Many (in the press, on talk radio, in the blogosphere) have asked for two things in regards to Terri Schiavo: 1) A more dispassionate view (specifically court-appointed and neutral) of the case, and 2) more therapy for Terri.

In regards to the first issue, one can go here (PDF) to see the report of Jay Wolfson, DrPH, JD, Guardian Ad Litem for Theresa Marie Schiavo (1 December 2024) (h/t: Kevin Alyward). Many seem to think that there has been insufficient fact-finding in this case, but if one does some research, one discovers that this is not the case.

And from that report, we get a semi-answer answer to the second:

In late Autumn of 1990, following months of therapy and testing, formal diagnoses of persistent vegetative state with no evidence of improvement, Michael took Theresa to California, where she received an experimental thalamic stimulator implant in her brain. Michael remained in California caring for Theresa during a period of several months and returned to Florida with her in January of 1991. Theresa was transferred to the Mediplex Rehabilitation Center in Brandon, where she received 24 hour skilled care, physical, occupational, speech and recreational therapies.

Despite aggressive therapies, physician and other clinical assessments consistently revealed no functional abilities, only reflexive, rather than cognitive movements, random eye opening, no communication system and little change cognitively or functionally.

On 19 July 1991 Theresa was transferred to the Sable Palms skilled care facility. Periodic neurological exams, regular and aggressive physical, occupational and speech therapy continued through 1994.

Such facts tend to vitiate the argument that if Terri was just given more therapy that she would improve, as well as countering the argument that Michael Schiavo was never interested in his wife’s recovery. While I have my questions about Mr. Schiavo, the bottom line here appears to be that there were several years of therapy that resulted in naught in terms of recovery for Terri.

Dr. Wolfson notes that in 1994 the Schindlers and Michael started to disagree about Terri’s care. The Schindlers attempted to have Michael removed as guardian. The court saw no evidence to remove Schiavo as guardain. Wolfson notes:

Proceedings concluded that there was no basis for the removal of Michael as Guardian Further, it was determined that he had been very aggressive and attentive in his care of Theresa. His demanding concern for her well being and meticulous care by the nursing home earned him the characterization by the administrator as “a nursing home administrator’s nightmare�. It is notable that through more than thirteen years after Theresa’s collapse, she has never had a bedsore.

By 1994, Michael’s attitude and perspective about Theresa’s condition changed. During the previous four years, he had insistently held to the premise that Theresa could recover and the evidence is incontrovertible that he gave his heart and soul to her treatment and care. This was in the face of consistent medical reports indicating that there was little or no likelihood for her improvement.

And here’s an interesting finding in the report:

It took Michael a long time to consider the prospect of getting on with his life – something he was actively encouraged to do by the Schindlers, long before enmity tore them apart. He was even encouraged by the Schindlers to date, and introduced his in-law family to women he was dating. But this was just prior to the malpractice case ending. As part of the first challenge to Michael’s Guardianship, the court appointed

In regards to the decision to remove the feeding tube:

In 1997, six years after Theresa’s tragic collapse, Michael elected to initiate an action to withdraw artificial life support from Theresa. More than a year later, in May of 1998, the first petition to discontinue life support was entered. The court appointed Richard Pearse, Esq., to serve as Guardian Ad Litem to review the request for withdrawal, a standard procedure.

In regards to Dr. Wolfson’s actual observations of Terri:

Terri is a living, breathing human being. When awake, she sometimes groans, makes noises that emulate laughter or crying, and may appear to track movement. But the scientific medical literature and the reports this GAL [Guardian ad litem, i.e., Dr. Wolfson] obtained from highly respected neuro-science researchers indicate that these activities are common and characteristic of persons in a persistent vegetative state.

In the month during which the GAL conducted research, interviews and compiled information, he sought to visit with Theresa as often as possible, sometimes daily, and sometimes, more than once each day. During that time, the GAL was not able to independently determine that there were consistent, repetitive, intentional, reproducible interactive and aware activities. When Theresa’s mother and father were asked to join the GAL, there was no success in eliciting specific responses. Hours of observed video tape recordings of Theresa offer little objective insight about her awareness and interactive behaviors. There are instances where she appears to respond specifically to her mother. But these are not repetitive or consistent. There were instances during the GAL’s visits, when responses seemed possible, but they were not consistent in any way.

This having been said, Theresa has a distinct presence about her. Being with Theresa, holding her hand, looking into her eyes and watching how she is lovingly treated by Michael, her parents and family and the clinical staff at hospice is an emotional experience. It would be easy to detach from her if she were comatose, asleep with her eyes closed and made no noises. This is the confusing thing for the lay person about persistent vegetative states.

Theresa’s neurological tests and CT scans indicate objective measures of the persistent vegetative state. These data indicate that Theresa’s cerebral cortex is principally liquid, having shrunken due to the severe anoxic trauma experienced thirteen years ago. The initial oxygen deprivation caused damage that could not be repaired, and the brain tissue in that area continued to devolve. It is noteworthy to recall that from the time of her collapse, and for more than three years, Theresa did receive active physical, occupational, speech and even recreational therapy.

In regards to further improvemnet:

In recent months, individuals have come forward indicating that there are therapies and treatments and interventions that can literally re-grow Theresa’s functional, cerebral cortex brain tissue, restoring part or all of her functions. There is no scientifically valid, medically recognized evidence that this has been done or is possible, even in rats, according to the president of the American Society for Neuro-Transplantation. It is imaginable that some day such things may be possible; but holding out such promises to families of severely brain injured persons today may be a profound disservice.

[…]

The GAL concludes 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.

The only hope that the report holds out is that a test could be conducted on her ability to swallow.

The bottom line is that this is not an easy case, and the facts are complex. However, at a minimum is it simply not the case that attempts weren’t made to help her, and that neutral observeres haven’t been involved.