Should Terri Schiavo’s Feeding Tube Have Been Removed?
General Reference (not clearly pro or con)
ABC News, in a Mar. 24, 2005 article entitled “Schiavo Case a Study in Judicial Review” by Annie Chiappetta, explained:
“In the more than seven years that the Terri Schiavo case has been winding through the Florida state and federal court systems, at least 10 judges have looked at the factual and legal issues surrounding the question of whether the severely brain-damaged woman’s feeding tube should be removed. Now, with the feeding tube removed on order from a state court judge and federal courts thus far refusing to intervene, the case has come down to very narrow legal points…
Experts say…the question is not about what Terri wanted, nor what Michael Schiavo wants, what the Schindlers want, what Congress wants or what the president of the United States wants. Like the lower federal courts that have already ruled in this case, the judicial inquiry is confined to whether Terri’s ‘due process was denied,’ explains Erwin Chemerinsky, a professor at Duke University School of Law.
In other words, the issue is whether the courts have given due consideration to all the issues in the case.”Mar. 24, 2005
Rebecca Dresser, JD, Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine at Washington University Law School, in a May-June 2005 article published in the Hastings Center Report, entitled “Schiavo’s Legacy: The Need for an Objective Standard,” explained:
“Since Terri Schiavo had no living will, the Florida judges applied the ‘substituted judgment’ standard to reach a decision about her care. This standard aims to produce the decision the patient would make if able… The courts found that Ms. Schiavo’s former statements constituted clear and convincing evidence that she would refuse the medical nutrition and hydration prolonging her life.
Yet the courts also recognized that the evidence was not all that strong…
The testimony about Ms. Schiavo’s previous statements was general enough to raise doubts about whether she would indeed have refused nutrition and hydration. And years after her brain injury, with her family so divided, could anyone really know what she would decide if she were, in the language of the Quinlan court, ‘miraculously lucid for an interval…and perceptive of her irreversible condition’?”May-June, 2005
The British Broadcasting Corporation (BBC), in its Mar. 31, 2005 “Timeline: Terri Schiavo case,” gave the basic background of Terri Schiavo’s medical condition:
“Terri Schiavo had been brain damaged since 1990 when, aged 26, her heart stopped beating temporarily and oxygen was cut off to her brain.”Mar. 31, 2005
Michael Schiavo, Terri’s husband, commented in an interview with Larry King that aired Oct. 27, 2003:
“This [removal of the feeding tube] is Terri’s wish. And I’m going to follow that wish, if it’s the last thing I can do for Terri. I love Terri deeply. And I’m going to follow it up for Terri.
…Removing somebody’s feeding tube is very painless. It is a very easy way to die… And it doesn’t bother me at all. I’ve seen it happen. I had to do it with my own parents.”Oct. 27, 2003
The American Civil Liberties Union of Florida argued in its Oct. 29, 2003 Petitioner’s Brief in the Terri Schiavo case:
“By authorizing the Governor to compel the surgical re-insertion of her feeding tube, the Florida legislature has trampled upon Mrs. Schiavo’s constitutional right to control her own medical treatment, specifically, her right to refuse unwanted artificial life support. This right is firmly grounded in both the Florida and federal constitutions.
Under Article I, Section 23 of the Florida Constitution, ‘[e]very natural person has the right to be let alone and free from governmental intrusion into the person’s private life.’… This constitutional right of privacy, which exceeds analogous protections under federal constitutional law, includes the right to self-determination with respect to medical treatment, that is, to decide for oneself whether or not to receive such treatment…
The constitutionally protected right to choose or reject medical treatment is not lost by virtue of physical or mental incapacity or incompetence. When the patient can no longer speak, the right may be exercised by a proxy, such as a close family member or friend, upon clear and convincing evidence. A written declaration is presumptively clear and convincing evidence of the patient’s wishes. Where, however, a person has not left a written declaration, oral declarations and evidence may constitute clear and convincing evidence of the patient’s wishes; the surrogate must make the medical treatment choice that the patient, if competent, would have made…
The Florida legislature has also codified the right to refuse treatment in Chapter 765 of the Florida Statutes. It provides that a health care surrogate or proxy may effectuate the wishes of an incapacitated patient–that is, a patient currently unable to communicate her health care decision–regarding treatment, including a wish to refuse life-prolonging procedures such as artificial nutrition and hydration. The incapacitated patient’s right to have her wishes carried out applies even where she has not executed a living will or other written advance directive for health care.”Oct. 29, 2003
Joshua Perry, JD, Assistant Professor at Vanderbilt University Medical Center, Larry Churchill, PhD, Professor of Medical Ethics at Vanderbilt and Howard Kirshner, MD, Professor of Neurology at Vanderbilt argue in their article “The Terri Schiavo Case: Legal, Ethical, and Medical Perspectives” that appeared in the Nov. 15, 2005 issue of the Annals of Internal Medicine:
“In our opinion, the law did not fail Terri Schiavo. In fact, no end-of-life guardianship case in U.S. history has generated as much high quality evidence, judicial attention, or legal scrutiny as the Terri Schiavo case…
The Florida guardianship was clear, and the law was followed. The judiciary was charged with 2 questions: 1) What was Terri Schiavo’s medical condition? 2)In such a condition, what would she choose to do? In the midst of an intense and intractable family dispute, amid dizzing media attention and unprecedented political intervention, the judicial process produced 2 answers. The process and the resulting answers were reviewed repeatedly by cautious, nonpartisan judges who demonstrated restraint and care in adjudicating Mrs. Schiavo’s case pursuant to her individual liberty and privacy interests. “Nov. 15, 2005
Andrew Cohen, JD, Legal Analyst for CBS News, argued in his Mar. 25, 2005 Los Angeles Times commentary “Why Schiavo’s Parents Didn’t Have a Case”:
“The Schindlers [Terri Schiavo’s parents] lost their case and their cause [to reinsert Terri Schiavo’s feeding tube]… because in the end they were making claims the legal system has never been able or willing to recognize. They lost because they long ago ran out of good arguments to make–those arguments having been reasonably rejected by state judge after judge–and thus were left with only lame ones…
Schiavo’s parents lost appeal after appeal specifically because they were asking the federal courts to declare that their constitutional rights had been violated by the Florida state court rulings in the case. They were arguing, in other words, thanks in part to their custom-made congressional legislation, that the federal Constitution gave them the right as losers in state court to get a new, full-blown trial in federal court.
If you ponder that notion you will realize just how astounding it is. If accepted, it would have meant the end of state courts as we know them. No decision at the state level ever would be final, because every losing litigant at the state court level would be able to walk into federal court and declare a federal constitutional violation…
And it is no wonder that the conservative U.S. Supreme Court decided for a fourth time to stay out of the case. This harsh reality won’t make it any easier for the Schindlers, but government cannot run on passion or emotion or sympathy. As the U.S. 11th Circuit Court of Appeals wrote: ‘There is no denying the absolute tragedy that has befallen Mrs. Schiavo… In the end, and no matter how much we wish Mrs. Schiavo had never suffered such a horrible accident, we are a nation of laws.'”Mar. 25, 2005
Joseph Fins, MD, Chief of the Medical Ethics Division of New York-Presbyterian Hospital/Weill Cornell Hospital, in an interview with The New York Times for a Mar. 25, 2005 article entitled “Neither ‘Starvation’ Nor the Suffering It Connotes Applies to Schiavo, Doctors Say,” commented:
“The window of opportunity to be diagnosed as even minimally conscious closes within three months of oxygen-deprivation brain damage…
Based on evidence accepted by the courts that Ms. Schiavo is in a persistent vegetative state and not in a more conscious state…the part of brain that allows one to suffer is not functioning…and that should be reassuring to people who are concerned.”Mar. 25, 2005
Sean Morrison, MD, Professor of Geriatrics and Palliative Care at Mount Sinai School of Medicine in New York, in an interview with The New York Times for a Mar. 25, 2005 article entitled “Neither ‘Starvation’ Nor the Suffering It Connotes Applies to Schiavo, Doctors Say,” explained:
“Evoking concepts like starvation is especially powerful…[because] we are so familiar with what it feels like to be hungry and have experienced the heartbreak of images from famine-ravaged regions…
Removing a feeding tube for a patient in a persistent vegetative state, which the courts have determined Ms. Schiavo is in, based on scientific evidence, is vastly different from a conscious person’s being refused meals…
No one is denying this woman food and water… People in a persistent vegetative state…have no knowledge of food.
They don’t recognize food… If you put food in their mouth, it would sit there until they took a breath, and then that food would go down into the lungs…
Withdrawal of nutrition is a common method for ending life, and many terminally ill patients choose that course…
I have never had a patient who has stopped eating and drinking who has expressed that they are hungry.”Mar. 25, 2005
Reverend Richard P. McBrien, Crowley-O’Brien Professor of Theology at the University of Notre Dame, argued in his Aug. 5, 2005 article “The Schiavo Case Re-Visited” published in The Tidings:
“For many Catholics–including priests and theologians educated in the years prior to, during, and immediately after the Second Vatican Council (1962-65)–the Terri Schiavo case was always morally clear-cut.
The traditional teaching of the Catholic Church for at least four centuries–a teaching reaffirmed and extended by the most prominent of the pre-Vatican II popes, Pius XII (1939-58)–distinguished between ordinary and extraordinary means of preserving life. No one, the church consistently taught, is obliged to use extraordinary means to sustain their life on this earth…
Almost every reputable Catholic moral theologian who commented on the Schiavo case concluded that continuing the use of a feeding tube to keep Mrs. Schiavo alive was a clear instance of an extraordinary means, and as such could be dispensed with. In the words of The Catechism of the Catholic Church, such means would be ‘disproportionate to the expected outcome’ (n. 2278).
The autopsy report removed all doubt that the withdrawal of the feeding tube, far from being an act of euthanasia or even outright murder, was entirely consistent with traditional Catholic moral principles.
Terri Schiavo, for her part, was re-born into eternal life.”Aug. 5, 2005
Anna Quindlen, Pulitzer Prize winning columnist, wrote in her Apr. 4, 2005 Newsweek article entitled “The Culture of Each Life” :
“Arguments about Terri’s case centered on something described as a ‘culture of life.’ It is an empty suit of a phrase, absent an individual to give it shape. There is no culture of life. There is the culture of your life, and the culture of mine. There is what each of us considers bearable, and what we will not bear. There are those of us who believe that under certain conditions the cruelest thing you can do to people you love is to force them to live. There are those of us who define living not by whether the heart beats and the lungs lift but whether the spirit is there, whether the music box plays.
There are many ways in which this case has been divvied up in public… But it is truly about that thing that defines free human beings: the right to self-determination instead of a one-size-fits-all approach in private matters, in those issues that take place in bedrooms and kitchens and hospices. It’s a primal demand for a personal sense of control in the face of intrusive government, intrusive medicine and intrusive strangers who think holding a crucifix like a blunt instrument makes them righteous when it really only makes them sanctimonious…
The Schiavo case has asked us to look at our own definition of life, not at some formless notion cobbled out of the Bible, medical textbooks and impersonal sentiment.
…Once the feeding tube was removed, polls showed that the majority of Americans believed Terri Schiavo should be allowed to die. That’s probably because they’ve been there. They are the true judges and lawmakers and priests. They’ve been at the bedside, watching someone they love in agony as cancer nipped at the spine, as the chest rose and fell with the cruel mimicry of the respirator, as the music of personality dwindled to a single note and then fell silent. They know life when they see it, and they know it when it is gone.”Apr. 4, 2005
Bobby Schindler, Terri Schiavo’s brother, spoke at a Walk For Life rally in Nebraska on Jan. 29, 2006 as Nebraska’s Lincoln Journal Star reported:
“Death by dehydration… is terrifying and ugly and has nothing to do with mercy…
My sister was very much alive. This was not an end-of-life issue…
That became the battle cry of the media… If she’s in a (persistent vegetative state), kill her. We have to stop describing people as being in a (persistent vegetative state).
All humans, even the brain damaged, are children of God, and they deserve life…
For example… one media poll during the Schiavo controversy asked: ‘Would you want to live in this condition? Yes or no?’
Of course, no one would choose to be disabled… But that doesn’t mean we should kill those who are.”Jan. 29, 2006
Not Dead Yet, a disability rights organization, filed an amicus brief in Bush v. Schiavo on July 12, 2004 that argued:
“A close examination of the issues shows that Ms. Schiavo’s fate is intertwined with that of many people with disabilities who must rely on surrogates. If the legal standard of proof in cases involving termination of life support is watered down to the point where Ms. Schiavo’s ‘quality of life’–as determined by others–justifies her death, then one cannot distinguish Ms. Schiavo from anyone else who is ‘incompetent,’ including thousands who cannot speak due to developmental or physical disabilities. It is naïve to believe such attitudes would not be used to justify the death of people with severe disabilities if the opportunity arose…
The lower court also found that HB 35-E [legislation that granted Jeb Bush the power to re-insert Terri Schiavo’s feeding tube] infringed on Ms. Schiavo’s right to privacy, specifically her right to refuse medical treatment. This finding ignores Ms. Schiavo’s equally-fundamental right not to have medical treatment–particularly life-sustaining treatment–withdrawn by a third party absent clear and convincing evidence that Ms. Schiavo would have made that decision herself. “July 12, 2004
Harriet Johnson, JD, Disability-Rights Lawyer, argued in her Mar. 23, 2005 article, “Not Dead at All: Why Congress Was Right to Stick Up for Terri Schiavo,” published in Slate:
“Ms. Schiavo, like all people, incapacitated or not, has a federal constitutional right not to be deprived of her life without due process of law.
In addition to the rights all people enjoy, Ms. Schiavo has a statutory right under the Americans With Disabilities Act (ADA) not to be treated differently because of her disability. Obviously, Florida law would not allow a husband to kill a nondisabled wife by starvation and dehydration; killing is not ordinarily considered a private family concern or a matter of choice. It is Ms. Schiavo’s disability that makes her killing different in the eyes of the Florida courts…
While we should not assume that disability prejudice tainted the Florida courts, we cannot reasonably assume that it did not.
…The legislation enabling Ms. Schiavo’s parents to sue did not take sides in the so-called culture wars. It did not dictate that Ms. Schiavo be fed. It simply created a procedure whereby the federal courts could decide whether Ms. Schiavo’s federally protected rights have been violated.
In the Senate, a key supporter of a federal remedy was Iowa Sen. Tom Harkin, a progressive Democrat and longtime friend of labor and civil rights, including disability rights. Harkin told reporters, ‘There are a lot of people in the shadows, all over this country, who are incapacitated because of a disability’…
I hope against hope that I will never be one of those people in the shadows, that I will always, one way or another, be able to make my wishes known… But if it happens otherwise, I hope whoever is appointed to speak for me will be subject to legal constraints. Even if my guardian thinks I’d be better off dead–even if I think so myself–I hope to live and die in a world that recognizes that killing, even of people with the most severe disabilities, is a matter of more than private concern.”Mar. 23, 2005
Jodie Gilmore, a freelance writer, in an Apr. 4, 2005 article in The New American titled “Court-ordered Euthanasia,” argued:
“Terri is not ‘brain dead,’ as headlines and news stories describe her. In fact, 14 independent medical professionals (six of them neurologists) have given either statements or testimony that Terri is not in a persistent vegetative state. Her family foundation website notes that she ‘responds to stimuli, tries to communicate verbally, follows limited commands, laughs or cries in interaction with loved ones, physically distances herself from irritating or painful stimulation, and watches loved ones as they move around her. None of these behaviors are simple reflexes and are, instead, voluntary and cognitive. Though Terri has limitations, she does interact purposely with her environment.’
Terri is not on life-support systems, such as a respirator, which could be construed as ‘over-zealous’ treatment, disproportionate to the expected outcome. She does have a gastric feeding tube, which is connected only at meal times. But the existence of a feeding tube does not magically metamorphose Terri from a human to a ‘houseplant,’ which is what Michael’s lawyer and euthanasia advocate, George Felos, compared her to…
The February 8 issue of Neurology published a study that measured the brain activity of patients in a ‘minimally conscious state’ (MCS). The study showed that severely brain-damaged patients, although they can’t follow simple instructions or even communicate, may retain at least some ‘cognitive function.’ According to a New York Times article, Dr. Joseph Fins, who is chief of the medical ethics division of the New York Presbyterian Hospital, Weill Cornell Medical Center, cited research indicating that nearly a third of persons diagnosed with PVS were really ‘minimally conscious’…
Dr. Richard Neubauer, medical director of the Ocean Hyperbaric Neurologic Center in Ft. Lauderdale, Florida, filed an affidavit rendering his medical opinion that Terri Schiavo was neither ‘brain dead’ nor in a ‘persistent vegetative state’… Dr. Neubauer, who has predicted that Terri could improve given proper hyperbaric therapy, has successfully treated brain-injured patients.”Apr. 4, 2005
William Burke, MD, PhD, Professor at Saint Louis University Health Sciences Center, as quoted in Wesley Smith’s article “A ‘Painless’ Death?,” which appeared in the Nov. 11, 2003 Weekly Standard, explained:
“A conscious [cognitively disabled] person would feel [the removal of a feeding tube] just as you or I would. They will go into seizures. Their skin cracks, their tongue cracks, their lips crack. They may have nosebleeds because of the drying of the mucus membranes, and heaving and vomiting might ensue because of the drying out of the stomach lining. They feel the pangs of hunger and thirst. Imagine going one day without a glass of water! Death by dehydration takes ten to fourteen days. It is an extremely agonizing death.”Nov. 11, 2003
Wesley J. Smith, JD, Anti-Euthanasia Activist, in his Nov. 11, 2003 article, “A ‘Painless’ Death?,” published in The Weekly Standard, argued:
“Many who support Terri Schiavo’s threatened dehydration assert that removing a feeding tube from a profoundly cognitively disabled person results in a painless and gentle ending. But is this really true? After all, it would be agonizing if you or I were locked in a room for two weeks and deprived of all food and water. So, why should we believe that cognitively disabled patients experience the deprivation differently simply because they receive nourishment through a feeding tube instead of by mouth?…
Yes, it is true that when people are actively dying from terminal disease, they often refuse food and water. The disease makes the food and water repulsive to them. In such circumstances, it is medically inappropriate to force food and water into a person who is actively rejecting it. Indeed, doing so could cause suffering.
But this isn’t what is happening to Terri. She isn’t dying of cancer. Her body isn’t shutting down as part of the natural dying process. Indeed, she is not dying at all–unless her food and water is taken away.”Nov. 11, 2003
J.P. Hubert Jr., MD, Catholic Biomedical Ethicist, argued in his Mar. 8, 2006 article “Fr. Richard McBrien and Others Mislead Catholic Public: Allege Schiavo Feeding Tube Removal OK” published by Catholic Online:
“There is no intellectually honest way to portray what occurred in the Schiavo case as anything but ‘Euthanasia by omission’ as Pope John Paul II described it in his 2004 allocution… The 2004 Papal teaching specifically addressed the issue of persistent vegetative state (PVS) and the moral necessity of providing sustenance as part of basic supportive and humane care, not extraordinary medical intervention…
While it is completely understandable and appropriate that people wish to be compassionate to those who suffer with PVS…ending their lives by dehydrating them to death is not a morally licit way to do so…
I feel the duty to reaffirm strongly that the intrinsic value and personal dignity of every human being do not change, no matter what the concrete circumstances of his or her life. A man, even if seriously ill or disabled in the exercise of his highest functions, is and always will be a man, and he will never become a ‘vegetable’ or an ‘animal’…
Even our brothers and sisters who find themselves in the clinical condition of a ‘vegetative state’ retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as His sons and daughters, especially in need of help.”Mar. 8, 2006
Paul McHugh, MD, Distinguished Service Professor of Psychiatry at Johns Hopkins University School of Medicine, wrote in his June, 2005 article titled “Annihilating Terri Schiavo” that appeared in Commentary Magazine:
“As soon as Terri Schiavo’s case moved into the law courts of Florida, the concept of ‘life under altered circumstances’ went by the boards–and so, necessarily, did any consideration of how to serve such life…
Terri Schiavo’s husband and his clinical and legal advisers, believing that hers was now a life unworthy of life, sought, and achieved, its annihilation. Claiming to respect her undocumented wish not to live dependently, they were willing to have her suffer pain and, by specific force of law, to block her caregivers from offering her oral feedings of the kind provided to all terminal patients in a hospice-even to the point of prohibiting mouth-soothing ice chips. Everything else flowed from there. How could such a thing happen? This, after all, is not Nazi Germany… But we in this country have our own, homegrown culture of death, whose face is legal and moral and benignly individualistic rather than authoritarian and pseudo-scientific…
Contemporary bioethics has become a natural ally of the culture of death, but the culture of death itself is a perennial human temptation; for onlookers in particular, it offers a reassuring answer (‘this is how X would have wanted it’) to otherwise excruciating dilemmas, and it can be rationalized every which way till Sunday. In Terri Schiavo’s case, it is what won out over the hospice’s culture of life.”June 2005