William Fisher

NEW YORK, Mar 23 2005 (IPS) — “Terri Schiavo has done nothing to deserve the death sentence she has been handed. She is a disabled woman guilty of nothing more than marrying a man who has not taken seriously his vows to love and protect her for as long as they both shall live.”

Or:

“Highly competent, scientifically based physicians using recognised measures and standards have deduced, within a high degree of medical certainty, that Terri is in a persistent vegetative state. She has no intellectual capacity. No hope of recovery. Neurological tests and brain scans indicate that Terri’s cerebral cortex is principally liquid, having shrunken due to the severe anoxic trauma experienced 13 years ago.”

These two statements crystallise what the Terri Schiavo case is all about.

The first, pleading for Terri to be kept alive, is from James Dobson, head of Focus on the Family, a powerful and politically well-connected right-wing religious organisation.

The second, recommending that she be allowed to die, is from Dr. Jay Wolfson, the neurologist who was appointed by a Florida court in 2003 to determine Schiavo’s best interests.

So, observers say, the case is about “right to life ideology” – and politics – versus medical evidence. The issue is further complicated by other medical and religious figures who disagree about both the diagnosis and the road forward.

Details of the case, which has caused a firestorm of controversy between the religious right-wing and the medical profession, are by now well-known. Terri, who is now 41, collapsed from heart failure 15 years ago. She has been kept alive by tubes that deliver food and water.

For four years after her collapse, she received intensive therapy, yet remained in what medical science terms a “persistent vegetative state” (PVS).

Since then, her husband, Michael – who has legal custody of Terri – has urged that she be allowed to die, and says his wife expressed that wish before her illness.

But her parents have fought to keep her alive.

The case ended up in the courts. The Florida state courts ruled several times that Terri was indeed a victim of PVS. The U.S. Supreme Court refused to hear the case on appeal, effectively telling the state courts their rulings were correct.

Florida Governor Jeb Bush, brother of the U.S. president, got the Florida legislature to pass a special law to allow the feeding tubes to remain in Terri’s body. That law was declared unconstitutional, and the tubes were removed.

Then last week, the case was seized on by Republicans in Congress, which passed a law giving the federal courts jurisdiction over this one case. In an unusually acrimonious debate, legislators attacked Terri’s husband for being indifferent to his wife’s plight and accused him of being motivated only by money.

Pres. George W. Bush flew back to Washington from his Easter holiday in Texas to sign the new law in the middle of the night. The next day, lawyers for Terri’s parents went to U.S. District Court to ask the judge to issue an temporary injunction ordering that the tubes be re-inserted pending further medical examinations.

The judge refused, and Terri’s parents immediately took the case one step higher, to the U.S. Court of Appeals. In a 2-1 ruling Wednesday, the court said that Terri’s parents “failed to demonstrate a substantial case on the merits of any of their claims” that her feeding tube should be re-inserted.

The case has raised profound medical, religious and ethical issues.

First, what is PVS? The American Medical Association (AMA) defines it as “a clinical condition of complete unawareness of the self and the environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brainstem autonomic functions…The permanent vegetative state means an irreversible state.”

The core medical question raised, according to the AMA, is that PVS “as with all clinical diagnoses in medicine, (is) based on probabilities, not absolutes.”

While it would appear that Terri exhibits all or most of the symptoms described for a PVS diagnosis by the AMA, there is disagreement among physicians even on these basic facts.

The religious community – mainly Christians, but also Jews, Muslims, and others – is split on what should be done. The “right to life” constituency believes it is morally wrong to take any life. Terri should be kept alive, regardless of her condition or prognosis. Most would maintain that view even if Terri had signed a “living will” expressing her own treatment desires.

Many supporters of Terri’s right to stay alive, including her parents, have said that removing her sources of nourishment will be extremely painful. But others contest that claim.

Dr. Linda Emanuel, the founder of the Education For Physicians in End-of-Life Care Project at Northwestern University, told IPS, “From the data that is available, it is not a horrific thing at all. In fact, declining food and water is a common thing among terminally ill patients. They usually lose desire for food or water, and often food and water make them worse, not better, since a seriously ill person does not handle either well.”

There are also other voices in the religious world. Rev. C. Welton Gaddy, president of the Interfaith Alliance, says, “All of us would do well to step back from the bedside of a woman caught somewhere between death and life, divorce our political initiatives from this realm of personal and familial pain, pray for the peace of Terri Schiavo and her family, and after taking a hard look at how we feel about politicians who are willing to manipulate even personal pain in an effort aimed at political gain, decide what we are going to do about our democracy.”

The case has also focused attention on the issue of assisted suicide. Opponents are flooding the Internet with quotes such as the following from Dr. C. Everett Koop, former surgeon general of the United States: “We must be wary of those who are too willing to end the lives of the elderly and the ill. If we ever decide that a poor quality of life justifies ending that life, we have taken a step down a slippery slope that places all of us in danger.”

But Emanuel said the morality of euthanasia was not the issue here.

“The case of Terri Schiavo is different from physician-assisted suicide,” she said.

“It is important to keep the distinctions clear. Withdrawing or withholding life-sustaining intervention with the intent to allow death to take its natural course is not the same thing as actively injecting or intervening with the intent to cause the death of someone who would otherwise stay alive.”

Terri’s parents say they will appeal to the U.S. Supreme Court. Doctors believe Terri can survive one to two weeks without water or nutrients.