Terri Shiavo

Terri Shiavo

This poor woman's story has gained prominence of late, with (it seems) everyone chipping in their two cents. Most of what I have read about her from the mainstream media and various blogs is based on hearsay, with various people commenting on what they would want if they found themselves in Terri's situation - which is strange considering that most of those commenting do not know the first thing about her situation.

Until this week, I really didn't know anything about the specifics of her case either. That was, until I read the Wolfson report. This report was prepared at the behest of Florida Governer Jeb Bush by Jay Wolfson, who as of December 2003 was Terri's Guardian ad Litem.

The report is only 38 pages long, but it covers a lot of ground, and clears up some of the misinformation swirling around her case. Wolfson met all the parties involved in the case, including Terri herself, sometimes visiting her several times a day. He also reviewed some 30 thousand pages of legal documents and the clinical records over the period 1990-2003.

Most people won't bother taking a half hour to read this report, instead relying upon he-said-she-said from various "news" sources, most of whom are quoting each other rather than knowing anything about the case themselves. With that in mind, I include here some of the highlights of the GAL report:


...25 February 1990... Theresa suffered a cardiac arrest... the cause of the cardiac arrest was adduced to dramatically reduced potassium level in Theresa's body... may be linked, in theory, to her drinking 10-15 glasses of iced tea each day. While no formal proof emerged, the medical records note that the combination of aggressive weight loss, diet control and excessive hydration raised questions about Theresa suffering from Bulimia...

...Theresa spent two and a half months as an inpatient at Humana Northside Hospital, eventually emerging from her coma state, but not recovering consciousness. On 12 May 1990, following extensive testing, therapy and observation, she was discharged to the College Park skilled care and rehabilitation facility. Forty-nine days later, she was transferred again to Bayfront Hospital for additional, aggressive rehabilitation efforts...

...Theresa was not responsive to neurological and swallowing tests. She received regular and intense physical, occupational and speech therapies...

...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...

...Despite aggressive therapies, physician and other clinical assessments consistently revealed no functional abilities, only reflexive, rather than cognitive movements, random eye opening, no communication system and little change cognitively or functionally...Periodic neurological exams, regular and aggressive physical occupational and speech therapy continued through 1994...

...Michael...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...

...Throughout the course of the litigation, deposition and trial testimony by members of the Schindler family voiced the disturbing belief that they would keep Theresa alive at any and all costs. Nearly gruesome examples were given, eliciting agreement by family members that in the event Theresa should contract diabetes and subsequent gangrene in each of her limbs, they would agree to amputate each limb, and would then, were she to be diagnosed with heart disease, perform open heart surgery...even if Theresa had told them of her intention to have artificial nutrition withdrawn, they would not do it...

...in 1999, following extensive bipartisan efforts, life-prolonging procedures were redefined as "any medical procedure, treatment, or intervention, including artificially provided sustenance and hydration..."... It is noteworthy that the general principle of artificial nutrition as artificial life support...is reflected in nearly all state's laws and within the guidelines of end of life care...

...Three independent sets of swallowing tests were performed early in Theresa's medical treatment: 1991, 1992 and 1993. Each of these determined that Theresa was not able to swallow without risk of aspiration (and consequent infection).

Swallowing tests and swallowing therapy address many of the core issues in contention. If Theresa can swallow, then she can take nutrition and hydration orally, and it is argued that she would not elect to stop eating. But to orally eat and drink, Theresa must possess cognitive capacity beyond mere reflex...

...The recognized gold standard test is the modified barium swallowing test... Theresa's three previous tests were barium swallowing tests...

...A particularly disarming aspect of persons diagnosed with persistent vegetative state is that they have waking and sleeping cycles. When awake, their eyes are often open, they make noises, they appear to track movement, they respond to deep pain, and appear startled by loud noises...they can often breathe (without a respirator) and swallow (saliva). But there is no purposeful, reproducible, interactive, awareness...Theresa is in a persistent vegetative state. This evidence is compelling...

...Theresa's neurological tests and CT scans indicate objective measures of the persistent vegetative state. These data indicate that Theresa's cerebral cortex is principally liquid, having shrunken due to the severe anoxic trauma experienced thirteen years ago. The initial oxygen deprivation caused damage that could not be repaired, and the brain tissue in that area continued to devolve...

...Theresa has also far outlived any documented periods from which persons in persistent vegetative states have emerged in any functional capacity. The reasonable degree of medical certainty associated with her diagnosis and prognosis is very high...

...The GAL concludes from the medical records and consultations with medical experts that the scope and weight of the medical information within the file concerning Theresa Shiavo consists of competent, well documented information that she is in a persistent vegetative state with no likelihood of improvement, and that the neurological and speech pathology evidence in the file support the contention that she cannot take oral nutrition or hydration and cannot consciously interact with her environment...


My take on the Guardian ad Litem report is this: that Terri Shiavo died in 1990, and her corpse has been artificially sustained for fifteen years. Through the first four years, both her husband and the rest of her family refused to believe that she was gone; her husband finally accepted that fact in 1994, and her parents have yet to do so.

There are no winners in this tragic tale. I feel sorry for her parents, and doubly so for her husband, who has been vilified in the press.

Having said that, the removal of the feeding tube is cynical at best; such an action allows the courts to pretend that they are not committing euthanasia on what remains of her corpse. One would not treat a dog in her condition so inhumanely. Of course, she is beyond caring what happens to her body - however, in the interests of treating her husband and family humanely it would be better if she were injected with a lethal dose of morphine or kurare.

May she soon rest in peace.