Nutrition, hydration/ pvs

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After studying the course materials located on Module 6: Lecture Materials & Resources page, answer the following:

1) Read ERD 32, 33, 34, 56, 57, 58 and make a summary. 

1) Cure / Care ethical analysis. 

2) What is a Swallow Test? When is it indicated? 

3) What is Enteral Nutrition (EN)? 

4) Describe:  

NJ tube 

5) NG tu;leral Nutrition (PN)? 

6) Describe:  

Total parenteral nutrition 

Partial parenteral nutrition 

7) What is the basic principle of N/H? Briefly describe the two exceptions. 

8) Make a summary of Terri Schiavo’s case. Provide the key details, in your own words. 

9) Provide an ethical analysis of Terri Schiavo’s case: should we continue with the PEG or not? Why yes or why not? You must support your answers with the bioethical analysis, terminology, and all the information you have learned. 

Instructions

The work is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.

If references are used, please cite properly according to the current APA style. Refer to your syllabus for further detail or contact your instructor.

References: (only use them)

Ethical and Religious Directives (ERD) for Catholic Health Care Services (6th ed.). (2018)

Cioffi, A. (2018, March 24). BIO 603 3 24 18 [Video file]. Retrieved from

BIO 603 3 24 18 (youtube video)

NUTRITION and HYDRATION

CURE / CARE

BASIC CARE:

• NUTRITION
• HYDRATION
• SHELTER
• HUMAN INTERACTION

SWALLOW TEST (THICKENED FLUIDS)

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

ENTERAL NUTRITION (TUBE FEEDING):

• NASO-GASTRIC TUBE (NG TUBE)
• NASO-JEJUNAL TUBE (NJ TUBE)
• PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

EXAMPLES
OF

ENTERAL
ACCESS

NPO = NOTHING PER ORAL (6-12 HRS)

PURPOSE:

• PREVENT ASPIRATION PNEUMONIA

• UNDERGO GENERAL ANESTHESIA

• WEAK SWALLOWING REFLEX

• GASTRO-INTESTINAL BLEEDING OR BLOCKAGE

PARENTERAL NUTRITION (INTRAVENOUS = IV):

• PARTIAL PARENTERAL NUTRITION (PPN)
• TOTAL PARENTERAL NUTRITION (TPN)

VASCULAR ACCESS
TO

PARENTERAL
NUTRITION

(VENOUS CIRCULATION)

TPN solutions :

• Concentrated
• can cause thrombosis of peripheral veins
• central venous catheter usually required

TPN not used routinely in patients with an intact GI tract

disadvantages:

• It causes more complications
• It does not preserve GI tract structure and function as well (PERISTALSIS)
• It is more expensive

Indications

TPN may be the only feasible option for patients who do not have a
functioning GI tract or who have disorders requiring complete bowel rest.

NUTRITION / HYDRATION

IN PRINCIPLE, ORDINARY CARE

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

PEG

ERD 56. A person has a moral
obligation to use ordinary or
proportionate means of preserving
his or her life. Proportionate means
are those that, in the judgment of
the patient, offer a reasonable
hope of benefit and do not entail
an excessive burden or impose
excessive expense on the family or
the community.

ERD 57. A person may forgo
extraordinary or disproportionate
means of preserving life.
Disproportionate means are those
that, in the patient’s judgment, do
not offer a reasonable hope of
benefit or entail an excessive
burden, or impose excessive
expense on the family or the
community.

ERD 58. There should be a
presumption in favor of providing
nutrition and hydration to all
patients, including patients who
require medically assisted nutrition
and hydration, as long as this is of
sufficient benefit to outweigh the
burdens involved to the patient.

N/H, IN PRINCIPLE, ARE ORDINARY MEANS OF LIFE SUPPORT

2 EXCEPTIONS:

• WHEN N/H CAN NO LONGER BE ABSORBED OR ASSIMILATED

• WHEN, IN THE ESTIMATION OF THE DYING PATIENT,

N/H BECOMES AN EXCESSIVE BURDEN

CASE STUDY: TERRY (SCHINDLER) SCHIAVO

(1963 – 2005; AGED 41)

TERRI SCHIAVO TIMELINE

“QUALITY OF LIFE” (SUBJECTIVE)

VS

“SANCTITY OF LIFE” (OBJECTIVE)

SACRED QUALITY OF HUMAN LIFE

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Sheet2

1963 BORN 3-Dec-63
Theresa (Terri) Marie Schindler is born in Pennsylvania.
10-Nov-84
1984 MARRIED Terri Schindler, 20, and Michael Schiavo, 21, are married at Our Lady of Good Counsel Church in Southhampton, Pennsylvania. The union is now among the “celebrity marriages” featured at About.com, a Website about marriage.
(20 Y/O) 1986
The couple move to St. Petersburg, where Ms. Schiavo’s parents had retired.
25-Feb-90
1990 COLLAPSE Ms. Schiavo suffers cardiac arrest, apparently caused by a potassium imbalance and leading to brain damage due to lack of oxygen. She was taken to the Humana Northside Hospital and was later given a percutaneous endoscopic gastrostomy (PEG) to provide nutrition and hydration. Police report
PEG 12-May-90
(26 Y/0) Ms. Schiavo is discharged from the hospital and taken to the College Park skilled care and rehabilitation facility.
18-Jun-90
Court appoints Michael Schiavo as guardian; Ms. Schiavo’s parents do not object.
30-Jun-90
Ms. Schiavo is transferred to Bayfront Hospital for further rehabilitation efforts.
Sep-90
Ms. Schiavo’s family brings her home, but three weeks later they return her to the College Park facility because the family is “overwhelmed by Terri’s care needs.”
Nov-90
Michael Schiavo takes Ms. Schiavo to California for experimental “brain stimulator” treatment, an experimental “thalamic stimulator implant” in her brain.
Jan-91
The Schiavos return to Florida; Ms. Schiavo is moved to the Mediplex Rehabilitation Center in Brandon where she receives 24-hour care.
19-Jul-91
Ms. Schiavo is transferred to Sable Palms skilled care facility where she receives continuing neurological testing, and regular and aggressive speech/occupational therapy through 1994.
May-92
Ms. Schiavo’s parents, Robert and Mary Schindler, and Michael Schiavo stop living together.
Aug-92
1992 1/4 M AWARD Ms. Schiavo is awarded $250,000 in an out-of-court medical malpractice settlement with one of her physicians.
Nov-92
1992 1 M AWARD The jury in the medical malpractice trial against another of Ms. Schiavo’s physicians awards more than one million dollars.  In the end, after attorneys’ fees and other expenses, Michael Schiavo received about $300,000 and about $750,000 was put in a trust fund specifically for Ms. Schiavo’s medical care.
(750Th TRUST) 14-Feb-93
Michael Schiavo and the Schindlers have a falling-out over the course of therapy for Ms. Schiavo; Michael Schiavo claims that the Schindlers demand that he share the malpractice money with them.
29-Jul-93
Schindlers attempt to remove Michael Schiavo as Ms. Schiavo’s guardian; the court later dismisses the suit.
1-Mar-94
First guardian ad litem, John H. Pecarek, submits his report.  He states that Michael Schiavo has acted appropriately and attentively toward Ms. Schiavo.
6-May-97
Michael Schiavo’s attorney Deborah Bushnell writes to the Circuit Court to request that the Schindlers receive notice of all filings in the guardianship proceeding, in anticipation of a forthcoming request to withdraw Ms. Schiavo’s PEG tube.
May-98
~1990 INFIDELITY  Michael Schiavo was in a relationship with Jodi Centonze, and had fathered their first child. He said he chose not to divorce his wife and relinquish guardianship because he wanted to ensure her final wishes (not to be kept alive in a PVS) were carried out.
1998 MICHAEL Michael Schiavo petitions the court to authorize the removal of Ms. Schiavo’s PEG tube; the Schindlers oppose, saying that she would want to remain alive.  The court appoints Richard Pearse, Esq., to serve as the second guardian ad litem for Ms. Schiavo.
PET PEG OUT 20-Dec-98
1998 TERRI The second guardian ad litem, Richard Pearse, Esq., issues his report in which he concludes that Ms. Schiavo is in a persistent vegetative state with no chance of improvement and that Michael Schiavo’s decision-making may be influenced by the potential to inherit the remainder of Ms. Schiavo’s estate.
PVS OFFICIAL January 24-27, 2000
Trial begins with Pinellas-Pasco County Circuit Court Judge George Greer presiding.
2000 JUDGE GREER 11-Feb-00
REMOVE PEG Judge Greer rules that Ms. Schiavo would have chosen to have the PEG tube removed, and therefore he orders it removed, which, according to doctors, will cause her death in approximately 7 to 14 days.
2-Mar-00
2000 SCHINDLERS The Schindlers file a petition with Judge Greer to allow “swallowing” tests to be performed on Ms. Schiavo to determine if she can consume—or learn to consume—nutrients on her own.
PET SWALLOW 7-Mar-00
2000 GREER Judge Greer denies the Schindlers’ petition to perform “swallowing” tests on Ms. Schiavo.
DENIES SWALLOW 24-Mar-00
2000 GREER Judge Greer grants Michael Schiavo’s petition to limit visitation to Ms. Schiavo as well as to bar pictures.  Judge Greer also stays his order until 30 days beyond the final exhaustion of all appeals by the Schindlers.
STAY PEG 30 DYS Greer Stay and Order Limiting Visitation
24-Jan-01
2001 2DCA Florida’s Second District Court of Appeal (2nd DCA) upholds Judge Greer’s ruling that permits the removal of Ms. Schiavo’s PEG tube.
REMOVE PEG 22-Feb-01
2001 SCHINDLERS The Schindler family’s motion for an Appellate Court rehearing is denied.
APPEAL 12-Mar-01
2001 MICHAEL Michael Schiavo petitions  Judge Greer to lift his stay, issued March 24, 2000, in order to permit the removal of Ms. Shiavo’s PEG tube.
REMOVE STAY 29-Mar-01
2001 GREER Judge Greer denies Michael Schiavo’s motion to lift stay issued on March 24, 2000; Michael Schiavo can remove Ms. Schiavo’s PEG tube at 1 p.m. on April 20.
REMOVE PEG 1 APR 10-Apr-01
The 2nd DCA denies the Schindlers’ motion to extend Judge Greer’s stay, which is scheduled to expire April 20, 2001.
12-Apr-01
2001 SCHINDLERS The Schindlers file a motion requesting that Judge Greer recuse himself.
REMOVE GREER The Schindlers petition the Florida Supreme Court to stay the removal of Ms. Schiavo’s PEG tube.
16-Apr-01
2001 GREER Judge Greer denies the Schindlers’ motion to recuse himself.
REMOVAL DENIED 18-Apr-01
2001 FL SUPREME The Florida Supreme Court chooses not to review the decision of the 2nd DCA.
REFUSE REVIEW 2DCA In re Schiavo, 789 So. 2d 248 (Fla. 2001).  Case No.: SC01-559
20-Apr-01
2001 FED CT JD LAZZARA Federal District Court Judge Richard Lazzara grants the Schindlers a stay until April 23, 2001, to exhaust all their possible appeals.
PEG STAY 4/23/01 23-Apr-01
2001 SUPREME CT KENNEDY Justice Anthony M. Kennedy of the United States Supreme Court refuses to stay the case for a review by that Court.
REFUSE STAY 24-Apr-01
4/23/01 PEG 1 REMOVED By order of trial court Judge Greer, and upon issuance of a 2nd DCA mandate, Ms. Schiavo’s PEG tube is removed
26-Apr-01
4/26/01 SCHINDLERS The Schindlers file an emergency motion with Judge Greer for relief from judgment based upon new evidence, which includes a claim that a former girlfriend of Michael Schiavo will testify that he lied about Ms. Schiavo’s wishes; Judge Greer dismisses the motion as untimely. Also on this date, the Schindlers file a new civil suit that claims that Michael Schiavo perjured himself when he testified that Ms. Schiavo had stated an aversion to remaining on life support.  Pending this new civil trial, Circuit Court Judge Frank Quesada orders Ms. Schiavo’s PEG tube to be reinserted.
4/26/01 JD QUESADA
REINSERT PEG 1
4/30/01 MICHAEL 30-Apr-01
APPEALS Michael Schiavo files an emergency motion with the 2nd DCA to allow the removal of Ms. Schiavo’s PEG tube.
9-May-01
The 2nd DCA announces a date for the hearing of oral arguments regarding Michael Schiavo’s motion of April 30, 2001.
11-Jul-01
7/11/01 2DCA The 2nd DCA remands the case back to Judge Greer.  (1) The 2nd DCA informs the Schindlers that they must address both their desire to have new evidence heard and their perjury claim against Michael Schiavo within the original guardianship proceeding; further, the Schindlers are instructed to file a new motion for relief from judgment in the guardianship proceeding. (2) The 2nd DCA instructs Judge Greer to weigh the Schinders’ new evidence in making a new determination of what Ms. Schiavo would have wanted. (3) The 2nd DCA denies Michael Schiavo’s request to discontinue the PEG tube.
CASE BACK TO GREER 7-Aug-01
After the 2nd DCA remands the case back to Judge Greer, he again finds that Michael Schiavo may remove Ms. Schiavo’s PEG tube on August 28.
10-Aug-01
AUG/10/01 GREER Judge Greer denies the Schindlers’ motion (1) to have their own doctors examine Ms. Schiavo, (2) to remove Michael Schiavo as her guardian, and (3) to disqualify himself from the proceedings.
REMOVE PEG 29 AUG 17-Aug-01
AUG/17/01 GREER Judge Greer delays the removal of Ms. Schiavo’s PEG tube until October 9 in order to allow the Schindlers time to appeal.
PEG STAY OCT/9/01 3-Oct-01
OCT/3/01 2DCA The 2nd DCA delays the removal of the PEG tube indefinitely.
PEG STAY INDEF 17-Oct-01
OCT/17/01 2DCA The 2nd DCA rules that 5 doctors should examine Ms. Schiavo to determine if she can improve with new medical treatment.  The Schindlers and Michael Schiavo are to choose 2 doctors each, and the court is to appoint a doctor.  The appeals court also affirms Greer’s denial of the motion to disqualify himself
RULE 5 MD EXAM 1-Nov-01
The 2nd DCA denies Michael Schiavo’s motion to rehear the case.
14-Dec-01
DEC/14/01 MICHAEL Michael Schiavo petitions the Florida Supreme Court to stay the October 17, 2001, ruling of the 2nd DCA.  He states that he and the Schindlers will attempt to mediate the dispute in lieu of further litigation.
PET FL SUPREME CT Michael Schiavo’s Notice of Appeal to the Florida Supreme Court
19-Dec-01
Attorneys meet with a mediator to determine which tests doctors should run on Ms. Schiavo.
10-Jan-02
JAN/10/02 FL SUPREME State Supreme Court stays all legal proceedings pending mediation; it orders attorneys to report on the status of mediation in sixty days.
STAY ALL TILL MED 13-Feb-02
FEB/13/02 MED FAILS Mediation between the Schindlers and Michael Schiavo fails.
14-Mar-02
The Florida Supreme Court denies Michael Schiavo’s petition to review the 2nd DCA’s ruling allowing 5 doctors to examine Ms. Schiavo.
October 12-22, 2002
The trial court holds a new hearing on new potential medical treatments.
15-Nov-02
The Schindlers contend that Michael Schiavo might have abused Ms. Schiavo and this abuse led to her condition. They ask the court for more time to collect evidence, and to remove Michael Schiavo as guardian.
22-Nov-02
Judge Greer rules that Ms. Schiavo’s PEG tube should be removed January 3, 2003.
13-Dec-02
Judge Greer stays his November 22 ruling: Ms. Schiavo should not have her PEG tube removed until an appeals court can rule on the case.
23-Dec-02
The 2nd DCA denies a motion Michael Schiavo filed seeking permission to remove the PEG tube.
6-Jun-03
6-06-03 Court Opinion
9-Jul-03
The 2nd DCA refuses to reconsider its decision.
22-Aug-03
FL SUPREME The Florida Supreme Court declines to review the decision.
30-Aug-03
Ms. Schiavo’s parents file a federal lawsuit challenging the removal of Ms. Schiavo’s PEG tube.
17-Sep-03
Judge Greer orders the removal of the PEG tube to take place on October 15, 2003. He also rejects the Schindlers’ request that Ms. Schiavo be given therapy to learn how to eat without the tube.
7-Oct-03
GOV BUSH Governor Jeb Bush files a federal court brief in support of the Schindlers’ effort to stop the removal of the PEG tube.
10-Oct-03
Federal Court Judge Richard Lazzara rules that he lacks the jurisdiction to hear the federal case.
14-Oct-03
The 2nd DCA refuses to block Judge Greer’s order to remove the PEG tube.
15-Oct-03
OCT/15/03 PEG 2 REMOVED Ms. Schiavo’s PEG tube is once again removed.
17-Oct-03
The Florida Circuit Court in Pinellas County and the First District Court of Appeal refuse to grant a request by “supporters” of the Schindlers to direct Gov. Bush to intervene in the case.
19-Oct-03
The Advocacy Center for Persons with Disabilities, Inc. files a federal court lawsuit that claims that the removal of Ms. Schiavo’s PEG tube is abuse and neglect.
20-Oct-03
FL HOUSE The Florida House of Representatives passes a bill, “Terri’s Law,” that allows the governor to issue a “one-time stay in certain cases.”
“TERRI’S LAW” House Bill 35-E
21-Oct-03
The Florida Senate passes the bill; Governor Bush issues an executive order directing reinsertion of the PEG tube and appointing a guardian ad litem for Ms. Schiavo.
Michael Schiavo files a state-court lawsuit arguing that “Terri’s Law” is unconstitutional and seeking an injunction to stop the reinsertion of the PEG tube; the court requests briefs on the Constitutional arguments about “Terri’s Law.”
FED CT The federal court denies the motion for a temporary restraining order filed in the lawsuit of the Advocacy Center for Persons with Disabilities, Inc.
0CT/21/03 PEG REINSERTED Ms. Schiavo’s PEG tube is reinserted.
22-Oct-03
David Demers, Chief Judge for the Pinellas County Circuit Court, orders both the Schindlers and Michael Schiavo to agree within 5 days on an independent guardian ad litem as required under the Governor’s order.  (“Terri’s Law” directs: “Upon issuance of the stay, the chief judge of the circuit court shall appoint a guardian ad litem for the patient to make recommendations to the Governor and the court.”)
28-Oct-03
President George W. Bush praises the way his brother, Governor Jeb Bush, has handled the Schiavo matter.
29-Oct-03
Michael Schiavo files court papers in his state-court lawsuit, arguing that “Terri’s Law” is unconstitutional. The American Civil Liberties Union has joined Michael Schiavo.
31-Oct-03
Judge Demers appoints Dr. Jay Wolfson as Ms. Schiavo’s guardian ad litem. Dr. Wolfson holds both medical and legal degrees; he is also a public health professor at the University of South Florida.  He is supposed to represent Ms. Schiavo’s best interest in court, but he has no authority to make decisions for her.
4-Nov-03
Governor Jeb Bush asks Circuit Court Judge W. Douglas Baird to dismiss Michael Schiavo’s suit (filed October 21, 2003) that challenges “Terri’s Law.”
8-Nov-03
Judge Baird denies Governor Bush’s motion to dismiss the state-court suit.
10-Nov-03
Governor Bush appeals Judge Baird’s decision; the filing of the appeal has the effect of staying the removal of Ms. Schiavo’s PEG tube.
14-Nov-03
Judge Baird vacates the stay.
14-Nov-03
In response to Judge Baird’s lifting the stay, the 2nd DCA issues an indefinite stay.
19-Nov-03
Governor Bush files a petition to remove Judge Baird.
21-Nov-03
Florida Sens. Stephen Wise and Jim Sebesta introduce legislation (S692) that would require persons in persistent vegetative states to be administered medically supplied nutrition and hydration in the absence of a living will, regardless of family beliefs about what those patients would have wanted. The measure is withdrawn from consideration on April 16, 2004.
1-Dec-03
University of South Florida Prof. Jay Wolfson, guardian ad litem, concludes in his report that Ms. Schiavo is in a persistent vegetative state with no chance of improvement.
10-Dec-03
The 2nd DCA refuses to remove Judge Baird, who is the presiding judge in the state-court lawsuit filed October 21, 2003. 
5-Jan-04
The Schindler family petitions the Pinellas County Circuit Court to reappoint Jay Wolfson, the guardian ad litem.
8-Jan-04
Judge Demers rejects the request to reappoint the guardian ad litem, citing the pending court decisions over the constitutionality of “Terri’s Law” as reason to wait on any action.
13-Feb-04
The 2nd DCA reverses Judge Baird’s ruling (in the case filed October 21, 2003) that denied the Schindlers permission to intervene in Michael Schiavo’s Constitutional challenge to “Terri’s Law.”  The 2nd DCA explains that Judge Baird did not follow proper procedure.  The court also gives permission to Governor Bush to question several witnesses who Judge Baird previously had ruled could not offer any relevant testimony.
12-Mar-04
Judge Baird again rejects the Schindlers’ request to intervene in Michael Schiavo’s suit that questions the constitutionality of “Terri’s Law.”
20-Mar-04
POPE JPII Pope John Paul II addresses World Federation of Catholic Medical Associations and Pontifical Academy for Life Congress on “Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas.” His remarks spark widespread interest and controversy.
29-Mar-04
Nursing home workers discover 4 “fresh puncture wounds” on one arm and a fifth wound on the other arm; the workers state that a hypodermic needle appears to have caused the wounds.  Attendants discovered the wounds shortly after the Schindlers visited Ms. Schiavo for 45 minutes.  Toxicology reports indicate that no substance was injected into Ms. Schiavo. Clearwater police later conclude that the marks might have been made by a device used to move Ms. Schiavo and, in any case, that no evidence of abuse or other wrongdoing could be found.
29-Mar-04
Judge Greer denies a motion filed by the Schindlers seeking to have Michael Schiavo defend himself in a hearing; they allege that he is violating a 1996 court order that requires him to share a sufficient amount of Ms. Schiavo’s medical information. Michael Schiavo claims that he has shared an adequate amount of information through attorneys.
16-Apr-04
S692 is withdrawn from consideration in the Florida Legislature.
23-Apr-04
The 2nd DCA rules that the Pinellas County trial court has jurisdiction to hear and is the proper venue for the case Michael Schiavo has filed against Governor Bush asserting that “Terri’s Law” is unconstitutional.
5-May-04
Pinellas Circuit Judge W. Douglas Baird rules that “Terri’s Law,” sought and signed by Gov. Bush and approved by the Legislature on October 21, 2003, is unconstitutional. The governor appeals the ruling.
1-Jun-04
The 2nd DCA grants a motion from attorneys for Michael Schiavo to send the case directly to the Florida Supreme Court and bypass a lower-court review. Meanwhile, attorneys for Gov. Bush file a motion asking that all appeals be halted until the issue of whether Michael Schiavo has the authority to fight the governor on his wife’s behalf is resolved.
16-Jun-04
Florida’s Supreme Court, pointing to “a question of great public importance requiring immediate resolution by this Court,” accepts jurisdiction and sets oral arguments for August 31, 2004.
30-Jun-04
2nd DCA affirms Judge Baird’s March 12 ruling denying the Schindlers the ability to intervene in the lawsuit over the constitutionality of “Terri’s Law.”
19-Jul-04
The Schindlers file a motion in the Circuit Court for Pinellas County seeking relief from judgment in Schindler v. Schiavo. Based in part upon the recent statement by Pope John Paul II, they argue that the orders mandating withdrawal of the PEG tube from Ms. Schiavo and authorizing Michael to challenge the constitutionality of “Terri’s Law” violate her “free exercise of her religious beliefs [and] her right to enjoy and defend her own life and, in fact, imperil her immortal soul.”
27-Jul-04
National group of bioethicists files amicus brief “in support of Michael Schiavo as guardian of the person.”
31-Aug-04
The Florida Supreme Court hears oral arguments in the lawsuit over the constitutionality of “Terri’s Law.”
31-Aug-04
Circuit Judge George Greer, opposed for re-election by an attorney who was known to oppose Greer’s rulings in the Schiavo case, is re-elected by a large margin.
23-Sep-04
Florida’s Supreme Court, unanimously affirming the trial court order, declares “Terri’s Law” unconstitutional.
4-Oct-04
Governor Bush files a motion and then an amended motion for rehearing and clarification of the Florida Supreme Court opinion issued on September 23, 2004
21-Oct-04
Florida Supreme Court denies Governor Bush’s amended motion for rehearing and clarification, as well as a motion seeking permission to file a second amended motion for rehearing and clarification. The Court issues a mandate to transfer jurisdiction back to Judge Greer.
22-Oct-04
In Pinellas County, at the trial-court level, Judge Greer denies the motion filed by the Schindlers on July 19, 2004. He also stays the removal of her PEG tube until December 6, 2004.
25-Oct-04
Governor Bush files a motion with the Florida Supreme Court asking that it recall the mandate it issued on October 22 because he will be filing a petition for certiorari regarding this case with the United States Supreme Court.
27-Oct-04
Florida Supreme Court grants Governor Bush’s motion asking that it recall the mandate issued on October 22. Proceedings in the trial and all appellate courts in the case of Bush v. Schiavo are stayed until November 29, 2004.
22-Nov-04
In the guardianship proceeding in Pinellas County, the Schindlers appeal from Judge Greer’s October 22 order denying their motion for relief from judgment.
1-Dec-04
Governor Bush files a petition for certiorari, seeking review of the Florida Supreme Court’s decision regarding “Terri’s Law,” with the U.S. Supreme Court.
29-Dec-04
2nd DCA, without opinion, denies the Schindlers’ November 22 appeal from Judge Greer’s order refusing to reopen the guardianship proceeding.
10-Jan-05
The Schindlers again ask Judge Greer to remove Michael Schiavo from his judicial appointed post of Ms. Schiavo’s guardian.
13-Jan-05
The Schindlers file two motions – one in the 2d DCA, asking it to reconsider its decision of December 29, 2004, and a second in the trial court guardianship proceeding, asking Judge Greer once again to prevent withdrawal of nutrition and hydration until the 2d DCA does so.
24-Jan-05
JAN/24/05 US SUPREME The United States Supreme Court refused to grant review of the case in which the Florida Supreme Court struck down “Terri’s Law” as unconstitutional.
REFUSES HEARING 7-Feb-05
Florida’s Department of Agriculture and Consumer Services cites the Terri Schindler-Schiavo Foundation for failing to register with the state to solicit donations.
11-Feb-05
In Pinellas County, Judge Greer denies the Schindlers’ motions, filed January 10 and 13, 2005. The order authorizing withdrawal of the PEG tube remains in effect, although implementation is stayed pending the outcome of currently pending appeals.
15-Feb-05
The Schindlers ask the 2nd DCA to stay the mandate issued when it refused to hear their most recent appeal.
16-Feb-05
Randall Terry, founder of the pro-life activist organization Operation Rescue, appears with the Schindlers at a news conference, vowing protest vigils against removal of the PEG tube.
18-Feb-05
The Schindlers again petition Judge Greer in Pinellas County for reconsideration of the order of February 11, 2005, in which the court upheld its judgment, made in the year 2000, that the PEG tube should be removed.
18-Feb-05
Florida Representatives Baxley Brown; Cannon; Davis, D.; Flores; Goldstein; Lopez-Cantera; Murzin; Quinones; Traviesa introduced H 701 in the Florida Legislature. H 701, mirroring S. 692 (introduced in October 2003 and withdrawn in April 2004), would require maintenance of medically supplied nutrition and hydration in incapacitated persons in most instances.
21-Feb-05
The 2d DCA denies the Schindlers’ motion of February 15, 2005, clearing the way for removal of the PEG tube when the current stay expires on February 22, 2005. Judge Greer schedules a hearing on the Schindlers’ motion of February 18, 2005, for February 23, 2005.
22-Feb-05
Judge Greer stays removal of the PEG tube until 5 p.m. on February 23, 2005 (after he hears argument on the motion filed by the Schindlers on February 18, 2005).
23-Feb-05
After a hearing, Judge Greer extends the stay preventing removal of the PEG tube until 5 p.m. on February 25, 2005, to permit time to issue an order detailing his decisions regarding matters discussed at the hearing. Officials from Florida’s Department of Children and Families (DCF) move to intervene in the case, but Judge Greer denies the motion to intervene at the hearing.
25-Feb-05
Judge Greer denies the motion before him and orders that, “absent a stay from the appellate courts, the guardian, Michael Schiavo, shall cause the removal of nutrition and hydration from the ward, Theresa Schiavo, at 1 p.m. on Friday, March 18, 2005.”
26-Feb-05
The St. Petersburg Times reports that a Vatican cardinal spoke on Vatican Radio opposing removal of the PEG tube.
28-Feb-05
The Schindlers file a number of motions with Judge Greer, addressing a range of issues. They also indicate that they will appeal the judge’s decision of February 25, 2005. Judge Greer denies some of the motions but agreed to set a hearing date to consider others.
7-Mar-05
The Schindlers appeal Judge Greer’s February 25, 2005 order to the 2nd DCA.
Bioethicists from six Florida universities submit an analysis of H701.
8-Mar-05
U.S. Rep. David Weldon (R.-Fla.) introduces in the United States House of Representatives H.R. 1151, titled the Incapactitated Persons’ Legal Protection Act. The bill would permit a federal court to review the Schiavo matter through a habeas corpus lawsuit.
9-Mar-05
The Florida House Health Care Regulation Committee considers H.701, voting to approve a Council/Committee Substitute 701 instead of the original version.
10-Mar-05
Judge Greer issues order denying Florida’s Department of Children and Families the right to intervene in the guardianship case.
14-Mar-05
The Judiciary Committee in the Florida House considers H.701, voting to approve another Committee substitute for the original bill. The South Florida Sun-Sentinel reports that the House and the Senate have agreed that this bill will come to a vote.
15-Mar-05
The Florida House Health & Families Council considers and approves the second committee substitute H.701.
The Florida Senate Judiciary Committee passes S.804, providing that medically supplied nutrition and hydration cannot be “suspended from” a person in a PVS if: (1) the purpose of the suspension is “solely to end the life of” a person in a PVS; (2) a conflict exists on the issue of suspension of medically supplied nutrition and hydration among the persons who could be proxy decisionmakers for that person under Florida law; and (3) the person in the PVS had not executed a written advance directive or deignated a health care surrogate.
16-Mar-05
The 2d DCA affirms Judge Greer’s orders and refuses to stay the scheduled March 18 withdrawal of the PEG tube.
The U.S. House of Representatives, by voice vote, passes H.R. 1332, the Protection of Incapacitated Persons Act of 2005. This bill would amend federal law to provide for removal of certain cases to federal court from state court, rather than authorizing use of the federal habeas corpus remedy to obtain federal court review, as H.R. 1151 would have.
17-Mar-05
The Florida House of Representatives approves H.701, after some amendments.
The Florida Senate votes down S.804.
FL DCF Florida’s Department of Children and Families (DCF) petitions the Florida Supreme Court for relief, and the Florida Supreme Court denies the petition.
US SENATE The U.S. Senate passes a “private bill” applying to the Schiavo case but differing from H.R. 1332. The U.S. Senate website, at http://www.senate.gov, explains a “private bill” as follows: “A private bill provides benefits to specified individuals (including corporate bodies). Individuals sometimes request relief through private legislation when administrative or legal remedies are exhausted. Many private bills deal with immigration–granting citizenship or permanent residency. Private bills may also be introduced for individuals who have claims again the government, veterans benefits claims, claims for military decorations, or taxation problems. The title of a private bill usually begins with the phrase, “For the relief of. . . .” If a private bill is passed in identical form by both houses of Congress and is signed by the President, it becomes a private law.”
The Schindlers ask the U.S. Supreme Court to hear the case, but the U.S. Supreme Court denies their petition.
Republican senators circulate a memo on the political advantages of supporting legislation to reinsert Ms. Schiavo’s nutrition tube. On April 7, The Washington Post reported that “The legal counsel to Sen. Mel Martinez (R-Fla.) admitted [on April 6] that he was the author of a memo citing the political advantage to Republicans of intervening in the case … Brian H. Darling, 39, a former lobbyist for the Alexander Strategy Group on gun rights and other issues, offered his resignation and it was immediately accepted, Martinez said.”
18-Mar-05
The U.S. House of Representatives Committee on Government Reform issues five subpoenas: one commanding Michael Schiavo to appear before it and bring with him the “hydration and nutrition equipment” in working order; three commanding physicians and other personnel at the hospice to do the same; and one commanding Ms. Schiavo to appear before it. The subpoenas would require that the PEG tube remain in working order until at least the date of testimony, March 25, 2005. The subpoenas are included as appendices to the U.S. House All Writs Petition (see just below).
The Committee on Government Reform also moves to intervene in the guardianship litigation before Judge Greer and asks Judge Greer to stay his order requiring removal of the PEG tube. Judge Greer denies the motions.
The Committee on Government Reform files an emergency all-writs petition with the Florida Supreme Court, effectively seeking reversal of Judge Greer’s denial of its motions. The Florida Supreme Court denies this petition.
The House Committee on Government Reform asks the U.S. Supreme Court to review the Florida Supreme Court’s denial of its petition. Justice Kennedy, acting for the Court, denies the application for relief.
MAR/18/05 PEG 3 REMOVED The PEG tube is removed in mid-afternoon. This is the third time the tube has been removed in accordance with court orders.
The Schindlers, as “next friends” of their daughter, file a petition for writ of habeas corpus in federal district court in the Middle District of Florida. That court dismisses the case for lack of jurisdiction and refuses to issue a temporary restraining order because “there is not a substantial likelihood that [the Schindlers] will prevail on their federal constitutional claims.”
March 19-20, 2005
The U.S. Senate delays its Easter recess and works on Saturday to reach a compromise with the House on a bill, S.686, closely resembling the special bill it passed on March 17. On Palm Sunday (which holiday is frequently noted in debate), it then passes S.686 and the U.S. House of Representatives returns from Easter recess for a special session to debate S.686.
20-Mar-05
House Democrats and Republicans hold news conferences.
21-Mar-05
Shortly past 12:30 a.m., the U.S. House of Representatives votes 203-58 to suspend its rules and pass S.686.
CONGRESS DEBATE Congressional Debate on S.686
President Bush signs S.686 at 1:11 a.m.
Federal District Court Judge James D. Whittemore, Middle District of Florida (in Tampa), hears arguments on the Schindlers’ motion that he order re-insertion of the PEG tube while the lawsuit they will assert pursuant to S.686 is litigated.
22-Mar-05
Federal District Court Judge Whittemore refuses to order re-insertion of the PEG tube.
The Schindlers appeal Judge Whittemore’s decision to the U.S. Court of Appeals for the Eleventh Circuit.
The Schindlers file an amended complaint in the federal district court, adding a number of new claims.
NPR “Morning Edition” broadcast
23-Mar-05
The U.S. Eleventh Circuit Court of Appeals, in a 2-1 vote, denies the Schindlers’ appeal.
United States Eleventh Circuit Court of Appeals, acting en banc (as a whole), refuses to rehear the Schindlers’ appeal, leaving intact the court’s ruling earlier in the day. 
House Democrats and Republicans hold news conferences.
The Florida Senate, by a vote of 21-18, again refuses to pass S.804. This bill was approved by the Senate Judiciary Committee on March 15, 2005.
Florida Governor Jeb Bush reports that a neurologist, Dr. William Cheshire, claims that Ms. Schiavo is not in a persistent vegetative state. The governor asks the Florida Department of Children and Families (DCF) to obtain custody of Ms. Schiavo in light of allegations of abuse. Judge Greer holds a hearing on the matter.
The Schindlers file a petition for writ of certiorari with the U.S. Supreme Court.
Judge Greer issues a restraining order prohibiting DCF from removing Ms.Schiavo from the hospice or otherwise re-inserting the PEG tube.
The Schindlers ask again for a restraining order in federal court.
Five members of the U.S. House of Representatives ask the U.S. Supreme Court to file a “friend of the court” brief.
24-Mar-05
The U.S. Supreme Court refuses to hear the Schindlers’ case.
The Schindlers file a Second Amended Complaint, adding several claims, in the federal court case. Count X, titled “Right to Life,” alleges a violation of the Fourteenth Amendment’s right to life because removing the PEG tube is “contrary to [Ms. Schiavo’s] wish to live.”
The trial court (Judge Whittemore) schedules a hearing for 6 p.m. and orders supplemental briefs on Count X.
Judge Greer denies DCF’s motion to intervene. DCF appeals Judge Greer’s order. Judge Greer vacates the automatic stay upon appeal. The 2d District Court of Appeal refuses to reinstate the stay. The Florida Supreme Court dismisses a motion on this matter because it “fails to invoke” the court’s jurisdiction.
25-Mar-05
Judge Whittemore denies the Schindlers’ second motion for an order re-inserting the PEG tube.
The Schindlers appeal Judge Whittemore’s order to the U.S. Court of Appeals for the Eleventh Circuit. The Eleventh Circuit affirms. The Schindlers announce that they will pursue no more federal appeals.
The Schindlers file an emergency motion attempting to convince Judge Greer to reinsert the PEG, at least temporarily until the Eleventh Circuit decides their appeal. The motion contends her family heard her try to verbalize “I want to live,” according to news reports. (This motion and accompanying affidavits comprise Appendix 7 of the Schindlers’ Petition linked under March 26, just below.)
DCF appeals Judge Greer’s March 23 denial of its first motion to intervene to the 2d DCA.
26-Mar-05
Judge Greer denies the Schindlers’ motion of March 25, 2005.
The Schindlers appeal to the Florida Supreme Court to reverse Judge Greer’s refusal to reinsert the PEG tube, but the Florida Supreme Court refuses to do so, citing a lack of jurisdiction.
News agencies report the arrest on March 25 of Richard Alan Meywes of Fairview, N.C., for offering $250,000 for the killing of Michael Schiavo and another $50,000 for the death of Judge Greer.
The Schindlers advise supporters demonstrating around the hospice to return home to spend the Easter holiday with their families. The protesters remain.
27-Mar-05
In an interview on CNN, Governor Bush says: “I cannot violate a court order. I don’t have power from the U.S. Constitution, or the Florida Constitution for that matter, that would allow me to intervene after a decision has been made.”
29-Mar-05
The Rev. Jesse Jackson leads a prayer service outside the hospice and speaks out against removal of the PEG tube.
The 2d DCA upholds Judge Greer’s ruling refusing to let the DCF intervene.
Despite earlier indications that they would pursue no further federal appeals, the Schindlers petition the entire Eleventh Circuit Court of Appeals for permission to file a motion for rehearing en banc although the time to do so has expired. A grant of that petition would enable the Schindlers to ask for review of the Eleventh Circuit decision of March 24.
30-Mar-05
The Eleventh Circuit permits the Schindlers’ filing and then, acting both through a panel and as a whole, denies the motion for rehearing.
The U.S. Supreme Court refuses to review the Eleventh Circuit ruling.
31-Mar-05
MAR/31/05 TERRI DIES Ms. Schiavo dies at 9:05 a.m. Her body is transported to the Pinellas Country Coroners’ Office for an autopsy.
Hospice of the Florida Suncoast issues a statement.
President Bush discusses Schiavo (video includes remarks on, WMD Commission Report)
Florida Gov. Bush issues a statement.
Judge Greer authorizes Michael Schiavo to administer Ms. Schiavo’s estate. 
On this date in 1976, the New Jersey Supreme Court ruled that PVS patient Karen Ann Quinlan could be disconnected from her respirator. She remained in a persistent vegetative state and died in 1985.
12-Apr-05
The Wall Street Journal Online / Harris Interactive Health Care Poll finds that “most people disapprove of how President Bush, Governor Bush, and the Congress handled the issue.” Harris Poll
15-Apr-05
In response to a motion from the media, Judge Greer orders DCF to release redacted copies of abuse reports regarding Ms. Schiavo. Newspapers report that DCF found no evidence of abuse after investigating the 89 reports filed before February 18, 2005. Thirty allegations are outstanding and still being investigated, but Judge Greer earlier had ruled that those allegations duplicated those previously filed.
17-May-05
More than six weeks after Ms. Schiavo’s death, Lisa Wilson is the last of the hundreds of protesters outside Ms. Schiavo’s hospice.
15-Jun-05
Dr. Jon Thogmartin, Florida’s District Six Medical Examiner, releases the results of Ms. Schiavo’s autopsy. He reports that the autopsy showed Ms. Schiavo’s condition was “consistent” with a person in a persistent vegetative state. “This damage was irreversible,” he said. “No amount of therapy or treatment would have regenerated the massive loss of neurons.” No evidence of abuse was found, he said.

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