THURSDAY, March 31, 2005 (HealthDay News) -- Terri Schiavo, the 41-year-old Florida woman at the center of the landmark right-to-die controversy that splintered her family and riveted the nation, died Thursday morning, 13 days after a judge ordered the removal of her feeding tube.
The attorney for Schiavo's husband and legal guardian, Michael Schiavo, announced the death of the severely brain-damaged woman, which came around 9 a.m., according to wire reports.
Schiavo's husband was with her when she died, but her parents, Robert and Mary Schindler, were not, according to a CNN report. Brother Paul O'Donnell, a Franciscan friar and friend of the Schindlers, said they went to the Pinellas Park hospice shortly after they learned of Schiavo's death and prayed at her bedside.
The lawyer for her parents said Schiavo's brother and sister were with her until just before she died.
"While they are heartsick, this is indeed a sad day for the nation, this is a sad day for the family," attorney David Gibbs said.
Schiavo's body was taken in an unmarked white van with police escort to the Pinellas County medical examiner's office, where an autopsy was planned that both sides hoped would reveal the extent of her brain damage and whether she was abused by her husband, as the Schindlers have contended, the Associated Press reported.
Florida Gov. Jeb Bush said that millions of people around the state and world will be "deeply grieved" by Schiavo's death but that the debate over her fate could help others grapple with end-of-life issues, according to MSNBC.
"After an extraordinarily difficult and tragic journey, Terri Schiavo is at rest," Bush said. "I remain convinced, however, that Terri's death is a window through which we can see the many issues left unresolved in our families and in our society. For that, we can be thankful for all that the life of Terri Schiavo has taught us."
As news of Schiavo's death spread through the crowd outside her hospice, some people began singing hymns, others started praying, the The New York Times reported.
Late Wednesday night, the Schindlers lost what Gibbs called their "last meaningful legal appeal" in their long-running battle to have their daughter's feeding tube reinserted when the U.S. Supreme Court refused once again to hear an emergency appeal from the family, CNN reported.
The Schindlers had called the court-ordered removal of the tube "judicial homicide."
Schiavo suffered what doctors called irreversible brain damage 15 years ago when her heart stopped due to a chemical imbalance, thought to have been caused by an eating disorder.
The unprecedented case pitted the woman's parents against her husband, who had argued for years that his wife's unwritten wish was to not be sustained by artificial means if the need ever arose. Her parents had insisted their daughter might one day get better and that she'd never have wanted to be cut off from food and water.
Through a series of state and federal legal battles reaching to the U.S. Supreme Court and back again, Michael Schiavo successfully maintained that his wife would not have wanted to live as she had since 1990.
Since suffering the heart stoppage that led to her severe brain damage, Schiavo had been kept alive with a gastric feeding tube. Under court order, doctors removed the tube three times after lawyers for her husband had successfully argued that Schiavo had told him of her wish not to be kept alive with extraordinary measures.
Twice, the Schindlers succeeded in having their daughter's feeding tube reinserted. But on March 18, Florida's Pinellas-Pasco Circuit Judge George Greer ordered the tube removed for the final time.
According to experts, Schiavo's condition had always fallen into a kind of gray zone between brain death and physical life.
Snippets of video taken by her family several years ago and aired on the media appeared to show her smiling and blinking up at others, suggesting real inner life.
Unfortunately, "that's the nature of a vegetative state, and that's what [was] so unnerving to family and staff taking care of her," Dr. Timothy Quill, a professor of medicine, psychiatry and medical humanities at the University of Rochester Medical Center, in Rochester, N.Y., told HealthDay in an interview last week.
But, early brain scans showed that Schiavo's cerebral cortex -- the part of her brain housing higher cognition -- probably ceased to function soon after she suffered the cardiac arrest that brought her to a hospital in 1990.
According to Quill and other specialists, the cerebral cortex is home to all those things that give us our essential humanity -- our personality, ability to interact and communicate, our awareness, memories. In that sense, he said, Terri Schiavo had been "gone" since 1990, even though her body, face and eyes continued to move.
Gregory Pence teaches philosophy and medical ethics at the University of Alabama at Birmingham and has followed the Schiavo case for years. He agreed with Quill that Schiavo had probably lost all semblance of human consciousness before her feeding tube was removed.
However, the base of Schiavo's brain still functioned, and although "there's still a lot of discussion, there's no consensus at all [among experts] that this constitutes death," Pence told HealthDay last week.
This means patients like Schiavo hover in an ideological and medical limbo, somewhere between life and death.
Quill, who is also director of the Palliative Care Program at the University of Rochester Medical Center, stressed that the family acrimony seen in the Schiavo case was rare, and most families who face these crises come to some kind of informed agreement to let the patient die.
The existence of a Living Will helps inform right-to-die decisions, Quill said. And, he added, "if there's one small silver lining in all of this, it's that it [the Schiavo case] has really increased the discussion -- people are saying, 'My gosh, look what can happen if I don't do this.' Not only can the courts get involved, but even the Congress and legislature. And that's people's worst nightmare -- having these groups involved in what's a personal, medical decision."
But Pence stressed that, while Living Wills can be extremely helpful, they may not fully protect incapacitated individuals from the kind of struggle that was waged over Terri Schiavo.
"No matter what advance directive you have, and no matter what the rest of the family agrees on, if one relative comes in and feels that, for personal reasons, they have to do a full-court press, there's nothing anyone can do," he said. "Nothing is going to be ironclad against a family member coming in and saying, 'This is not what she wanted.'"
That's why appointing what's legally called a "health care proxy," as well as close personal discussions with all close family members, may be key to ensuring that your wishes are met should the worst occur, Quill said.
"It's not enough to just fill out these documents," he said. "It's really talking to your family about what is important to you. Because they are going to have to have that as a basis for making these decisions later."
For more on death and dying, visit the National Library of Medicine.