Till death us do part

For love or money? That's the question surrounding lawsuits in Florida that by the end of July may result in the death of Terri Schiavo, 37, a St. Petersburg woman institutionalized since February 1990 with severe brain damage.

It has been more than 11 years since Mrs. Schiavo suffered a heart attack at age 25. An eating disorder-related potassium imbalance triggered the seizure, squelching for five minutes the flow of oxygen to Mrs. Schiavo's brain. She suffered acute and permanent brain damage, and lost all speech and most cognitive ability. Initially, a neurologist classified Mrs. Schiavo as "PVS"-in a "persistent vegetative state," or "eyes-open" state of unconsciousness. Other doctors said such a diagnosis was premature.

For a decade Mrs. Schiavo, a dark-haired woman with large brown eyes, lived in a succession of hospitals and nursing homes. Today, she is confined to a tiny room with a slim bed, chest of drawers, and a single aluminum window at Woodside hospice in Largo, Fla., a secluded, pine-shaded facility where terminally ill people go to die. She receives food and water through a tube. But though her condition is considered "terminal" according to Florida statute, she is not terminally ill in the sense that she is actively dying. She also is not in PVS, according to her parents and others who visit her regularly.

"When we come to visit, she'll see us and laugh ear-to-ear," said Bob Schindler, Mrs. Schiavo's father. "Her mother will hug her goodbye and Terri will start to cry." Mrs. Schiavo often turns her head purposefully when people speak to her, according to affidavits filed this year by six neurologists. She makes guttural sounds that appear to be attempts at speech. She also opens her eyes during the day and closes them at night to sleep.

A total of nine neurologists have also stated that Terri Schiavo is not in PVS. "It is obvious to me that Ms. Schiavo is a viable human being who is at least semi-responsive to her environment," physician Richard Neubauer stated in a May 2001 affidavit. Dr. Neubauer is a recognized expert in hyperbaric oxygen therapy, a type of treatment he believes might improve Terri's condition. "She is not brain dead nor is she in a persistent vegetative state."

So why did a Florida appeals court on July 11 decide that Mrs. Schiavo should die sometime after July 20, unless a circuit court judge changes his mind? And why is Mrs. Schiavo at Woodside, a home for the terminally ill, in the first place? Because her husband Michael ordered her transferred there last year.

Mrs. Schiavo's trip to the hospice actually began in 1997, when Mr. Schiavo hired as his attorney George Felos, a yoga devotee and right-to-die specialist. Mr. Schiavo told Mr. Felos that before her attack, his wife had given him an "oral living will," telling him that if she ever were radically incapacitated, she would not want to be kept alive by artificial means. Terri Schiavo is not hooked to any heroic lifesaving devices, but Mr. Felos had in 1990 successfully argued before the Florida Supreme Court that tube-feeding constitutes artificial life support. In 1997, Mr. Felos filed with the Pinellas County Circuit Court, on Michael Schiavo's behalf, a petition asking that doctors withdraw Mrs. Schiavo's food and water.

When Mrs. Schiavo's parents Bob and Mary Schindler learned of the petition three months later, they were devastated. Since 1993, they had locked legal horns with Michael Schiavo over their daughter's future and his use of medical funds set aside for her care. That year, he'd cut off the Schindlers' access to her medical records. In addition, he refused to allow any physicians to examine her without his specific approval. To block Mr. Schiavo's attempt to end her life, the parents filed an objection to his petition.

The Schindlers charged that Mr. Schiavo was in a hurry to bury their daughter so he could inherit $700,000 in medical funds that remained from a 1992 malpractice settlement won on Mrs. Schiavo's behalf-and marry the woman he'd been engaged to for five years.

But when the life-support petition went to trial in 2000, Judge George Greer ruled that neither Mr. Schiavo's financial interests nor his love life were relevant to the case. Doctors testifying on Michael Schiavo's behalf called his wife's apparently conscious responses-laughing, crying, turning toward visitors-"reflexes." Mr. Schiavo and two of his relatives testified that Mrs. Schiavo had made statements to them, when healthy, about not wanting to be hooked up to machines.

On Feb. 11, 2000, Judge Greer granted Mr. Schiavo's petition to terminate his wife's life. On April 24, 2001, after both the Florida and U.S. Supreme Courts had rebuffed the Schindlers' appeals, Woodside caregivers removed Mrs. Schiavo's feeding tube-her only source of nutrition-and for 60 hours she slipped slowly toward her grave. But on April 26, the death march abruptly ceased. Frank Quesada, another circuit court judge, ordered feeding resumed after the Schindlers presented evidence that Mr. Schiavo had lied about his wife's "oral living will."

It is no surprise that Mrs. Schiavo, a severely disabled but apparently aware human being, should be targeted for death. Beginning in the 1980s, bioethicists-some of whom have no medical training and no objective moral anchor-began to debate the emerging "ethical problem" that disabled and frail elderly people were living too long. Wesley J. Smith, an attorney for the Anti-Euthanasia Task Force, shows in Culture of Death (Encounter Books, 2000) that some argued that patients who couldn't feed themselves had descended to a subhuman moral rank with a "quality of life" no longer worth sustaining. Withdrawing food and water from such "un-people" would be the same as withdrawing, say, artificial respiration from patients who could not breathe on their own.

Many doctors and theologians disagreed that administering nutrition to a patient amounts to artificial life support. Theologian Paul Ramsey, for example, argued that withholding food from an actively dying patient who could no longer assimilate food and water could be humane. But withholding nutrition to cause death is wrong because it is not based on the patient's actual medical needs, but rather on the perceived moral worth of a human life.

Despite such objections, the slippery ethical slope rapidly became an established beachhead. Dehydrating disabled people to death, a practice that seemed barbaric only two decades ago, today is legal in all 50 states. Among those patients most commonly targeted are those profoundly disabled-people like Terri Schiavo.

Though Michael Schiavo claims today that his wife said she would not want to live cognitively disabled, receiving food through a tube, he apparently forgot that statement when, on Nov. 5, 1992, he sat in the witness box in Courtroom B of the Pinellas County Courthouse in Clearwater, Fla. From behind a wooden railing to his left, six jurors could see that he was a blond young man, tall and strong, but with blue eyes drawn with grief. It had been nearly three years since Mrs. Schiavo's heart attack. While she lay institutionalized at Mediplex, a nearby rehabilitation facility, her husband's attorneys laid out for the jury in Courtroom B a malpractice case against Stephen Igel, a Pinellas County doctor Mr. Schiavo said could have prevented his wife's seizure.

Mr. Schiavo's then-attorney Glenn Woodworth let the jury know that his client had enrolled in nursing school to learn to care for his wife, and that he wanted to care for her at home. "If you had the resources available to you," Mr. Woodworth asked, alluding in part to any malpractice award the jury might grant, "if you had the equipment and the people, would you do that?"

"Yes, I would-in a heartbeat," Mr. Schiavo replied. "She's my life and I wouldn't trade her for the world." Grief closed Mr. Schiavo's throat and he seemed unable to go on. He bowed his head while Mr. Woodworth asked the judge to grant a moment of pause. Then, collecting himself, Mr. Schiavo continued haltingly: "I believe in the vows that I took with my wife, through sickness, in health, for richer or poorer. I married my wife because I love her and I want to spend the rest of my life with her. I'm going to do that."

On Nov. 10, 1992, the jury awarded Michael and Terri Schiavo nearly $2 million for damages, future rehabilitation, and medical care. Three months later, Michael Schiavo received the money. Four months after that, he made his first attempt to end his wife's life.

Shortly after receiving the malpractice money, Mr. Schiavo moved Mrs. Schiavo from the Mediplex rehab facility to Sabal Palms nursing home. There, he added a "Do Not Resuscitate" order to his wife's medical record and in July directed caregivers to withhold from her antibiotics needed to treat a urinary tract infection. He knew, he later said in a deposition, that his wife would likely develop sepsis-poisoning of the bloodstream-and die. Nursing home employees refused to comply, saying such an act would be illegal.

The Schindlers contend that Mr. Schiavo's attempt to end his wife's life so soon after pleading with a malpractice jury for money to pay for her care and rehabilitation show that he either misled the jury or is lying to the court now about Mrs. Schiavo's "oral living will." If she said she would not want her life sustained by artificial means, why would Mr. Schiavo sue for her long-term care? If he sued hoping his wife would recover, but now wants to disconnect her feeding tube because she has not progressed during the past eight years, why did he try to end her life just four months after receiving the funds to rehabilitate her?

Most Florida newspapers downplay Mr. Schiavo's two adulterous relationships during his wife's ordeal. (Attorney George Felos objected to WORLD's use of the word adultery. Is it so awful, he asked, "that a young man who lost his wife might seek comfort in the arms of another woman?") Mr. Schiavo has admitted affairs with a Cindy Brashers during the 1992 malpractice trial and with a Jodi Centonze soon afterwards. Mr. Schiavo is now engaged to Jodi Centonze.

WORLD asked Mr. Felos why, if Mr. Schiavo really isn't after his wife's medical fund money as the Schindlers charge, his client doesn't simply divorce his wife and marry Miss Centonze? "He wants to carry out his wife's wishes not to be kept alive artificially," Mr. Felos said. "He's afraid the Schindlers won't do that."

The media portray the Schindlers as well-meaning but unreasonable parents who don't know when to let go. Mary Schindler manages a Hallmark store in St. Petersburg Beach. Bob Schindler, a former distributor and engineer, made the decision last year to resign from his job so that he could devote his full attention to his daughter's case. The two are practicing Roman Catholics. "We're fighting for Terri's life to the end," he said. "Any parent would."

All the fighting, it seems, has been uphill. The Schindlers, for example, had little money to pay attorneys and no money to hire or depose expert witnesses for the 2000 life-support trial. Meanwhile, using the fund meant for his wife's care, Mr. Schiavo has paid George Felos at least $200,000 to expedite her death.

During the 2000 trial, neurologist James Barnhill testified on behalf of Mr. Schiavo about Mrs. Schiavo's condition. Based on his review of her CAT scans, he told the court that most of her brain was destroyed, replaced by scar tissue and spinal fluid, leaving her no hope of recovery. But Florida neurologist William Hammesfahr, in a June 2001 affidavit, stated that his own review of Mrs. Schiavo's CAT scans revealed significant, viable brain tissue. "The CAT scan readings or MRI readings of Ms. Schiavo's brain were misrepresented to the court during the trial in January 2000," Dr. Hammesfahr said.

Mr. Schiavo declined to be interviewed for this article and has not allowed new doctors to examine Mrs. Schiavo in person. On June 25, 2001, Tampa Bay television reporter Laura McElroy asked him why: "There's six doctors who say that they could help Terri. Why not let them examine her?" Mr. Schiavo responded, "That would be up to the judge." Ms. McElroy asked, "But would you like to see Terri improve if there's that possibility?" He responded, "Ah, Terri has been through years and years of rehabilitation. There's no more improvement for Terri."

Michael Schiavo is his wife's sole medical guardian; he needs no judge to approve a doctor's visit, according to Pat Anderson, the parents' lawyer. Further, Ms. Anderson said her office's "painstaking review" of Mrs. Schiavo's medical records revealed "no evidence of systematic, proper rehabilitation efforts. We do, however, find instances where Mrs. Schiavo's physicians recommended physical and occupational therapy, and her husband would not permit it."

Neither would Judge George Greer permit Ms. Anderson to submit new evidence that surfaced the day after Mrs. Schiavo's feeding was stopped. On April 25, 2001, a St. Petersburg deejay batted the Schiavo case around on a radio call-in program. One listener who called in was Cindy Brashers Shook, the woman with whom Mr. Schiavo had a 1992 affair. Mrs. Shook, now married, portrayed Mr. Schiavo in a negative light.

The Schindlers heard about the call and, with their daughter's dehydration already underway, immediately called a private investigator, who interviewed Mrs. Shook. She told the investigator that during their relationship Mr. Schiavo said things like, "How the hell do I know what to do?" about his wife: He and his wife were young, the conversations went; they hadn't been married that long, and had never discussed such life-and-death topics.

On April 26, two days after Terri Schiavo's feeding tube was removed, Pat Anderson contacted Judge Greer. Mrs. Shook's statement, she told him, was evidence that Mr. Schiavo fabricated his wife's "oral living will." But Judge Greer said more than a year had passed since the 2000 trial, and it was too late for new evidence. Within an hour, Ms. Anderson filed a new lawsuit before Judge Frank Quesada, charging Mr. Schiavo with perjury. Judge Quesada ordered Mrs. Schiavo's feeding resumed. Mr. Felos then threw a legal counterpunch by asking a Florida appeals court to enforce Judge Greer's original mandate, and have Terri Schiavo put to death by removing her feeding tube.

Last week, the appeals court issued its opinion: The panel affirmed Judge Greer's denial of new evidence, and reversed Judge Quesada's injunction to resume feeding Mrs. Schiavo. But the panel also denied Mr. Felos's motion to enforce Judge Greer's life-support removal mandate, and directed Judge Greer to delay such enforcement until after July 20. The court applied a narrowly construed rule to the case that permits a party to challenge a judgment regardless of time limitations when "it is no longer equitable that the judgment or decree" be applied.

Bob and Mary Schindler have until July 20 to prove that it is "no longer equitable" that their daughter should be dehydrated until dead.