Terri collapsed in her house one morning in 1990, shortly after a fertility-related medical procedure. Some believe the collapse was caused by an interaction between a possible eating disorder and the procedure; in her teens, Terri weighed over 200 pounds, but weighed closer to 120 pounds when she collapsed. Her collapse woke her husband Michael, and she was rushed to the hospital with multiple resuscitations en-route. At the hospital, Terri suffered briefly from comas and seizures, and was initially on a ventilator, but these subsided quickly and the ventilator was removed; however, she remained in a PVS. An experimental treatment was attempted, and failed. Total brain death was clearly evident. Shortly thereafter, and almost 5 years after she collapsed, Michael started the process of having her feeding tube removed, and Terri's parents began the crusade to "save" their daughter's life.
The Florida legislature has attempted to intervene twice before, but has since developed cold feet and is unwilling to commit political suicide with Jeb Bush. Many Florida state legislators, and not just Democrats, see the legislative action as a severe intrusion into individual rights. Republican leaders on a federal congressional level demanded members return to Washington to pass specific legislation allowing further review of her parents case, which was delivered well after midnight to President Bush. Still, two appeals to a federal court that followed have been rejected on the grounds court interference would be a violation of Terri's constitutional rights. A federal judge has issued a strongly worded warning to the governor of Florida not to take Terri into state custody. The state legislature has adjourned for Easter holiday. Though the previous three appeals of the case did not approach justices after going through the federal circuit, it is unlikely that the Supreme Court will take the case; most of the justices are strong supporters of state's rights. It appears that most, if not all, options of further appeal have finally been exhausted, and there is a strong chance Terri's body will cease to function in a few days.
The tapes show a woman responding to stimuli
Many legislators have viewed less than ten minutes of selectively provided footage of home movies and concluded that Terri is "cognizant of her surroundings" and is "alive". Tom DeLay stooped to an all-time low calling Florida Judge Greer a "murderer and terrorist" and cited such footage as why he believes Terri is not in a PVS. Only a small handful of legislators have any medical training; as Barny Frank put it, "The caption tonight ought to be: 'We're not doctors, we just play them on C-SPAN.'" Among those who do are the two republican lawmakers who sponsored bill S.686 - Dave Weldon (from Florida), a specialist in internal medicine, and Bill Frist, a cardiologist (note, Dave Weldon's site incorrectly refers to bill S626). Yet some medical professionals have indicated that offering a medical opinion based on viewing a few minutes of videotape and intentional use of their credentials to manipulate public opinion amounts to severe medical malpractice, if not outright unethical conduct. In 1996 a CAT scan showed, according to 2nd District Federal Court ruling, "severely abnormal structure" and that her cerebral cortex is "simply gone and replaced with spinal fluid". EEGs were flatline. Federal judges have ruled, after viewing all of the tapes (there are many, not just the 5-10 minutes her parents have chosen to share with legislators or the media) Terri's reactions are only coincidental. Indeed, grunts, screams, grimaces, and random motions "without purpose" are very characteristic of PVS. All court-appointed doctors have concluded responses are reflexive or without purpose. Most of those in support of the opinion Terri is "alive" have not so much as stepped foot inside her room; of those that have, few have attempted to interact with her or examine her. Dr. Hammesfahr, one of the few doctors to have examined her and concluded she was not in a PVS, has an extremely questionable background. Dr. Cheshire, who has also declared Terri is not in a PVS, also has an axe to grind. Neither doctor has addressed the rather clear evidence provided by the CAT scans and EEGs- nor have Weldon or Frist. Laughably, in a transcript of one of Frist's speeches to the Senate floor on March 17th, Frist reveals his ignorance of PVS: "I mentioned that terry's brother told me that terry laughs, smiles, and tries to speak. Doesn't sound like a woman in persistent vegetative state."
In truth, patients in a PVS do show such symptoms: "Patients in VS can demonstrate behaviours that are associated in non-brain injured individuals with emotional experience, such as crying, grimacing, smiling, or laughing (Royal College of Physicians, 2003). When the patient fulfils diagnostic criteria for VS, these behaviours must reflect subcortical functions and are not indicative of subjective distress. Not surprisingly, this can be difficult for relatives to understand, and many families reasonably perceive these behaviours as signs that the patient is intentionally trying to 'wake up' (Jacobs et al., 1986)." (emphasis added).
Terri has a chance of recovery
After 5 years in a persistent vegetative state, the medical community is in nearly universal agreement that any recovery is impossible. It has been 15 years. Clear, indisputable medical evidence proves she is completely braindead; as Dr. Cranford has pointed out in the Times article cited above, "Her CAT scan shows massive shrinkage of the brain [...] Her EEG is flat - flat. There's no electrical activity coming from her brain." The reason she is still is able to breathe and has autonomic/reflexive responses is not because she is "alive", but because her brain stem is still functioning. There is no consciousness or memory in the brain stem. The brain cannot "grow back"; it can 'reroute' and deal with incredible trauma (albeit at reduced capacity) if enough of the brain is undamaged and still active, but total brain death is permanent.
Removing the tube would be painful or unusual
We wrongly infer from our own intense suffering when we are hungry that Terri must feel this hunger. Most doctors will tell you there's little pain involved and many cognizant patients prefer it. Keep in mind we're also not brain-dead. Because Terri has no active brain tissue left, her body is incapable of 'feeling' pain beyond autonomic responses in the brain stem to stimuli.
It's not moral
Morals certainly enter into the decision, but certainly not your morals, and it's not your decision. Nor is it up to a judge, the legislature, the President, or the Pope. Thus far, only the judicial branch has consistently and clearly recognized it has no right to inject itself into the matter. It is purely the decision of the legal guardian; in this case, Michael, her husband. Multiple challenges by Terri's parents asserting he has self-serving financial motives have failed, as have assertions that he abused her, or that his dating another woman (and having two children with her) invalidates his marriage and hence his right as guardian. While it is doubtful as a Catholic that Terri would approve of his affair and fathering two children out of wedlock- as a Catholic, she could also abhor divorce. It could swing both ways, and it's not our decision.
Speaking of the Pope, last year he said, "The evaluation of the probability, founded on scarce hope of recovery after the vegetative state has lasted for more than a year, cannot ethically justify the abandonment or the interruption of minimal care for the patient, including food and water." One notes the mention of "scarce hope" (in Terri's case, there is zero hope- she simply has no brain left) and "one year" (she's been in a PVS for 15 years). To a certain extent, I agree with his statement. I suspect most medical professionals do as well; one year isn't nearly enough time purely from statistical perspectives, and human life is too important to say "oh, we don't want to wait, sorry", yank the plug, and turn out the lights- simply because it was expensive, emotionally difficult, or what have you. As a K5'er pointed out, there hasn't been any specific comment by the Pope on Terri's case, although a Vatican newspaper condemned the tube removal, and some Vatican officials have strongly condemned judicial decisions to block the tube removal as well. Interestingly, not everyone in the Catholic church agrees; for centuries it has been the church's position that extraordinary measures are not obligatory in prolonging someone's life. This could launch a whole other article, but instead, I'll just link to the Chicago Tribune article instead.
The public is outraged!
Most of the surveys, posed in a variety of ways ranging from "if you were Terri, would you want your feeding tube removed" to "do you support the judge's decision to deny the appeal" and so on- show a public mostly in support of the husband's position and against federal legislative/executive intervention. The percentages drop slightly if you pose these questions to people who identify themselves as conservative Christians. Look really hard at a photo of Terri. Place yourself in that bed. Picture yourself being there for a decade and a half, brain-dead, flailing at random like a fish out of water because you have no brain left, being kept alive by a feeding tube. Your face plastered across the newspapers and TV sets of the world. If that isn't enough to make you run out right now and draw up a living will, I don't know what is.
I suspect most people who are aware of the facts are outraged that the parents won't accept that their daughter's brain is completely dead, that her "reactions" are well documented symptoms of PVS, and the government has been able to inject itself numerous times into what is easily the most private matter a family can face. I strongly suspect that public opinion would swing significantly in favor of the husband if most people simply understood the facts behind the situation, or had the conviction to accept that, in the land of the free, their personal or religious beliefs shouldn't have much bearing on such an intimate matter for another individual.
Terri's husband just wants her money
This argument conjures up images of a bank account flush with millions from malpractice suits and whatnot. After her initial collapse, her husband sued for medical malpractice. Yes, he won. The settlement was for approximately one million dollars, $700,000 of which went to a trust fund for Terri's treatment. $300,000 went to her husband. The $700,000 is mostly gone thanks to over a decade of legal challenges brought by her parents and 15 years of medical care; in 2003 Michael's attorneys said there was about $50,000 left. Terri (and her husband) have little to no money left; her medical bills are currently paid for by Medicare, and the hospice covers her room and board. Michael offered to donate the settlement to charity if her parents agreed to remove the tube. Her parents refused. A businessman recently offered $1M to Michael to give up guardianship of his wife. He refused.
Perversions of government
You can thank your lucky stars that our judicial system stepped in to check the other two branches of the federal government, which have clearly gone berserk. No matter whether you feel "the tube" needs to be put back in or not, I am frightened by the vigor with which members of the legislative and executive branches of our government attempted to force themselves so deeply into such an intimately personal decision by one individual and one family. Further, while faced with a variety of issues of critical importance to the future of millions of Americans, our federal legislators went for a week's vacation. However, for the purpose of "saving" one brain-dead woman, they suddenly found time to jump back on planes to DC and work feverishly into the night. What?
What is the lesson in all of this for us on a personal level? Write a living will, and talk to your family about your wishes. Terri's wishes are at best unclear since her husband did not immediately reveal a conversation he claimed to have had with her on the subject. If Terri had a living will, chances are better that her wishes would have been observed, and she would have lived or died with far more dignity and privacy than she has. If her living will had indicated a desire to terminate care, her parents would have possibly been more easily able to come to terms with the death of their daughter, her family might be able to speak to each other, and she would have died, with far more dignity and peace, over a decade ago. It's not her fault, certainly- facing our own mortality can be extremely difficult, especially if you have a spouse or children. Given the stakes, the effort seems worth it.