Friday, March 31, 2006

The Death of Terri Schiavo - Part Two

(continued from previous post)

The closest thing to a collaborative effort of bishops speaking out on Terri's behalf came from the Florida Conference of Bishops. On February 28, they issued a statement titled "Continued Concerns for Terri Schiavo". While not as strong as it might have been, the statement was unequivocal in asserting Terri's right to continue receiving food and water, saying "As long as they effectively provide nourishment and help provide comfort, we should see them [food and water] as part of what we owe to all who are helpless and in our care." Furthermore, they quoted Pope John Paul II's address to the International Congress on the Vegetative State:
I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering.

The bishops' use of the Holy Father's statement indicates that they understood him to be authoritatively presenting Church teaching. They understood that Terri's case was not about "end-of-life" issues or the "right-to-die", but was about providing the most basic human care to someone in need.

The Holy See itself also spoke out on behalf of Terri's right to live. On February 24, Cardinal Renato Martino, the President of the Pontifical Council for Justice and Peace, said on Vatican Radio, "If Mr. Schiavo succeeds legally in causing the death of his wife, this not only would be tragic in itself, but would be a grave step toward the legal approval of euthanasia in the United States." He concluded his remarks by noting that "No one can be the arbiter of life except God himself." Less than a week later, on March 7, Cardinal Martino issued an even stronger statement. After saying that Terri would have death "inflicted on her over a number of terrible days, even weeks," the cardinal went on to observe that "the state of Florida has many laws on its books which protect animals", and that such animals received a greater protection under the law than did Terri. He demanded that "It must stop here and now", and concluded by saying that:
Society must realize that we can never inflict this sort of death on a human being, on any other creature, without each and every one of us and society as a whole suffering a terrible fate.

In what seemed to be a response to the progressive Catholic moralists who supported the removal of Terri's feeding tube, the Vatican's top bioethicist, Bishop Elio Sgreccia, president of the Pontifical Academy for Life, said on March 3 that removal of Terri's feeding tube would be "direct euthanasia", adding that "withdrawing Schiavo's gastric tube would not be a matter of allowing her to die, but would inflict death." The bishop explained that the academy usually does not comment on specific cases before courts, but "silence in this case could be interpreted as approval." Going farther than other churchmen had up to that point, Bishop Sgreccia denounced the rulings of the courts, saying:
As far as we are concerned, denying someone access to food and water is a cruel way of killing someone...Taking into account only medical and anthropological considerations, we feel an obligation to affirm that such a decision violates the rights of Terri Schiavo and, therefore, constitutes an abuse of judicial authority.

The "Exit Protocol"

In spite of the lobbying of the Schindlers, the untiring work of friends and volunteers on their behalf, the protests and witness of those praying for and defending Terri's right to life, and the courageous witness of some bishops and the Holy See, the efforts to save Terri failed and she died on the morning of March 31. While her death was reported and lamented worldwide, few suspected beforehand that the circumstances of her death would be subject to the cruelty, distortions, and media "spin" that had characterized so much of the coverage of the struggle over her life.

In spite of the lobbying of the Schindlers, the untiring work of friends and volunteers on their behalf, the protests and witness of those praying for and defending Terri's right to life, and the courageous witness of some bishops and the Holy See, the efforts to save Terri failed and she died on the morning of March 31. While her death was reported and lamented worldwide, few suspected beforehand that the circumstances of her death would be subject to the cruelty, distortions, and media "spin" that had characterized so much of the coverage of the struggle over her life.

One of the "memes" continually appearing in media was that Terri was dying a "peaceful", "quiet" death. Michael Schiavo and his attorney George Felos appeared on television numerous times and told viewers that Terri was going to simply "slip away". Some defenders of removing her feeding tube went so far as to describe death by dehydration and starvation as "euphoric." Such fanciful characterizations of Terri's death defied not only what many would regard as common sense, but medical evidence supplied by the very hospice in which Terri's death occurred.

Last fall Cheryl Ford, RN, a nurse from Tampa who has been very active in the efforts to save Terri's life, undertook a review of medical records from when Terri was first admitted to Woodside Hospice, on behalf of the Schindlers. Woodside Hospice is run by Hospice of the Florida Suncoast. It is of interest to note that Michael Schiavo's attorney, George Felos, was a member of the Board of Directors of Hospice of the Florida Suncoast until the Terri Schiavo case began to attract widespread public attention a few years ago.

In her research, Ms. Ford found a document titled "Exit Protocol" in Terri's file. The document is on Hospice of the Florida Suncoast "Patient Care Notes" stationery, and "Symptom Management Orders" stationery. It is dated April 19 & 20, 2001. They are signed by Lisa Miller, Pharm. D, a clinical pharmacist on the staff of Hospice of the Florida Suncoast, and Dr. Victor Gambone, a physician affiliated with the hospice. The documents include the clinical pharmacist's notes of her conversation Dr. Gambone, and the order for medications signed by Dr. Gambone. The document was produced in anticipation of the first time Terri's feeding tube was removed, in 2001. It lays out, in clinical detail, the procedures to be followed in bringing about Terri's death by starvation and dehydration. It is too lengthy to be reproduced here in its entirety. However, a verbatim transcription is available at the March 24 post of my weblog, Thrown Back and the scans of the documents themselves are also available there for download.

Several parts of the "Exit Protocol" are worth summarizing here. After describing how Terri's nutrition and hydration, including daily vitamins, are to be discontinued, the document has the following note:
3. Monitor symptoms of pain/discomfort. If noted, medicate with Naproxen rectal suppository 375 mg Q8* prn.

[Q8* prn = "every 8 hours as needed". Naproxen is a pain-reliever, available in it's over-the-counter version Aleve.]

We were told repeatedly that dying by denial of nutrition and hydration was, as Michael said on the "Larry King Live" program, "painless and probably the most natural way to die". But if it's painless, then why was it necessary to "monitor symptoms of pain/discomfort", and why would medication be needed for that pain and discomfort?

Another section of the document deals with the breakdown in skin integrity which occurs in the "peaceful" death Terri endured:
4. Signs of compromised skin integrity — continue vigilant skin care, provide moistener to lips, consult wound-care specialist if needed.

As the body dehydrates, the skin loses its tone and dries out. Left untreated, this will lead to cracking and bleeding. The lips are even more sensitive in this respect. "Vigilant skin care" is the liberal use of lotions and moisteners to mask these symptoms. The lips must be continually swabbed with special moisteners, and have lip balm applied to them. In the last stages, though, in spite of such measures, skin breakdown often occurs. Because of the body's debilitated state, normal healing mechanisms do not function. Hence the need to consult wound-care specialists to deal with ulcers and open sores.

Another aspect of "slipping away" by starvation and dehydration is "terminal agitation":
7. Multifocal myoclonus or terminal agitation (sometimes caused by electrolyte imbalance). Consider diazepam rectal administration 5-10 mg. May repeat in 4 hours if not resolved then daily - twice daily as needed.

Myoclonus is twitching or spasm of the muscles. Multifocal means "occurring in many different parts of the body". This is usually the result of imbalance in electrolytes, the chemicals, such as salt, potassium, and calcium, which make your bodies internal electrical "batteries" work. Nerve impulses and muscle contractions are governed by electro-chemical reactions utilizing these chemicals. Dehydration causes these chemicals to be out of balance, interfering with normal nerve and muscle function. This can result in nerves and muscles "firing off" uncontrollably, causing spasm. The patient will writhe and become extremely agitated. The experience is similar to muscle cramps resulting from strenuous exercise (especially when one has sweated profusely), only occurring repeatedly all over the body. Diazepam (more commonly known as Valium) is a muscle relaxant.

In Dr. Gambone's medical orders, under the heading of "Pain", the doctor orders morphine:
Morphine (MSIR) 5-10 mg IM [IM = intra-muscular; that is, injected into a large muscle such as the buttocks] or by rectal suppository.

If no relief after reaching upper range, repeat dose in 1 hour and increase subsequent doses by 50% q 3 hour prn [every 3 hours as needed].

The use of morphine for pain requires little explanation. Here morphine is specifically prescribed for the pain Terri isn't supposed to be feeling. George Felos, under questioning from the press, admitted on March 29 that Terri had in fact been given morphine. In spite of this fact, and the descriptions by the Schindlers and others of Terri's "emaciated" condition, Felos said he "saw no evidence of any bodily discomfort whatsoever."

Terri's "peaceful", "quiet" death required the use of pain-relieving suppositories, muscle relaxants, constant swabbing of her mouth, and injections of morphine to manufacture. Most of the so-called "treatment" given under Terri's "Exit Protocol" was in fact not treatment at all. It was a regimen of medication intended to mask the symptoms of dying by starvation and dehydration, in order to perpetrate an illusion: the illusion that she was peacefully "slipping away", when in fact she was dying in a painful and brutal way.

The Husband Who Wasn't There

Terri's "quiet" death was not the only illusion created by George Felos and his accomplices in the mainstream media. Felos worked very hard to overcome Michael Schiavo's cold persona so as to portray him as a caring, sympathetic husband. This took some doing, as Michael's long-standing adulterous relationship with a live-in lover naturally cast doubt on his motivations and interests regarding Terri. But the illusions and spin were not limited to when Terri was alive; they also carried over into the descriptions of Terri's death itself.

The first indication of how Terri's death would be spun by George Felos and Michael's sympathizers appeared on March 28, 4 days before Terri died. CBS News erroneously ran an obituary of Terri on its website. While CBS quickly realized its error and removed the obituary, it was nonetheless up long enough to be reported by talk-show host Glenn Beck and read by thousands. After observing that Terri died "surrounded by stuffed animals and medical equipment", the obituary said that Michael Schiavo "was at the bedside of his wife Terri when she died".

Pre-written obituaries are not unusual: news organizations keep obituaries of many public figures on file, for immediate release upon their death. But Terri's is unusual in two respects. Firstly, it is inaccurate. Among other things, Terri was not "surrounded" by very much "medical equipment" at all. After all, she was being starved and dehydrated to death. She was receiving no life-support, and in fact no care aside from the measures, enumerated above, designed to mask the true nature of her death. But even more problematic is the description of Michael being "at the bedside" of Terri as she died. How could the writer of the obituary possibly know that Michael would be at her bedside at Terri's death four days beforehand?

Careful reading of the news stories from the days leading up to Terri's death uncovers more evidence of Terri's death story taking shape. After Terri's death, many media sources reported that Michael had been staying at the hospice, either "in a spare room", or "down the hall" from Terri during the days leading up to her death. At least one report described Michael as having stayed at the hospice for the entire 13 days between the removal of the feeding tube and Terri's death. But the earliest story I found mentioning Michael's supposed bedside vigil with Terri comes from March 26, only five days before she died. Furthermore, Schiavo attorney George Felos, when questioned by the media on March 28, "would not say" whether his client was "staying full time at Hospice". Why would Felos refrain from saying something which would so obviously make his client appear sympathetic? The simplest explanation is that it wasn't true, and a good attorney like Felos would be very careful not to actually state an easily verified untruth on the record.

However, by the evening of March 31, the day Terri died, Felos was telling CNN that Michael Schiavo had been staying at the hospice for the previous two weeks "in a room just down the hall" from her. Again, if that was true, why wasn't Felos willing to say it 4 days earlier? Furthermore, it is interesting to note that in the 8 days between the removal of the feeding tube on March 18, and the first questions about Michael's presence on March 27, the press took no notice of either Michael's presence, or his arrivals or departures. Given the small army of reporters and the large crowd of vigil-keepers constantly present at the hospice, it strains credibility to suppose that Michael could have come and gone from the premises entirely unnoticed over the course of two weeks. It also strains credibility to propose that Michael could have remained sequestered at the hospice for two weeks straight: taking his meals there, being separated from his girlfriend and children, not even going home for a change of clothing during the entire period. An Agence France-Presse story of March 27 also seemed to notice the difficulty in substantiating Michael's presence, remarking that "no one knows the exact whereabouts of the husband right now", and that "no one knows how he gets to and from the hospice."

The Schindlers and Fr. Pavone also noted that, in all of the time they spent with Terri (twice or three times daily totaling several hours a day) during those final weeks, they never once saw Michael at the hospice, nor did they see any evidence that he was there. Bobby Schindler remarked that on several occasions, he and his family were asked by the police to leave Terri's room, so that Michael could visit, but they never saw him. "We saw [George] Felos, we saw Deborah Bushnell [another Schiavo attorney], but we never saw Michael there," Bobby said.

Most disturbing is the strong possibility that George Felos' description of the scene at Terri's death was also a product of meme-making. Recall the erroneous CBS obituary mentioned above placed Michael at Terri's bedside at the time of her death, which had not yet happened. After Terri died, George Felos stated that Michael had been present at her death, and had "cradled her head" in his arms at the moment she died. While no one but Michael Schiavo and George Felos know for sure what really transpired in that room, the Schindlers are skeptical: Bobby Schindler explained that, on the morning Terri died, he and his sister Suzanne had been with Terri most of the night. One of the three police officers stationed outside of Terri's room then came in and told Bobby and Suzanne that they would have to leave, so that Terri's "condition could be evaluated." They knew Terri was close to death, and wanted to remain. Bobby disputed with the police, but "they were told in no uncertain terms that they had to leave," Fr. Pavone told CNN. Michael Schiavo, according to the Schindlers and Fr. Pavone, had ordered that the Schindlers could not be present when Terri died. Bobby told me that an interval of five to ten minutes elapsed while he was arguing with the police and waiting outside Terri's room. During this period, he saw no sign of Michael, nor heard any indication that he was coming. "For all I know, Father, my sister died alone in that room," he said. He and Suzanne were ushered away.

The next thing they were told was that Terri had died. After another 15 - 20 minutes, they, and Fr. Pavone, were allowed back into Terri's room. Again, there was no sign of Michael. Fr. Pavone, at the press conference he and Schindler attorney David Gibbs gave after Terri's death, also remarked on Michael's absence. He related, in answer to a reporter's query, that his "first question, as I went in the room after it was first announced that Terri had died, was 'where's Michael?'" He added, "He was nowhere to be seen."

It would seem that the CBS obituary represented a "script" of sorts for Terri's death, and that George Felos saw to it that the script was played out. Bobby Schindler says he was "disgusted" by how Michael Schiavo and George Felos misrepresented Terri's death: "The whole thing was staged, Father," he told me.

A Legacy of Life

While Michael Schiavo may have "won" the battle to end his wife's life, and George Felos may have "won" the test case he wanted, and had the script of Terri's death played out in the desired manner, the Schindlers are not despairing or ready to give up. They are grieving deeply, as anyone who lost a daughter or sister might be expected. Their grief is compounded by the fact that Michael Schiavo refused to allow Terri's remains to be given a funeral Mass or Catholic burial. As of this writing, Michael has still not disclosed to the Schindlers where Terri's cremated remains will be interred, or when he intends to inter them.

But the Schindlers vow to go on. At a memorial Mass held for Terri in the Southampton, Pennsylvania parish where she grew up, Bob told me that he intends to see to it that some good is brought out of his daughter's death. He said he wants "to make sure nothing like this ever happens to anyone else again." Bobby told me that he intends to give up his teaching career, and work full time to educate and inform the public about the truth of his sister's case and the dignity of life of those who are disabled or otherwise regarded as "unworthy of life". He said he wants to see to it that his sister's legacy "is a legacy of life, not of death."

At the reception following that memorial Mass for Terri, Fr. Pavone spoke powerfully about Terri's cause, the danger which her death poses for our society, and our duty to protect the lives of those who are weak and helpless. Terri Schiavo, though she could not speak, gave witness to the inherent and incalculable worth of every person. Fr. Pavone concluded his remarks by saying that Terri's death "is not the end of Terri's fight, it is the beginning of a new chapter! Death will not have the last word!"