Terri Schiavo and The Living Will: We Will Never Swallow The Same Again

Does It Matter That Terri Can't Swallow? No.

The Absent Reflex

Much has been made over the issue of Terri Schiavo’s swallowing. It is because Schiavo cannot swallow that a feeding tube was inserted directly into her stomach.. It is this feeding tube that has been the object of gargantuan legal, moral and ethical struggles.

But what is swallowing and why should it carry such import?

There are three stages of swallowing: the oral, chewing phase; the pharyngeal reflex phase wherein the food is propelled over the vocal cords and into the esophagus; and, the esophageal stage, during which food travels to the stomach.

The fight over Terri Schiavo involves only one of these three stages and that is the pharyngeal stage.

During the pharyngeal stage of swallowing, the body senses there is food in the back of the throat. This “sensation,” initiates a reflex:  an involuntary muscle contraction akin to a knee jerk.

In one rapid sequence the body shutters the nearby opening to the lungs (the trachea) and shunts the food to the esophagus. The reflex is over and the food travels down the esophagus to the stomach.

Swallowing, Breathing, Beating – Not The Same Family

In this way swallowing is entirely different from breathing and heart beating. Breathing and heart beating go on constantly, without stop. Although they too have reflex properties associated with certain of their functions, the motors for breathing and heart beating are in an ever-on position, the alteration of which would mean rapid demise of the organism.

This is not the case with swallowing which, being a reflex, is only used sporadically, during feeding. This is the crux of the case that has been ignored – no abused – by the ethicists and lawyers involved with the Terri Schiavo case.

Most reflex circuits are local, and wired differently from other motor functions. When there is pizza in the back of the mouth the body cannot wait for the cerebral cortex to give permission to swallow. Instead, the rapid swallowing reflex obeys a different, shorter circuit, (much the same as the knee jerk) involving a brief pathway to the nearby brainstem. Studies show that the cerebral cortex is important only in the voluntary initiation of swallowing.

So Why Are We So Focused on Terri’s Cerebral Cortex?

Neurologists, ethicists and hospice specialists are parading across the news each day affirming that Terri Schiavo has so little cerebral cortex that she cannot possibly think, feel or act volitionally. Yet the debate over ending her life is centered NOT on any essentially cortical activity – the debate is over a reflex that occurs on a different neurological level.

What the courts have decided is that because Terri Schiavo has lost the ability to initiate and reproduce this local, noncortical neurological reflex, her fate rests in the hands of Michael Schiavo.

The obtrusive error that has been made here, by the ethicists and the courts, is in centering this case on that reflex.

There can be no doubt that if Terri Schiavo maintained the brainstem swallowing reflex -- everything else being equal -- there would be no court case, and no national hand-wringing. Ms. Schiavo would be left alone to live out her life under the care of her parents.

But we should no more be basing the life and death of Terri Schiavo on this reflex than we should on a knee jerk.

Can’t Pee? Stay Away From Florida’s Courts

What the courts have done is to pick one reflexive neural pathway and decide that this is the critical and key determinant of life and death.

The mistake that has been made – the knot that is being undone – is in centering this legal and ethical decision around the swallowing reflex. Because, the case can now be made that other similar reflexes may similarly be exploited.

Namely, I am thinking of micturation. Urination. Peeing.

Urinating is more akin to swallowing than swallowing is to breathing or heart beating. The urinary bladder fills with liquid and thus stimulates neuroreceptors in the bladder wall that in turn leads to the urination reflex.

Another Tube, Another Problem?

More frequently than swallowing, urinating is a reflexive process that is frequently dysfunctional. For many reasons there are people who cannot adequately perform this reflex and who therefore need the assistance of a tube. In this case it is not a feeding tube allowing ingress to the body; rather, it is a urinary catheter which allows egress.

Tens of thousands of Americans live today with catheters in their urinary bladders. These catheters may be transurethral (through the penis or female urethra) or percutaneous (stuck through the body wall directly into the bladder).

What would happen if one were to remove the urinary catheter from those who have them? They would die. Slowly, urine would accumulate, the kidneys would become engorged via backflow, and nitrogenous wastes would build up in the bloodstream leading to coma and death.

In this sense, there is no difference between a feeding tube and a urinary catheter. So why are we not talking about removing Terri Schiavo’s urinary catheter? Why are we focused on the feeding tube?

That the courts should decide that the primitive local reflexive action of swallowing is the deciding physiological factor between life and death makes no sense physiologically, teleologically or morally.

There is nothing inherently nutritive about swallowing. Neither does the absence of this reflex necessitate death, as would one see were respiration or circulation suddenly be cut off.

The Living Will of the Future?

The bogus argument over Terri Schiavo’s “living will” or desire “not to live like this” has devolved into the presence or absence of this swallowing reflex. Therefore, all living wills in the future will, by necessity, need to be broken down into checklists of neurological items constituting an inventory of both voluntary and reflexive neurological activities that we are either willing, or not willing, to live with.

Would you live without a knee-jerk reflex? Without a sneeze? Without the exhaustive reflexes of micturation and defecation? Which will you choose?

Comments

[Jhn1]

The most interesting part is the refusal by judge Greer to permit any tests to determine if Terri might actually be able to swallow because if she could, then not permitting fluids and nutrition is simply judicial execution.

[JimK]

You continue to focus on completely irrelevant points in this case. It doesn't matter whether Terri Schiavo is in a persistant vegitative state, a minimally conscious state, or (god forbid) completely and fully mentally functional but has lost the ability to have any voluntary control over her body.

The court found clear and convincing evidence that she had expressed her wishes to not have her life maintained by artificial means. Various appeals courts repeatedly reaffirmed this. It has been extensively litigated.

This is a right to die case where the parents don't like their daughter's decision. They have used every legal and a couple of extra-legal methods to subvert it. The question of her actual state of conciousness is only a smokescreen put up to try to make irrelevant issues sound meaningful.

The only issue is whether her husband should be permitted to comply with her wishes or whether her parents are going to be permitted to subvert them.

[CodeBlueBlogMD]

You cannot deny that if Terri's swallowing reflex were not extinct, there would be no case, no trial...nothing.

Therefore, the entire affair rests on the shoulders of this one neurological effect which is akin to a knee-jerk more than breathing.

[Maggie4life]

The clear and convincing evidence was not all that clear. The testimony itself keeps changing to cover up the errors of Michael Schiavo.

I contend that the statute of limitations should have been enforced in this case, that is the length of time between the accident, the alleged statement and the court case was so long that the sudden memory should have been thrown out because it extended beyond a statute of limitations.

This is part of the problem with this case. The decisions of George Greer are not in any way accurate or just. He has rubber stamped the abuse of Theresa Schivo.

[Shari]

This has to do with the CT scan. Thought you might look at this thread quicker.

This is Dr. Cranford (Dr. Death) explaining her CT scan.
See what you think.

http://www.msnbc.msn.com/id/7328639/

[MaxedOutMama]

JimK, Michael himself said on TV that he wasn't sure what she'd want. The "decision" you refer to was never documented in writing, and the witnesses at the trial (Terri's family, Michael's family, and Terri's friend) heard different statements. Assuming they are all telling the truth, Terri had not fully formed her opinion. Somehow, Judge Greer arrived at the position that only one side was telling the truth, using reasoning to throw out the friend's testimony that has since been refuted. But anyway, he found it all "clear and convincing."

Remember never to say that you feel like dying when you're down with the flu - someone might help you along the way. The very idea of informed consent and advance medical directives was formalized so that people could give careful consideration with an understanding of the consequences before expressing a choice. Judge Greer's decision flies in the face of a huge structure of medical consent procedures.

As to the point raised in the post, I too have been wondering "why draw the line here?" Once you establish that people don't have the right to a feeding tube, what's to restrain you from saying that people have no right to a urinary catheter, a colostomy, etc? That, by the way, was one of Michael's statements. Michael said that Terri would kill us all if she knew "he had people taking care of her bodily functions." Many people do regard incontinence with great disgust.

I don't think people will leave the line here. "Bioethicists" have been arguing for quite a while that parts are parts and that some people have less of a right to their parts than others. "Bioethicists" are arguing positions that the bulk of the American public is not aware of. There is a reason why disability groups and the families of disabled are determined to fight this sort of reasoning.

[Mad House Madman]

Unfortunately, I don't agree with your case. I do agree with what JimK had to say and I believe that it is true.

The court have found evidence to support the fact that Terri did not want to live like this. they found this from her husband (who everyone has villified for no apparent reason) AND from her sister. The fact that her parents dispute that Terri has ever admitted this does not say much (how many things do you tell your husband that you don't tell your parents-think about this).

I also don't agree that were it not for this reflex there would be no case. That I believe is untrue.

Finally, this is a seperate point completely and unrelated to your post. Starvation is one of the most peaceful ways to die. (http://content.nejm.org/cgi/content/abstract/349/4/359?hits=20&where=fulltext&andorexactfulltext=and&searchterm=Ganzini+&search_tab=articles&sortspec=Score%2Bdesc%2BPUBDATE_SORTDATE%2Bdesc&excludeflag=TWEEK_element&searchid=1112138328015_10264&FIRSTINDEX=0&journalcode=nejm) sorry for the long link.

Said my peace about Terry Schiavvo. No more.

[William]

Terri CAN swallow.

Michael's own attending physician
admitted this in court testimony.
(available online)

A nurse's affidavit states that
prior to the malpractice trial
she was being spoon fed daily.
(available online)

www.zimp.org/stuff/

[William]

As for JimK's point about irrelevant
points - he is correct about that !

True, Terri is not PVS, according to MICHAEL'S own testimony (available online)
in the Malpractice trial. He narrates a video tape of him walking with her.

But JimK is correct. It IS irrelevant.
Judge Greer has ruled that Terri WANTS to
die.

However, the court found clear and convincing evidence based on -perjured- testimony from Michael (Judge Quesada).

Why did Judge Greer ignore the recommendation of the FIRST Guardian ad Litem - who also pointed out the ONLY person to say Terri would want to die was someone who stood to benefit from her death.

Only later did Michael's brother and Sister-in-law suddenly "remember" detailed conversations with her from years before...

So, for years no one, including Michael, claimed Terri would not wish to live (only 4 months after the malpractice case...).

In the Malpractice testimony, Michael said he planned to become a nurse, and care for Terri for decades, and several people state in affidavits that Michael ADMITTED Terri did NOT say what he now claims!

Judge Greer ignored the sworn affidavits of two women that Michael was romantically involved with AFTER Terri's collapse,
who BOTH stated that Michael admitted Terri had NEVER spoken to him about her "wishes".

("I told KRT, "Kim, I swear to you he never knew what Terri wanted.
He would confide in me all the time about how he did not know, and he would ask me what I thought he should do."
Michael had no idea what Terri's wishes were,")

...i find that very clear and convincing...
but I spent a lot of time reading court
documents and affidavits for myself.

www.zimp.org/stuff/

http://www.theempirejournal.com/53209_schiavo_case_tangled_web_o.htm

http://www.rense.com/

http://www.theempirejournal.com/greer_schiavo_articles.htm

http://host85.ipowerweb.com/~friendso/guardian.pdf
Affidavit of Richard Pearse GAL for Terri, dated 12/29/98

"...according to MICHAEL'S own testimony (available online) in the Malpractice trial. He narrates a video tape of him walking with her."

I keep hearing this, but have not been able to find the documentation. Where is it?

[Maggie4life]

William, you have done good work here. I want to concentrate upon the evidence that does not exist that Terri was bulimic. If you check the hospital records it says that she had an enteric infection that was treated by Flagyl. Since I have not seen the evidence in the malpractice case, I am wondering if this treatment with Flagyl was brought up.

Also, I do believe that there is a good reason to show that Unjust Judge George Greer disregarded evidence that was clear and convincing in favour of evidence that was to say the least, conveniently remembered. There is an angle that I want to fix on relating to recent statements by Schiavo and Felos regarding that "clear and convincing evidence". I have been seeing a set pattern of contradictions in the statements of Schiavo, but not necessarily of Schiavo's own statements. I am not being very clear here, and as I check the details I will post them on my own blog. I am convinced more than ever that Schiavo and his brother were coached by George Felos about what they were to say in court in order for Greer to claim that it was clear and convincing. Remember it was Greer who made the mistake about when Karen Ann Quinlan died, and he said that his mistake was not relevant to his decision.

[CodeBlueBlogMD]

I often wonder if people read most posts or just skim them.

Today's post deals with the pharyngeal phase of swallowing, its neurological control, its relationship to the cerebral cortex and the advisability of deciding that the presence or absence of that reflex decides whether Terri Schiavo will live or die.

JimK bypasses the entire argument and reverts to the standard line about the merits of the case and the court's ajudication. Then others go on to agree with JimK althopugh he adresses nothing I have said except that the swallowing reflex is a completely irrelevant point.

I ask JimK and Madhouse Madman and William the following:

If Terri Schiavo's injury had spared the pharyngeal reflex phase of swallowing (meaning: her videoesophagram would show swallowing reflex without aspiration) she would NOT have a feeding tube.

I ask you. In that case, how would the case come to court? How would Terri Schiavo's "wishes" to not live in a PVS be actuated?

Cyanide? Gunshot? Lethal injection.

Answer? THERE WOULD BE NO WAY TO ENFORCE TERRI SCHIAVO'S SUPPOSED WISH TO DIE IF SHE MAINTAINED A SWALLOWING REFLEX.

Therefore my case is completely and utterly relevant.

It is the absence of the reflexive pharyngeal phase of swallowing that is allowing the court to insist on seeing through Terri Schiavo's wishes as they determined them.

If there were a swallow there would be no feeding tube.

I would also ask all three of these readers to tell me if they think that bladder drainage tubes (Foley catheters) should be removed in cases such as Terri Schiavo? This would actuate death as cleanly and efficiently as dehydration.

How about it?

[William]

Dr Boyle:

I first learned of you in the thread
at Megan McArdle. I was very impressed
by your words, in spite of what I felt
were vicious attacks.

With the utmost respect, I feel you
did not read my two posts.
Please do not include me with JimK.

I of course agree with you completely,
and as my first post stated, there is
NO doubt that Terri CAN swallow !
(I sent you an email earlier tonight
with additional information on that.)

I was only trying to show JimK that
even ignoring swallowing, there is
plenty of evidence that Terri never
made her "wishes" known to Michael
and that he is a liar among other things.

Again, he swore in the malpractice trial he would take care of her for the rest of her life (estimated 50 years), then 4 months later (one month after getting the money)
he suddenly remembered she she didn't want to live ???

Terri supported him when he was unemployed.
She wanted to divorce him, and was afraid of him. As far as I can tell, her "eating disorder" started long after they got married, and Cindy Shook's affidavit (his girlfriend before his current "fiancee") clearly states Michael was the one who wanted Terri to lose weight... until she was anorexic-looking.

The fact he lied to the police about
not fighting with Terri that day, told
different accounts of how he "found" her,
that he knew CPR and did nothing for all
the time he waited (he didn't even call
911 first...), and much more, should also raise serious questions to anyone.

The questions YOU have raised about the shunt have fascinated me. Especially when you said it can actually cause additional deterioration. Michael's orders for Terri to not leave the room (broken wheelchair), no music, no therapy at all, shades drawn, etc., seem to provide for a sensory deprived environment. It seems obvious he wanted her to deteriorate. Like the shunt could do,
and leaving in the implants after the doctor said they should be removed.

Older documents indicated that before the malpractice trial, Terri could talk better, and walk some (including Michael's own testimony). One report clearly stated she was improving.

(btw, I did read an estimate that the healing bone fractures happened about 18 months earlier, which would place them at or before the night she got her neck injury...)

My apologies for being so long...

I intend to continue to read you avidly.
Your latest post about the neurologists is yet more of your parting the clouds of confusion, with what I consider great personal courage in the face of attacks on you.

[William]

Sorry, one more quick point:

Maggie4life makes an excellent point about statue of limitations.

Judge Greer accepted Michael and his relatives suddenly remembering Terri's "wishes" after many years -
yet he rejected the Schindler's perjury motion, because it had been more than ONE year. (the motion that Judge Quesada then ruled in favor of...)

Also, the police never said that Michael didn't abuse and attempt to murder Terri.
What was said was that the Statue of Limitations for those charges had expired...

[Patricia]

Affidavits were never going to be enough in this case, as the judge won't admit them. Any refutations of her being PVS would have to be very public, beyond the internet.

[jaed]

THERE WOULD BE NO WAY TO ENFORCE TERRI SCHIAVO'S SUPPOSED WISH TO DIE IF SHE MAINTAINED A SWALLOWING REFLEX.

I actually don't think this is the case, since she is also under court order prohibiting attempts to give her food or drink by mouth (and police are stationed in her room to enforce this). If she could swallow (or more precisely, if it were unambiguous and uncontested that she can), the court could still have enforced its order by prohibiting feeding by mouth without reference to the tube, since even in this case she'd still need someone to feed her.

[Sylvia]

THERE WOULD BE NO WAY TO ENFORCE TERRI SCHIAVO'S SUPPOSED WISH TO DIE IF SHE MAINTAINED A SWALLOWING REFLEX.

I agree. Jaed, the court documents show that the death judge ruled that nutrition & hydration by normal means is experimental treatment because (according to the experts that he chose to believe said that) she could not swallow. So if she had the swallowing reflex, the feeding tube would never be in place & someone would have been feeding her all along. Unless as the doctor suggested, the death judge would rule to give her cyanide, lethal injection, or gunshot!

[JimK]

There are a number of very good points raised in this thread, so it took a while to give appropriate thought to the answer.

First to the author of this blog. I think the default position has to be the no artificial means says exactly that. In other words, catheterization, etc. would be included. Having said that, this really gets to the heart of why we need advanced directives and thorough discussions with whomever we’ve given our medical POA to. If I’m fully conscious and otherwise normally functional, I may very well decide for myself that catheterization is not included and I’ll be just fine with a catheter in. If I’m non-responsive with no prospect for improvement (yes, I know there is also a difficult definition in the words no prospect for improvement), I’m going to want my medical POA to pull the catheter or refuse to have it inserted. I have no desire to torture my family by unnecessarily prolonging my body after I can’t direct its use.

These are all items that can be, but probably won’t be, covered in written advanced directives. I imagine each of us could think of exceptions we would like to write into such directives, but including all possible scenarios could quickly lead to a book the size of War and Peace. It is much more problematic in the absence of written directives since the comment “I wouldn’t want to have my life maintained like that” can have many different meanings to different people. Once again, make sure your medical POA is willing to “think like you” and make tough decisions when necessary. In the absence of a medical POA, the default is your spouse in most states, so make sure they know what you want and are willing to stand up to those who would not carry out your wishes, whatever they are.

To those questioning sudden remembrance of verbal directives years later, by following a couple of links off of Shrinkette’s blog you can find a lawyer discussing why it was in neither the plaintiff nor the defendant’s interest in the malpractice suits to bring up Terri’s wishes.

There is also a question of when do you give up hope for improvement. How many years will it take for any of us to decide that our (parent, spouse, child) will never get better? When have they reached the point at which THEY would want to let go? My mother and I faced this question 37 years ago when my father was dying of emphysema and COPD. Fortunately, we had a Physician who was willing to let us make this decision even though at the time, it was against almost everyone’s official policies. I’m going to face it again as my mother is in a nursing home with moderate to advanced Alzheimer’s disease.

As to the question of how one would carry out Terri’s wishes if she still had a swallowing reflex, that one has no good answers. The line between complying with a patient’s wishes and euthanasia gets awfully fuzzy there. In the absence of written wishes, it’s going to be a tough call for anyone to withhold food and/or water from someone who can swallow normally. I suspect this is a more common problem than most of us thought. When my mother was first diagnosed with Alzheimer’s, we dealt with an elder law attorney to make sure her advanced life directives and medical POA were done properly and, hopefully, avoid future problems. One of the clauses he suggested inserting, based on his past experience, was what her wishes would be if she was in just this condition….no control over bodily functions, unable to feed herself, but able to swallow if someone put food down her throat. She wrote in that she was to be denied sustenance, but I suspect we’ll have some in depth discussions with the ethics committee at the nursing home if she arrives at that point.

As far as questions of statute of limitations….Since appeals courts found no reversible errors in either decision, I have to assume that the court was in compliance with the applicable laws.

In regards to the recently raised issue of abuse or attempted murder. I don’t see any conflict between carrying out Terri’s wishes and prosecuting Michael for any crime for which they can find evidence. In fact, if you believe Michael attempted to murder her, pulling her tubes would likely convert it from attempted murder to a murder case and provide for a stiffer sentence. It seems if I was a spousal victim that would also be in line with my wishes.

[mod ervador]

I believe there's no contention (other than that raised by Dr. CBB) that Ms. Schiavo maintains a swallow reflex. She swallows her own saliva. She also maintains significant brainstem activity in other areas as well, and nobody has contended the opposite (as far as I know). The contention is over the amount of activity above the brainstem.

Swallow tests have been performed in the past on Ms. Schiavo. There were apparently insufficient cranial sensory and/or motor pathways intact to elicit the pattern that propells the bolus near the back of the mouth to a position where the involuntary (brainstem, or medullary) esophageal reflex component would take over, i.e. she couldn't swallow any more than minimal saliva production. So this was consistent with other indicators of loss of cortical activity. In one of the later tests (I can't find the link now) she aspirated. Thus it was reasoned that further testing posed a risk, with no probable cause to suspect improvement in that area given the other indicators which were unimproved.

[Maggie4life]

There is one issue that is being avoided with these answers. I would like to respond to JIMK but I do think that it would be getting off the topic to respond in any depth about what perhaps for him is an attempt to ease his own conscience about life decisions that were made. I think that he needs to do some further research on this whole case - sometimes you have to read with a grain of salt.

There is testimony via affidavit that Terri Schindler could swallow and that she was able to consume pudding. This testimony was tossed out by George Greer. The nurse that gave this testimony stated that they had given her feed via a bottle - that means she could suck in the same way as a baby. I have a few other thoughts on the subject of babies and reflex actions, but they are not relevant here.

What I would like to know is why the judge was allowed to state that hand feeding Terri would be experimental.

I am of the view that the whole thing, the way in which this woman has been set up to die is a charade. I need to get my thoughts down on my own blog about some issues that have come to light in a Larry King interview.

[Bill]

As modervador notes, she failed at least 3 "gold standard" modified barium swallow tests (http://abstractappeal.com/schiavo/WolfsonReport.pdf)

"The ability to orally ingest food and water – to swallow substances other than saliva, is predicated on a level of cognitive capacity.

Without cognitive capacity, the intentional act of oral nutrition and hydration is likely to lead to aspiration. Eating and drinking are not unconscious processes.

Therefore, Theresa's neurological status is directly linked to her ability to swallow." (pp. 27-28)

Maggie,

The CNA (not a nurse) who stated in her affidavit that she could swallow Jello didn't have the medical background/training to be able to evaluate whether she could swallow safely.

There was no way for that CNA to know whether she was swallowing or silently aspirating.

[Kathleen]

Re the clear and convincing evidence: I am a lawyer, a Canadian lawyer albeit, but I believe the law of evidence is the same in Florida: communications between spouses are privileged (a spouse cannot be called to be a witness as to what the other spouse said). So Michael Shiavo's evidence about Terri's purported death wish was not only inadmissable as hearsay, it was inadmissible as a privileged spousal communication.

The only other witnesses to Terri's death wish were Michael Schiavo's brother and sister in law. Their evidence of her statement was also hearsay. But then then evidence is a third year course. Judge Greer would have dropped out by then.

This case will stink to the high heavens for a thousand years. Hitler is dancing in hell.

[mod ervador]

Kathleen,

isn't it more like "a spouse cannot be FORCED to be a witness as to what the other spouse said"? If the spouse freely offers, then the "privileged" status is waived, right?

Anyway, hearsay is admissible in some cases. If 3 witnesses say that "she said X" and under cross-examination their reliability as witnesses is not impugned, then it has been reliably established that "she said X."

http://abstractappeal.com explains it better.

Considering the number of appeals this case has had, if the rules of evidence were violated it would have been dinged for that early on.

No. Spousal communication are not admissible. Period.

Judge George Greer's negligence regarding evidence:

According to Florida law, as I understand it ( I do not practice in that jurisdiction) in order to withdraw life support from a dying person there must be "clear and compelling" evidence of the patient's wishes (this law was cooked up by George Felons oops Felos himself).

1. Hearsay is inadmissible unless it falls into one of the exclusions, which Michael Schiavo's evidence of his cuckholded wife did not fall into

2. Communications between spouses are inadmissible as evidence (that is why gangsters marry their girlfriends before being tried for a crime.) Therefore Michael Schiavo's evidence was inadmissible at both kill Terri hearings as a privileged communication and hearsay.

3. Michael Schiavo's evidence at the hearing to kill his estranged wife should have been impeached by a prior inconsistent statement made in Terri's malpractice trial when he said that Terri's life expectancy was 51 more years, that is why he needed 20 million, that he was going to care for her for the rest of her life, and he did not disclose to the malpractice jury that she had expressed a death wish which he intended to follow up on.

4. The only other evidence of Terri Schindler-Shiavo's purported death wish was that of Michael Schiavo's brother and sister in law. These witnesses were never cross-examined. Their evidence was also inadmissible as hearsay.

Judge Greer's negligence regarding the issue of guardianship:

5. Terri should have had her own guardian for the purposes of the kill Terri litigation (a guardian ad litem). In Florida it is illegal for a judge to act as guardian ad litem for anyone other than a member of his own family. Judge Greer said that he felt that he could act as guardian ad litem for Terri himself.

6. Judge Greer was in a conflict of interest. He had received campaign donations from George Felons, oops Felos and other lawyers acting for Michael Schiavo.

7. Judge Greer permitted most of the malpractice funds ($447,000)which a jury had allocated specifically to Terri for her rehabilitation, and which were held in trust by the Court, to be paid out to George Felos and other lawyers acting for Michael Schiavo in his quest to have her legally killed. This is a clear breach of a fiduciary and judicial duty.

Judge Greer dismissed three applications to have Michael Schiavo removed as guardian. This was also in violation of guardianship law which requires that there be no material conflicts of interest between the guardian and the incompetent person. If Terri was to recover MS would not get the funds allocated for her rehabilitation that were remaining after his quest for her death. Further, as he had taken on a common law spouse (a criminal offence by Florida law) he was in a conflict of interest. If Terri recovered, what would he do - scrap the common law wife and kiddies and go running into her arms. No. There was no solution for Terri but that she be dead. Michael did not divorce Terri and marry the common law wife because then he would not have inherited her estate. Michael Schiavo had every reason in the world to want his disabled wife dead. None of those reasons had to to with any death wish he remembered after he got his hands on the $1.4 million.

Judge Greer's negligence in administering Terri's death sentence

8. Judge Greer prohibited the administering of water or food by mouth for Terri after he ordered her killed which is in breach of Florida law, and that of all 50 states. Bobby Schindler said that his mother would have been arrested on the spot if she had tried to put ice chips to Terri's lips.

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