Terri Schiavo is a Florida woman who lived fifteen years in a persistent vegetative state before finally dying of dehydration on March 31, 2005 after her feeding tube had been removed. Terri had become the focus of a fierce battle between those who believed that she would never recover and should be allowed to die; and those who believed that her life, such as it was, should be prolonged indefinitely. On the side of euthanasia, Terri's husband and legal guardian Michael Schiavo; against him, Terri's family, governor Jeb Bush, and the right-to-life movement.
Rarely mentioned in the impassioned debate that swirled around Terri's fate is the fact that her condition was probably the result of an eating disorder, bulimia. Thus Terri's life and death can also be read as a sad commentary on our weight-obsessed culture and the dangerous lengths people - the majority of them women - will go to to achieve a "perfect" body.
Born in 1963, Theresa Marie Schindler was named after Saint Teresa of Avila. The eldest of three children raised in a suburb of Philadelphia, Terri struggled with weight from an early age. By her senior year in a Roman Catholic high school she was 5'3" tall and weighed 250 lbs, but after a period of dieting was able to lose 100 lbs. She may also have started to induce vomiting around this time in order help her control her weight.
In 1982 Terri met Michael in a sociology course at a community college. He was her first boyfriend, and five months later they were engaged. They married in November 1984 and moved to St. Petersburg, Florida two years later; Terri's parents followed not long after. Michael worked as a restaurant manager and Terri as an insurance claims clerk. She was fully bulimic by this time and would regularly go to the bathroom to purge immediately after a meal. Michael was aware of her condition, but not how dangerous it could be.
By 1989 Terri's weight had dropped to 110 lbs and she had stopped menstruating; the couple visited an obstetrician to get fertility services and counselling in order to try and start a family. The obstetrician did not take a full medical history, however, and did not discover Terri's eating disorder.
Early one morning in February 1990 Terri had a heart attack and collapsed in the hallway of her and Michael's apartment. By the time emergency services arrived she had slipped into a coma, and attempts to resuscitate her failed. At this point Michael could have refused interventions to save her, for her brain had been deprived of oxygen long enough that severe and probably irreparable damage was likely. However, he refused to accept that possibility, and Terri was intubated and ventilated. Terri's hospital discharge records note that her heart attack was caused by hypokalemia - abnormally low levels of potassium - a result of attempting to survive on liquids in order to maintain her weight. She was sent to a rehabilitation centre and emerged from her coma two and a half months later, but she never regained consciousness and remained in a persistent vegetative state.
Michael was appointed Terri's legal guardian, with no objection from Terri's parents, and he set about trying to find a way to revive her. He took her to California for an experimental technique which implanted electrical stimulators in Terri's brain, but the attempt was unsuccessful. Back in Florida, where Terri lived in a brain injury care centre, Michael visited her often and took her out, hoping to spark a recovery. He studied nursing at college and eventually became an emergency room nurse. He was a fierce advocate for her care, and it is evidence of his efforts that, though pressure sores are common in the immobile, Terri never suffered from any. He sued the obstetrician who had provided the couple with fertility services for medical malpractice, and the evidence was strong enough for the claim to be settled out of court in Michael's favour. Most of the $1 million he received has been spent paying for Terri's care and fighting in court to end her life.
Much of the debate around Terri's fate centred around how conscious she actually was. During her later life medical evidence showed profound and irreparable damage, a verdict that was confirmed by an autopsy performed after her death. An EEG of Terri's brain revealed no electrical activity, and a CAT scan in 2002 showed massive atrophy of brain tissue. She no longer had a cerebral cortex, and the only tissue remaining was the brain stem that controls autonomic functions such as breathing and heart beating. It was only a feeding tube giving her sustenance that prolonged her life - an ironic twist, given that it was her unwillingness to eat in the first place that caused her condition. And it was this feeding tube that became the focus of a long and bitter tug of war between Terri's husband and her parents.
By 1994 Michael had accepted that his wife was not going to recover and discontinued most of the therapies she received; in 1998 he filed a petition to have her feeding tube removed. Although she left no living will, he argued - and her sister concurred - that she had indicated verbally that she wouldn't want to be kept alive as a vegetable.
Terri's parents and her husband were initially close - he had called them along with 911 when Terri collapsed - but the relationship has long since soured. They opposed Michael's attempts to remove the feeding tube, arguing that as a Catholic Terri would not have chosen euthanasia. They wanted to believe that Terri had a chance to regain some semblance of normal life; they claimed that their daughter was responsive, and used heavily edited videotapes to prove it. (The fact that Terri's eyes were open helped lend credence to the idea that she was aware of her surroundings, so deeply rooted is the idea that the eyes are the windows to the soul.) They even accused Michael of causing Terri's condition, pointing to extensive physical trauma revealed by a bone scan of Terri taken in 1991 - but which they didn't know about until 2002 - as evidence of domestic violence. They charged that Michael wanted her feeding tube removed because he was afraid she would recover and testify against him.
Most medical experts concur that the trauma is consistent with Terri's fall and the subsequent attempts to resuscitate her.
Michael was successful in having the feeding tube removed three times, only to have the removal overturned by the courts. The case went all the way to the Supreme Court, which declined to rule in favour of Terri's parents and their right-to-life supporters. Terri's body finally went the way of her mind, fifteen years after her brain was irreparably damaged and thirteen days after her feeding tube was removed for the last time.
Michael is now free to marry his new partner and mother of his two children.
And we should all think about writing living wills of our own, so that our wishes will be carried out even if we are unable to speak for ourselves.