[Congressional Record Volume 151, Number 33 (Thursday, March 17, 2005)]
[Senate]
[Pages S3090-S3092]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                             TERRI SCHIAVO

  Mr. FRIST. Mr. President, in closing tonight, I will take a few final 
moments to speak on an issue that I opened with early this morning, 
about 14 hours ago, an issue which Senators Martinez and Santorum were 
on the floor speaking to about 45 minutes ago. It has to do with the 
Terri Schiavo case in Florida.
  I close this evening speaking more as a physician than as a U.S. 
Senator and speak to my involvement as a physician and as a Senator and 
as leader in the Senate in what has been a fascinating course of events 
for us over the last 48 hours, a saga which has not ended but one which 
we took major steps toward tonight in seeing that this woman is not 
starved to death tomorrow beginning at 1 o'clock, about 13 hours from 
now.
  When I first heard about the situation facing Terri Schiavo, I 
immediately wanted to know more about the case from a medical 
standpoint. I asked myself, just looking at the newspaper reports, is 
Terri clearly in this diagnosis called persistent vegetative state. I 
was interested in it in part because it is a very difficult diagnosis 
to make and I have been in a situation such as this many, many times 
before as a transplant surgeon.
  When we do heart transplants and lung transplants--and they are done 
routinely and were done routinely at the transplant center that I 
directed at Vanderbilt--in each and every case when you do a heart 
transplant or a lung transplant or a heart-lung transplant, the 
transplanted organs come from someone who is brain dead and death is 
clearly defined with a series of standardized clinical exams over a 
period of time, as well as diagnostic tests.
  Even brain death is a difficult diagnosis to make, and short of brain 
death, there are stages of incapacitation that go from coma to this 
persistent vegetative state to a minimally conscious state. They are 
tough diagnoses to make. You can make brain death with certainty, but 
short of that it is a difficult diagnosis and one that takes a series 
of evaluations over a period of time because of fluctuating 
consciousness.
  So I was a little bit surprised to hear a decision had been made to 
starve to death a woman based on a clinical exam that took place over a 
very short period of time by a neurologist who was called in to make 
the diagnosis rather than over a longer period of time. It is almost 
unheard of. So that raised the first question in my mind.
  I asked myself, does Terri clearly have no hope of being 
rehabilitated or improved in any way? If you are in a true persistent 
vegetative state, that may be the case. But, again, it is a very tough 
diagnosis to make and only by putting forth that rehabilitative therapy 
and following over time do you know if somebody is going to improve. At 
least from the reporting, that has not been the case.
  Then I asked myself, because we have living wills now and we have 
written directives which are very commonplace now, but 10 years ago 
they were not that common and, to be honest with you, a lot of 20- and 
30-year-olds do not think about their own mortality and do not offer 
those written directives. They did not 10 years ago. Now they do with 
increasing frequency. I encourage people to do that.
  So, I asked, did they have a written directive? And the answer was 
no. And did she have a clear-cut oral directive? And the answer was no.
  So my curiosity piqued as I asked to see all of the court affidavits. 
I received those court affidavits and had the opportunity to read 
through those over the last 48 hours. My curiosity was piqued even 
further because of what seemed to be unusual about the case, and so I 
called one of the neurologists who did evaluate her and evaluated her 
more extensively than what at least was alleged other neurologists had. 
And he told me very directly that she is not in a persistent vegetative 
state. I said, well, give me a spectrum from this neurologist who 
examined her. To be fair, he examined her about 2 years ago and, to the 
best of my knowledge, no neurologist has been able to examine her. I am 
not positive about that, but that is what I have been told in recent 
times. But at that exam, clearly she was not in a persistent vegetative 
state, and of 100 patients this neurologist would take care of, she was 
not at the far end of being an extreme patient in terms of her 
disability. He described it as if there were 100 patients, she might 
have been the 70th but not the 80th or 90th or 100th.
  So I was really curious that a neurologist who has spent time with 
her says she is not in a persistent vegetative state but they will 
begin starving her to death tomorrow at 1 o'clock because of what 
another neurologist said.
  I met with her family and her son. Her son says she has a severe 
disability. A lot of people have severe disabilities, such as cerebral 
palsy and receptive aphasia, but her brother said that she responds to 
her parents and to him. That is not somebody in persistent vegetative 
state.
  I then met in person with the chairman of the Judiciary Committee 2 
days ago in Florida to discuss the case. He told me that they had 
exhausted all options in the State of Florida to reverse what was going 
to be inevitable tomorrow, Friday, the 18th of March; and that is, that 
feedings and hydration were going to stop, that everything had been 
exhausted.

  He said the courts have been exhausted, and that all of the court 
decisions and the court cases had not been based on the facts because 
the facts were very limited and were the conclusions of one judge and 
two neurologists, and that was it, and that there were, in terms of the 
affidavits--I will get the exact number that I read--there were 
something like 34 affidavits from other doctors, who said that she 
could be improved with rehabilitation.
  So then it came to, what do you do? Here is the U.S. Senate that 
normally does not and should not get involved in all of these private-
action cases. It is not our primary responsibility here in the U.S. 
Senate. But with an exhaustion of a State legislature, an exhaustion of 
the court system in a State--yet all of this is based on what one judge 
had decided on what, at least initially, to me, looks like wrong data, 
incomplete data. But somebody is being condemned to death--somebody who 
is alive; there is no question she is alive--is being condemned to 
death.
  It takes an action to pull out a feeding tube. It takes an action to 
stop feeding. The inaction of feeding becomes an action. And thus, as I 
started talking about it this morning, the question was, what do we do? 
Bills had been put forth broadly on the floor, and Senator Martinez had 
very effective legislation, but it had to do with the habeas corpus, a 
very large issue that we have not had hearings on and debated.
  So what we decided to do was to fashion a bill that was very narrow, 
aimed

[[Page S3091]]

specifically at this case that would say she is not going to be starved 
to death tomorrow, but let's go and collect more information, have 
neurologists come in and obtain a body of facts before such a decision 
would be made.
  That is what we have done. As Senator Martinez said, and Senator 
Santorum said, we are not there yet. We have three different tracks 
going on that will be going on over the course of tonight. In my 
office, right now, letters are being written and being sent out, and we 
will not give up, and we have not given up. We passed the bill here 
tonight. The House has a bill. And I am confident if we continue 
working, and we are going to stay in session--we are not staying in 
session tonight but we are going to stay in session until we complete 
action.
  Let me just comment a little bit about the Terri Schiavo case because 
what I said is how we got involved. What I am about to say is a little 
bit more information than we have been able to talk about on the floor 
today because of the focus on the Budget Committee, although when we 
were just off the floor in the cloakroom behind us and in my office, we 
have been going nonstop on this all day long--all day long.
  Terri Schiavo is right now in a Florida hospice. She is breathing on 
her own. So she does not have a ventilator keeping her lungs expanding. 
She is breathing on her own. She is not a terminal case. She is, as I 
said, disabled. Under court order, this feeding tube was to be removed 
tomorrow, in about 14 hours from now. When her feeding tube is removed, 
she does not receive food; she starves to death. She has no hydration 
and she becomes dehydrated, has cardiovascular collapse, her heart and 
lungs would work overtime, and, of course, she would die.
  Her parents, Bob and Mary Schindler, have been fighting for over 10 
years to prevent her death. Imagine, if you and your spouse had a 
daughter, and you said: Don't let her die. We will take care of her. We 
will financially take care of her. How in the world can you have 
somebody come in and remove a feeding tube? That is what they have been 
saying for 10 years. They love her. They say that she responds to them. 
They would welcome the chance--welcome the chance--to be her guardian.
  As I understand it, Terri's husband will not divorce Terri and will 
not allow her parents to take care of her. Terri's husband, who I have 
not met, does have a girlfriend he lives with, and they have children 
of their own.
  A single Florida judge ruled that Terri is in this persistent 
vegetative state. And this is the same judge who has denied new 
testing, new examinations of Terri by independent and qualified medical 
professionals. They have not been allowed.
  As I mentioned, the attorneys for Terri's parents have submitted 33 
affidavits from doctors and other medical professionals, all of whom 
say that Terri should be re-evaluated. About 15--I read through the 
affidavits--and about 14 or 15 of these affidavits are from board 
certified neurologists. Some of these doctors, very specifically, say 
they believe, on the data they had seen, that Terri could benefit from 
therapy.
  There have been many comments that her legal guardian, that is 
Terri's husband, has not--it ranges. It is either that he has not been 
aggressive in rehabilitation, to other reports saying that he has 
thwarted rehabilitation since 1992. I can only report what I have read 
there because I have not met him.

  Persistent vegetative state, which is what the court has ruled, I say 
that I question it, and 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 
here in the Capitol. And that footage, to me, depicted something very 
different than persistent vegetative state.
  One of the classic textbooks we use in medicine today is called 
``Harrison's Principles of Internal Medicine.'' And in the 16th 
edition, which was published just this year, 2005, on page 1625, it 
reads:

     . . . the vegetative state signifies an awake but 
     unresponsive state. These patients have emerged from coma 
     after a period of days or weeks to an unresponsive state in 
     which the eyelids are open, giving the appearance of 
     wakefulness.

  This is from ``Harrison's Principles of Internal Medicine.''
  This ``unresponsive state in which the eyelids are open''--I quote 
that only because on the video footage, which is the actual exam by the 
neurologist, when the neurologist said, ``Look up,'' there is no 
question in the video that she actually looks up. That would not be an 
``unresponsive state in which the eyelids are open.''
  Skipping on down to what the Harrison's textbook says about 
``vegetative state,'' I quote:

       There are always accompanying signs that indicate extensive 
     damage in both cerebral hemisphere, e.g. decerebrate or 
     decorticate limb posturing and absent responses to visual 
     stimuli.

  And then, let me just comment, because it says: ``absent responses to 
visual stimuli.'' Once again, in the video footage--which you can 
actually see on the Web site today--she certainly seems to respond to 
visual stimuli that the neurologist puts forth.
  And lastly--I will stop quoting from the classic internal medicine 
textbook--one other sentence:

       In the closely related minimally conscious state the 
     patient may make intermittent rudimentary vocal or motor 
     responses.

  I would simply ask, maybe she is not in this vegetative state and she 
is in this minimally conscious state, in which case the diagnosis upon 
which this whole case has been based would be incorrect.
  Fifteen neurologists have signed affidavits that Terri should have 
additional testing by unbiased, independent neurologists. I am told 
that Terri never had an MRI or a PET scan of her head, and that 
disturbs me only because it suggests she hasn't been fully evaluated by 
today's standards. You don't have to have an MRI or PET scan to make a 
diagnosis of persistent vegetative state, but if you are going to allow 
somebody to die, starve them to death, I would think you would want to 
complete a neurological exam. She has not had an MRI or a PET scan, 
which suggests she has not had a full neurological exam.
  I should also note that the court sided with the testimony of Dr. 
Ronald Cranford, who is an outspoken advocate of physician-assisted 
suicide.
  A 1996 British Medical Journal study conducted in England's Royal 
Hospital for Neurodisability concluded there was a 43 percent error 
rate in the diagnosis of PVS. It takes a lot of time, as I mentioned 
earlier, to make this diagnosis with a very high error rate. If you are 
going to be causing somebody to die with purposeful action, like 
withdrawal of the feeding tube, you are not going to want to make a 
mistake in terms of the diagnosis.
  I mentioned that Terri's brother told me Terri laughs, smiles, and 
tries to speak. That doesn't sound like a women in a persistent 
vegetative state. So the Senate has acted tonight and the House of 
Representatives acted last night. The approaches are different, and 
over the course of tonight and tomorrow, I hope we can resolve those 
differences. It is clear to me that Congress has a responsibility, 
since other aspects of government at the State level had failed to 
address this issue, that we do have a responsibility given the 
uncertainties that I have outlined over the last few minutes.
  Remember, she has family members--her parents and brother--who say 
they love her, they will take care of her, they will be responsible for 
her, and they will support her. There seems to be insufficient 
information to conclude that Terry Schiavo is in a persistent 
vegetative state. Securing the facts, I believe, is the first and 
proper step at this juncture. Whoever spends time making the diagnosis 
with Terri needs to spend enough time to make an appropriate diagnosis.
  At this juncture, I don't see any justification in removing hydration 
and nutrition. Prudence and caution and respect for the dignity of life 
must be the undergirding principles in this case.
  I will close with an e-mail a friend sent me once they saw that we in 
this body were involved in this case. It reads:

       I know you are dealing with so many major issues, but I 
     believe this one threatens to send us down another shameful 
     path we may never recover from.
       I don't think I ever had an occasion to tell you that I 
     have a severely brain damaged adult daughter that I cared for 
     in my home for 20 years. Sasha's functioning level is far 
     below Terri's, but she has been such a blessing in my life. 
     Dietrich Bonhoffer said, ``Not

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     only do the weak need the strong, but the strong need the 
     weak.'' It's hard to explain that in a day and age where 
     physical perfection is so highly valued, but I know it to be 
     true.
       Senator Frist, as you fight this battle today, hold fast. 
     If ever the weak needed a champion, it is now.
       on behalf of my sweet Sasha . . .

  Then the e-mail is signed.
  I close tonight with those powerful words.

                          ____________________