Schiavo autopsy reports 'undetermined' cause of death; shows no eating disorder or trauma

by Joni B. Hannigan, posted Wednesday, June 15, 2005 (14 years ago)

LARGO, Fla. (BP)--Despite sifting through mountains of photographs and sorting through autopsy specimens, a Florida medical examiner said June 15 Terri Schiavo’s cause of death will be certified as “undetermined,” though postmortem findings indicate she died of “marked dehydration.”

Chief Medical Examiner Jon Thogmartin told reporters in a televised press conference the 40-year-old woman who died March 31 -- 13 days after her feeding tube had been removed by court order -- showed no signs of strangulation or trauma. Nor did Schiavo likely suffer from an eating disorder, he said.

“Her heart functioned fine for 25 years … and on that day something happened that her heart didn’t beat,” Thogmartin said. “If that’s not a testament to the strength of her heart, nothing is. Whatever stopped her heart that day was not in the heart, [but an] extrinsic force outside the heart causing the heart not to beat.”

Contradictory to widely circulated media reports that Schiavo suffered a severe brain injury after a heart attack brought on by an eating disorder, both Thogmartin and forensic pathologist Stephen Nelson said they found no evidence that was the case. What they agreed on was that she had suffered a severe brain injury after her heart stopped beating.

Michael Schiavo, Terri’s husband and legal guardian, and her parents, had been at odds for nearly a decade since Michael began court proceedings to end his wife’s life. Court-appointed doctors said she was in a persistent vegetative state, and Michael and his relatives testified she would not want to live in that physical state.

Bob and Mary Schindler, Terri’s parents, told the Florida Baptist Witness last year they suspected Michael, who lives with his fiancé and their two children, may have caused Terri’s collapse. They also said Terri’s rehabilitation stopped too soon -- shortly after Michael won a malpractice suit against Terri’s doctors, accusing physicians of not diagnosing a possible eating disorder.

On March 18 her feeding tube was removed by order of Florida Judge George W. Greer. In what was perhaps the most litigated pro-life case in American history, a battle over Terri’s life raged for nearly two weeks in both the state and federal courts, and in both the Florida state legislature and Congress. Meanwhile, Terri slowly dehydrated.

And although the medical examiner said he could not determine why Terri collapsed 15 years ago, he did say results of the autopsy showed Terri’s brain, at death, was abnormally small, weighing 615 grams -- and had “profoundly atrophied.” He said no amount of therapy could have reserved her condition, and that she was blind.

“It’s very sad to look at the whole spectrum of her medical record and look at that optimism fall,” Thogmartin said.

Neurologist Stephen Nelson said that persistent vegetative state is a clinical diagnosis and that the autopsy could not solve the debate over Schiavo's diagnosis. But he did say that there "was nothing in the autopsy that is inconsistent with persistent vegetative state."

Thogmartin said Terri’s body showed signs of severe osteoporosis and that after her collapse her bones became "palpably soft.” The autopsy also revealed Terri had a treatable urinary tract infection and pneumonia at the time of her death.

“She could have lived easily for another decade,” Thogmartin said. He also said it was “a miracle” she revived in 1990 after losing a measurable blood pressure for more than an hour after she collapsed.

Bobby Schindler, Jr., Terri’s brother, said the autopsy report is little comfort to a family that wanted to take Terri home and care for her.

“We weren’t surprised the medical examiner said Terri’s brain was damaged,” Schindler told the Florida Baptist Witness after the autopsy report was released. “The fact that the medical examiner ruled out bulimia and ruled out a heart attack, without a doubt, adds more questions.”

Finding out why Terri collapsed will be even more elusive now, since only Terri and Michael knew what happened that night, Schindler said. “He killed a person that was disabled.”

The case, Schindler said, raised an important question: What happens to disabled people when they are no longer wanted?

“This goes back to the whole quality of life issue,” Schindler said. “Are we going to decide when it’s okay and not okay to kill people? This doesn’t change the fact that we are starving and dehydrating human beings to death.”

Priests for Life's Frank Pavone, a friend of the Schindlers, said the autopsy's findings cannot speak to the moral issues surrounding the case.

“Her physical injuries and disabilities never made her less of a person," he said in a statement. "No amount of brain injury ever justifies denying a person proper humane care. That includes food and water. A person with a 'profoundly atrophied' brain needs profound care and love. Terri did not die from an atrophied brain. She died from an atrophy of compassion on the part of her estranged husband and those who helped him to have her deliberately killed."

David Gibbs III, attorney for the Schindler family, told the Witness the autopsy report still leaves America with the question of whether it will return to its historic position that “all life is sacred” and worthy of protection.

“We are still on the turn in the road,” Gibbs said. “Tragically, the medical examiner did not provide anything to deal with the legal and moral issues. Much of what he said we already knew. She was significantly brain injured. He answered some questions but he created many others.”

For instance, Gibbs said the medical examiner referred to times when Terri was given morphine for pain, despite the notion she was a “vegetable” and had no cognizant thoughts. The attorney also said he wondered if therapy would have helped Terri to learn to swallow during the last 12 years, despite Thogmartin’s findings that she could not swallow.

Gibbs said unanswered questions remain as to why Terri collapsed. He pointed to the gap between the time Michael Schiavo said his wife collapsed (4:30 a.m.) and the time he called paramedics (5:40 a.m.)

St. Petersburg, Fla., attorney Pat Anderson, who worked on the case for a number of years before Gibbs, told the Witness she still has questions.

"Dr. Thogmartin is to be commended for his thoroughness and the care with which he proceeded in conducting this autopsy. However, the cause of Terri's collapse remains a mystery, despite his investigation,” Anderson said. “Surely, something caused her healthy, 26-year-old heart to stop beating back in 1990 in the pre-dawn darkness of her home."

C. Ben Mitchell, associated professor of bioethics and contemporary culture at Trinity International University in Deerfield, Ill., told the Witness he believes the medical examiners findings should prompt careful thinking about the future of medical care.

“This confirms our worst fears,” Mitchell said. “Terri Schiavo died, not of any illness, but at the hands of her husband and his lawyers.

“Americans are going to have to decide what kind of society they want to live in; one where the vulnerable are dehydrated to death or where medical care includes compassionate care. Terri Schiavo should be alive today and in the loving embrace of her parents. Instead, her husband rendered her a death sentence and the courts carried it out.”

Florida Gov. Jeb Bush, in a statement issued to the press, thanked Thogmartin and his office for their work, and urged compassion towards Terri’s family.

“Amidst the medical terminology we must remember that we are talking about a human life -– a wife, a daughter, a sister and a friend,” Bush said. “Terri’s life and her death remind us all that life is so fragile and must be valued. We will continue to strive to protect our most vulnerable citizens. All innocent human life is precious and government has a duty to protect the weak, disabled and vulnerable.

“Our thoughts and prayers remain with the Schindler family during this most difficult time."

Joni B. Hannigan is managing editor of the Florida Baptist Witness, online at

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