Bill Frist

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the adjournment resolution (H. Con. Res. 103) which is at the desk, provided that the resolution be agreed to and the motion to reconsider be laid upon the table.

Mr. FRIST

Mr. FRIST. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that the Senate stand in adjournment under the previous order.

Mr. FRIST

Mr. FRIST. Mr. President, tomorrow the Senate will convene for a short period of morning business. There will be no rollcall votes tomorrow. It appears that we have achieved compromise language with the House with respect to the Schiavo situation. It is my hope that the House will act on this language and send it to us early tomorrow afternoon, and I will have more to say on that tomorrow.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that when the Senate completes its business today, the Senate adjourn until 2 p.m. on Sunday, March 20. I further ask that following the prayer and pledge, the morning hour be deemed expired, the Journal of proceedings be approved to date, the time of the two leaders be reserved, and the Senate then begin a period of morning business with Senators permitted to speak for up to 10 minutes each.

Mr. FRIST

Mr. FRIST. In order to place the bill on the calendar under the provisions of rule XIV, I object to further proceeding.

Mr. FRIST. I understand there is a bill at the desk that is due for a second reading.

Mr. FRIST

Mr. FRIST. Mr. President, the Congress has been working nonstop over the last 3 days to do its part to uphold human dignity and affirm the culture of life. I am pleased to announce that the House and Senate Republican leadership have reached an agreement on a legislative solution. The Senate has come in today to pass an adjournment resolution which we will send shortly to the House of Representatives. Procedurally, this action will have the effect of bringing the House into session so they can either pass compromise legislation by unanimous consent on Sunday or place this legislation on the suspension calendar for consideration early Monday morning. The Senate will be prepared to reconvene as soon as the House passes this new legislation. It has been more than 24 hours since Terri Schiavo's feeding tube was removed. Under the legislation we will soon consider, Terri Schiavo will have another chance. It is a simple bill, only two pages long. It allows Terri's case to be heard in Federal court. More specifically, it allows a Federal district judge to consider a claim ``by or on behalf of Theresa Marie Schiavo for the alleged violation of any right of Theresa Marie Schiavo under the Constitution or laws of the United States relating to the withholding or withdrawal of food, fluids, or medical treatment necessary to sustain her life.'' I am pleased with our progress thus far, and I am committed as leader to see this legislation pass and give Terri Schiavo one last chance at life.

Mr. FRIST

Mr. FRIST. Mr. President, I will be very brief. This is an opportunity to talk to a number of my colleagues. As most people know, this is coming to the floor very quickly. And the real, fundamental reason is, if we do not act, there is a good chance that a living human being would be starved to death in a matter of days. That is why the action now. That is why we are, not rushing things, but deliberating quickly, so we can get it to the House of Representatives. She will be starved to death next Friday. I have had the opportunity to look at the video footage upon which the initial facts of this case were based. And from my standpoint as a physician, I would be very careful before I would come to the floor and say this, that the facts upon which this case were based are inadequate. To be able to make a diagnosis of persistent vegetative state--which is not brain dead; it is not coma; it is a specific diagnosis and typically takes multiple examinations over a period of time because you are looking for responsiveness--I have looked at the video footage. Based on the footage provided to me, which was part of the facts of the case, she does respond. That being the case, and also recognizing she has not had a complete neurological exam by today's standards--allegedly, she has not had a PET scan or MRI scan; not that those are definitive, but before you let somebody die, before you starve somebody to death, you want a complete exam and a good set of the facts of the case upon which to make that decision. All we are saying today is, do not starve her to death now--forever, I would argue--but establish the facts based on medical science today, and then make a determination in the future. That is what we will accomplish with passage of this bill.

Mr. FRIST. I will.

Mr. FRIST. Mr. President, if we could have regular order, just a very brief explanation and we will proceed. We are going to interrupt the budget for a few minutes to discuss a bill we have been talking about over the course of the day. It has to do with a particular case in Florida. We will talk a little bit about the background for a very limited period of time. Then we will resume with the debate on the budget and the amendment process. This should take a total of about 15 or 16 minutes. It is important we do it now. The House is preparing to leave--if they have not left--and the immediacy of this bill centers on the life of a particular person. That is why we are interrupting the debate now. With that, I turn to my colleague.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of S. 653, a bill introduced by Senator Martinez regarding Theresa Marie Schiavo, that the bill be read a third time and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. FRIST. Mr. President, I make another appeal to our colleagues. We are going to start strictly cutting off the votes. We are going to ask people to stay in the Chamber or right outside the Chamber. Again, we have a lot of votes. We have to get through them. I also want to take 2 minutes to address an issue that I mentioned this morning in opening, and it has to do with a particular case in Florida, the Terri Schiavo case. Over the course of the day and, indeed, yesterday, we have been working together, both sides of the aisle, to bring resolution to an issue that has fallen to us which we, for the most part in this body, agree we need to address before leaving today. I am going to propound two unanimous consent requests. We do not want to have at this point a large debate or discussion on the issue, but it is important that we act now because in working with the House of Representatives, we do, at the end of the day, want to pass legislation. And because they will be going out shortly over the course of the day, we want to make it clear it is an issue we are all working toward and I believe we can solve today and, thus, I will propound will have these two unanimous consent requests. I will explain very briefly the first of the two unanimous consent requests. The House has a bill they have passed. It is a bill that, for the most part, on both sides of the aisle there has been some concern that we have not been able to get unanimous consent just in our discussions. That will be the first unanimous consent request. The second unanimous consent request will be a private relief bill that is targeted to this particular case. It is a bill that both sides are discussing, and it is a bill on which I think over the next several hours we can come to some sort of mutual agreement. What is important is that this body act. If we do not act, there is a possibility that a woman who is alive today--and everybody agrees she is alive today--while we are on recess will have termination of all feeding and water. She will be starved to death. Without going into a lot of details--a lot of people are discussing it--that is what we would do from a procedural standpoint. The first unanimous consent request relates to a House bill that many people told me is unacceptable. The second unanimous consent request relates to a bill on which we worked together and is very targeted. Unanimous Consent Request--H. R. 1332 Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 1332, the House-passed legislation relating to Theresa Marie Schiavo, that the bill be read a third time and passed, the motion to reconsider be laid upon the table, and that any statements relating to the bill be printed in the Record.

Mr. FRIST

Mr. FRIST. Mr. President, this morning we will immediately resume consideration of the budget resolution. We have an order in place from last night which sets aside specific debate times in relation to several amendments this morning. There is no debate time remaining on the resolution beyond this time agreement. Senators, therefore, can expect a lengthy series of votes to begin sometime around 1:30 today. This vote-arama will necessitate continued cooperation from all Members. I cannot stress enough the importance of every Senator staying on the floor or very close by throughout the afternoon and into the evening. This is always a trying and challenging period because of the unusual nature of what happens over the course of the day. But beginning around 1:30, we will start a series of votes that will go on for a while. I encourage my colleagues to work with the managers to use restraint in not offering amendments if they are purely message amendments and are not substantive. It is going to be a challenge to bring everything to closure over the course of today and early into this evening already, so please use restraint in terms of whether to offer amendments. Terri Schiavo I know we want to get started, but I did want to bring to the attention of my colleagues an issue that we do have to act on before we leave. I do so on behalf of a number of my colleagues on both sides of the aisle who have come up and said: There is an important issue facing the country that we have not addressed in the past and that other systems of government and other branches of government have inadequately addressed, and, therefore, it is time for the U.S. Senate to speak. It centers on the fact that if we don't act or if somebody does not act, a living person who has a level of consciousness, who is self- breathing, will be starved to death in the next 2 weeks--thus the action that is required to be done either later tonight or tomorrow in order to prevent that starvation to death by Terri Schiavo. I first heard about the situation facing Terri Schiavo actually several years ago, but the immediacy of it has played out in the last several days because of this decision that has been made, not by her parents who want to keep her alive, not by her family who wants to keep her alive, but by her husband. From a medical standpoint, I wanted to know a little bit more about the case itself, so I had the opportunity to review the initial tapes that were made, the physical examination on which the case was ultimately based, the fact that she was in a persistent vegetative state, and scores of neurologists had come forward and said that it doesn't look like she is in a persistent vegetative state. It is a strange word, ``vegetative state,'' that connotes all sorts of things to lay people. It is a medical term that means that she is not in a coma. Persistent vegetative state is a specific diagnosis that typically has to be made over a period of multiple examinations, usually multiple days, and some neurologists say should be made over several weeks. The facts of this case are that it was made by a single, or maybe two, but a single examination over a very short period of time. The professionals themselves who have viewed those tapes question that initial diagnosis. The other questions arise: Does she have any hope of being rehabilitated? I talked personally to one of the neurologists who examined her, and he said, absolutely, she can greatly improve, substantially improve if she is given the appropriate rehabilitation. I asked myself, had she expressed her wishes about the end of her life? She had no written directive in terms of what would happen if such an event struck her. Did she have an advanced medical directive? The answer is no. So we have come to the point where on this floor we are going to have to face the question of whether we believe that a conscious woman who is breathing on her own--and yes, she has a severe disability, similar to what cerebral palsy might be. She can't physically feed herself. She can't verbally express her desires at this juncture, but she has no legal direction. The question is, Should we allow her to be starved to death? I mention that because it is an important case. It has to do with the culture of life. I believe this body is going to have to speak on this particular matter before we leave for recess. I yield the floor. Amendment No. 204

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 4 p.m. on Monday, March 21; I further ask that following the prayer and the pledge, the morning hour be deemed to have expired, the Journal of the proceedings be approved to date, the time for the two leaders be reserved, and the Senate begin a period of morning business, with Senators permitted to speak therein for up to 10 minutes each.

Mr. FRIST

Mr. FRIST. Mr. President, if there is no further business to come before the Senate, I ask unanimous consent that the Senate stand in adjournment under the previous order.

Mr. FRIST

Mr. FRIST. On Monday, the Senate will convene for a short period of morning business. There will be no rollcall votes, although we hope to finish our business with respect to the legislation relating to my comments on the Theresa Marie Shiavo case. I want to take this opportunity to thank Chairman Gregg and Senator Conrad for the tremendous, outstanding work on the budget resolution this week. Today alone, we conducted 25 votes to complete this resolution. Although it was not a record in terms of votes in 1 day, I would guess that we broke the land speed record as to the greatest number of votes in the shortest timeframe. We started voting at 1:17 and finished our last vote just after 10 p.m. It is ironic, but last night, I believe, on the floor in the evening we predicted--and it is rare to predict--that we would finish sometime around 10 p.m. tonight, and indeed we may have missed it by a couple of minutes. I thank all of our colleagues for their patience and endurance. I hope we finish our work on the Schiavo issue early next week and, if so, we will begin the Easter break.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that during this adjournment of the Senate, the majority leader, the assistant majority leader, and the senior Senator from Virginia be authorized to sign duly enrolled bills or joint resolutions.

Mr. FRIST

Mr. FRIST. Mr. President, in closing tonight, I will take a few final moments to speak on an issue that I opened with early this morning, about 14 hours ago, an issue which Senators Martinez and Santorum were on the floor speaking to about 45 minutes ago. It has to do with the Terri Schiavo case in Florida. I close this evening speaking more as a physician than as a U.S. Senator and speak to my involvement as a physician and as a Senator and as leader in the Senate in what has been a fascinating course of events for us over the last 48 hours, a saga which has not ended but one which we took major steps toward tonight in seeing that this woman is not starved to death tomorrow beginning at 1 o'clock, about 13 hours from now. When I first heard about the situation facing Terri Schiavo, I immediately wanted to know more about the case from a medical standpoint. I asked myself, just looking at the newspaper reports, is Terri clearly in this diagnosis called persistent vegetative state. I was interested in it in part because it is a very difficult diagnosis to make and I have been in a situation such as this many, many times before as a transplant surgeon. When we do heart transplants and lung transplants--and they are done routinely and were done routinely at the transplant center that I directed at Vanderbilt--in each and every case when you do a heart transplant or a lung transplant or a heart-lung transplant, the transplanted organs come from someone who is brain dead and death is clearly defined with a series of standardized clinical exams over a period of time, as well as diagnostic tests. Even brain death is a difficult diagnosis to make, and short of brain death, there are stages of incapacitation that go from coma to this persistent vegetative state to a minimally conscious state. They are tough diagnoses to make. You can make brain death with certainty, but short of that it is a difficult diagnosis and one that takes a series of evaluations over a period of time because of fluctuating consciousness. So I was a little bit surprised to hear a decision had been made to starve to death a woman based on a clinical exam that took place over a very short period of time by a neurologist who was called in to make the diagnosis rather than over a longer period of time. It is almost unheard of. So that raised the first question in my mind. I asked myself, does Terri clearly have no hope of being rehabilitated or improved in any way? If you are in a true persistent vegetative state, that may be the case. But, again, it is a very tough diagnosis to make and only by putting forth that rehabilitative therapy and following over time do you know if somebody is going to improve. At least from the reporting, that has not been the case. Then I asked myself, because we have living wills now and we have written directives which are very commonplace now, but 10 years ago they were not that common and, to be honest with you, a lot of 20- and 30-year-olds do not think about their own mortality and do not offer those written directives. They did not 10 years ago. Now they do with increasing frequency. I encourage people to do that. So, I asked, did they have a written directive? And the answer was no. And did she have a clear-cut oral directive? And the answer was no. So my curiosity piqued as I asked to see all of the court affidavits. I received those court affidavits and had the opportunity to read through those over the last 48 hours. My curiosity was piqued even further because of what seemed to be unusual about the case, and so I called one of the neurologists who did evaluate her and evaluated her more extensively than what at least was alleged other neurologists had. And he told me very directly that she is not in a persistent vegetative state. I said, well, give me a spectrum from this neurologist who examined her. To be fair, he examined her about 2 years ago and, to the best of my knowledge, no neurologist has been able to examine her. I am not positive about that, but that is what I have been told in recent times. But at that exam, clearly she was not in a persistent vegetative state, and of 100 patients this neurologist would take care of, she was not at the far end of being an extreme patient in terms of her disability. He described it as if there were 100 patients, she might have been the 70th but not the 80th or 90th or 100th. So I was really curious that a neurologist who has spent time with her says she is not in a persistent vegetative state but they will begin starving her to death tomorrow at 1 o'clock because of what another neurologist said. I met with her family and her son. Her son says she has a severe disability. A lot of people have severe disabilities, such as cerebral palsy and receptive aphasia, but her brother said that she responds to her parents and to him. That is not somebody in persistent vegetative state. I then met in person with the chairman of the Judiciary Committee 2 days ago in Florida to discuss the case. He told me that they had exhausted all options in the State of Florida to reverse what was going to be inevitable tomorrow, Friday, the 18th of March; and that is, that feedings and hydration were going to stop, that everything had been exhausted. He said the courts have been exhausted, and that all of the court decisions and the court cases had not been based on the facts because the facts were very limited and were the conclusions of one judge and two neurologists, and that was it, and that there were, in terms of the affidavits--I will get the exact number that I read--there were something like 34 affidavits from other doctors, who said that she could be improved with rehabilitation. So then it came to, what do you do? Here is the U.S. Senate that normally does not and should not get involved in all of these private- action cases. It is not our primary responsibility here in the U.S. Senate. But with an exhaustion of a State legislature, an exhaustion of the court system in a State--yet all of this is based on what one judge had decided on what, at least initially, to me, looks like wrong data, incomplete data. But somebody is being condemned to death--somebody who is alive; there is no question she is alive--is being condemned to death. It takes an action to pull out a feeding tube. It takes an action to stop feeding. The inaction of feeding becomes an action. And thus, as I started talking about it this morning, the question was, what do we do? Bills had been put forth broadly on the floor, and Senator Martinez had very effective legislation, but it had to do with the habeas corpus, a very large issue that we have not had hearings on and debated. So what we decided to do was to fashion a bill that was very narrow, aimed specifically at this case that would say she is not going to be starved to death tomorrow, but let's go and collect more information, have neurologists come in and obtain a body of facts before such a decision would be made. That is what we have done. As Senator Martinez said, and Senator Santorum said, we are not there yet. We have three different tracks going on that will be going on over the course of tonight. In my office, right now, letters are being written and being sent out, and we will not give up, and we have not given up. We passed the bill here tonight. The House has a bill. And I am confident if we continue working, and we are going to stay in session--we are not staying in session tonight but we are going to stay in session until we complete action. Let me just comment a little bit about the Terri Schiavo case because what I said is how we got involved. What I am about to say is a little bit more information than we have been able to talk about on the floor today because of the focus on the Budget Committee, although when we were just off the floor in the cloakroom behind us and in my office, we have been going nonstop on this all day long--all day long. Terri Schiavo is right now in a Florida hospice. She is breathing on her own. So she does not have a ventilator keeping her lungs expanding. She is breathing on her own. She is not a terminal case. She is, as I said, disabled. Under court order, this feeding tube was to be removed tomorrow, in about 14 hours from now. When her feeding tube is removed, she does not receive food; she starves to death. She has no hydration and she becomes dehydrated, has cardiovascular collapse, her heart and lungs would work overtime, and, of course, she would die. Her parents, Bob and Mary Schindler, have been fighting for over 10 years to prevent her death. Imagine, if you and your spouse had a daughter, and you said: Don't let her die. We will take care of her. We will financially take care of her. How in the world can you have somebody come in and remove a feeding tube? That is what they have been saying for 10 years. They love her. They say that she responds to them. They would welcome the chance--welcome the chance--to be her guardian. As I understand it, Terri's husband will not divorce Terri and will not allow her parents to take care of her. Terri's husband, who I have not met, does have a girlfriend he lives with, and they have children of their own. A single Florida judge ruled that Terri is in this persistent vegetative state. And this is the same judge who has denied new testing, new examinations of Terri by independent and qualified medical professionals. They have not been allowed. As I mentioned, the attorneys for Terri's parents have submitted 33 affidavits from doctors and other medical professionals, all of whom say that Terri should be re-evaluated. About 15--I read through the affidavits--and about 14 or 15 of these affidavits are from board certified neurologists. Some of these doctors, very specifically, say they believe, on the data they had seen, that Terri could benefit from therapy. There have been many comments that her legal guardian, that is Terri's husband, has not--it ranges. It is either that he has not been aggressive in rehabilitation, to other reports saying that he has thwarted rehabilitation since 1992. I can only report what I have read there because I have not met him. Persistent vegetative state, which is what the court has ruled, I say that I question it, and I question it based on a review of the video footage which I spent an hour or so looking at last night in my office here in the Capitol. And that footage, to me, depicted something very different than persistent vegetative state. One of the classic textbooks we use in medicine today is called ``Harrison's Principles of Internal Medicine.'' And in the 16th edition, which was published just this year, 2005, on page 1625, it reads: . . . the vegetative state signifies an awake but unresponsive state. These patients have emerged from coma after a period of days or weeks to an unresponsive state in which the eyelids are open, giving the appearance of wakefulness. This is from ``Harrison's Principles of Internal Medicine.'' This ``unresponsive state in which the eyelids are open''--I quote that only because on the video footage, which is the actual exam by the neurologist, when the neurologist said, ``Look up,'' there is no question in the video that she actually looks up. That would not be an ``unresponsive state in which the eyelids are open.'' Skipping on down to what the Harrison's textbook says about ``vegetative state,'' I quote: There are always accompanying signs that indicate extensive damage in both cerebral hemisphere, e.g. decerebrate or decorticate limb posturing and absent responses to visual stimuli. And then, let me just comment, because it says: ``absent responses to visual stimuli.'' Once again, in the video footage--which you can actually see on the Web site today--she certainly seems to respond to visual stimuli that the neurologist puts forth. And lastly--I will stop quoting from the classic internal medicine textbook--one other sentence: In the closely related minimally conscious state the patient may make intermittent rudimentary vocal or motor responses. I would simply ask, maybe she is not in this vegetative state and she is in this minimally conscious state, in which case the diagnosis upon which this whole case has been based would be incorrect. Fifteen neurologists have signed affidavits that Terri should have additional testing by unbiased, independent neurologists. I am told that Terri never had an MRI or a PET scan of her head, and that disturbs me only because it suggests she hasn't been fully evaluated by today's standards. You don't have to have an MRI or PET scan to make a diagnosis of persistent vegetative state, but if you are going to allow somebody to die, starve them to death, I would think you would want to complete a neurological exam. She has not had an MRI or a PET scan, which suggests she has not had a full neurological exam. I should also note that the court sided with the testimony of Dr. Ronald Cranford, who is an outspoken advocate of physician-assisted suicide. A 1996 British Medical Journal study conducted in England's Royal Hospital for Neurodisability concluded there was a 43 percent error rate in the diagnosis of PVS. It takes a lot of time, as I mentioned earlier, to make this diagnosis with a very high error rate. If you are going to be causing somebody to die with purposeful action, like withdrawal of the feeding tube, you are not going to want to make a mistake in terms of the diagnosis. I mentioned that Terri's brother told me Terri laughs, smiles, and tries to speak. That doesn't sound like a women in a persistent vegetative state. So the Senate has acted tonight and the House of Representatives acted last night. The approaches are different, and over the course of tonight and tomorrow, I hope we can resolve those differences. It is clear to me that Congress has a responsibility, since other aspects of government at the State level had failed to address this issue, that we do have a responsibility given the uncertainties that I have outlined over the last few minutes. Remember, she has family members--her parents and brother--who say they love her, they will take care of her, they will be responsible for her, and they will support her. There seems to be insufficient information to conclude that Terry Schiavo is in a persistent vegetative state. Securing the facts, I believe, is the first and proper step at this juncture. Whoever spends time making the diagnosis with Terri needs to spend enough time to make an appropriate diagnosis. At this juncture, I don't see any justification in removing hydration and nutrition. Prudence and caution and respect for the dignity of life must be the undergirding principles in this case. I will close with an e-mail a friend sent me once they saw that we in this body were involved in this case. It reads: I know you are dealing with so many major issues, but I believe this one threatens to send us down another shameful path we may never recover from. I don't think I ever had an occasion to tell you that I have a severely brain damaged adult daughter that I cared for in my home for 20 years. Sasha's functioning level is far below Terri's, but she has been such a blessing in my life. Dietrich Bonhoffer said, ``Not only do the weak need the strong, but the strong need the weak.'' It's hard to explain that in a day and age where physical perfection is so highly valued, but I know it to be true. Senator Frist, as you fight this battle today, hold fast. If ever the weak needed a champion, it is now. on behalf of my sweet Sasha . . . Then the e-mail is signed. I close tonight with those powerful words.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table.

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the consideration of S. Res. 90 which was submitted earlier today.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, the motions to reconsider be laid upon the table en bloc, and that any statements relating to the resolution be printed in the Record.

Mr. FRIST. Mr. President, I ask unanimous consent that the Senate proceed to the consideration of S. Res. 91 submitted earlier today.

Mr. FRIST

Mr. FRIST. I ask unanimous consent the bill be read a third time and passed, the motion to reconsider be laid upon the table, and any statements relating to the bill be printed in the Record.

Mr. FRIST. I ask unanimous consent the Senate proceed to the immediate consideration of H.R. 1270, which was received from the House.

Mr. FRIST

Mr. FRIST. Mr. President, I ask unanimous consent that the resolution be agreed to, the preamble be agreed to, and the motion to reconsider be laid upon the table.