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Sunday Journal

The lost lesson of Terri Schiavo

Published October 26, 2003

In November 1992, a jury in Clearwater returned a verdict in favor of Terri and Michael Schiavo for more than $6.8-million. The jury found that Terri had been the victim of substandard medical care that caused, in part, her coma. The jury also found that Terri was partly at fault and the verdict was reduced accordingly, to about $2-million. I was the lead trial lawyer for Terri and Michael.

I have followed from afar the saga of the Schiavo family since the trial. The battles over whether to disconnect Terri's life support have been extensively covered in the media. What has not been widely reported is the cause of Terri's coma.

By all accounts, Terri was a fine young woman. She had a good job, a good marriage and many friends. Most who knew Terri, however, were unaware that she was sick. Terri suffered from an eating disorder known as bulimia nervosa, commonly called bulimia. The disease causes its victims to overeat ("binge") and soon thereafter vomit ("purge"). The cycle of binging and purging is extremely dangerous. The human heart, to work properly, requires a balance of the body's electrolytes. Vomiting can upset the electrolyte balance and cause abnormal heart rhythms that can lead to heart attack. That is what happened to Terri. One night, Terri purged, which caused her potassium level to drop low enough to cause a heart attack. Before fire rescue arrived and took her to the hospital, Terri's brain had been deprived of oxygen for long enough to produce catastrophic brain damage.

The trial of the medical malpractice case established that the health care providers who treated Terri should have figured out that she had an eating disorder and referred her to the appropriate specialists for treatment. In awarding the Schiavos a substantial verdict, the jury understood that with appropriate care and treatment, the tragedy could have been avoided.

While Terri was a victim of medical negligence, she was also a victim of a society that tells young women, at every opportunity, that their physical appearance - how they look - is all-important. Terri was a victim of "lookism," as that term is described and documented at length in Reviving Ophelia, a book by Dr. Mary Pipher that deals with the pressure placed on young women to look good at almost any cost. This eye-opening, disturbing and wonderfully informative book should be required reading for all parents involved in raising a daughter.

The book's subtitle is Saving the Selves of Adolescent Girls. Terri was unable to save herself. Her bulimia and coma were products of her loss of self. She, like so many other young women, developed an eating disorder as a result of wanting to be thinner because everywhere she turned, society bombarded her with clear and unmistakable signals that if she was not thin, she would be less valued than those who were.

The pressure on women to be thin, to look good, starts early in life. The message is delivered from the time girls are old enough to watch TV or go to the movies. My two oldest children are daughters, ages 11 and 8. Already, I see the same signals being directed at them. It sends chills down my spine when I hear my daughters reading the calorie content from the side of cereal boxes.

The preparation and trial of the Schiavo case required that I immerse myself in medical literature and work with medical experts on eating disorders. I learned that many eating disorders, while treatable, are incurable. I also learned to be on the lookout for signs of preoccupation with weight in my daughters.

On the other hand, adolescent obesity is on the rise and a cause for concern. True obesity obviously requires treatment while adolescent "chubbiness" usually does not. How parents of overweight children deal with the issue can be critical. Children who are the subject of constant badgering, ridicule and harassment by parents or peers are at far greater risk for falling victim to lookism and feeling the need to lose weight regardless of the physical, psychological and emotional costs. They are also at increased risk for developing eating disorders.

As parents, we do not have much control over how our kids' peers treat them. We have total control, however, over how we respond. Parents who are confused or uncertain over how to deal with their overweight child should talk to their pediatrician or to other health care professionals with experience and training in the area. Well-intentioned but uninformed parents may make mistakes dealing with adolescent weight issues that can have profound consequences for their children.

My wife and I regularly battle the forces of lookism that are at work on our daughters by emphasizing the importance of judging people by how they act, not how they look. I find myself constantly discussing with my girls the core concept that developing into a person with a good heart and good spirit is more important than growing up with good looks.

The moral of the Terri Schiavo story is that society must be ever mindful of the forces at work that caused this tragedy. While we will never be able to eradicate lookism in our society, we can do our best to instill values that will help our children overcome the powerful negative influences they will be exposed to as they travel through their teenage years and beyond.

If parents, teachers and other role models work diligently at combating the forces that lead to eating disorders in young women, some will be spared Terri Schiavo's fate. If even one person is so spared, it is worth the effort.

- Gary Fox is a partner in the Miami law firm of Stewart Tilghman Fox & Bianchi, P.A.

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