Legal options shrink in Schiavo case

Terri Schiavo's parents are waging a legal and political battle on several fronts as they fight to have a feeding tube re-inserted to keep their daughter alive.

The White House says it has run out of legal options for Mrs Schiavo

But they are quickly running out of options.

The US Supreme Court has now refused to hear the case.

And a Florida judge shortly afterwards rejected a petition by Governor Jeb Bush to obtain legal custody of Mrs Schiavo.

Under US law, end of life issues are usually left to the states, which have differing legal guidelines with respect to the withdrawal of care.

However, an unusual intervention by the US Congress on 20 and 21 March forced the case into the federal courts, which have resisted overturning the Florida state courts.

State issue

The Schiavo case is extremely rare in that most of these cases are decided by families and do not often land in the court system, said Sandra Johnson, a professor of law and healthcare ethics at St Louis University.

TERRI SCHIAVO CASE Feb 1990: Mrs Schiavo collapses May 1998: Mr Schiavo files petition to remove feeding tube, triggering legal battle Feb 2000: Court rules to remove feeding tube Oct 2003: Florida's lower house passes "Terri's Law", allowing governor to order doctors to feed Mrs Schiavo Sept 2004: Florida Supreme Court strikes down law Dec 2004: Case goes to US Supreme Court Jan 2005: Court rejects petition 18 Mar 2005: Florida court again allows removal of tube 22 Mar 2005: Federal judge turns down parents' appeal 23 Mar 2005: Appeals court backs federal ruling Timeline: Terri Schiavo case Q&A: US feed-tube case

"The Schiavo case is not presenting any new legal or medical issues that haven't been decided for decades. This is an explosion of the legal process," Ms Johnson said.

Although states have varying standards for the withdrawal of care of individuals in a persistent vegetative state, clear standards exist.

In Florida, the standard is that the decision to end care should be made as the patient herself would make the decision.

Mrs Schiavo's husband Michael has argued that, based on conversations he had with her, she would want care withdrawn if left in such a state.

But the case has been thrust into the courts because of the bitter division between Mrs' Schiavo husband and her parents, Bob and Mary Schindler, Ms Johnson said.

And she adds: "In the US, in the political context of end of life decisions of this sort, a persistent vegetative state and the withdrawal of food and water, this is our crucible. This is the place where values conflict and compromises are hard to come by."

Under the US constitution, end of life issues have been left to the states under the laws of guardianship for the incompetent and vulnerable and the general protection of the welfare of citizens, she said.

That is why the case has, for the most part, been argued in Florida state courts.

Federal courts

The extraordinary act of Congress moved the case into the federal court system.

But a federal judge then ruled against the reinsertion of the feeding tube on the grounds that the case had little chance of success. An appeal in a circuit court in Atlanta also failed.

The Schindlers then unsuccessfully petitioned for a hearing before the US Supreme Court, although the court had twice previously refused to hear the case.

The US Supreme Court has ruled only in one end-of-life case - that of Nancy Cruzan in 1990.

In 1983, Ms Cruzan, then 25, lost control of her car. The car overturned, and she was discovered face down in a ditch with no vital signs.

Medics were able to revive her. After a brief coma, she was left in an unconscious state.

In that case, Ms Cruzan's parents wanted to remove her feeding tube after she had been in a persistent vegetative state for 10 years.

Missouri state law required "clear and convincing evidence" of the patient's wishes for such withdrawal of care.

The US Supreme Court was asked to rule on the constitutionality of the Missouri law.

The court agreed to hear the case and ruled that while the Missouri law called for a high standard of evidence, it was constitutional.

The parents returned to court and presented evidence supporting their case, and Ms Cruzan was allowed to die.

However, the US Supreme Court has always refused to hear the Schiavo case, saying the federal courts have no business in a legal area in which the states have jurisdiction.

The US Supreme Court would only become involved if there was a question on the constitutionality of state law, as in the Cruzan case, or if the state was involved in care for the individual, Ms Johnson said.

If all of the Schindler family's legal efforts fail, President George W Bush has said the White House has few legal options.