Peter Orr

Under the Constitution, citizens of the United States are granted particular and incontestable rights: "life, liberty and the pursuit of happiness." Teresa Marie Schiavo should not have been an exception.

The advancements in modern medicine that now make it possible to sustain life artificially have raised an important question regarding liberty. Is the choice to decline such treatment among the rights we're assured, and if so, what does that look like? These questions were first addressed on a judicial level in 1990.

In response to a case similar to Terri's involving a patient named Nancy Cruzan, the Supreme Court ruled that a terminally ill patient in a "persistent vegetative state" (PVS) has a constitutional right to decline life-sustaining medical treatment. The diagnosis of PVS, according to expert Dr. Fred Plum (who also coined the term), requires that the "body is functioning entirely in terms of its internal controls:" temperature, heartbeat, and pulmonary ventilation. Muscle reflexes and nerves are "maintained for low-level conditioned responses," but "there is no behavioral evidence of either self-awareness or awareness of the surroundings in a learned manner." Therein is the problem. A PVS patient does not have the ability to decline such treatment because they cannot function cognitively.

To resolve this cruel irony, the Supreme Court ruled that as long as sufficient evidence existed that the removal of life-sustaining treatment was the wish of the patient, the legal guardian of that patient could authorize such a conclusion. Therefore, when considering the decision to remove such treatment, there are three imperative elements: the patient must be PVS, their wishes must be clear and the guardian must approve of the decision. Each of these was questionable in the case of Terri Schiavo, but justice was not achieved, and she died as a result.

First, there is debate over Terri's state of being. Many neurologists saw her and many diagnosed her as PVS. However, there were several doctors who were not entirely convinced of her condition. She could follow a balloon around the room with her eyes, she responded with a smile to music and the faces of family or friends, and she groaned in obvious pain when pinched. Despite these behavioral tendencies, many doctors also found reason to believe that Terri could swallow on her own, and required the feeding tube only because she could not chew and could potentially choke due to the muscle debilitation in her jaw and mouth. These observations were small and many doctors were not convinced, but because this was a matter of life and death, such observations were hugely significant -- though ultimately ignored.

The second question addresses Terri's wishes, which were unclear. People on both sides remember Terri commenting on life-sustaining treatment. Terri's childhood friend Diane Meyer recalls her saying, "How did they know she would want this? How did they know she wouldn't want to go on?" in a conversation they had about a woman whose feeding tube was removed. Scott Schiavo, Michael's brother, recalls Terri responding to a woman hooked up to a ventilator. According to him, she said, "Not me. No way. I would not want to live like that." Since there is no more conclusive evidence on either side, both statements can be taken as false, in which case nothing has been proved. Or both can be assumed to be true, which explains Terri responding positively to life in the case of the feeding tube and negatively to the ventilator -- quite a different matter. Without a written or verbal statement it's impossible to say, but with the information that is known, her wishes can be relatively deduced.

Lastly and most heartbreaking is the dilemma of Michael Schiavo, Terri's guardian. As her spouse, Michael was her legal guardian, and although he opted for experimental procedures and trained to become a nurse early on, it is obvious he did not care for Terri in the right ways: by remaining faithful and by collaborating with her parents on what was best for her. Terri had plenty to live for, but instead of resting in the hands of those who loved her enough to fight for her life, find joy in her company and keep hope in her recovery, her fate lay in the hands of a husband who had given up, had a new girlfriend and two illegitimate children, and could bank on her Medicare.

Why was Michael Schiavo so insistent on Terri's death? If it was release from his marriage he sought, he could have painlessly divorced her. If he no longer wanted to care for her or invest emotionally in the tragedy of her condition, her parents would have gladly taken over as her guardian and primary caretaker. Maybe he simply did not want her to suffer any longer, but if that's so, his change in attitude came at a very opportune time and his lifestyle since has been quite problematic. It seems apparent to me that from the moment Michael collected $300,000 when he sued Terri's fertility therapist for malpractice (by not detecting the potassium imbalance that caused Terri's heart attack) and refused to use the money for medical treatments (a situation that birthed the conflict between Michael and Terri's family), his own interests began to outweigh Terri's. He was no longer concerned about what she and her family would lose in her death, but what he could gain. Michael Schiavo was clearly not a suitable guardian for Terri.

Hopefully Terri's death was not in vain, and we too can gain something from it. No doubt the debate will continue and perhaps some clarity in the legal procedures regarding this issue will result. As far as this particular case is concerned, here's what it comes down to for me. In the Constitution, Americans are guaranteed one freedom before they are assured liberty: life. The uncertainty of Terri's condition, the skepticism over her wishes, and the questionable integrity of her guardian add up to, in my opinion, enough reasonable doubt to err on the side of life rather than on a liberty that Terri may or may not have employed.