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The Terri Schiavo Saga: The Making of a Tragedy and Lessons Learned

2005; Elsevier BV; Volume: 80; Issue: 11 Linguagem: Inglês

10.4065/80.11.1449

1942-5546

C. Christopher Hook, Paul S. Mueller,

Ethics and Legal Issues in Pediatric Healthcare

The recent case of Terri Schiavo has been an important medical, legal, and ethical controversy. However, much of the public discussion of the tragedy has been based on inaccurate information regarding the facts of the case and the actual legal and ethical issues involved. This article reviews the pertinent aspects of the case and the ethical and legal questions raised and highlights the lessons we should learn from this unique story. The recent case of Terri Schiavo has been an important medical, legal, and ethical controversy. However, much of the public discussion of the tragedy has been based on inaccurate information regarding the facts of the case and the actual legal and ethical issues involved. This article reviews the pertinent aspects of the case and the ethical and legal questions raised and highlights the lessons we should learn from this unique story. On March 31, 2005, a 41-year-old woman, Theresa Marie Schiavo (born December 3, 1963), died, the final complication of a cardiac arrest on February 25, 1990. Her illness and death had been the focus of a major medical, legal, theological, ethical, political, and social controversy, a controversy that continues. While other issues, such as the controversy over embryonic stem cells and cloning, generate significant discussion and debate, the plight of Terri Schiavo is the most important case of clinical ethics in more than a decade. The results of this case threaten to undo at least 30 years of ethical and legal progress that has enabled individuals the freedom to control and limit medical interventions performed on them. The case also highlights the deep divisions and fears within our society regarding life and death, the role of the government and courts in life decisions, and the treatment of disabled persons. A hallmark of the Schiavo case is the confusion surrounding the facts and operative questions. Was she in a persistent vegetative state (PVS) or a minimally conscious state?1 What, if any, hope of cognitive recovery did she have? Are these questions relevant to the due process of decision making in this case? What were the events surrounding Terri's cardiac arrest that caused her brain injury? What were Terris previously expressed wishes regarding life-sustaining treatments (LSTs) for situations such as PVS and in which she could not make decisions for herself? What is the role of the courts in adjudicating uncertainty and familial conflict? What are the duties of surrogate decision makers? Do they have specific obligations? Is PVS a disability or a life-threatening pathology? Is the provision of artificially supplied fluid and nutrition (AFN) mandatory humane comfort care, or is it a medical intervention that can be refused, withheld, and/or withdrawn? Did Terri suffer during the process of dehydration? Numerous aspects of this case will never be clarified. Future students will be forced to contend with inadequate or incomplete information, just as we who have followed the case contemporaneously have had to do. However, there are sufficient facts for us to learn from this case, lessons that are critical to our patients, our practices, and our society. In this article we attempt to bring as much light as possible to a case shrouded in misinformation, inadequate reporting by the media, and misleading claims and pronouncements made by public figures about the patient, her condition and prognosis, and the ethical and legal issues in the tragedy. We hope to objectively answer some of the aforementioned questions but acknowledge at the outset that we cannot address them all. Our goal is not to pass moral judgment on the individuals involved directly in the case—something we cannot and will not attempt to do—but to try to provide objective information and understanding in the hopes of stimulating rational discussion and much needed healing to our society. We also acknowledge that there are people of good will on the many "sides" of this issue, individuals who sincerely hold deep beliefs divergent from one another. We cannot resolve all these disagreements but wish to at least help to ensure that the ongoing discussion about this case is based on as much fact as possible. Because our goal was to review and evaluate the facts of the case1Wijdicks EFM Cranford RE Clinical diagnosis of prolonged states of impaired consciousness in adults.Mayo Clin Proc. 2005; 80: 1037-1046Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, rather than depend on the incomplete reporting in the lay press, we tried to access as many primary documents of the proceedings as possible. An excellent source was the Web site created and maintained by Steven Haidar and Kathy Cerminara at the University of Miami,2Cerminara KL Goodman KW Key events in the case of Theresa Marie Schiavo.Available at: www.miami.edu/ethics/schiavo/timeline.htmGoogle Scholar which not only provided an excellent and thorough timeline of the events but also provided links to original reports, judicial decisions, and some of the testimony presented during the court proceedings.3Wolfson J A report to Governor Jeb Bush in the matter of Theresa Marie Schiavo.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar We were unable to directly access Terri's medical records and consequently had to depend on the summations of that information as recorded in various legal and court documents. On February 25, 1990, then 26-year-old Terri Schiavo fell unconscious in her apartment in St Petersburg, Fla. Her husband of 5 years, Michael Schiavo, called the paramedics but did not perform cardiopulmonary resuscitation. Terri was anoxic until help arrived. She was resuscitated but never regained consciousness, and a percutaneous endoscopic gastrostomy (PEG) tube was placed to provide nourishment and hydration. It has been stated that the cardic arrest was precipitated by an electrolyte imbalance, given that her first potassium level obtained in the hospital after resuscitation was only 2.0 mEq/L (reference range, 3.6-4.8 mEq/L). The hypokalemia has been said to be due to anorexia concurrent with attempts of assisted reproduction procedures, but given that the potassium assay was performed after her resuscitation, the actual cause of Terri's cardiac arrest remains unresolved.4Thogmartin JR Report of autopsy.Available at: www.miami.edu/ethics2/schiavo/061505-autopsy.pdfGoogle Scholar The police were called to investigate the situation, but the reporting officers found no evidence of physical struggle or abuse in the apartment, nor was any present on Terri's physical examination.5St Petersburg Police Department incident report.Available at: www.miami.edu/ethics2/schiavo/02259%20police%20report.pdfGoogle Scholar (At Terri's autopsy years later, the only sign of bony irregularity was a vertebral compression fracture due to severe osteoporosis, which was likely due to her prolonged bedridden state, and there was no evidence of previous fractures, tracheal injury, or other signs of trauma.5St Petersburg Police Department incident report.Available at: www.miami.edu/ethics2/schiavo/02259%20police%20report.pdfGoogle Scholar Despite a reexamination of the events surrounding the original event requested by Governor John Ellis [Jeb] Bush, prosecutors Doug Crow and Bob Lewis could find no credible evidence of physical trauma or abuse, nor of any wrongdoing by Michael Schiavo.6Crow D Lewis B Memo to State Attorney Bernie McCabe from prosecutors Doug Crow and Bob Lewis.Available at: www.miami.edu/ethics2/schiavo/070705-Crow-Lewis-to-McCabe.pdfGoogle Scholar Governor Bush subsequently closed the inquiry.) After several weeks, Terri was transferred to a skilled care and rehabilitation facility. Because there was no advance directive, Michael was appointed Terri's formal guardian on June 18, 1990, by the court. Terri's parents, Robert and Mary Schindler, did not object to this appointment. In the hopes of bringing Terri home for her care, Michael received some nursing training; however, an attempt at home care in September 1990, provided in the Schindlers' home with Michael in residence, proved too overwhelming, and Terri was returned to the chronic care facility after 3 weeks. Two months later, Michael took Terri to California to pursue experimental thalamic stimulator implant treatment to improve or restore her level of consciousness. The treatment failed, and they returned to Florida in January 1991; Terri was placed in the Mediplex Rehabilitation Center in Brandon, Fla. Numerous neurologic evaluations revealed only reflexive behaviors consistent with a PVS. Multiple swallowing studies showed severe oropharyngeal dysphagia, but Terri continued to receive intensive physical, speech, and occupational therapy. Michael continued to live in the Schindler home for several more months until May 1992. According to the report by the third guardian ad litem (a court-appointed individual who is an advocate for and represents the best interests of the ward) appointed during subsequent court trials, Michael was fixated on Terri's care for the first 4 years after her cardiac arrest. The Schindlers encouraged Michael to move on with his life and to start dating. Michael, in turn, would introduce the women he was dating to the Schindlers.3Wolfson J A report to Governor Jeb Bush in the matter of Theresa Marie Schiavo.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar In 1994, Michael appeared to have changed his belief that Terri would recover to the belief that she would never improve. He elected to not treat a urinary tract infection that had developed and requested that Terri's status be changed to "do not resuscitate." When the facility challenged this, Michael rescinded the requests but subsequently transferred Terri to another facility. The relationship between Michael and the Schindlers deteriorated in 1992 after he and Terri were awarded damages in 2 malpractice suits (regarding her infertility treatments and a possible association with her subsequent cardiac arrest): the first for $250,000 and the second for $300,000 to Michael for loss of consortium and $750,000 to a trust fund for Terri's care (the trust fund was controlled by South Trust Bank, not Michael). Several claims have been made about the cause of the breakdown in the relationship between Michael and the Schindlers (arguments regarding plan of care, anger because Michael did not share the malpractice award with the Schindlers, etc), but the complete truth will probably remain unknown to the outside world and ultimately is not relevant to our discussion. The result is that on July 29, 1993, the Schindlers petitioned the court to remove Michael as Terri's guardian. Because no basis was found for such removal, the suit was dismissed. The findings of the first guardian ad litem appointed in the case, John H. Pecarek, were that Michael had been very aggressive and attentive in his care of Terri. Noting no evidence for infections or skin breakdown and referring to reports of tirades by Michael that would bring nurses to tears if Terri's care was not performed meticulously, Pecarek stated in his March 1, 1994, report, "Although I have concluded that Mr. Schiavo is a nursing home administrator's nightmare, I believe the ward (Terri) gets more care and attention from the staff…as a result of his advocacy and complaining on her behalf."7Copeland L Lawrence J Feud may be as much over money as principle.USA Today. March 24, 2005; (Accessibility verified September 20, 2005.)Available at: www.usatoday.com/news/nation/2005-03-24-schiavo-money-cover_x.htmGoogle Scholar Four years later, in May 1998, Michael petitioned the court to authorize the removal of Terri's PEG tube. Because the Schindlers opposed this petition, claiming that Terri would have wanted to be kept alive, the court appointed a second guardian ad litem, Richard L. Pearse, to serve on behalf of Terri's interests. In December 1998, Pearse issued his report, which noted that Terri was in a PVS and, according to her treating physicians, had no chance of improvement. Pearse believed that the only evidence of Terri's wishes concerning LSTs was hearsay evidence from Michael, which did not, in his mind, present the clear and convincing evidence standard required by In re Guardianship of Browning precedent and Florida State Law (see subsequent discussion). In addition, Pearse suggested that Michael may have had a significant financial conflict of interest.8Pearse Jr, RL In re: The guardianship of Theresa Schiavo, an incapacitated person: report of guardian ad litem: case no. 90-2908GD-003.Available at: www.miami.edu/ethics/schiavo/122998%20Schiavo%20Richard%20Pearse%20GAL%20report.pdfDate: December 29, 1998Google Scholar Pearse stated, however, that "In fairness to the Petitioner, should this Court disagree with the foregoing analysis of the evidence and find it to clearly and convincingly reflect the actual wishes and intentions of the ward…the feeding tube should be withdrawn."8Pearse Jr, RL In re: The guardianship of Theresa Schiavo, an incapacitated person: report of guardian ad litem: case no. 90-2908GD-003.Available at: www.miami.edu/ethics/schiavo/122998%20Schiavo%20Richard%20Pearse%20GAL%20report.pdfDate: December 29, 1998Google Scholar9In re: the guardianship of Theresa Marie Schiavo, incapacitated. File No. 90-2908GD-003. February 11, 2000: p. 9. Available at: www.miami.edu/ethics2/schiavo/021100-Trial%20Ct%20Order%200200.pdf. Accessibility verified September 27, 2005.Google Scholar On January 24, 2000, the trial to determine Terri's wishes began in the Pinellas-Pasco County Circuit Court under the direction of Judge George Greer. Presented to the court were depositions from Michael and from Michael's brother and sister-in-law recounting statements made proximate to family funerals and in other conversations in which Terri had stated she would not want to be maintained on artificial life support should she become seriously ill and dependent on such measures to maintain life. On the other hand, the Schindlers indicated that, if Terri had provided clear directives that she would not want to be maintained on artificial life support while in a PVS, they would still insist that she be given all treatment and life support possible.10Florida governor's office executive order number 03-201.Available at: www.miami.edu/ethics2/schiavo/Schiavo%20Controversy%20Fla_%20Gov_%20Exec_%20Order%20No_%2003-201.htmDate: October 21, 2003Google Scholar Among the testimony heard was that of Father Gerard Murphy, from the diocese of St Petersburg and the State of Florida chaplain for the Catholic Medical Association. Father Murphy stated that removal of the feeding tube from Terri would be in keeping with Roman Catholic teachings provided that Terri had mentioned to her husband and to her brother and sister-in-law that she would not want to be kept alive artificially if she were dependent on the care of others. Father Murphy also stated that, given the fact that Terri had not received Communion or participated in confession for at least a 2-year period before her medical event, she would not be considered a practicing Catholic. When asked about the Schindlers' assertions that if they were in a PVS or unconscious state without hope of recovery that they would want all medical treatments and procedures possible to keep them alive, even to the extent of amputations in the case of gangrene or that would result in the impoverishment of their family, Father Murphy replied that the Catholic church had no such vitalistic requirement. Regarding the claims of the Schindler family that Terri should be kept alive because it gives them pleasure, regardless of the extent of life support or disfigurement by necessary amputation, Father Murphy stated that this was contrary to the Gospel and to the teachings of Christ and the Catholic church.11Of the sixth judicial circuit state Florida in and for Pinellas County probate division: case no. 90-2908-GD3 I: excerpt of trial testimony of Father Murphy.Available at: www.miami.edu/ethics/schiavo%20Testimony%20of%20Father%20Murphy.docDate: January 24, 2000Google Scholar Judge Greer issued his ruling on February 11, 2000, granting the removal of the PEG tube. He stated, The court does find that Terri Schiavo did make statements which are creditable and reliable with regard to her intention given the situation at hand…. Statements which Terri Schiavo made which do support their relief sought by her surrogate…include statements to him prompted by her grandmother being in intensive care that if she was ever a burden she would not want to live like that. Additionally, statements made to Michael Schiavo which were prompted by something on television regarding people on life support that she would not want to life [sic] like that also reflect her intention in this particular situation. Also, the statements she made in the presence of Scott Schiavo at the funeral luncheon for his grandmother that 'if I ever go like that just let me go. Don't leave me there. I don't want to be kept alive on a machine.' And to Joan Schiavo following a television movie in which a man following an accident was in a coma to the effect that she wanted it stated in her will that she would want the tubes and everything taken out if that ever happened to her are likewise reflective of this intent. The court specifically finds that these statements are Terri Schiavo's…and the testimony…is reliable, is creditable and rises to the level of clear and convincing evidence to this court.9In re: the guardianship of Theresa Marie Schiavo, incapacitated. File No. 90-2908GD-003. February 11, 2000: p. 9. Available at: www.miami.edu/ethics2/schiavo/021100-Trial%20Ct%20Order%200200.pdf. Accessibility verified September 27, 2005.Google Scholar The Schindlers proceeded with several petitions, which prompted Judge Greer to issue a stay on his original order until 30 days beyond the final exhaustion of all appeals by the Schindlers. The Schindlers appealed to the Florida Second District Court of Appeal, which on January 24, 2001, upheld Judge Greer's original ruling permitting the removal of the PEG tube. Responding to the Schindlers' claim that clear and convincing evidence of Terri's wishes had not been produced during the original trial, the Second District Court of Appeal stated, We have reviewed that testimony and conclude that the trial court had sufficient evidence to make this decision…. Her statements to her friends and family about the dying process were few and they were oral. Nevertheless, those statements, along with other evidence about Theresa, gave the trial court a sufficient basis to make this decision for her.…After due consideration, we conclude that the trial judge had clear and convincing evidence to answer this question as he did.12In re: guardianship of Theresa Marie Schiavo, incapacitated. Case No. 2D00-1269. February 22, 2001: pp 7-9. Available at: www.miami.edu/ethics2/schiavo/1-24-01_DCA%20Opinion.pdf. Accessibility verified September 20, 2005.Google Scholar Another aspect of the Second District Court of Appeal's opinion is their statement regarding the court's duties in cases in which a patient's intent or wishes are unknown: "In Browning, we stated: 'In making this difficult decision, a surrogate decision-maker should err on the side of life.…In cases of doubt, we must assume that a patient would choose to defend life in exercising his or her right of privacy.' We confirm today that a court's default position must favor life."13Wolfson J Letter to Governor Jeb Bush: pages 23-33.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar (We subsequently discuss the importance of this decision and these statements in light of assertions by some that the judiciary supports euthanasia, has contempt for life, and as a result, promulgates a social agenda from the bench.) Throughout the next few months, the Schindlers requested an Appellate Court rehearing and that Judge Greer recuse himself, as well as petitioned the Florida Supreme Court to stay the removal of the PEG tube, which had been scheduled to be removed on April 20, 2001. All requests and petitions were denied. However, on April 20, Federal District Court Judge Richard Lazzara granted a stay until April 23 to allow the Schindlers all possible attempts at appeal. An appeal was issued to the US Supreme Court, but on April 23, US Supreme Court Justice Anthony Kennedy refused to stay the case pending a formal review by that court. The PEG tube was removed on April 24. Two days later, the Schindlers filed an emergency motion with Judge Greer claiming new evidence that Michael had perjured himself about Terri's wishes, the source being a former girlfriend of Michael's. When Judge Greer dismissed the motion as untimely, the Schindlers filed a civil suit against Michael, leading Circuit Court Judge Frank Quesada to order that the PEG tube be reinserted pending the trial. A series of appeals and court orders were exchanged to establish jurisdiction for the trial, and on August 7, 2001, Judge Greer once again found that the tube could be removed. However, Judge Greer delayed removal to allow the Schindlers time to appeal, and on October 3 the Second District Court of Appeal delayed removal of the PEG indefinitely. On October 17, 2001, the Second District Court of Appeal ordered that 5 physicians examine Terri to determine whether her condition could improve with additional medical treatment. Michael and the Schindlers chose 2 physicians each, and the court selected 1 physician. However, the process was delayed for mediation to determine which tests physicians could perform on Terri. Mediation failed, and hearings involving the 5 physician witnesses and Terri's primary physician occurred October 12 through 22, 2002. The 2 physicians selected by the Schindlers stated that Terri was not in a PVS and that beneficial treatments were possible. However, neither physician was able to present factual documentation of the success in someone in Terri's condition of the treatments recommended (vasodilation therapy and hyperbaric oxygen treatments), and the court found that those recommendations lacked credibility.14In re: The guardianship of Theresa Marie Schiavo, incapacitated: No. 90-2908-GB-003.Available at: http://abstractappeal.com/schiavo/trialctorder11-02.txtDate: November 22, 2002Google Scholar The other 3 physicians concurred with previous medical evaluations that Terri was in a PVS with no chance of improvement. Notably, one of the physicians that Michael selected, although an expert in the area of PVS, was controversial in light of previous statements regarding the withholding or withdrawal of AFN from patients in a PVS. This physician's involvement inflamed members of the public who were becoming increasingly interested in and vocal about the case and who believed that withdrawing the PEG tube was akin to euthanasia. In response to these proceedings, the Schindlers rescinded their earlier acknowledgment that Terri was in a PVS. On November 15, 2002, the Schindlers filed another petition to remove Michael as guardian, this time not only claiming that he was neglecting and "abusing" Terri by providing inadequate care and rehabilitation but also suggesting that Michael may have been directly responsible for Terri's original injury through an act of physical abuse.15In re: the guardianship of Theresa Marie Schiavo, incapacitated: petition to remove guardian and to appoint successor guardian.Available at: www.miami.edu/ethics2/schiavo/Nov%2022%202002%20Petition%20to%20remove%20MS%20as%20Guardian.htmGoogle Scholar On the basis of the medical testimony, Judge Greer again ruled that the PEG tube could be removed but stayed the ruling pending an appellate court challenge. The Second District Court of Appeal affirmed Greer's order, setting October 15, 2003, as the date for PEG tube removal. Throughout the next several months, there were multiple challenges and filings, including an appeal to the Florida Supreme Court (which declined to review the decision). Nevertheless, on October 15, the PEG tube was capped. On October 19, 2003, the Advocacy Center for Persons with Disabilities filed a federal lawsuit claiming the cessation of AFN was abuse and neglect. Increasingly, groups representing persons with disabilities got involved with the case and expressed fears that what was happening to Terri was evidence of how the nondisabled society devalues persons with disabilities. On October 20, the Florida House of Representatives passed Terri's Law, which was passed the next day by the Florida Senate and signed by Governor Jeb Bush, who then immediately issued an executive order10Florida governor's office executive order number 03-201.Available at: www.miami.edu/ethics2/schiavo/Schiavo%20Controversy%20Fla_%20Gov_%20Exec_%20Order%20No_%2003-201.htmDate: October 21, 2003Google Scholar directing the reconnection of the PEG tube, which was done, and appointing a third guardian ad litem. Terri's Law, HB 35-E,16Senate amendment: Bill No. HB 35-E.Available at: www.miami.edu/ethics2/schiavo/102003_HB35-E.pdfGoogle Scholar was a brief statement authorizing a onetime stay for the specific prevention of withholding or withdrawing nutrition and hydration in a patient whose circumstances fit the unique situation of Terri. Also on that same day, Michael, joined by the American Civil Liberties Union, filed a state court lawsuit asserting that Terri's Law was unconstitutional. Ten days later, Jay Wolfson, DrPH, JD, was appointed as the third guardian ad litem. Wolfson issued his report on December 1, 2003. During his term as guardian ad litem, Wolfson spent a large amount of time with Terri, sometimes visiting her multiple times during a day. He reported, During that time, the GAL [guardian ad litem] was not able to independently determine that there were consistent, repetitive, intentional, reproducible interactive and aware activities…. Hours of observed video tape recordings of Theresa offer little objective insight about her awareness and interactive behaviors.13Wolfson J Letter to Governor Jeb Bush: pages 23-33.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar He concluded, …from the medical records and consultations with medical experts that the scope and weight of the medical information within the file concerning Theresa Schiavo consists of competent, well documented information that she is in a persistent vegetative state with no likelihood of improvement, and that the neurological and speech pathology evidence in the file support the contention that she cannot take oral nutrition or hydration and cannot consciously interact with her environment.13Wolfson J Letter to Governor Jeb Bush: pages 23-33.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar Despite Wolfson's explicit articulation that the courts had meticulously followed Florida law and constitutional principles in arriving at their conclusions regarding Terri's wishes,13Wolfson J Letter to Governor Jeb Bush: pages 23-33.Available at: www.miami.edu/ethics2/schiavo/wolfson%27s%20report.pdfDate: December 1, 2003Google Scholar Governor Jeb Bush rejected Wolfson's conclusions and Wolfson's recommendation that AFN be discontinued.17Statement by: Governor Jeb Bush: guardian ad litem's report.Available at: http://sun6.dms.state.fl.us/eog_new/eog/library/releases/2003/December/litems-report_12-2-03.htmlDate: December 2, 2003Google Scholar Michael's legal challenge to Terri's Law culminated in the opinion of Pinellas Circuit Judge W. Douglas Baird, released on May 6, 2004, declaring that Terri's Law was unconstitutional, a clear violation of the separation of powers.18Michael Schiavo vs Jeb Bush and Charlie Crist: order granting petitioner's motion for summary judgment.Available at: www.miami.edu/ethics2/schiavo/Filed_05-06-04_Baird-rules-TerrisLaw-unconstitutional.pdfGoogle Scholar Governor Bush appealed the ruling, which was then referred directly to the Florida Supreme Court. The Florida Supreme Court ruled unanimously to affirm Judge Baird's conclusions and declared Terri's Law unconstitutional on September 23, 2004.19Supreme Court of Florida. No. SC04-925: corrected opinion.Available at: www.floridasupremecourt.org/decisions/2004/ops/sc04-925.pdfDate: September 23, 2004Google Scholar Governor Jeb Bush filed for rehearing and was denied twice, but the Florida Supreme Court ultimately stayed its order to remove the PEG tube pending an appeal by Governor Bush to the US Supreme Court. On January 24, 2005, the US Supreme Court refused to grant review. Judge Greer then gave permission for the PEG tube to be removed on March 18, and the tube was removed on that date. Petitions by the Schindlers to the Second District Court of Appeal, the Florida Supreme Court, and the US Supreme Court to intervene were denied. The series of events that followed are unique in the history of American politics, law, and bioethics. On March 7, 2005, US Representative David Weldon of Florida introduced in the US House of Representatives H.R. 1151, the Incapacitated Person's Legal Protection Act,20109th Congress. A bill to amend title 28, United States Code, to provide the protections of habeas corpus for certain incapacitated individuals whose life is in jeopardy, and for other purposes.Available at: www.miami.edu/ethics2/schiavo/HR1151.pdfGoogle Scholar which would allow federal judicial review of state court orders to withdraw or withhold AFN, with similar legislation also introduced in the US Senate. On March 20, with a voice vote of only 3 members present, the bill was passed in the Senate. The House bill, by a vote of 203 t