Not unexpected, but a blow nonetheless:

WASHINGTON (AP) – The Supreme Court on Thursday refused to order Terri Schiavo’s feeding tube reinserted, rejecting a desperate appeal by her parents to keep their severely brain-damaged daughter alive.

The decision, announced in a terse one-page order, marked the end of a dramatic and disheartening four-day dash through the federal court system by Bob and Mary Schindler.

Justices did not explain their decision, which was at least the fifth time they have declined to get involved in the Schiavo case.

The Supreme Court is always loathe to overturn lower court rulings unless there’s some kind of blockbuster error by the original judge or the issue gives them an opportunity to make new law.

In the Schindler case, Greer evidently, according to legal precepts, made no error in his Finding that Terri is PVS.

The court’s decision was not surprising. Not only had justices repeatedly declined to intervene in the Schiavo case on prior occasions, but they routinely defer to state courts on family law issues. Judges in various Florida courts have sided with Schiavo’s husband in the 15 years since she suffered brain damage.

The issue before the high court was whether Schiavo’s tube should be reinserted while her case is fully reviewed in the lower courts.

Justices could have ruled in favor of the parents if they had found a “substantial likelihood” the Schindlers would win on the merits or that Congress intended for Schiavo to remain attached to a feeding tube during the federal court review called for in the bill passed last weekend

How could this be? What criteria did Greer use for his Finding that Terris is PVS?

It has to do with 1) a legal definition of PVS; and 2) How Greer arrived at his decision that Terri would not want to live under those conditions. Here’s the “legal” definition of PVS:

Persistent Vegetative State (PVS): A clinical condition of complete unawareness of the self and environment. Even though PVS patients may exhibit sleep wake cycles, they show no evidence of response to or understanding of environmental stimuli. Unlike with a coma, there is no reasonable hope for recovery for those in a PVS. Normally it takes up to 3 months to make a definitive diagnosis of PVS for patients who suffered a loss of oxygen to the brain. It can take a year to make a definitive diagnosis of PVS for patients who suffered a blow to the head. Although life expectancy for patients in a PVS is between two and five years, there a a number of cases where PVS patients are sustained on life support for decades. It has been estimated that there are somewhere between 15,000 and 35,000 PVS patients being sustained in the U.S. at any given time.

Remember, Greer never visited Terri’s bedside to determine for himself whether Terri had any “response or understanding of environmental stimuli.”

And here’s how Greer got away with ordering the feeding tube removed even though Terri didn’t leave a Living Will declaration. In legal terms, it’s called “Substituted Judgment:”

Substituted Judgment: This standard of decision making permits the decision maker to take into account the patient’s general value system and personal beliefs as well as previously made statements about medical treatments. The decision maker is to “stand in the patient’s shoes” and make the decision the patient would make in the same situation, if able. The description of the concept in the Jobes decision (New Jersey) is often cited by other courts, and instructs the surrogate decision maker to refer to:

[“the patient’s personal value system for guidance. The surrogate considers the patient’s prior statements about reactions to medical issues, all facets of the patient’s personality that the surrogate is familiar with—with, of course, particular reference to his or her relevant philosophical, theological, and ethical values—in order to extrapolate what course of medical treatment the patient would choose.”]

In other words, Greer had extraordinarily wide latitude to rule however he wished on the question of Terri’s wishes.

This is something that can be fixed by legislation, as the Florida legislature was trying to do until the measure was finally defeated yesterday:

The Florida Senate rejected a bill Wednesday to keep Terri Schiavo alive, turning back an attempt to resolve the contentious end-of-life debate with a state law, as legislators did in 2003.

The bill would have prohibited patients like Schiavo from being denied food and water if they didn’t express their wishes in writing. It would have applied only to cases where families disagreed on a patient’s wishes. The 21-18 vote came five days after her feeding tube was removed under court order.

Let me say that I’m cognizant of all the issues raised by both conservatives and liberals on this matter. I do believe that end of life decisions are generally a family matter and should not be interfered with by the state (especially the Congress, although my feelings about this exception are mixed, I think they did the right thing).

The thing that makes this case so frightening to me is the way the state court rode roughshod over Terri’s rights. In the end, the courts didn’t allow anyone TO SPEAK FOR TERRI! This is the job of the guardian. The fact that Michael’s conflict of interest in this matter is so profound, so obvious, and the courts, due to tradition and law were helpless to do anything about it, should open our eyes to the necessity for a change in law.

Terri is not alone. Who will stand up for the rights of those among us who can’t speak or are only vaguely aware of their surroundings? Who’s to say a guardian has a big enough conflict of interest that it should disqualify them from further representing the afflicted? Can these matters be legislated? Adjudicated?

Tough questions…few answers.