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Medscape
30-07-2025
- Health
- Medscape
Terri Schiavo's Legacy: When to Ethically Stop Life Support
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine in New York City. Twenty years ago this month, from the time I'm talking with you, in March 2005, a young woman named Terri Schiavo was allowed to die. It was one of the most controversial, and probably the most important, end-of-life-care cases ever to unfold in the United States. Terri was left permanently unconscious after a heart attack. Her husband [Michael Schiavo], after efforts were made to see if they could revive her and after efforts were made to see if she really was permanently unconscious, basically said she would not want to be in this state. She was kept alive by artificial nutrition, artificial fluids, and he said she just wouldn't want to be hereunable to think, sense, or feel, implying, "I know her, I have decision-making authority, and I want her feeding tubes and her artificial fluids disconnected. I want her to be allowed to die. That's what she would want." He wasn't saying that's what he would want. He said that's what she would want, acting as her, if you will, guardian or person making a substituted judgment. Terri's parents and her brother did not agree. They felt that Terri might recover. They also argued that they weren't totally convinced she was completely unable to communicate, think, feel, or hear. They made tapes when they went to visit her that suggested that she wasn't totally unconscious and was somewhat responsive. They went to court in the state of Florida where Terri was after her heart attack in a long-term care facility and engaged in a legal battle with Michael, the husband, to keep her alive. That fight took over 8 years, I think. It went up and down the Florida court system as to who could make the decision on whether artificial nutrition and fluids could be stopped. The fight reached 14 Florida courts, up and down their appellate system, then five federal courts, then intervention from the US Congress on the side, I should add, of Terri's parents and siblings. There were people arguing from the floor of Congress, including Congressman David Weldon and Senator Bill Frist [both of whom are physicians], that they didn't think she was in a permanent vegetative was very controversial because they made that diagnosis based on videos, without seeing her. Ultimately, the Supreme Court was approached. They said they were not going to hear the case, but the last court decision gave authority to the husband. On March 31, 2005, Terri's artificial life support was discontinued and she died. That case has reverberated throughout American healthcare ever since. It's not just a story of how we got to where we are in terms of having the right to stop care that a person doesn't want. This set the stage for stopping care that some people think is not medical care — food and water — but others argue quite vociferously that it's technology coming through a tube made out of special solutions,not eating pudding off a spoon. One issue that seems to have been resolved by the Schiavo case is that artificial feeding, artificial life support, and artificial fluids are medical technologies and can be stopped. At the same time, we have had many arguments since about how you adequately diagnose permanent vegetative state. Some scientists today are arguing that even with what we think is permanent vegetative state, there still may be some consciousness there. I don't believe that was true at all for Terri because on autopsy, her brain had shrunk to the size of a walnut. Her optic nerves had disconnected from her brain. She would not have been able to sense, feel, observe, or respond to any stimuli. Do we have to make a more precise diagnosis of permanent vegetative state before we get into arguments about what to do next? I do believe also that it's important, if you are dealing with someone who's terminally ill or has a serious illness, to get the discussion going early about who's in charge. We still have fights between husbands, families, sisters, and cousins coming in about who has veto power or decision-making power. The earlier we can establish who it is that the patient wants to speak for them if they can't, the better. Reenacting that war that we saw in the courts and Congress over Terriis a lesson that early communication, although it's hard to do, can really save terrible and disturbing emotional battles — not only for the family, but also for the nurses, doctors, and everybody who's involved in treating someone when one of these fights breaks out about stopping food and water, shutting off the ventilator, or stopping dialysis or antibiotics. Terri has quite a legacy. She left us with the understanding that it is possible legally and ethically to end life support, that someone else can make that decision, and that a [spouse] has more standing than the rest of the family. Given all that, it's still important to engage in early, explicit discussion about who ought to be in charge if the patient can't be. I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
Yahoo
30-03-2025
- Health
- Yahoo
Terri Schiavo: 20 years after her death, her case still shapes end-of-life debates
The Brief Terri Schiavo was a Florida woman who lived in a persistent vegetative state for 15 years. Her husband claimed she did not want to live on life support; her family disagreed, and their battle reached the U.S. Supreme Court and even the White House. Decades later, many Americans still lack documented end-of-life care plans. CLEARWATER, Fla. - Twenty years have passed since the death of Terri Schiavo, the Florida wife who had been in a persistent vegetative state for 15 years before her feeding tube was removed in March of 2005. Her husband insisted that Terri told him she'd never want to be on life support. But her family disagreed. Terri died on March 31, heading into her 14th day without food and water amid what was the final legal setback for her parents after the U.S. Supreme Court again refused to hear their plea to reinsert her feeding tube. Terri's life and death captivated the country and fueled conversations about end-of-life care and the necessity of the documents, known as advance directives or living wills. The backstory Terri Schiavo was born Theresa Marie Schindler to Robert and Mary Schindler on December 3, 1963, according to She was the first of three children the Schindlers would have. In 1983, Terri met Michael Schiavo. The couple married a year later and later moved from Pennsylvania to Florida. Dig deeper In 1990, at 26 years old, Terri collapsed at her home in Florida. Paramedics responded, and she was admitted to a local hospital. Heart attack and drug involvement were ruled out. Doctors never determined the underlying cause of her collapse but she was diagnosed with hypoxic encephalopathy – a neurological injury caused by lack of oxygen to the brain. She was placed on a ventilator and eventually had to have a feeding tube. Days after her feeding tube was removed, she died on March 31, 2005. Big picture view Terri's case divided her family and the country over the right to die and sparked end-of-life debates. The battle went through several courts and even to the White House after her husband declared that his wife stated she did not want to ever be on life support. Her parents refuted that claim, making every effort to keep her alive. "Schiavo was huge landmark in maintaining the rights of spouses to stop any and all medical interventions," Arthur Caplan of New York University told ABC News in 2015. "But it raised all sorts of uncomfortable questions about when it becomes acceptable to remove someone from life support, even when the law makes it clear." A 2005 USA TODAY/CNN/Gallup poll showed that after Terri's death, 52% of Americans believed the feeding tube should've been removed, while 42% believed it should've remained. Timeline The court battle over Terri's condition, care, and preferences lasted for over a decade. 1990: Terri collapses at home on February 25. She's admitted to Northside Hospital in St. Petersburg, Florida. Doctors diagnose her with a brain injury. 1991: Terri is transferred to Sable Palms Nursing Facility in Largo, Florida, for physical rehabilitation. 1993: Terri's husband and her family become at odds over the course of her treatment. Michael's guardianship is challenged in court by Terri's family. 1998: Michael's attorney files a petition to withdraw life support. 2000: Judge George W. Greer in Pinellas-Pasco's Sixth Judicial Circuit hears the petition to withdraw life support and orders Terri's feeding tube to be removed. Terry is transferred to the Hospice of the Florida Suncoast. Terry's family tries to appeal the ruling, but the Florida Supreme Court and the U.S. Supreme Court decline to hear the case. 2001: Terri's feeding tube is removed, but the judge issues an injunction allowing the tube to remain. 2002: A medical evidentiary trial is held where the judge ultimately rules that Terri is in a peristent vegetative state and orders the feeding tube to be removed. 2003: The Florida Legislature holds a special session and passes "Terri's Law", giving authority to then-Governor Jeb Bush to reinsert Terri's feeding tube. The law is ultimately ruled unconstitutional. 2005: The U.S. Supreme Court declines to hear the case. After more legal back-and-forth and commentary from Congress and Gov. Bush's brother, President George W. Bush, a judge rules for Terri's feeding tube to be removed. She dies nearly two weeks later. Why you should care Twenty years after her death, it seems that most Americans don't document how they would like to handle their own end-of-life care. According to Hospice News, many Americans know the types of end-of-life care they wish to receive, but only 22% have documented their wishes. The outlet also reported that about 25% of those who have documented their wishes are white. African Americans represented 22%, Hispanics 21% and Asians 7%. "Advance care planning is something that can benefit all people. Unfortunately, there is a gap between thinking about end-of-life planning and actually documenting those wishes," Dr. Joseph Shega, executive vice president and chief medical officer at VITAS, told the outlet. "I can't stress enough how valuable advance care planning is for all Americans. It allows patients to make their preferences known early and is useful as they become seriously ill and enter advanced disease stages." The Source The Associated Press contributed to this report. The information in this story came from a mix of sources, including historical records, court rulings, and FOX TV coverage of Terry Schiavo's case. Specific details about Schiavo's life and medical condition are cited from while legal proceedings and public reaction are drawn from past reporting by outlets such as ABC News and USA TODAY/CNN/Gallup. The article also references expert opinions, like those from Arthur Caplan of New York University, and recent statistics on end-of-life planning from Hospice News. This story was reported from Los Angeles.
