An autopsy on Terri Schiavo found that she had massive, irreversible brain damage, a Florida medical examiner's office said yesterday in a report that gave scientific support to her husband's decision to withdraw her feeding tube.
But for Schiavo's parents and others, the findings didn't end the ethical or medical debate that eventually drew in Congress and the White House. Bob and Mary Schindler still say that their daughter would not have wanted her life ended and that she was not in a persistent vegetative state, their lawyer, David Gibbs III, said.
Schiavo's brain weighed 615 grams, about half the normal weight, and she was incapable of seeing, the medical examiner's office found after her death March 31. The report found no evidence she had been abused, nor any indication why she collapsed in 1990.
"This damage was irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons," said the report, released at a news conference by Pinellas-Pasco Medical Examiner Dr. Jon Thogmartin.
Researchers and doctors agreed that the autopsy results added little new information to the picture.
"I don't think it changes anything," said Dr. Timothy Quill, director of the Center for Palliative Care and Clinical Ethics at the University of Rochester. "It shows that her brain was severely damaged, and we knew that already from the MRIs."
Efforts by Schiavo's husband to remove her feeding tube had long been buttressed by medical experts who said she could not recover.
University of Maryland Medical Center neurosurgeon Howard Eisenberg said yesterday that some of her remaining brain tissue might not have been functioning brain cells, but scar tissue.
'No awareness of self'"[The autopsy] certainly supports the contention that she had no awareness of self," Eisenberg said. "She didn't exist as Terri Schiavo anymore."
The autopsy also found clear evidence of blindness. Although her eyes were undamaged, the brain area that processed visual signals had died. Neurologists said this was not new information because brain scans and behavioral exams had already led doctors to the same conclusion.
"The blindness thing is a red herring," said Dr. Ronald Cranford, a neurologist and ethicist at the University of Minnesota. "Her whole brain was not functioning, not just her visual cortex. She had no cerebral cortex function at all."
Cranford has served as an unpaid adviser to Terri Schiavo's husband, Michael Schiavo. But others agreed with his assessment.
"Everyone who examined her said she wasn't picking up visual cues in her environment," Quill said. "She wasn't picking up any cues in her environment."
Countering family video
The medical examiner's conclusions countered a videotape released by the Schindlers that seemed to show Schiavo smiling and able to follow some movements.
But doctors said her reactions were automatic responses that did not require conscious thought. The autopsy, which was based on 274 external and internal body images, and scrutiny of medical records, police reports and social service agency records, came to the same conclusion.
The Schindlers nevertheless said they plan to discuss the autopsy with other medical experts and might take some unspecified legal action.
Photos to be released
Michael Schiavo, according to his attorney, George Felos, "was pleased to hear the hard science and evidence of those findings." Felos said his client plans to release autopsy photographs of her shrunken brain.
Thogmartin said that Schiavo died from dehydration, and did not appear to have suffered a heart attack or to have ingested harmful drugs or other substances prior to her death.
He said that after her feeding tube was removed, she would not have been able to eat or drink if she had been given food by mouth, as her parents requested.
In Washington, White House Press Secretary Scott McClellan said that the autopsy results did not change the president's position on her case. President Bush had hoped federal courts would intervene.
The cause of her collapse 15 years ago remains a mystery. The autopsy and post-mortem investigation found no proof that she had an eating disorder, as was suspected at the time, Thogmartin said.
Over the years, the Schindlers had sought independent investigation of their daughter's condition and what caused it. Abuse complaints to state social workers were ruled unfounded.
During the seven-year legal battle, federal and state courts rejected attempts at intervention by Florida lawmakers, Gov. Jeb Bush, Congress and President Bush on behalf of her parents. Many religious groups, including the Roman Catholic Church, said the removal of sustenance violated fundamental religious tenets.
About 40 judges in six courts were involved in the case at one point or another. As Schiavo's life ebbed away following the final removal of her feeding tube, Congress rushed through a bill to allow the federal courts to take up the case, and Bush signed it March 21, but the courts refused to step in.
Those on both sides of the case agreed that the autopsy was not likely to alter anyone's perspective.
Edward Furton, an ethicist at the National Catholic Bioethics Center in Philadelphia, said the results had no bearing on whether Schiavo should have been allowed to die.
"It makes no difference from the Catholic point of view," he said. "The fact is, she was a living human being and deserved food and water like any other human being."
But some experts said the autopsy still had value, because it found no evidence that Schiavo had been abused, perhaps by her husband.
"The power of the autopsy is that it refutes these untrue claims. That's the key," said University of Pennsylvania bioethicist Arthur Caplan, who has written extensively on the Schiavo case. "This shows that there was no abuse."