Woman's Feeding Tube Is Ordered Reinstated

Manuel Roig-Franzia
Washington Post
October 22, 2003
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MIAMI, Oct. 21 -- Gov. Jeb Bush ordered doctors to resume tube-feeding a severely brain-damaged woman Tuesday after an unprecedented vote of the Florida legislature gave him authority to override the wishes of her husband and the orders of the courts.

The legislature intervened, at the urging of Bush (R), six days after doctors removed the feeding tubes that were keeping alive Terri Schiavo, 39, who has been in a vegetative state for 13 years since collapsing and going into cardiac arrest. Before the legislature's vote, Schiavo had been expected to die within days from lack of nourishment.

"This is a response to a tragic situation," Bush told reporters in Tallahassee. "People are responding to cries for help, and I think it's legitimate."

A hospital in Clearwater began giving fluids intravenously to Schiavo, who was cheered by demonstrators as she was moved from a hospice in Pinellas Park earlier in the evening.

Both sides in the fiercely contentious right-to-die debate described Bush's decision as a singularly significant moment in the long, heated history of patients kept alive by artificial means.

"It's beyond extraordinary, bordering on flat-out irresponsible," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine. "The things that could come flying out of that Pandora's box could tie up the legislature for a long time."

But Wesley J. Smith, an attorney with the International Task Force on Euthanasia and Assisted Suicide, called Bush's action "an important first step in revisiting this issue of dehydrating people to death."

Prominent political leaders have intervened in right-to-die cases before, including Missouri then-Attorney General William Webster, who sought to block the removal of life-support systems from Nancy Cruzan, who was eventually disconnected from a feeding tube in 1990 after her case became the first right-to-die dispute to go before the U.S. Supreme Court. But bioethics experts could not recall another instance before Tuesday's Florida vote when an entire legislature stepped in to pass a law that would overturn court rulings in an ongoing right-to-die case.

The bill passed Tuesday was narrowly tailored to fit the Schiavo case. It limited the governor's authority to intervene in cases in which there is no living will, the patient is in a persistent vegetative state and family members are challenging the removal of feeding tubes.

Even so, critics say the law could clear the way for dissident family members to challenge everything from organ donations to autopsies.

"If you spread out that authority to a wider circle, you're going to get logjam after logjam after logjam," Caplan said.

Bush sided with Schiavo's parents, Robert and Mary Schindler, who have been locked in a bitter, decade-long legal fight with her husband, Michael Schiavo. A court-appointed physician had said Schiavo's cognitive abilities could not be restored, countering the findings of doctors working for the Schindlers who argued that she could be rehabilitated using controversial therapeutic techniques, such as administering large amounts of oxygen.

Michael Schiavo won time and again before Tuesday's vote, emerging victorious in Florida's state courts, its Supreme Court, in the federal courts and in the U.S. Supreme Court, which refused to hear the case.

"Miracles do happen," Patricia Eddy, a Schindler family friend, said Tuesday.

Terri Schiavo left no written instructions, but her husband testified that she told him she would not want to live in a vegetative state. The courts have been clear, legal experts said, that spouses have the authority to make decisions in such cases. Indeed, the Schiavo case presented little in the way of new legal issues related to a patient's right to die, even though its emotional appeal was vast, judging from the deluge of e-mails and phone calls to Florida lawmakers over the past week.

"Things are going a little crazy," said William Allen, director of the Bioethics, Law and Medical Professionalism program at the University of Florida. "This has been legally settled for over a decade."

The power of video images broadcast repeatedly on 24-hour cable news programs and over the Internet was undeniable as interest in the case surged in recent days. Images of Terri Schiavo appearing to smile, react to voices and grunt were proof, the Schindlers said, that something was clicking in her brain, that there was hope she could regain cognitive abilities. But Michael Schiavo's experts said they were nothing more than reflex actions, common among patients with brain injuries.

Because Terri Schiavo is not in a coma, her eyes are often open. Patients who are in comas usually have their eyes closed and are in a "sleep-like state" from which they cannot be aroused, experts say. But vegetative patients, such as Schiavo, have almost normal sleep and wake cycles; they sometimes move their lips or their hands.

"It's much harder on families and much harder on health care providers to accept," said Ronald Cranford, a professor with the University of Minnesota Bioethics Center, who worked as a consultant to Michael Schiavo.

The big question is whether these patients have cognitive abilities or have hope of regaining them. Allen, who has seen images of Schiavo's brain at conferences, said it is so damaged that key portions are reduced "to mush" and it is clear her condition will not improve.

Attempts to overturn the legislature and Bush are almost a certainty. Michael Schiavo's attorney, George Felos, tried unsuccessfully to get a federal court order blocking the new bill before it was passed Tuesday.

Schiavo's case attracted the attention of an assortment of national rights groups, including the well-known antiabortion activist Randall Terry, all of whom pressed Bush and state lawmakers to take action before Terri Schiavo dies.

"I can't understand the insanity of Florida," Cranford said. "You have a governor who has no clue what he's doing, but knows how to pander to the special interest groups."

The bill was pushed through the legislature at a stunning pace following negotiations between Bush and the key lawmakers. "This is the legislature that couldn't agree on anything this year, and they got together on this in 18 hours," said Pat Anderson, the Schindlers' attorney. "I'm astonished."

House Speaker Johnnie Byrd, a conservative Republican from Plant City near Tampa and candidate for the U.S. Senate, said, "Every life is precious."

"We're talking about a human life; there's no second chance," he said. "There's no do-over if we make a mistake."