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152-485: The Terri Schiavo case was a series of court and legislative actions in the United States from 1998 to 2005, regarding the care of Theresa Marie Schiavo (née Schindler ) ( / ˈ ʃ aɪ v oʊ / ; December 3, 1963 – March 31, 2005), a woman in an irreversible persistent vegetative state . Schiavo's husband and legal guardian argued that Schiavo would not have wanted prolonged artificial life support without

304-468: A feeding tube because the brainstem , the center of vegetative functions (such as heart rate and rhythm, respiration, and gastrointestinal activity) is relatively intact. Many people emerge spontaneously from a vegetative state within a few weeks. The chances of recovery depend on the extent of injury to the brain and the patient's age – younger patients having a better chance of recovery than older patients. A 1994 report found that of those who were in

456-526: A permanent vegetative state can be made if, after exhaustive testing and a customary 12 months of observation, a medical diagnosis is made that it is impossible by any informed medical expectations that the mental condition will ever improve. Hence, a "continuous vegetative state" in the UK may remain the diagnosis in cases that would be called "persistent" in the US or elsewhere. While the actual testing criteria for

608-560: A PVS was set in 1993 in the case of Tony Bland , who sustained catastrophic anoxic brain injury in the 1989 Hillsborough disaster . An application to the Court of Protection is no longer required before nutrition and hydration can be withdrawn or withheld from PVS (or 'minimally conscious' – MCS) patients. This legal grey area has led to vocal advocates that those in PVS should be allowed to die . Others are equally determined that, if recovery

760-478: A PVS) were carried out. The court denied the motion to remove the guardian, allowing that the evidence was not sufficient and, in some instances, not relevant. It set April 24, 2001, as the date on which the tube was to be removed. In April 2001, the Schindlers filed a motion for relief from judgment citing new evidence of Terri Schiavo's wishes. Judge Greer denied the motion as untimely under Rule 1.540(b)(5) of

912-500: A PVS. Greer noted that "most of the doctor affidavits submitted are based on their understanding of Schiavo's condition from news reports or video clips they have seen. Many are obviously not aware of the medical exams undertaken for the 2002 trial." Following Greer's order on March 18, 2005, to remove the feeding tube, Republicans in the United States Congress subpoenaed both Michael and Terri Schiavo to testify at

1064-484: A balanced accounting equation. A ledger is a record of accounts . The ledger is a permanent summary of all amounts entered in supporting Journals which list individual transactions by date. These accounts are recorded separately, showing their beginning/ending balance . A journal lists financial transactions in chronological order, without showing their balance but showing how much is going to be entered in each account. A ledger takes each financial transaction from

1216-432: A congressional hearing. Greer told congressional attorneys, "I have had no cogent reason why the (congressional) committee should intervene." He also stated that last-minute action by Congress does not invalidate years of court rulings. President George W. Bush and Congressional Republicans anticipated Greer's adverse ruling well before it was delivered and worked on a daily basis to find an alternative means of overturning

1368-414: A delay, the exam was unlikely to show any residual neck findings." Regarding the cause and manner of Schiavo's death, Thogmartin wrote, "Mrs. Schiavo suffered severe anoxic brain injury. The cause of which cannot be determined with reasonable medical certainty. The manner of death will therefore be certified as undetermined." Schiavo's body was cremated . Her parents organized a memorial Mass for her at

1520-420: A diagnosis of "permanent" in the UK are quite similar to the criteria for a diagnosis of "persistent" in the US, the semantic difference imparts in the UK a legal presumption that is commonly used in court applications for ending life support. The UK diagnosis is generally only made after 12 months of observing a static vegetative state. A diagnosis of a persistent vegetative state in the US usually still requires

1672-533: A diagnosis of a persistent vegetative state, although in some cases, such as that of Terri Schiavo , such rulings have generated widespread controversy. In the UK, the term is discouraged in favor of two more precisely defined terms that have been strongly recommended by the Royal College of Physicians (RCP) . These guidelines recommend using a continuous vegetative state for patients in a vegetative state for more than four weeks. A medical determination of

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1824-434: A female of her age, height, and weight, due to the loss of a massive number of neurons. Microscopic examination revealed extensive damage to nearly all brain regions , including the cerebral cortex , the thalamus , the basal ganglia , the hippocampus , the cerebellum , and the midbrain . The neuropathologic changes in her brain were precisely of the type seen in patients who enter a PVS following cardiac arrest. Throughout

1976-452: A heated nebulizer or removal of the assisted oxygen if it is no longer needed. The authors further recommend additional research to determine if this chilling effect may either delay recovery or even may contribute to brain damage. There are two dimensions of recovery from a persistent vegetative state: recovery of consciousness and recovery of function. Recovery of consciousness can be verified by reliable evidence of awareness of self and

2128-406: A lack of a living will and questions regarding Michael's credibility, Pearse recommended denying his petition to remove her feeding tube. Pearse reported that the issue of conflict of interest applied to the Schindlers as well, since, had Michael divorced Terri as they wanted him to, they would have inherited the remainder of Terri Schiavo's estate upon her death. Given the lack of a living will ,

2280-630: A living will, her wish not to be kept alive by any artificial means, including receiving food and water "by a gastric tube or intravenously." At that time, it was common to remove people from ventilators, but the law in Florida was not clear on removing them from feeding tubes. In a landmark ruling, the Florida Supreme Court decided that Browning had "the constitutional right to choose or refuse medical treatment, and that right extends to all relevant decisions concerning one's health." During

2432-538: A machine where her chance for recovery was minuscule. According to Abstract Appeal Trial Order, her parents "claimed that Terri was a devout Roman Catholic who would not wish to violate the Church's teachings on euthanasia by refusing nutrition and hydration ." Judge Greer issued his order granting the petition for authorization to discontinue artificial life support for Terri Schiavo in February 2000. In this decision,

2584-404: A motion, asking for permission to attempt to provide Schiavo with "Food and Water by Natural Means". This second motion asked for permission to "attempt to feed" Schiavo by mouth. Judge Greer denied the second motion on March 8, saying "it has become clear that the second motion is part and parcel of the previous motion on medical evaluations. The same declarations are being used for both motions and

2736-466: A painful stimulus, still activates "primary" sensory cortices in these patients but these areas are functionally disconnected from "higher order" associative areas needed for awareness. These results show that parts of the cortex are indeed still functioning in "vegetative" patients. In addition, other PET studies have revealed preserved and consistent responses in predicted regions of auditory cortex in response to intelligible speech stimuli. Moreover,

2888-641: A patient constitutes futile care. An American bioethicist, Jacob M. Appel , argued that any money spent treating PVS patients would be better spent on other patients with a higher likelihood of recovery. The patient died naturally prior to a decision in the case, resulting in the court finding the issue moot . In 2010, British and Belgian researchers reported in an article in the New England Journal of Medicine that some patients in persistent vegetative states actually had enough consciousness to "answer" yes or no questions on fMRI scans. However, it

3040-439: A patient is highly unlikely ever to achieve higher functions above a vegetative state. This diagnosis does not mean that a doctor has diagnosed improvement as impossible, but does open the possibility, in the US, for a judicial request to end life support. Informal guidelines hold that this diagnosis can be made after four weeks in a vegetative state. US caselaw has shown that successful petitions for termination have been made after

3192-457: A patient is in a PVS, the more severe the resulting disabilities are likely to be. Rehabilitation can contribute to recovery, but many patients never progress to the point of being able to take care of themselves. The medical literature also includes case reports of the recovery of a small number of patients following the removal of assisted respiration with cold oxygen. The researchers found that in many nursing homes and hospitals unheated oxygen

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3344-753: A person can still respond, in varying degrees, to stimulation. A person in a coma, however, cannot. In addition, PVS patients often open their eyes in response to feeding, which has to be done by others; they are capable of swallowing, whereas patients in a coma subsist with their eyes closed. Cerebral cortical function (e.g. communication, thinking, purposeful movement, etc.) is lost while brainstem functions (e.g. breathing, maintaining circulation and hemodynamic stability, etc.) are preserved.  Non-cognitive upper brainstem functions such as eye-opening, occasional vocalizations (e.g. crying, laughing), maintaining normal sleep patterns, and spontaneous non-purposeful movements often remain intact. PVS patients' eyes might be in

3496-444: A petitioner to prove in court that recovery is impossible by informed medical opinion, while in the UK the "permanent" diagnosis already gives the petitioner this presumption and may make the legal process less time-consuming. In common usage, the "permanent" and "persistent" definitions are sometimes conflated and used interchangeably. However, the acronym "PVS" is intended to define a "persistent vegetative state", without necessarily

3648-477: A physician, I think a compelling case can be made that doctors have an ethical obligation to assist such patients by removing treatment. I suspect that, if such individuals are indeed trapped in their bodies, they may be living in great torment and will request to have their care terminated or even active euthanasia." This article contains text from the NINDS public domain pages on TBI. [1] Archived 2005-10-19 at

3800-456: A preliminary fMRI examination revealed partially intact responses to semantically ambiguous stimuli, which are known to tap higher aspects of speech comprehension. Furthermore, several studies have used PET to assess the central processing of noxious somatosensory stimuli in patients in PVS. Noxious somatosensory stimulation activated midbrain , contralateral thalamus , and primary somatosensory cortex in each and every PVS patient, even in

3952-517: A relatively fixed position, or track moving objects, or move in a disconjugate (i.e., completely unsynchronized) manner. They may experience sleep -wake cycles, or be in a state of chronic wakefulness. They may exhibit some behaviors that can be construed as arising from partial consciousness, such as grinding their teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus . Individuals in PVS are seldom on any life-sustaining equipment other than

4104-469: A restaurant manager, while Terri took up a bookkeeping job with an insurance company. She had naturally dark hair, but dyed it blonde. In the early morning of February 25, 1990, Schiavo collapsed in a hallway of her St. Petersburg, Florida apartment. Firefighters and paramedics , arriving in response to her husband Michael's 9-1-1 call, found her face-down and unconscious. She was not breathing and had no pulse . They attempted to resuscitate her and she

4256-549: A single order by Florida's Second District Court of Appeal, came to be known by the court as Schiavo II in its later rulings. On August 10, 2001, on remand from the Florida Second District Court of Appeal , Judge Greer heard a motion from the Schindlers claiming that new medical treatment could restore sufficient cognitive ability such that Terri Schiavo herself would be able to decide to continue life-prolonging measures. The court also heard motions from

4408-653: A single order by the Florida Second District Court of Appeal, came to be known by the court as Schiavo III in its later rulings. In October 2002, on remand by the Second District Court of Appeal, an evidentiary hearing was held in Judge Greer's court to determine whether new therapy treatments could help Terri Schiavo restore any cognitive function. In preparation for the trial, a new computed axial tomography scan (CAT scan)

4560-514: A syndrome that seemed to have been made possible by medicine 's increased capacities to keep patients' bodies alive. An ongoing debate exists as to how much care, if any, patients in a persistent vegetative state should receive in health systems plagued by limited resources. In a case before the New Jersey Superior Court, Betancourt v. Trinitas Hospital , a community hospital sought a ruling that dialysis and CPR for such

4712-585: A trial was held before Pinellas County Judge George Greer during the week of January 24, 2000, to determine what Schiavo's wishes would have been regarding life-prolonging procedures. Michael Schiavo was represented by attorney George Felos , who had won a landmark right-to-die case before the Florida Supreme Court in 1990. The trial included testimony from eighteen witnesses regarding her medical condition and her end-of-life wishes. Michael Schiavo claimed that his wife would not want to be kept on

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4864-425: A vegetative state a month after a trauma, 54% had regained consciousness by a year after the trauma, whereas 28% had died and 18% were still in the vegetative state. For non-traumatic injuries such as strokes , only 14% had recovered consciousness at one year, 47% had died, and 39% were still vegetative. Patients who were vegetative six months after the initial event were much less likely to have recovered consciousness

5016-592: A woman diagnosed with PVS was able to activate predictable portions of her brain in response to the tester's requests that she imagine herself playing tennis or moving from room to room in her house. The brain activity in response to these instructions was indistinguishable from those of healthy patients. In 2010, Martin Monti and fellow researchers, working at the MRC Cognition and Brain Sciences Unit at

5168-471: A year after the event than in the case of those who were simply reported vegetative at one month. A New Scientist article from 2000 gives a pair of graphs showing changes of patient status during the first 12 months after head injury and after incidents depriving the brain of oxygen. After a year, the chances that a PVS patient will regain consciousness are very low and most patients who do recover consciousness experience significant disability. The longer

5320-400: Is a record of small-value purchases before they are later transferred to the ledger and final accounts; it is maintained by a petty or junior cashier. This type of cash book usually uses the imprest system : a certain amount of money is provided to the petty cashier by the senior cashier. This money is to cater for minor expenditures (hospitality, minor stationery, casual postage, and so on) and

5472-464: Is a set of rules for recording financial information in a financial accounting system in which every transaction or event changes at least two different ledger accounts. A daybook is a descriptive and chronological (diary-like) record of day-to-day financial transactions ; it is also called a book of original entry . The daybook's details must be transcribed formally into journals to enable posting to ledgers. Daybooks include: A petty cash book

5624-429: Is a three-column list. Column One contains the names of those accounts in the ledger which have a non-zero balance. If an account has a debit balance, the balance amount is copied into Column Two (the debit column ); if an account has a credit balance, the amount is copied into Column Three (the credit column ). The debit column is then totalled, and then the credit column is totalled. The two totals must agree—which

5776-481: Is adjusted by an equal and opposite amount. Other adjustments such as posting depreciation and prepayments are also done at this time. This results in a listing called the adjusted trial balance . It is the accounts in this list, and their corresponding debit or credit balances, that are used to prepare the financial statements. Finally financial statements are drawn from the trial balance, which may include: The primary bookkeeping record in single-entry bookkeeping

5928-565: Is at all possible, care should continue. The existence of a small number of diagnosed PVS cases that have eventually resulted in improvement makes defining recovery as "impossible" particularly difficult in a legal sense. This legal and ethical issue raises questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, and professional responsibilities. Most PVS patients are unresponsive to external stimuli and their conditions are associated with different levels of consciousness. Some level of consciousness means

6080-549: Is common. An example study with 40 patients in the United Kingdom diagnosed with PVS reported 43% of the patients were considered to have been misdiagnosed, and another 33% had recovered whilst the study was underway. Some PVS cases may actually be a misdiagnosis of patients being in an undiagnosed minimally conscious state . Since the exact diagnostic criteria of the minimally conscious state were only formulated in 2002, there may be chronic patients diagnosed as PVS before

6232-626: Is competent to make those decisions. At the moment it is premature to conclude that the individual able to answer 5 out of 6 yes/no questions is fully conscious like you or I." In contrast, Jacob M. Appel of the Mount Sinai Hospital told the Telegraph that this development could be a welcome step toward clarifying the wishes of such patients. Appel stated: "I see no reason why, if we are truly convinced such patients are communicating, society should not honour their wishes. In fact, as

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6384-838: Is evidence of partially functional cerebral regions in catastrophically injured brains. To study five patients in PVS with different behavioral features, researchers employed PET, MRI and magnetoencephalographic (MEG) responses to sensory stimulation. In three of the five patients, co-registered PET/MRI correlate areas of relatively preserved brain metabolism with isolated fragments of behavior. Two patients had had anoxic injuries and demonstrated marked decreases in overall cerebral metabolism to 30–40% of normal. Two other patients with non-anoxic, multifocal brain injuries demonstrated several isolated brain regions with higher metabolic rates, that ranged up to 50–80% of normal. Nevertheless, their global metabolic rates remained <50% of normal. MEG recordings from three PVS patients provide clear evidence for

6536-513: Is frequently misdiagnosed, and that the reasons for withdrawal of life support from a patient should be scrutinized since even family member surrogates can have conflicts of interest. The Palm Sunday Compromise granted the federal review they sought, but it was limited to only the Schiavo case. The seven-year case generated a great deal of public attention and activism. There was extensive media coverage and both sides courted public opinion. In 2000,

6688-429: Is given to non-responsive patients via tracheal intubation. This bypasses the warming of the upper respiratory tract and causes a chilling of aortic blood and chilling of the brain which the authors believe may contribute to the person's nonresponsive state. The researchers describe a small number of cases in which removal of the chilled oxygen was followed by recovery from the PVS and recommend either warming of oxygen with

6840-461: Is lost in obscurity, but recent research indicates that methods of keeping accounts have existed from the remotest times of human life in cities. Babylonian records written with styli on small slabs of clay have been found dating to 2600 BC. Mesopotamian bookkeepers kept records on clay tablets that may date back as far as 7,000 years. Use of the modern double entry bookkeeping system was described by Luca Pacioli in 1494. The term " waste book "

6992-440: Is not by chance—because under the double-entry rules, whenever there is a posting, the debits of the posting equal the credits of the posting. If the two totals do not agree, an error has been made, either in the journals or during the posting process. The error must be located and rectified, and the totals of the debit column and the credit column recalculated to check for agreement before any further processing can take place. Once

7144-456: Is not considered a life-prolonging procedure under Florida law. Since clinical records indicated that Terri Schiavo was not responsive to swallowing tests and required a feeding tube, Judge Greer ruled that she was not capable of orally ingesting sufficient nutrition and hydration to sustain life, and denied the request. The Medical Examiner in his postmortem report was more definitive and reaffirmed that Schiavo could not have swallowed. In 2000,

7296-409: Is possible. In recent years, a number of studies have demonstrated an important role for functional neuroimaging in the identification of residual cognitive function in persistent vegetative state; this technology is providing new insights into cerebral activity in patients with severe brain damage. Such studies, when successful, may be particularly useful where there is concern about the accuracy of

7448-438: Is recognized by statute law as death in only a very few legal systems. In the US, courts have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion. In England, Wales and Scotland, the legal precedent for withdrawal of clinically assisted nutrition and hydration in cases of patients in

7600-657: Is reimbursed periodically on satisfactory explanation of how it was spent. The balance of petty cash book is Asset . Journals are recorded in the general journal daybook. A journal is a formal and chronological record of financial transactions before their values are accounted for in the general ledger as debits and credits . A company can maintain one journal for all transactions, or keep several journals based on similar activity (e.g., sales, cash receipts, revenue, etc.), making transactions easier to summarize and reference later. For every debit journal entry recorded, there must be an equivalent credit journal entry to maintain

7752-602: Is the cash book , which is similar to a checking account register (in UK: cheque account, current account), except all entries are allocated among several categories of income and expense accounts. Separate account records are maintained for petty cash, accounts payable and accounts receivable , and other relevant transactions such as inventory and travel expenses. To save time and avoid the errors of manual calculations, single-entry bookkeeping can be done today with do-it-yourself bookkeeping software. A double-entry bookkeeping system

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7904-417: Is to record the financial effects of transactions. An important difference between a manual and an electronic accounting system is the former's latency between the recording of a financial transaction and its posting in the relevant account. This delay, which is absent in electronic accounting systems due to nearly instantaneous posting to relevant accounts, is characteristic of manual systems, and gave rise to

8056-466: Is unclear whether the fact that portions of the patients' brains light up on fMRI will help these patient assume their own medical decision making. Professor Geraint Rees, Director of the Institute of Cognitive Neuroscience at University College London, responded to the study by observing that, "As a clinician, it would be important to satisfy oneself that the individual that you are communicating with

8208-541: The American Center for Law and Justice (ACLJ), appealed the right to participate in the "Terri's Law" case, with the court scheduling an oral argument date for June 14. The Schindlers' other attorney, Pat Anderson, was concurrently challenging Michael Schiavo's right to be her guardian, and, on June 16, 2004, she made a petition for writ of quo warranto . On May 5, 2004, Baird found "Terri's Law" unconstitutional , and struck it down. Bush appealed this order to

8360-706: The Karen Ann Quinlan case and Nancy Cruzan case , two landmark right-to-die cases. Quinlan entered a persistent vegetative state in 1975, and her family was allowed to remove her from a ventilator in 1976 after a ruling by the New Jersey Supreme Court based on her right of privacy. She died of pneumonia in 1985. Cruzan was diagnosed with PVS in 1983 and her legal case reached the Supreme Court, which ruled that "clear and convincing evidence" of her wishes to die under such circumstances

8512-531: The United States , it is estimated that there may be between 15,000 and 40,000 patients who are in a persistent vegetative state, but due to poor nursing home records exact figures are hard to determine. The syndrome was first described in 1940 by Ernst Kretschmer who called it apallic syndrome . The term persistent vegetative state was coined in 1972 by Scottish spinal surgeon Bryan Jennett and American neurologist Fred Plum to describe

8664-475: The University of Cambridge , reported in an article in the New England Journal of Medicine that some patients in persistent vegetative states responded to verbal instructions by displaying different patterns of brain activity on fMRI scans. Five out of a total of 54 diagnosed patients were apparently able to respond when instructed to think about one of two different physical activities. One of these five

8816-542: The Wayback Machine and [2] . Bookkeeping Bookkeeping is the recording of financial transactions, and is part of the process of accounting in business and other organizations. It involves preparing source documents for all transactions, operations, and other events of a business. Transactions include purchases, sales, receipts and payments by an individual person, organization or corporation. There are several standard methods of bookkeeping, including

8968-442: The mnemonic device AEIOU-TIPS to recall portions of the differential diagnosis: Alcohol ingestion and acidosis, epilepsy and encephalopathy, infection, opiates, uremia, trauma, insulin overdose or inflammatory disorders, poisoning and psychogenic causes, and shock. Despite converging agreement about the definition of persistent vegetative state, recent reports have raised concerns about the accuracy of diagnosis in some patients, and

9120-491: The single-entry and double-entry bookkeeping systems. While these may be viewed as "real" bookkeeping, any process for recording financial transactions is a bookkeeping process. The person in an organisation who is employed to perform bookkeeping functions is usually called the bookkeeper (or book-keeper). They usually write the daybooks (which contain records of sales, purchases, receipts, and payments), and document each financial transaction, whether cash or credit, into

9272-586: The " Palm Sunday Compromise " and transferred jurisdiction of the Schiavo case to the federal courts. The bill passed the House on March 21, 2005, at 12:41 a.m. ( UTC−5 ). Bush flew to Washington, D.C. from his vacation in Texas in order to sign the bill into law at 1:11 a.m. While the bill had been proposed by Republican Senators Rick Santorum and Mel Martínez , it also had the support of Democratic Senator Tom Harkin due to disability rights concerns in

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9424-476: The "Terri's Law" case but were denied by Judge W. Douglas Baird, a Circuit Judge in the Florida Sixth Circuit. They appealed, and, on February 13, 2004, the Florida Second District Court of Appeal (Second District Court of Appeals) ordered Baird to hold further hearings on the issue. On March 17, 2004, Baird denied the Schindlers the right to intervene a second time. The Schindlers, represented by

9576-421: The 20th century, principally through the cases of Karen Ann Quinlan and Nancy Cruzan." The outcome of the Schiavo case was also in part determined by a 1990 Florida case, Guardianship of Estelle Browning . In that case, attorney George Felos, representing a Browning relative, successfully argued that Browning's feeding tube should be removed before the Florida Supreme Court . The elderly Browning had expressed, in

9728-519: The British Royal College of Physicians of London, "a wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent (or 'continuing') vegetative state". The vegetative state is a chronic or long-term condition. This condition differs from a coma : a coma is a state that lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In

9880-496: The Florida Rules of Civil Procedure. The Second District Court of Appeal upheld Greer's decision but remanded the issue in order to give the Schindlers an opportunity to file a new motion. On April 24, 2001, Terri's feeding tube was removed for the first time. The Schindlers filed a civil suit against Michael Schiavo alleging perjury , which was assigned to another court. The judge, Frank Quesada, issued an injunction against

10032-1013: The Holy Name of Jesus Catholic Church in Gulfport on April 5, 2005. Father Frank Pavone , the founder of the Priests for Life anti-abortion organization, delivered the homily. Michael Schiavo had his wife's cremated remains interred in a cemetery on June 20, 2005. The Schindlers' attorney stated that the family was notified by fax only after the memorial service; by then, the family had already started getting calls from reporters. The ashes were interred at Sylvan Abbey Memorial Park in Clearwater, Florida . The epitaph (pictured) reads: Schiavo / Theresa Marie / Beloved Wife Born December 3, 1963 Departed this Earth / February 25, 1990 At peace March 31, 2005 [ Dove with olive branch image ] I kept my promise The Schiavo case has been compared to

10184-550: The January 2000 evidentiary hearing had Iyer contacted them in 1996 as her affidavit alleges." On October 15, 2003, Schiavo's feeding tube was removed. Within a week, when the Schindlers' final appeal was exhausted, State Rep. Frank Attkisson and the Florida Legislature passed "Terri's Law" in an emergency session giving Governor Jeb Bush the authority to intervene in the case. Governor Bush immediately ordered

10336-679: The Mediplex Rehabilitation Center in Bradenton, Florida . On July 19, 1991, Schiavo was transferred to the Sabal Palms Skilled Care Facility, where she received neurological testing and regular speech and occupational therapy until 1994. In mid-1993, Michael Schiavo requested a do not resuscitate order for her after she contracted a urinary tract infection . In 1992, Michael filed a malpractice suit against Terri's gynecologist on

10488-549: The PAC later that year. The Schindlers continued operation of the Terri Schindler Schiavo Foundation, with a new goal of helping individuals in situations similar to Terri's. In April 2010, Michael Schiavo charged that the Schindlers were improperly using Terri's name, as he held the rights to it, and that the family was using the foundation in order to make money. A Florida television station looked at

10640-521: The Schiavo case. Harkin had worked with disability rights groups for years and co-authored the 1990 Americans with Disabilities Act . American disability rights groups traditionally tend to ally themselves with Democrats and the political left; however, in the Schiavo case, they joined pro-life organizations in opposing the removal of her feeding tube and supporting the Palm Sunday Compromise. According to Marilyn Golden , Harkin's support

10792-518: The Schindler family and one from Dr. Alexander T. Gimon. At the hearing, the Schindlers' counsel read into the record additional affidavits from three speech professionals and two nurses. In particular, nurse Carla Sauer Iyer asserted that she was able to feed Terri Schiavo orally but that Michael characterized any such interaction as "therapy" and ordered her not to do so. Iyer claimed in her affidavit that her initial training in 1996 consisted solely of

10944-405: The Schindler family attorney, still held out hope "that Terri might be able to take nourishment orally, despite past findings that she is incapable". Judge Greer formally denied the motion and ordered the "removal of nutrition and hydration from the ward" and set the time and date for the removal of the feeding tube as "1:00 p.m. on Friday, March 18, 2005". On February 28, 2005, the Schindlers filed

11096-472: The Schindlers (Terri Schiavo's parents) enjoyed an amicable relationship, with the Schindlers allowing Michael to live rent-free in their condominium for several months. In November 1990, Michael Schiavo took Terri to the University of California, San Francisco , for experimental nerve stimulation with a thalamic stimulator . The treatment took several months and was unsuccessful. He returned to Florida with her in January 1991 and admitted her as an inpatient to

11248-661: The Schindlers again challenged Michael Schiavo's guardianship. The Schindlers suggested that he was wasting the assets within the guardianship account by transferring Terri Schiavo to a Pinellas Park, Florida , hospice "after it was clear that she was not 'terminal' within Medicare guidelines" for hospices. By this time, while still legally married to Terri Schiavo, 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

11400-425: The Schindlers and their supporters produced six video clips intended to support their case, totaling less than six minutes, and released those clips to public websites. Judge Greer ruled that Terri Schiavo was in a PVS, and was beyond hope of significant improvement. The trial court order was particularly critical of Hammesfahr's testimony, which claimed positive results in similar cases by use of vasodilation therapy,

11552-513: The Schindlers created the Terri Schindler-Schiavo Foundation to garner support. During the weeks when Schiavo's feeding tube was removed in 2005, activists kept up an around-the-clock vigil outside her hospice. The protests were described as loud but non-violent. There were dozens of arrests, with most being for crossing a police line with water for Schiavo. Two polls conducted shortly after Schiavo's feeding tube

11704-414: The Schindlers released books telling their sides of the story. Schiavo's was called Terri: The Truth , while the Schindlers' was titled A Life that Matters: The Legacy of Terri Schiavo – A Lesson for Us All . Persistent vegetative state There are several definitions that vary by technical versus layman's usage. There are different legal implications in different countries. Per the definition of

11856-444: The Schindlers to remove the guardian (Michael Schiavo) and to require Judge Greer to recuse himself. Judge Greer denied the motions and the Schindlers appealed to the Second District Court of Appeals. On October 17, 2001, the Court of Appeal affirmed the denials of the motions to remove and recuse. The Court of Appeals acknowledged that their opinion misled the trial court, and they remanded the question of Terri Schiavo's wishes back to

12008-430: The Second District Court of Appeals came to be known as Schiavo IV in later rulings. Around the start of 2003, the Schindlers began to create more publicity by lobbying for their case to keep their daughter alive. On September 11, 2003, the Schindlers petitioned the court to forestall removal of the feeding tube in order to provide for "eight weeks' therapy". Accompanying the petition were four affidavits from members of

12160-537: The Second District Court of Appeals, but on May 12, 2004, the court issued an "Order Relinquishing Case for Entry of Final Judgment and Order to Show Cause Why this Proceeding Should Not be Certified to the Supreme Court As Requiring Immediate Resolution". The Second District Court of Appeals, in sending it directly to the Florida Supreme Court, invoked "pass through" jurisdiction. The Florida Supreme Court then overturned

12312-532: The U.S. Congress, and President George W. Bush; and four denials of certiorari from the Supreme Court of the United States . The case also spurred highly visible activism from the United States anti-abortion movement , the right-to-die movement , and disability rights groups. Since Schiavo's death, both her husband and her family have written books on their sides of the case, and both have also been involved in activism over related issues. Terri Schiavo

12464-408: The UK and several other countries) were written to pay money out of the account. Nowadays such transactions are mostly made electronically. Bookkeeping first involves recording the details of all of these source documents into multi-column journals (also known as books of first entry or daybooks ). For example, all credit sales are recorded in the sales journal; all cash payments are recorded in

12616-424: The absence of detectable cortical evoked potentials . In conclusion, somatosensory stimulation of PVS patients, at intensities that elicited pain in controls, resulted in increased neuronal activity in primary somatosensory cortex, even if resting brain metabolism was severely impaired. However, this activation of primary cortex seems to be isolated and dissociated from higher-order associative cortices. Also, there

12768-466: The absence, abnormality or reduction of evoked responses. Despite major abnormalities, however, these data also provide evidence for localized residual activity at the cortical level. Each patient partially preserved restricted sensory representations, as evidenced by slow evoked magnetic fields and gamma band activity. In two patients, these activations correlate with isolated behavioral patterns and metabolic activity. Remaining active regions identified in

12920-475: The account to be located in the general ledger. The equity section of the chart of accounts is based on the fact that the legal structure of the entity is of a particular legal type. Possibilities include sole trader , partnership , trust , and company . Computerized bookkeeping removes many of the paper "books" that are used to record the financial transactions of a business entity; instead, relational databases are used today, but typically, these still enforce

13072-405: The accounts balance, the accountant makes a number of adjustments and changes the balance amounts of some of the accounts. These adjustments must still obey the double-entry rule: for example, the inventory account and asset account might be changed to bring them into line with the actual numbers counted during a stocktake . At the same time, the expense account associated with use of inventory

13224-496: The autopsy. On March 24, 2005, Judge Greer denied a petition for intervention by the Florida Department of Children and Families (DCF) and signed an order forbidding the department from "taking possession of Theresa Marie Schiavo or removing her" from the hospice and directed "each and every and singular sheriff of the state of Florida" to enforce his order. The order was appealed to the Second District Court of Appeals

13376-416: The basis that he failed to diagnose bulimia as the cause of her infertility. Terri had gone to the doctor because she had stopped menstruating but the doctor had failed to take her medical history into account which might have revealed an eating disorder. During the case, one of Terri's friends testified that she knew Schiavo was bulimic. In November 1992, Michael won the case and was awarded $ 6.8 million by

13528-585: The best wishes and best interests" of Schiavo, and report them to Governor Bush. Wolfson's report did not change Michael's role as her legal guardian and did not otherwise obstruct him legally. Michael Schiavo opposed the Governor's intervention in Schiavo's case, and was represented, in part, by the American Civil Liberties Union (ACLU). At the same time, Robert and Mary Schindler, her parents, attempted to intervene and participate in

13680-446: The case. In April 2005, the families disagreed over Schiavo's burial. The Schindlers had wanted her body to be buried in Florida, while Michael Schiavo said at the time that he would cremate her body and then have her ashes buried in her home state of Pennsylvania . In June 2005, however, Schiavo's ashes were buried in Florida instead. The words "I kept my promise" were included on the marker, referring to his promise to follow what he said

13832-425: The cash payments journal. Each column in a journal normally corresponds to an account. In the single entry system , each transaction is recorded only once. Most individuals who balance their check-book each month are using such a system, and most personal-finance software follows this approach. After a certain period, typically a month, each column in each journal is totalled to give a summary for that period. Using

13984-443: The cerebral cortex, the large pyramidal neurons that comprise some 70% of cortical cells – critical to the functioning of the cortex – were completely lost. The pattern of damage to the cortex, with injury tending to worsen from the front of the cortex to the back, was also typical. There was marked damage to important relay circuits deep in the brain (the thalamus) – another common pathologic finding in cases of PVS. The damage was, in

14136-587: The connotations of permanence, and is used as such throughout this article. Bryan Jennett , who originally coined the term "persistent vegetative state", has now recommended using the UK division between continuous and permanent in his book The Vegetative State , arguing that "the 'persistent' component of this term ... may seem to suggest irreversibility". The Australian National Health and Medical Research Council has suggested "post coma unresponsiveness" as an alternative term for "vegetative state" in general. Unlike brain death , permanent vegetative state (PVS)

14288-438: The correct daybook—that is, petty cash book, suppliers ledger, customer ledger, etc.—and the general ledger . Thereafter, an accountant can create financial reports from the information recorded by the bookkeeper. The bookkeeper brings the books to the trial balance stage, from which an accountant may prepare financial reports for the organisation, such as the income statement and balance sheet . The origin of book-keeping

14440-418: The court found that Terri Schiavo was in a persistent vegetative state and that she had made reliable oral declarations that she would have wanted the feeding tube removed. This decision was upheld by the Florida Second District Court of Appeal (2nd DCA) and came to be known by the court as Schiavo I in its later rulings. In March 2000, the Schindlers filed a motion to permit assisted feeding of Terri, which

14592-460: The diagnosis and the possibility that residual cognitive function has remained undetected. Researchers have begun to use functional neuroimaging studies to study implicit cognitive processing in patients with a clinical diagnosis of persistent vegetative state. Activations in response to sensory stimuli with positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and electrophysiological methods can provide information on

14744-608: The environment, consistent voluntary behavioral responses to visual and auditory stimuli, and interaction with others. Recovery of function is characterized by communication, the ability to learn and to perform adaptive tasks, mobility, self-care, and participation in recreational or vocational activities. Recovery of consciousness may occur without functional recovery, but functional recovery cannot occur without recovery of consciousness. There are three main causes of PVS (persistent vegetative state): Potential causes of PVS are: In addition, these authors claim that doctors sometimes use

14896-401: The extent to which, in a selection of cases, residual cognitive functions may remain undetected and patients are diagnosed as being in a persistent vegetative state. Objective assessment of residual cognitive function can be extremely difficult as motor responses may be minimal, inconsistent, and difficult to document in many patients, or may be undetectable in others because no cognitive output

15048-474: The feeding tube be reinserted. Governor Bush sent the Florida Department of Law Enforcement (FDLE) to remove Schiavo from the hospice. She was taken to Morton Plant Rehabilitation Hospital in Clearwater, where her feeding tube was surgically reinserted. She was then returned to the hospice. Part of the legislation required the appointment of a guardian ad litem (GAL) , Jay Wolfson, to "deduce and represent

15200-538: The first functional correlate of clinical–pathological reports associating permanent unconsciousness with structural damage to these regions. The specific patterns of preserved metabolic activity identified in these patients reflect novel evidence of the modular nature of individual functional networks that underlie conscious brain function. The variations in cerebral metabolism in chronic PVS patients indicate that some cerebral regions can retain partial function in catastrophically injured brains. Statistical PVS misdiagnosis

15352-430: The following day, which resulted in an automatic stay under state law. While the stay was in effect, Florida Department of Law Enforcement personnel prepared to take custody of Terri Schiavo and transfer her to a local hospital for reinsertion of the feeding tube. Once Greer was made aware of the stay, he ordered it lifted and all parties stood down. Governor Bush decided to obey the court order despite enormous pressure from

15504-411: The foundation's tax records and found that for 2008, it paid 64% of the $ 91,568 it raised in salaries to Terri's father, Robert Schindler Sr., her sister, Suzanne Vitadamo, and her brother, Robert Schindler Jr. Their attorney said the foundation does its work effectively and that the high percentage for salaries was due to the small amount of money the foundation raises. He also said that the Schindlers had

15656-454: The hospital, she was noted as suffering from hypokalemia (low potassium levels): her serum potassium level was an abnormally low 2.0  mEq / L (the normal range for adults is 3.5–5.0 mEq/L). Her sodium and calcium levels were normal. Electrolyte imbalance is often caused by drinking excessive fluids , and a serious consequence of hypokalemia can be heart rhythm abnormalities, including sudden arrhythmia death syndrome . Schiavo

15808-597: The instruction, "Do what Michael Schiavo tells you or you're terminated", and that standing orders were not to contact the Schindler family, but that she "would call them anyway". On September 17, 2003, Judge George Greer denied the petition, and wrote that "the Petition is an attempt by Mr. and Mrs. Schindler to re-litigate the entire case. It is not even a veiled or disguised attempt. The exhibits relied upon by them, clearly demonstrate this to be true." Regarding Iyer's statements, Greer wrote that they were "incredible to say

15960-412: The invasiveness of the procedures. Stimulation techniques include sensory stimulation, sensory regulation, music and musicokinetic therapy, social-tactile interaction, and cortical stimulation. There is limited evidence that the hypnotic drug zolpidem has an effect. The results of the few scientific studies that have been published so far on the effectiveness of zolpidem have been contradictory. In

16112-402: The journal and records it into the corresponding accounts. The ledger also determines the balance of every account, which is transferred into the balance sheet or the income statement . There are three different kinds of ledgers that deal with book-keeping: A chart of accounts is a list of the accounts codes that can be identified with numeric, alphabetical, or alphanumeric codes allowing

16264-437: The jury, later reduced to $ 2 million as Terri was found partly at fault for her condition. After attorneys' fees and other expenses, Michael received $ 300,000 and $ 750,000 was put in a trust fund for Terri's medical care. According to Michael, in early 1993 the Schindlers demanded that he share the malpractice money with them. On June 18, 1990, the court appointed Michael Schiavo as Terri Schiavo's legal guardian; this appointment

16416-476: The law as unconstitutional. On February 23, 2005, the Schindlers filed a motion for relief from judgment pending medical evaluations. The Schindlers wanted Schiavo to be tested with an fMRI and given a swallowing therapy called VitalStim. The motion was accompanied by thirty-three affidavits from doctors in several specialties, speech-language pathologists and therapists, and a few neuropsychologists, all urging that new tests be undertaken. Patricia Fields Anderson,

16568-528: The least" and that "Ms. Iyer details what amounts to a 15-month cover-up from April 1995 through July 1996, which include the staff of Palm Garden of Largo Convalescent Center, the Guardian of the Person, the guardian ad litem , the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler ... It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for

16720-421: The ledger is called posting . Once the posting process is complete, accounts kept using the "T" format (debits on the left side of the "T" and credits on the right side) undergo balancing , which is simply a process to arrive at the balance of the account. As a partial check that the posting process was done correctly, a working document called an unadjusted trial balance is created. In its simplest form, this

16872-464: The legal process by utilizing the authority of the United States Congress . On March 20, 2005, the Senate, by unanimous consent , passed their version of a relief bill; since the vote was taken by voice vote, there was no official tally of those voting in favor and those opposed. Soon after Senate approval, the House of Representatives passed an identical version of the bill S.686, which came to be called

17024-504: The months after her initial collapse. Indeed, within an hour of her initial hospital admission, radiographic examination of her cervical spine was negative. Specifically, external signs of strangulation including cutaneous or deep neck injury, facial/conjunctival petechiae, and other blunt trauma were not observed or recorded during her initial hospital admission. Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such

17176-460: The motion appears to be an alternative pleading to the previous motion. Both are asking for an experimental procedure." The following day, Greer denied the first motion as well, citing that an affiant doctor for Michael cautioned that fMRI was an experimental procedure that should be conducted in an academic setting, because Schiavo had already undergone swallowing tests and failed, and because VitalStim had only been performed on patients who were not in

17328-502: The original decision to remove the feeding tube, staff at the Pinellas Park hospice facility disconnected the feeding tube on March 18, 2005, and Schiavo died on March 31, 2005. The Schiavo case involved 14 appeals and numerous legal motions , petitions, and hearings in the Florida courts; five suits in federal district court ; extensive political intervention at the levels of the Florida state legislature, Governor Jeb Bush ,

17480-704: The political right. If Bush (or the Florida Legislature) had ignored Greer's order by attempting to remove her from the hospice, a confrontation between the Pinellas Park Police Department and the FDLE agents could have ensued. In jest, one official said local police discussed "whether we had enough officers to hold off the National Guard." Terri Schiavo died at a Pinellas Park hospice on March 31, 2005. Schiavo's body

17632-406: The possibility of myocarditis ). Thogmartin found that "there was no proof that Terri Schiavo ever had an eating disorder such as bulimia." Regarding the possibility of strangulation or domestic violence as a cause of Schiavo's initial collapse, the report states: "No trauma was noted on any of the numerous physical exams or radiographs performed on Mrs. Schiavo on the day of, in the days after, or in

17784-415: The presence, degree, and location of any residual brain function. However, use of these techniques in people with severe brain damage is methodologically, clinically, and theoretically complex and needs careful quantitative analysis and interpretation. For example, PET studies have shown the identification of residual cognitive function in persistent vegetative state. That is, an external stimulation, such as

17936-408: The primary books of accounts—cash book, purchase book, sales book, etc.—for immediately documenting a financial transaction. In the normal course of business, a document is produced each time a transaction occurs. Sales and purchases usually have invoices or receipts . Historically, deposit slips were produced when lodgements (deposits) were made to a bank account ; and checks (spelled "cheques" in

18088-425: The prospect of recovery, and, in 1998, he elected to remove her feeding tube . Schiavo's parents disputed her husband's assertions and challenged Schiavo's medical diagnosis, arguing in favor of continuing artificial nutrition and hydration. The highly publicized and prolonged series of legal challenges presented by her parents, which ultimately involved state and federal politicians up to the level of George W. Bush ,

18240-435: The removal of feeding tube until this was settled. The feeding tube was reinserted on April 26, 2001. On appeal by Michael Schiavo, the Second District Court of Appeal reversed Judge Quesada's order. In the same time frame, Michael Schiavo filed a motion to enforce the mandate of the guardianship court (that the feeding tube be removed). The Second District Court of Appeal denied the motion. These three decisions, all published in

18392-450: The removal of her feeding tube and, in a speech delivered on the Senate floor, challenged the diagnosis of Schiavo's physicians of Schiavo being in a persistent vegetative state (PVS): "I question it based on a review of the video footage which I spent an hour or so looking at last night in my office." After her death, the autopsy showed signs of long-term and irreversible damage to her brain consistent with PVS. Frist defended his actions after

18544-408: The right to use Terri's name as she is a public figure. The foundation had been fined $ 1,000 shortly before Schiavo's death for failing to file timely paperwork. In September 2010, the Schindlers renamed the organization the "Terri Schiavo Life and Hope Network". (Page headers in the web publication show the name change occurred in 2010, compare volume 1 to 2 for 2010) In 2006, both Michael Schiavo and

18696-561: The rules of double-entry, these journal summaries are then transferred to their respective accounts in the ledger , or account book . For example, the entries in the Sales Journal are taken and a debit entry is made in each customer's account (showing that the customer now owes us money), and a credit entry might be made in the account for "Sale of class 2 widgets" (showing that this activity has generated revenue for us). This process of transferring summaries or individual transactions to

18848-402: The secondary notion of the minimally conscious state became known. Whether or not there is any conscious awareness with a patient's vegetative state is a prominent issue. Three completely different aspects of this should be distinguished. First, some patients can be conscious simply because they are misdiagnosed (see above). In fact, they are not in vegetative states. Second, sometimes a patient

19000-453: The success of which is unsupported in the medical literature. This ruling was later affirmed by Florida's Second District Court of Appeal, which stated that "this court has closely examined all of the evidence in the record", and "we have ... carefully observed the video tapes in their entirety." The court concluded that "if we were called upon to review the guardianship court's decision de novo , we would still affirm it." This decision by

19152-457: The then U.S. president , caused a seven-year (1998 to 2005) delay before Schiavo's feeding tube was ultimately removed. On February 25, 1990, at age 26, Schiavo went into cardiac arrest at her home in St. Petersburg, Florida . She was resuscitated, but had severe brain damage due to lack of oxygen to her brain and was left comatose . After two and a half months without improvement, her diagnosis

19304-447: The three PVS patients with behavioral fragments appear to consist of segregated corticothalamic networks that retain connectivity and partial functional integrity. A single patient who sustained severe injury to the tegmental mesencephalon and paramedian thalamus showed widely preserved cortical metabolism, and a global average metabolic rate of 65% of normal. The relatively high preservation of cortical metabolism in this patient defines

19456-447: The trial court and required an evidentiary hearing to be held. The court specified that five board certified neurologists were to testify. The Schindlers were allowed to choose two doctors to present findings at an evidentiary hearing while Schiavo could introduce two rebuttal experts. Finally, the trial court itself would appoint a new independent physician to examine and evaluate Terri Schiavo's condition. These decisions, all published in

19608-549: The vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. The vegetative state is also called a "coma vigil". The chances of regaining awareness diminish considerably as the time spent in the vegetative state increases. Persistent vegetative state is the standard usage (except in the UK) for a medical diagnosis, made after numerous neurological and other tests, that due to extensive and irreversible brain damage

19760-665: The vegetative state. Currently no treatment for vegetative state exists that would satisfy the efficacy criteria of evidence-based medicine . Several methods have been proposed which can roughly be subdivided into four categories: pharmacological methods, surgery, physical therapy, and various stimulation techniques. Pharmacological therapy mainly uses activating substances such as tricyclic antidepressants or methylphenidate . Mixed results have been reported using dopaminergic drugs such as amantadine and bromocriptine and stimulants such as dextroamphetamine . Surgical methods such as deep brain stimulation are used less frequently due to

19912-403: The words of Thogmartin, "irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons." The cardiac pathologist who studied Schiavo's heart found it and the coronary vessels to be healthy, which excludes the possibility that her initial collapse was the result of myocardial infarction , although there was a localized area of healed inflammation (opening

20064-527: The years of legal proceedings, disability rights groups and activists closely monitored and involved themselves in the case. In March 2003, twelve disability rights groups, led by Not Dead Yet, along with four other amici filed an amicus curiae brief in which they opposed the removal of Schiavo's feeding tube. They also used the Schiavo case to advocate for federal review in cases where third parties decide to withdraw life support from patients unable to give consent. They argued that persistent vegetative state

20216-417: Was "unclear" whether the Schiavo case represents a landmark decision . The Terri Schiavo affair involved a dispute between family members and her legal guardian over her wishes when there is no documented desire. According to medical ethicist Matthew Stonecipher, "The movement to challenge the decisions made for Terri Schiavo threatened to destabilize end-of-life law that had developed over the last quarter of

20368-503: Was also able to "answer" yes or no questions, again by imagining one of these two activities. It is unclear, however, whether the fact that portions of the patients' brains light up on fMRI could help these patients assume their own medical decision making. In November 2011, a publication in The Lancet presented bedside EEG apparatus and indicated that its signal could be used to detect awareness in three of 16 patients diagnosed in

20520-739: Was born Theresa Marie Schindler to Mary (born 1941) and Robert Schindler (1937–2009) on December 3, 1963, in Lower Moreland Township, Montgomery County, Pennsylvania , a suburb of Philadelphia . She was the oldest of three children. Her mother reported that, as a child, Schiavo would spend hours in her bedroom arranging her collection of stuffed animals. As a teen, she enjoyed listening to John Denver and reading Danielle Steel romances. She attended Bucks County Community College , where she met Michael Schiavo in 1982. The two began dating and married on November 10, 1984. They moved to Florida in 1986, following her parents. Michael worked as

20672-654: Was changed to that of a persistent vegetative state. For the next two years, doctors attempted occupational therapy, speech therapy, physical therapy and other experimental therapy, hoping to return her to a state of awareness, without success. In 1998, Schiavo's husband Michael Schiavo petitioned the Sixth Circuit Court of Florida to remove her feeding tube pursuant to Florida law. He was opposed by Terri's parents, Robert and Mary Schindler. The court determined that Schiavo would not have wished to continue life-prolonging measures, and on April 24, 2001, her feeding tube

20824-400: Was correctly diagnosed but is then examined during the early stages of recovery. Third, perhaps some day the notion itself of vegetative states will change so to include elements of conscious awareness. Inability to disentangle these three example cases causes confusion. An example of such confusion is the response to an experiment using functional magnetic resonance imaging which revealed that

20976-595: Was eventually switched from being fed by a nasogastric feeding tube to a percutaneous endoscopic gastrostomy (PEG) feeding tube. Garcia J. DeSousa, a board-certified neurologist in St. Petersburg, Florida, who previously treated Schiavo, cared for her during her initial admission to Humana Northside; both he and Victor Gambone, an internist and Schiavo family physician, independently made the diagnosis of persistent vegetative state within approximately one year after her sudden cardiac arrest. From 1990 to 1993, Michael Schiavo and

21128-540: Was her wish not to be kept alive artificially. The statement angered the Schindlers. In December 2005, Michael Schiavo created a political action committee , TerriPAC. It was formed to raise money to support right-to-die candidates and oppose candidates who had voted for government involvement in the Schiavo case. In 2007, TerriPAC paid a $ 1,350 fine to the Federal Election Commission for failing to file complete and timely records. Schiavo shut down

21280-558: Was in a persistent vegetative state (PVS). Drs. Maxfield and Hammesfahr testified that she was in a minimally conscious state . As part of the court-ordered medical exam, six hours of video of Terri Schiavo were taped and filed at the Pinellas County courthouse. The tape included Terri Schiavo with her mother and neurologist William Hammesfahr. The entire tape was viewed by Judge Greer, who wrote, Terri "clearly does not consistently respond to her mother". From that six hours of video,

21432-459: Was legally in a persistent vegetative state as defined by Florida Statutes, Title XLIV, Chapter 765, § 101(12). This includes the "absence of voluntary action" and an "inability to communicate or interact purposefully". Pearse found that there was no possibility of improvement but that Michael Schiavo's decisions might have been influenced by the potential to inherit what remained of Terri Schiavo's estate as long as he remained married to her. Due to

21584-401: Was necessary for passage of the bill, as any voice opposition by Democrats would have delayed it. As in the state courts, all of the Schindlers' federal petitions and appeals were denied, and the U.S. Supreme Court declined to grant certiorari , effectively ending the Schindlers' judicial options. At the same time, the so-called Schiavo memo surfaced, causing a political firestorm. The memo

21736-454: Was needed. Cruzan's family did not have enough evidence of that, but later produced more. She died after being removed from life support in 1990. The "Terri Schiavo case" actually refers to a series of cases. It differed from the Quinlan and Cruzan cases by involving settled law rather than breaking new legal ground on the right-to-die issue. In 2006, Professor Lois Shepherd, PhD JD, states it

21888-551: Was not disputed by the Schindlers at the time. In May 1998, Michael Schiavo filed a petition to remove Terri Schiavo's feeding tube, which her parents opposed. Richard Pearse was appointed by the court as a second guardian ad litem (GAL) , and on December 29, 1998, reported "Dr. Jeffrey Karp's opinion of the ward 's condition and prognosis is substantially shared among those physicians who have recently been involved in her treatment." Pearse concluded from Karp's and Vincent Gambone's diagnosis of Persistent Vegetative State that Schiavo

22040-482: Was performed, which showed severe cerebral atrophy . An EEG showed no measurable brain activity. The five physicians chosen were William Maxfield, a radiologist , and four neurologists : William Hammesfahr, Ronald Cranford, Melvin Greer and Peter Bambakidis. The five doctors examined Terri Schiavo's medical records, brain scans, the videos, and Terri herself. Cranford, Greer, and Bambakidis testified that Terri Schiavo

22192-402: Was released on June 15, 2005. In addition to studying Terri Schiavo's remains, Thogmartin scoured court, medical and other records and interviewed her family members, doctors and other relevant parties. Examination of Schiavo's nervous system by neuropathologist Stephen J. Nelson, revealed extensive injury. The brain itself weighed only 615 g (21.7 oz), only half the weight expected for

22344-494: Was removed for the final time in 2005 showed that a large majority of Americans believed that Michael Schiavo should have had the authority to make decisions on behalf of his wife and that the U.S. Congress overstepped its bounds with its intervention in the case. Since Terri Schiavo's death in March 2005, her family and Michael Schiavo have clashed a number of times. Each side has also worked to promote their own causes related to

22496-410: Was removed for the first time, only to be reinserted several days later. On February 25, 2005, a Pinellas County judge again ordered the removal of Terri Schiavo's feeding tube. Several appeals and federal government intervention followed, which included Bush returning to Washington, D.C., to sign legislation moving the case to the federal courts. After appeals through the federal court system that upheld

22648-665: Was taken to the Office of the District 6 Medical Examiner for Pinellas and Pasco counties, based in Largo, Florida. The autopsy was conducted on April 1, 2005, and revealed extensive brain damage. The manner of death was certified as "undetermined." The autopsy was led by Chief Medical Examiner Jon R. Thogmartin. In addition to consultation with a neuropathologist (Stephen J. Nelson), Thogmartin also arranged for specialized cardiac and genetic examinations to be made. The official autopsy report

22800-487: Was transported to the Humana Northside Hospital. Paramedics had her intubated and ventilated . The cause of Schiavo's collapse was determined to be cardiac arrest . Her medical chart contained a note that "she apparently has been trying to keep her weight down with dieting by herself, drinking liquids most of the time during the day and drinking about 10–15 glasses of iced tea ." Upon admission to

22952-400: Was used in colonial America, referring to the documenting of daily transactions of receipts and expenditures. Records were made in chronological order, and for temporary use only. Daily records were then transferred to a daybook or account ledger to balance the accounts and to create a permanent journal; then the waste book could be discarded, hence the name. The primary purpose of bookkeeping

23104-443: Was written by Brian Darling , the legal counsel to Florida Republican senator Mel Martínez. It suggested the Schiavo case offered "a great political issue" that would appeal to the party's base (core supporters) and could be used against Senator Bill Nelson , a Democrat from Florida , because he had refused to co-sponsor the bill. Nelson easily won re-election in 2006. Republican majority leader and physician Bill Frist opposed

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