he repeated in a recent interview with medical examiner Jon Thogmartin. Schiavo has consistently said he called for emergency help immediately after finding his wife and that fire rescue arrived within a few minutes of the call. To our knowledge he was never asked about or confronted with the difference between his estimation of the time and the records indicating the fire rescue was called at 5:40 and began resuscitation efforts at 5:52.

Understandably, Michael Schiavo is not the only witness who has been inconsistent or had difficulty recalling the timing of events surrounding Terri's collapse and resuscitation. Shortly after finding Terri, Michael Schiavo called his in-laws and told them what happened. It is unclear whether he or the Schindlers called Bobby Schindler who lived in the same complex as Michael and Terri and who immediately went to their apartment and arrived before the paramedics. Although Terri's parents had been awakened in the middle of the night with extremely disturbing news and waited at their house for a subsequent phone call on their daughter's condition, they have no clear idea what time they were called by Michael. They had previously provided our office a timeline indicating that they were called as early as 3-4 a.m. but recently told Thogmartin they could not recall the time. Similarly, Terri's brother, Bobby Schindler, told Dr. Thogmartin he could not remember the time that he was called or initially arrived at the Schiavo residence except in relation to the arrival of the paramedics.

It is not contradicted that Michael Schiavo appeared frantic and extremely distraught throughout the incident. Under these extraordinary circumstances, where both Mr. Schiavo and his accusers have similar difficulty in reconstructing exact times, it cannot be credibly argued that this discrepancy is incriminating evidence. Nor, in light of his consistent and uncontradicted claims that he immediately called 911, can his error in estimating the time be considered an admission that he waited over an hour to get help for his wife. It does not appear that Schiavo's error was considered to be of probative value in either the civil suit or in the subsequent guardianship proceedings. Schiavo was not confronted by opposing lawyers (or by Dr. Thogmartin) with the potential inconsistency nor was he given the exact times recorded by paramedics as a point of reference. The most obvious explanation is also the most logical: under the extremely stressful circumstances his attention to and memory of the exact time were faulty - in the same way that the recollections of Mr. and Mrs. Schindler and Bobby are flawed.

Curiously, a delay such as this would further undermine the speculation that Michael Schiavo caused Terri's collapse by assaulting her. Neither the medical examiner nor our assistants were able to identify any plausible manner by which Schiavo - having physically overcome Terri without injuring her or being injured himself - could keep her incapacitated but sufficiently alive that she could still be resuscitated almost an hour later. Additionally, we could discern no rational motivation for attacking one's spouse allowing her to linger near death for forty minutes or more and then calling for help in sufficient time to save her life so she could potentially name her assailant.

Again, unless you are hopelessly biased in your opinion about Michael Schiavo based on your understanding of the subsequent disagreement between him and Terri's parents, there is no way you can read the facts of this case without admitting that he deserves the lion's share of the benefit of the doubt where allegations abuse or assault are concerned. He deserves much more than just the standard presumption of innocence.

2.) Did Michael Schiavo deny Terri care or therapy?

Nope - that's just another vicious slander perpetrated by people with no conscience - no care about right and wrong; and propagated by others who unfortunately trusted them. Again, from the GAL report (pdf):

On 18 June 1990, Michael was formally appointed by the court to serve as Theresa’s legal guardian, because she was adjudicated to be incompetent by law. Michael’s appointment was undisputed by the parties.

The clinical records within the massive case file indicate that Theresa was not responsive to neurological and swallowing tests. She received regular and intense physical, occupational and speech therapies. Theresa’s husband, Michael Schiavo and her mother, Mary Schindler, were virtual partners in their care of and dedication to Theresa. There is no question but that complete trust, mutual caring, explicit love and a common goal of caring for and rehabilitating Theresa, were the shared intentions of Michael Shiavo and the Schindlers. In late Autumn of 1990, following months of therapy and testing, formal diagnoses of persistent vegetative state with no evidence of improvement, Michael took Theresa to California, where she received an experimental thalamic stimulator implant in her brain. Michael remained in California caring for Theresa during a period of several months and returned to Florida with her in January of 1991. Theresa was transferred to the Mediplex Rehabilitation Center in Brandon, where she received 24 hour skilled care, physical, occupational, speech and recreational therapies. Despite aggressive therapies, physician and other clinical assessments consistently revealed no functional abilities, only reflexive, rather than cognitive movements, randomeye opening, no communication system and little change cognitively or functionally. On 19 July 1991 Theresa was transferred to the Sable Palms skilled care facility. Periodic neurological exams, regular and aggressive physical, occupational and speech therapy continued through 1994.
[...]
{after the malpractice settlement} The Schindlers petitioned the court to remove Michael as Guardian. They made allegations that he was not caring for Theresa, and that his behavior was disruptive to Theresa’s treatment and condition.
Proceedings concluded that there was no basis for the removal of Michael as Guardian Further, it was determined that he had been very aggressive and attentive in his care of Theresa. His demanding concern for her well being and meticulous care by the nursing home earned him the characterization by the administrator as “a nursing home administrator’s nightmare”. It is notable that through more than thirteen years after Theresa’s collapse, she has never had a bedsore.

The GAL properly recognizes Terri's parents' role as partners with Michael in seeking the most aggressive therapy for her. But, bear in mind also that Michael was the legal guardian. That means that none of the therapy or examinations that took place during these four years were done without his say-so.

This point also sheds light on some other questions and media failures. As if the complete lack of evidence that Terri's collapse was due to criminal activity were not enough to exonerate Michael from charges that his abuse or assault caused her collapse, it is unthinkable that Michael would have worked so hard in hopes of her recovery if he thought she might recover and testify against him.

Also, this goes toward answering another bit of innuendo, phrased as a specious question: "why did it take Michael so long to 'remember' about Terri's wishes?" That will be addressed separately, but this goes a long way toward pointing to the fact that he knew her wishes all along, but because he was desperately hopeful for her, he wasn't satisfied until 1997 that there was no hope for recovery and that the only course remaining was to ask the court to honor those wishes.

Finally, the fact that those in the public who sympathized with Michael's accusers weren't aware of his extensive efforts toward her rehabilitation represents an unconscionable failure on the part of the press. Instead of researching and presenting these facts about Michael's care, they opted to announce (in the headlines) each and every "statement" of Terri's brother, mother, father, and others of Michael's detractors (including Tom DeLay). Then, (near the end of the story), whatever responses provided by advocates for Michael would be included. Had the media done their jobs, or the American people excersized better critical thinking skills about the reports they heard from the media, then it would have been obvious to everyone that it was very unlikely that Michael had caused Terri's collapse, or had anything but her best interests at heart when he asked the court to honor her wishes not to have her life prolonged.

3.) Were Michael Schiavo's actions motivated by greed?

If they were, then he is more stupid than anyone might have imagined. After spending on Terri's care virtually all of the money in the trust fund that was established to care for her by the malpractice verdict, Michael continued to press for the feeding tube to be removed.

In March of 2005, he was offered $1,000,000 to abandon his efforts, divorce Terri, and turn over her care to her parents. According to his lawyer, but otherwise unsubstantiated, he also turned down another $10,000,000 offer. So, his choices were to be relieved of the burden of caring for Terri, be able to remarry, have her feeding tube removed, and be left with nothing more than he had before, or to be relieved of the burden of caring for Terri, be able to remarry, turn over care to her parents, and make a profit of $1-10 million. The only possible explanation for his unwillingness to make a profit on the deal was that he was utterly convinced of Terri's wishes and cared more for seeing them fulfilled than for making money.

4.) Was Terri blind, or could she respond to visual stimuli, including a moving balloon, or the entrance of a familiar person into her room?

The autopsy reports that she was blind. Some people remain convinced that Terri was not blind, at least not when the famous videos were made. They still insist that the selectively edited video that appeared to show Terri tracking a balloon, and the testimony that she frequently smiled when a family member appeared in the room discount this finding, was evidence that she was conscious and had her sight. I'm not a doctor, but I have yet to hear of a reputable doctor - any doctor, actually - endorsing this view. It does not stand to reason that, in the two weeks that Terri's body dehydrated, these neurons not only died, but decayed further than her previously healthy brain stem. It stands to reason, therefore, that the cortical damage that rendered her blind occurred concurrently with the atrophy of the other brain centers that she lost. It stands to reason, also, that many medically trained personnel are familiar with the autopsy results on people who have died by dehydration, and would have been immediately aware of it if her autopsy results had been consistent with her having had vision prior to the feeding tube being removed, and at least some of them would have spoken up to the media. So, I feel as justified as possible without being medically trained, in agreeing that she was blind during the "balloon following" video.

The media and advocates for Michael did an acceptable job in making the public aware that the video they were exposed to on pro-tube websites and in the news media were highly and selectively edited. I believe that it was a failure of critical thinking on the part of the Public to be convinced by this type of evidence that Terri was consciously aware of her environment. I believe that it is a more serious failure of critical thinking on the part of those who still cling to that viewpoint and insist that she could not have been blind when the video was recorded to view it as evidence that she was not blind at the time. Medical experts have provided the public on more than one occasion with a reasonable medical explanation: that Terri's eye movements were a random result of unconscious brain-stem activity, and that such random movements (or vocalizations in other cases) will eventually give the appearance of deliberate activity if the patient is continually presented with possible stimuli - when the stimuli and the movement accidentally coincide. Even if Terri had not been blind at the time, the edited video would be very poor evidence that she was aware. A court, presented with the full, four hour video and expert physician testimony, determined that her responses were random, and that those that appeared deliberate were unrepeatable. The strong evidence we have that she was blind only confirms the view that those videos were meaningless as evidence of conscious awareness on her part.

5.) Was Terri in a PVS?

The experts nearly unanimously testified that CT scans and clinical evidence showed Terri Schiavo to be in a Persistant Vegetative State, meaning she was incapable of conscious awareness, and that she had no hope of recovery or rehabilitation. A very few doctors, most of whom never actually examined her, and including one self-promoting physician who did examine her, but had already been disciplined by the Florida Board of Medicine for falsely advertising his experimental therapy for stroke victims (Disciplinary order (.pdf)), dissented from that view. (Dr. Hammesfahr, through his advertising practices, did convince a Florida congressmen to write a letter of "nomination" to the Nobel selection committee. He was, in no sense of the word, nominated by the board, or his peers in medical practice for that prize. Unfortunately, the media , and especially Sean Hannity, was willing to report the false claim that he was a Nobel nominee.).

Autopsy reports confirm that she had almost no remaining cerebral cortex - the cognitive centers of the brain, and autopsy evidence is consistent in every way with the clinical determination of PVS. There is very little else to say about it. Those who are willing to ignore the evidence and cling to the vanishingly small possibility that Terri was in a "minimally conscious" condition have a right to their view, but the evidence, objectively considered, renders that view unthinkably unlikely.

6.) Was Terri's death by dehydration painful or uncomfortable? Were other options preferable for her?

This is a very difficult question. I am not medically trained, and I cannot answer from my own expertise. I can only rely on others. Yet some others, often even less qualified than I, have firmly held opinions on this - including the view that Terri's death by dehydration was painful, and that (some) other option was preferable, given what evidence we have of her wishes.

Unfortunately, there is very little published from the medical community and accessible to non-professionals about whether and how pain or discomfort is experienced in a PVS. A few expert testimonies are presented in this National Geographic piece:

But because PVS patients are unaware, neurologists believe the patients feel no hunger—ketosis or no ketosis. Neurologists also say that PVS patients feel no other forms of pain or suffering, including thirst.

"To suffer or feel pain, there needs to be sufficient cerebral activity to perceive a stimulus as unpleasant," Sigsbee said. "In PVS that neural integration does not exist."

According to Bernat, hospice nurses and doctors say that terminally ill, dying patients who do not eat or drink do not suffer. "They are given mouth care—moistening of dry mouth—and sometimes medications if they are restless. But they usually die very peacefully," he said.

Despite the general consensus that people in a persistent vegetative state feel no bodily pain, Schiavo's caregivers at Woodside Hospice recently began administering the painkiller morphine to her. "Since some relatives claim she is not in PVS, this practice reassures them she will not suffer," Bernat said.

Furthermore, although many non-experts have hotly disputed this, some medical reports suggest that a death by dehydration is not a horror even to those who are aware at the time the feeding tube is removed:

Even for patients who are conscious to begin with, death by dehydration appears peaceful, according to a study published in 2003 in the New England Journal of Medicine.

A survey of 107 hospice nurses who cared for terminally ill patients who chose to die by refusing food and water found that "most deaths . . . were peaceful, with little suffering."

The study asked nurses to rate the patients' deaths on a zero-to-nine scale, with nine being the best possible death; the median rating was eight.

Christine Exposito, a registered nurse at HospiceCare of Southeast Florida, said in about half of the cases in which one of her terminal patients loses the ability to survive without a feeding tube, the patient's family will allow the patient to die of dehydration.

Perhaps so, perhaps not. Either way, there is little reason to believe those whose only brain activity is in the reflexive brain stem - such as Terri Schiavo - actually experience any discomfort from this type of death.

There are those who remind us that our society considers it a criminal cruelty to allow even an animal (for whom we are expected to care) die this way. Certainly, this is true in some cases. In others (i.e. certain methods of poisoning rats), one can legally purchase the means to do it without concealing one's intentions. But a bigger issue is whether the alternative we use for domestic animals: euthanasia - is suitable for humans. I tend to side with the conservatives on this point: euthanasia lends itsself far too easily to abuse. But, almost universally, those who decry the dehydration death of Schiavo are those who also support legislation that outlaws a painless lethal injection (or a messy suffocation from adiminstering food and water by mouth, for that matter). Certainly, euthanasia is illegal. For patients who have expressed a wish not to have their lives artificially extended, whether by means of a surgically implanted feeding tube or by other means, the only remaining options are to ignore their wishes, or to allow them to die by dehydration among removing artificial feeding.

If the medical experts agree that a PVS patient cannot experience pain and discomfort, and the best determination possible of the patient's wishes are that she would prefer not to have her life continued artificially, especially when additional palliative care is given to ensure that discomfort is minimized, as was done in Terri Schiavo's case, I feel that the better of those two options is to allow death by dehydration, with plenty of morphine for just-in-case.

I certainly understand how others, out of a sense of caution and compassion, would disagree with me and others who feel as I do, including Michael Schiavo. I do not understand how they justify a bitter and hateful attitude toward Michael or those who agree with him (or with me, for that matter) about the preferability of removing artificial feeding, when his viewpoint is grounded in compassion, care for her wishes, and when it is made in the face of a very difficult, and even heart-wrenching, necessity to decide whether or not the possible discomfort of a death by dehydration outweighs her expressed wishes and the indignity of a life indefinitely extended by artificial means and absent awareness, responsiveness, or even the ability for the most rudimentary self-determination.

And, I wonder again how many of those people were even aware that Terri's care would include the administration of morphine as a secondary guard against the possibility of discomfort until her death, because of the irresponsibility of the news media, and those who manipulated it.

7.) Was the court right in its finding of clear and convincing evidence of Terri's wishes?

At long last, a truly controversial question. I think it may be impossible to know. I'm only passingly familiar with the testimony and evidence the court used to make its ruling, and I'm less than 100% certain that they found correctly. On the other hand, I know that several appellate courts upheld the view that the legal standard of clear and convincing proof had indeed been met. Whether they found rightly or wrongly, the law required that the court make a decision and abide by it. Someone has to make a decision when there is a dispute about the wishes of the person inolved, and the courts are the only suitable venue for exploring the evidence in a fair and objective way and deciding responsibly how the law applies to a case. More on this in the next point.

I also believe that, under those circumstances, it is just as wrong to mistakenly extend her life in such circumstances, when we can't be completely certain that is what she would want as it is to mistakenly stop extending it.

Absent the hope that she will ever be able to do even the least action of her own accord, or ever be consciuos of her own life, I think the importance of "life" (or the appearance of it maintained by the body) is dwarfed by the importance of her wishes. I know that many disagree with me about that, and may even (purposefully or not) turn my words around to make it seem as though her handicap makes her less of a person to me. Although I think that, ethically, personhood is tied up in experience and self-determination, not just vital signs, what I really am saying here is that without the experience of it, or the ability to control it in even the most rudimentary ways, Terri's "life" had very little or no meaning to her.

On the other hand, I believe that, if it is possible to ascertain what her wishes were with any reasonable degree of certainty - meaning the Florida legal standard of clear and convincing proof of them, then that should carry a lot of weight. After all, that is the only choice that remains in any sense her own choice to make. I agree with most everyone else that, if there's not clear and convincing evidence about what she would have wanted, that we should "err on the side of life"... but just barely. I've made my intentions clear to my family, because even if I had the slightest sliver of awareness left, I would hate to be trapped in an insensate and impotent body for countless years simply because I failed to express the wish. I would also hate for my family to be burdened with maintaining my body so long after I've departed it. I expect that would be the case for many others for whom we "erred on the side of life", to their ultimate disservice.

8.) Did the courts' ruling create new law or precedent?

No. Arguments that the Schiavo case was an instance of judicial activism usually include one or both of these two assertions: a) the Schiavo case defined artificial feeding as "life support" (for the first time), b) the Schiavo case created a precedent that overrided a previous requirement that a written living will was the only valid expression of a patient's wishes. With the help of Abstract Appeal, a Florida lawyers webiste about Florida law (especially the Schiavo information page), I've put together sufficient proof that neither of these assertions is true:

On point a)...
Florida law already explicitly defined artificial feeding as life support.
§ 765.102(3), Florida Statutes:

"Life-prolonging procedure" means any medical procedure, treatment, or intervention, including artificially provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term does not include the administration of medication or performance of medical procedure, when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain.

On point b)...
Judicial precedent in Florida already allowed a patient's wishes to be honored, even if they weren't expressed in a living will, since 1990.
In re GUARDIANSHIP OF Estelle M. BROWNING. (9/13/1990):

We are persuaded that when the patient has taken the time and the trouble to specifically express his or her wishes for future health care in the event of later incapacity, the surrogate need not obtain prior judicial approval to carry out those wishes. This applies whether the patient has expressed his or her desires in a "living will," through oral declarations, or by the written designation of a proxy to make all health care decisions in these circumstances.

That the court of appeals, on reviewing the Schiavo case, specifically cited Browning shows that their intent was not to set new precedent on the matter, but to follow existing precedent.

Browning, itself, may have set new precedent in Florida, but it also honored precedent set by the U.S. Supreme Court in a case where the state of Missouri prevailed upon the USSC to affirm their decision to prevent the removal of a feeding tube. The case was Cruzan v. MO DOH. The conservative side of the court ruled in favor of MO, and this quote is from the Nixon-appointed, conservative Chief Justice Rhenquist, writing for the Court:

In sum, we conclude that a State may apply a clear and convincing evidence standard in proceedings where a guardian seeks to discontinue nutrition and hydration of a person diagnosed to be in a persistent vegetative state. The Supreme Court of Missouri held that in this case the testimony adduced at trial did not amount to clear and convincing proof of the patient's desire to have hydration and nutrition withdrawn. In so doing, it reversed a decision of the Missouri trial court which had found that the evidence "suggested" Nancy Cruzan would not have desired to continue such measures, but which had not adopted the standard of "clear and convincing evidence" enunciated by the Supreme Court.

Some comments in summary:

I do concur (quietly, respectfully, and humbly with regard to my incomplete knowledge and expertise) with Florida law, U.S. case law precedent, and with the findings of the courts who believed they were honoring Terri's wishes concerning artificial feeding and hydration. As I mentioned under point 7.), above, I base this in part on my personal values: I value freedom of self-determination more highly than I value "life" that is completely devoid of experience or even a semblance of self-determination.

I understand that others believe that a heart-beat and respiration is more important than self-determination, at least when the evidence about the individual's choice is not expressed in a written and notarized document. My problem is not with those who hold this view. My problem is with those who are radicalized and intolerant of me, others like me, the courts, and Michael Schiavo because of their differences. My problem is with those who have failed to exercise critical thinking with respect to press and advocates' accounts of the situation, and - after being misled, have supported and propagated falsehoods and innuendo against Michael based on their false beliefs. My problem is with the press for failing to exercise critical examination of the statements it recieved from the Schindler camp, and for presenting an unbalanced and misleading case to the American public as a result. My problem is with the Schindler's surrogates and advocates (especially Randall Terry, Jeb Bush, Tom DeLay, and Bill Frist) who played fast and loose with the truth and who chose the tactics of personal destruction, deception, and hate-mongering instead of seeking to expose the truth and let the matter be decided on its own merits, honestly presented.

Ok... I believe I have covered all the bases. I shouldn't have had to. The media should have done the proper fact-checking. We, the people should have used reason and moderation in expressing opinions on most of these matters - especially the slander of Michael Schiavo, recognizing that we were not a part of the family (i.e. that most aspects of this private family's dispute were none of our business), that we were not qualified doctors, that we had no first-hand experience with Terri's condition, that we were not legal experts, and that we hadn't we been privy to the all of the evidence, including the best available. We should have recognized that we had little room for second-guessing the courts who were experts, did have access to all of the evidence, including the best available, and had a well-defined procedure for settling such disputes, including the option for appeals to higher courts if the lower courts were thought to be in error. Every qualified court, from the Baptist, Republican Judge Greer and on up the chain of appeals reached the same conclusion. It may not be the correct one, but it stands a better chance than any conclusion the rest of us might reach when we are informed only by talk show hosts, a spineless media, and ideologues who care more about an agenda than they do about people.

To those who feel that the statutory and case law that the Florida courts followed is wrong-headed, I encourage you to debate this issue in any forum you choose. I don't ask for you to be silent. I don't insist that you must be wrong. I only ask for a few small considerations from you when you carry this debate forward. I ask that you respect the privacy of and understand the difficulties facing individual families and private individuals. I ask that you critically examine what you learn from the press or other accounts. I ask, when the press fails to act responsibly, that you hold them accountable. I ask that you employ not only your personal values about life and self-determination, but also that you employ respect, and seek the truth, as best you can understand it. I also hope that you will have humility, and recognize the limitations of your own understanding of medicine, difficult ethical questions, and/or law. If you do these things, you will not only gain respect for your side of the debate among your adversaries. You will gain a more sympathetic hearing from those who are as yet undecided. And, you stand a much better chance of learning something important, and of teaching something important to people on the other side of the issue.

Posted by smijer at July 14, 2005 07:00 AM