Editor’s note: The following article is by Diana Lynne, author of a
powerful, comprehensive book on Terri Schiavo’s life and death, entitled
The Court-Ordered Death of an American Woman.” This latest WND Books
release is now available at WorldNetDaily’s online store.
Will there be another Terri Schiavo? The resounding word from those in the
trenches of advance-directive law is yes.
“I can’t imagine that there couldn’t,” said Karmen Hanson, an end-of-life
policy analyst with the National Conference of State Legislatures. “It all
depends on how the laws are interpreted.”
In the wake of the 41-year-old Florida woman’s court-ordered death on
March 31, following 13 days of dehydration, tens of thousands across the
country have rushed to prepare living wills with the goal of having their
medical-care preferences honored in the event of incapacitation.
Unlike Schiavo, who suffered severe brain damage at the age of 26 when
she mysteriously collapsed at home in 1990, tens of thousands are putting
their wishes in writing to have life-sustaining procedures withdrawn should
similar circumstances befall them.
“Terri Schiavo’s whole situation was by far the exception,” Jonathan
Keyserling, vice president of public policy analysis and strategy for the
National Hospice and Palliative Care Organization, commented to WND. “Every
day there are tens of thousands, if not hundreds of thousands of people, who
proceed through the end-of-life process with little dispute about the end
All 50 states have advance-directive laws, but they differ from state to
Every state but Massachusetts and Michigan have living-will statutes and
provide forms on which residents can indicate preferences for specific
life-sustaining medical treatment.
All states also provide the opportunity for a competent adult, and in
some cases an emancipated minor, to designate a health-care surrogate. This
avoids the necessity for a court-appointed guardian, as was needed in the
case of Terri Schiavo who had no advance directive.
As exhibited in the Schiavo case, in the absence of an advance directive,
most states outline a hierarchy of people who can be empowered by the court
to make medical decisions for the incapacitated. These usually begin with
the spouse, followed up by adult children, then parents or other relatives.
Some states include close friends and hospital ethics committees as the
last-resort patient advocate.
“In most states, unless there is clear evidence either through an advance
directive or the appointment of a health-care surrogate, or clear
conversations within the family, the dispute [between family members
demonstrated in the Schiavo case] can rise again,” added Keyserling. “That’s
why, we have pushed so hard as an organization.” Caring Connections, a
partnership with NHPCO, tracks and monitors state legislation on advance
directives in order to keep its list of living-will forms available for
download from its website current.
NHPCO, a powerful hospice lobby, actively has been promoting hospice
care, the use of advance directives and changes in public policy to foster
both for over a decade, thanks to a $148 million initiative called Last
Acts funded by the Robert Wood Johnson Foundation. WND reported on this campaign
last week. A more comprehensive
analysis of the Terri Schiavo story is also available from WND Books.
Disparity in the state laws concerns what medical conditions trigger the
execution of the advance directive. Only four states, Alabama, Idaho,
Oklahoma and Tennessee, specifically call for patients to be “terminally
Most other states instead reference a “terminal condition” or “incurable
or irreversible condition.” Only 17 states plus the District of Columbia
link these conditions with “imminent” or “close” death, or death that would
result “within a relatively short time,” “within six months” or “in the near
future.” In these states, it is understood that the patients are
Seven states plus the District of Columbia rigorously define “terminal”
to mean death will occur regardless of whether life-sustaining procedures
are administered. These are Delaware, Kansas, Louisiana, New Hampshire,
Texas and Vermont and Wyoming.
Elsewhere, in states like Connecticut, Illinois,Iowa, South Dakota and
Florida – where the familial tug-of-war over Terri Schiavo’s fate played
out – “terminal condition” means a condition that results in death in the
absence of life-sustaining procedures. In Terri Schiavo’s case, she was
ruled to be in a persistent vegetative state and lacking awareness of her
self and her environment. She was not, however, terminally ill, but had a
life span estimated by the medical examiner of another decade.
George Felos, the right-to-die attorney who represented Michael Schiavo’s
effort to remove his wife’s gastric feeding tube over the objections of her
parents and siblings, successfully argued Terri Schiavo was terminally ill
because she had the terminal condition of being unable to swallow. Thus,
without the feeding tube, she would be unable to receive food and fluids.
Couple this inability with the 2000 court order to remove the device, and
death for Terri Schiavo was imminent.
Hospice watchdog and nurse Ron Panzer, with the Hospice Patients
Alliance, scoffs at this use of the term “terminal.”
“If George Felos didn’t eat, he would be dead too,” said Panzer.
While the Schiavo court case turned on the alleged oral expression of
Terri’s end-of-life preferences as recollected by her husband, his brother
and his sister-in-law – which were disputed by the Schindlers – most states
require an advance directive to be a written document signed and witnessed
by a non-relative or notary. This requirement clearly lowers the potential
Meanwhile, in reaction to the Schiavo case, Florida legislators fortified
the state’s unique stance in May and voted to specify in the statute that
oral expression prior to incapacitation represents a valid advance
Advance directives ignored?
Despite the post-Schiavo rush to fill out living wills, there’s
indication even that won’t help prevent future life-versus-death court
battles. An April 15 report by the Robert Powell Center for Medical Ethics
Committee concluded the laws of all but 10 states may allow doctors and
hospitals to disregard advance directives when they call for treatment,
food, or fluids.
“Increasingly, health-care providers who consider a patient’s ‘quality of
life’ too low are denying life- preserving measures against the will of
patients and families – and the laws of most states provide no effective
protection against this involuntary denial,” read the report.
It’s not just pro-life forces who are concerned over advance directives
“There exists a gap between what patients expect with regard to end of
life care and what actually happens,” Jack Schwartz, Maryland assistant
attorney general and the director of health policy development for the
National Conference of State Legislatures, lamented at a recent annual
meeting where the name “Terri Schiavo” repeatedly cropped up. “The policy
task is getting the care delivery system to give people what they want.”
It all goes back to the interpretation of law.
Coming tomorrow … Part II of this series, “Will you be the next
Terri?” will take a look at which states lean pro-life or pro-death in
their advance-directive laws.
Diana Lynne’s powerful, comprehensive book on Terri Schiavo’s life and death, entitled “Terri’s Story: The
Court-Ordered Death of an American Woman.” is now available at
WorldNetDaily’s online store.