When Terri Schiavo entered a persistent vegetative state (PVS), the issue of tube-feeding patients in such a condition had already been addressed by a number of state courts, including Florida's,1 and was also at the center of a U.S. Supreme Court case.2 Terri Schiavo was a young married woman who suffered anoxic encephalopathy, which resulted in her being left in a persistent vegetative state. She did not have an advance directive, came from a Catholic family, and had parents who were actively involved in the legal case. The only difference between Schiavo and the earlier Cruzan case in the Supreme Court seems to have been that Nancy Cruzan's parents fought to have their daughter's feeding tube removed, while Terri Schiavo's parents struggled to keep their daughter's tube in place.

A Media-Friendly Case

The Schiavo case became the most publicized tube-feeding case in American jurisprudence. It was particularly attractive to televised news media for the following reasons:

*Intense family conflict. In seeking to have Terri's feeding tube removed, her husband, Michael, claimed he wanted only to honor his wife's wishes, while Terri's parents, Bob and Mary Schindler, were convinced their daughter would never choose to starve to death. The conflict was complicated by unsavory accusations on both sides as well as unparalleled legal rancor.

*The willingness of Terri's parents to use television to put forward their point of view. In previous cases, families seemed to have avoided the media entirely, or at least shied away from their attention. Terri's father, on the other hand, appeared to positively embrace TV news as a tool to further his fight to save his daughter. He was frequently interviewed on news broadcasts and by all appearances grew completely comfortable on camera.

*The widespread availability of video that showed Terri blinking, moving and making facial expressions. No other PVS case has had as much visual material or exposure. When video of Terri was accompanied by her father's assertion that she could respond to those around her, many people found it easy to agree with him. Seeing is believing. This also led many viewers to mistrust Terri's husband, who chose to speak almost entirely through his attorney.

The result of this extraordinary media-particularly television-exposure was to generate great public interest in the case and create political pressure on Florida's lawmakers and governor to intervene. In the days following the removal of Terri's feeding tube in October, 2003, the pressure became so intense that the Florida legislature passed a hastily drafted law authorizing the governor to set aside the court's decision and order a surgical procedure that would provide Terri with a new feeding tube. Terri's parents, it seemed, had finally won a victory-in the court of public opinion if not in the courts of law.

But did the public perception of this case, mediated via television, reflect the truth? Or did the media, by their very nature, distort key issues? Why did there seem to be significant differences between the "reality" of the Schiavo case as played out on television and as played out in jurisprudence? And what about the inherent biases of television news-those of "objectivity," perceived credibility, open questions and visual emphasis? Each of these will be looked at in turn below.

The Mandates of TV News

First, consider the basic nature of television news:

* Veteran journalist Robert MacNeil said that the unfortunate operating mandate behind televised news "is to keep everything brief, not to strain the attention of anyone but instead to provide constant stimulation through variety, novelty, action, and movement. You are required.to pay attention to no concept, no character, and no problem for more than a few seconds at a time...bite-sized is best...complexity must be avoided...nuances are dispensable...qualifications impede the simple message...visual stimulation is a substitute for thought...and verbal precision is an anachronism."3

* Predictable events-what historian Daniel Boorstin called "pseudo-events"4 -such as press conferences or protests stand the greatest chance of being covered. Not only do they help assignment editors plan allocation of camera crews and reporters, but such events are easy to cover. Lobbyists and special pleaders know how to play to television's attraction for the predictable, the visual, and the dramatic and avoid boring the audience. As MacNeil said, "All television gravitates towards drama, and what passes for drama is often belligerence, people barking at each other, like soap opera actors, sounding vehement to make up for cardboard characters or too little rehearsal time."5

These verities of television news are neither amoral nor accidental. They are, at best, non-moral craft-based variables. They result from an unwritten agreement between commercial television and its viewers. Television (and its consultants) aims to effectively package content to deliver the largest number of eyeballs to the advertisers. Thus, viewer preferences drive mainstream coverage. Their votes, whether cast by their remote controls or Nielsen ratings tell news producers what stories to cover, how to cover them, even what the reporters and anchors and news sets should look like.

Critics Frank Mankiewicz and Joel Swerdlow, more than a quarter-century ago, wrote that some informal and unacknowledged laws of television news have developed:

Unattractive faces are almost never on camera in "good guy" roles; a fire at night will almost always be shown though an equally serious daytime fire won't.... All this has led to an overriding law-The Trivial Will Always Drive Out the Serious. There are other limitations and strictures. A story with film, for example, will almost always take precedence over one that must be read from the anchor desk or reported in a "stand-up" on the spot. If there is film, the action film will almost always replace the film that includes only a conversation or a discussion-"talking heads" are to be avoided if at all possible.6

Or, in a cynical formulation, "if it bleeds, it leads."

What do these principles of television news mean to the viewer? Does television's preference for the visual mean broadcast news is geared to emotions rather than intellect? Does the emphasis on action rather than thought, happenings rather than concepts, protagonists rather than underlying issues, mean television news is devoid of explanation and nuance and is, therefore, only comprehensible to the already well-informed members of the public? Is it possible that most television news reporting does little, if anything, to develop audiences' potential to analyze, think independently, or learn from grasping overall social patterns in the unfolding of events?

Contrast these ideas with the legal system. Judges don't cater to short attention spans, and will painstakingly explore concepts, problems, and questions of fact for as long as may be required. Complexity must be grappled with; nuances are not only important but indispensable; qualifications are not impediments; there is concern for truth and valid judgment; and verbal precision, far from being abandoned as anachronistic, is the cornerstone of clear understanding.

The Bias of Objectivity

In televised news reports on the Schiavo case, it was common to see stories trying to equally present both the views of Terri's husband and those of Terri's parents. Yet the potential for several kinds of bias remains. To a journalist, objectivity is an institutional craft value advocating a lack of bias or prejudice or stressing impersonal detachment. Whether "myth" or "standard operating procedure," objectivity has had a long shelf-life in media criticism.7

The earlier mantra of newscasting was "fair and accurate." Today, as Fox News claims, the slogan is "fair and balanced." The implication is that fair and balanced coverage will automatically be objective coverage. To be "fair," the newscast need only give some attention to both (assuming there are only two) sides on the air. To be "balanced," the newscast need only give both sides roughly equal time or emphasis, even though this is a perversion of the no-longer-in-force F.C.C. "fairness doctrine" and the "equal opportunity for political candidates" language originally found in the Communications Act. To be "objective," reporters must avoid passing judgment, and sometimes must ignore knowledge gained from sources that cannot be quoted. Instead, they keep everything controversial and open to question. If someone says something, even though the reporter knows that it might be a lie, one can't go wrong by quoting it exactly-and without comment. Through these techniques, reporters not only create the impression of unbiased reporting, they also extend the story's potential impact and life since a story without controversy can hardly be expected to capture and hold the attention of viewers.

The challenges of being an objective journalist are morally significant. Recently several arguments have been raised asking for a revised definition of the term, a "softening" of expectations about whether or how journalists can be "objective." Journalism professor Michael Ryan has said journalists in a democracy have a "moral covenant" with their audiences to provide "complete, balanced, fair, and accurate information and commentary." Admitting that "pure objectivity" is unattainable, he advocated an "objective approach" which would find journalists attempting to provide information that is complete, precise, balanced, and accurate; viewing powerful authorities and institutions with skepticism; considering new evidence and alternative interpretations; serving no religious, economic, social, or political agendas; recognizing their own predispositions and not allowing those predispositions to determine outcomes; using creativity in the search for facts and opinions that don't conform to the dominant narrative; and sharing all information freely.8

Jay Rosen, intellectual founder of the "public journalism" movement, noted that:

Objectivity can mean many things in journalism. The disinterested pursuit of truth, the care to ground reporting in verifiable facts, the principled attempt to restrain one's own biases and avoid prejudice are core values from which the press draws practical guidance and moral strength. No one should trifle with them. But objectivity also has its weaknesses. Under its influence "facts" tend to be placed in one category, "opinions" or personal views in another; with this division the journalist's mind appears to be successfully mapped. This works for some purposes.but there is a whole category of intellectual work that eludes the language of objectivity, with its attendant concerns about "bias."9

Whether there are objectively occurring events is not the issue; the debate is over whether news can be an objective enterprise. Cole Campbell, editor of the St. Louis Post-Dispatch at the time, said "It's absolutely correct to say that there are objectively occurring events.Speeches are made, volcanoes erupt, trees fall. But," he continued, "news is not a scientifically observable event. News is a choice, an extraction process, saying that one event is more meaningful than another event. The very act of saying that means making judgments that are based on values and based on frames."10

The Bias of Perceived Credibility

The next area of potential bias concerns the issue of apparent credibility. In televised news media, one's credibility usually depends not on one's education, expertise, and knowledge, but on how well one "comes across" on camera. According to communications theorist Neal Postman, the credibility of the teller is the ultimate test of the truth of a proposition. By "credibility" Postman referred to the impression of sincerity, authenticity, vulnerability or attractiveness conveyed by the actorreporter.11

Terri's father clearly came across as most credible. He was comfortable on camera and spoke with an appealing sincerity. Terri's husband, on the other hand, let his attorney do the talking. His discomfort on camera and his personal silence left many viewers cold and gave the impression that Michael Schiavo had something to hide. His explanation for not engaging in interviews was that he tried to maintain his wife's privacy. Even so, the result was that most viewers readily identified with Terri's father and found him more believable. So despite roughly the same amount of attention being given to both points of view, the credibility gap led to a bias in favor of Terri's father, according to Tampa Bay television journalist Mark Douglas.12

Consider the images of other protagonists and newsmakers in the Schiavo saga: Randall Terry, who founded the anti-abortion group "Operation Rescue"; Florida Governor Jeb Bush (who rushed "Terri's Law" through the legislature) and his brother, President George W. Bush; the Rev. Jesse Jackson; Senator (and physician) William Frist (who viewed the controversial videotape and concluded from that that Terri was not PVS); the Pope; an endless array of attorneys and judges and random protesters. Even though there were some less-well-known voices from the "right-to-die" movement and others on the husband's side, the credibility meter was tilted in favor of the most articulate, the most passionate, the most photogenic. Such is the nature of news.

The Bias of Open Questions

Another area of potential bias concerns the matter of "truthfulness"-fidelity to established facts. Journalists are responsible for balancing truth claims according to unwritten standards of veracity and significance. Not many journalists grapple systematically and philosophically with issues of epistemology, but all of them try hard to avoid passing along blatant untruths. It is more than a simple matter of semantics; it is a matter of first principles.

The tendency in televised news is to depart from epistemological inquiry in order to keep the story controversial and "alive." The central technique involves presenting established facts as if they are open to question. For example, it was common to see televised reports on the Schiavo case cast doubt upon medical diagnosis of Terri's PVS. Long after that had been settled, reporters continued saying that Terri Schiavo was in "what some doctors call a persistent vegetative state." In making these attributions, reporters repeatedly gave the impression that there was real controversy over Terri's diagnosis, and that only "some" doctors thought Terri was in PVS. When this statement was coupled with video of Terri, and her father's flat denial that his daughter was in PVS, viewers were led to believe that there was real doubt about her diagnosis.

The truth was that Terri's diagnosis was firmly established. Many qualified medical specialists had personally examined and tested Terri. All but two concluded that Terri was in PVS. Virtually unreported was the fact that these two physicians had a significant conflict of interest, since they were offering to ply their proprietary treatments upon Terri and would gain beneficial publicity merely from the attempt. The courts, after assessing the validity and credibility (in the other sense of the word) of the medical testimony, consistently concluded that Terri was in PVS. Even the independent guardian appointed by the Circuit Court concluded, after a careful review, that Terri was in PVS and that the evidence was compelling.13 Nevertheless, television news reporters repeatedly presented the matter of Terri's diagnosis as if it were a point of great controversy.

Another important example of forsaking fact for the sake of story involved the matter of treatment for Terri. While news reporters frequently mentioned that treatment for Terri's PVS had been offered by two of the physicians involved in her case, the reporters made no judgment-and, indeed, probably were personally unqualified to make such judgment-about whether the proposed treatments were legitimate or not. What the reporters left unstated was that the two treatments in question, vasodilation therapy and hyperbaric therapy, had been thoroughly considered by the trial court. The court found a total absence of supporting case studies or medical literature that would support the use of either for patients with PVS. In addition, any proposed treatment would have to do the impossible-re-grow or recreate the missing parts of Terri's brain that were destroyed

more than a decade earlier when she suffered a cardiac arrest and stopped breathing. This loss of most of her cortex was almost never reported.

By not reporting more facts about the proposed treatments, reporters maintained the veneer of objectivity by not "taking sides." But, as a consequence, the viewer was left with the clear-and erroneous-impression (often ratified by her father) that Terri was being denied treatment. Many thought that a terrible injustice was taking place, that treatment that could help her was being withheld. In reality, the fact that Terri's condition was untreatable was a settled matter. Presenting it as an open issue was not only unfaithful to the facts; it deceived viewers and was unjust to Terri Schiavo.

Another basic semantic and epistemological problem throughout the coverage of Terri Schiavo was journalists' seeming inability to strike a balance between "objective" medical science and "subjective" moral beliefs. As researchers have noted,

Some journalists used terms such as "right to live" and "right to die" or "extending her life" and "prolonging her death" interchangeably. Some casually repeated pejoratively inaccurate words such as "murder" and "starvation." Some printed or uttered value-laden phrases such as "saving her life" and "Terri's champions" indiscriminately.14

There is no doubt that this was a particularly difficult environment in which journalists had to gather and report firmly established facts and truth. General assignment reporters-many of whom were "parachuted" into St. Petersburg ill-prepared for the complex situation-had to produce, on deadline, news accounts that advanced the story. Even local reporters, who had lived for 14 years with the story and knew the local players, were overwhelmed by the carnival of competing claims. Little wonder there was a tendency to ask "open questions."

The Bias of Visual Emphasis

A final source of bias in televised news stories results from selecting only those aspects that can be effectively presented visually, punctuated by sound bites. A good example: Because there is no video of Terri expressing her wishes, and no sound bites from people who remember her past statements, the matter of Terri's wishes was downplayed in the media and therefore in the minds of viewers.

The courts, on the other hand, had carefully addressed this issue. The courts heard testimony from relatives and friends regarding Terri's past statements on treatment at the end of life. A number were recent statements made by a mature Terri on serious occasions such as funerals or times when a loved one was seriously ill. These statements, recalled by Terri's husband and a couple of Terri's in-laws, whom she had grown close to, all indicated that Terri would not choose to remain on artificial nutrition and hydration in the devastating setting of PVS. On the other side, Terri's parents said they believed Terri would want to be kept alive, based on a statement she made when she was a young girl.

The judge regarded the more recent, mature, and serious statements as having greater weight than those she made prior to becoming an adult. He also found the more recent statements to be sufficiently clear and convincing as to warrant the conclusion that Terri would not want to be maintained in PVS on a feeding tube. By contrast, the televised news media, in failing to report the court's examination of Terri's wishes, continually left viewers with the impression that Terri had no opinion about how she would want to be cared for. This is certainly a vital point, for if viewers had been made aware that Terri wouldn't have wanted the feeding tube, the central issue in the case may have been resolved.

Much of the above was too nuanced for television's vast visual maw. Lacking recent video of Terri (courts had forbidden any advocate from taking still or video pictures of Terri in the nursing home), television had to use old images, pictures of courthouse doors, or the current day's protesters. The oft-viewed and oft-maligned tape made years earlier by Terri's parents seemed to show her to be capable of thought, speech, and the ability to communicate. However, as medical ethicist Art Caplan describes it, it was a heavily edited piece of advocacy, excerpts culled from hours and hours of taping. "Family members would move into Terri's field of vision to make it look like she was 'looking' at them. Her grimaces and twitches were edited to appear as smiles."15

Caplan said that television simply could not resist showing the tape, running it round the clock as though it were a documentary-in the process doing more "to undermine the public's understanding of what it means for a person to be in a permanent vegetative state than any single piece of video ever broadcast in the United States."16 That tape, of course, also influenced politicians (Gov. and Pres. Bush, Sen. Frist, among others) and muddled public policy decisions.

Toward the end, the vigil outside the hospice had become a media circus, created for and eagerly devoured by television cameras and reporters. Moments after Terri Schiavo's death, a man began to play his trumpet, and he was immediately surrounded by a congregation of cameramen, two or three deep.17 As described by a St. Petersburg Times TV columnist, TV news outlets had plenty of images to help tell the story of Terri Schiavo's death, even though most of them-the tearful family members, talkative advocates, protesters complete with signs, shrines and flowers--supported Mrs. Schiavo's parents. "What viewers saw, as TV delivered what it could live and largely unedited, was a blur of hastily convened news conferences, protesters and political sound bites."18

To curse television-a visual medium that lives by its capacity to deliver eyeballs to advertisers-for presenting dramatic, gripping images at the expense of thoughtful analysis is overly simplistic. On the other hand, to ask it to somehow dampen the feeding frenzy and present perspective is fully justified. Even veteran reporters who were fully immersed in the Schiavo coverage now say they wish they had had the individual and institutional support to occasionally pull back and provide the bigger picture.19

What TV News Actually Portrayed

In conclusion, the Terri Schiavo case attracted unprecedented media attention, not because of questions of law or ethics, but because it was a compelling story full of conflict, accusations, debatable diagnoses, "denied treatments," and the dramatic intervention by Florida's legislature and governor. It was also compelling because at its center was a father fighting for the life of his daughter against "the system," which seemed determined to force Terri's death through dehydration and starvation. Yet much of this was hyperbole, frenzy, and spin-all put forward for the sake of keeping the story alive.

But would Terri have wanted to be kept alive as she was? The central issue was about Theresa Schiavo's right to make her own decision, independent of her parents and independent of her husband. In overlooking this, the media played a key role in frustrating Terri's right to be free of unwanted medical intervention. Though the reporting was in many cases fair, balanced, and objective by media standards-and may very well have helped many people understand end-of-life issues and the need for living wills-it paradoxically left viewers with the false impression that Terri may not have been in PVS, that she could possibly have improved if she were not denied treatment, and that nothing was known of her wishes. The media's treatment of the case, while perhaps improving ratings for its news shows, did not improve Terri's situation, nor did it help educate the public. Instead, the result was to agitate and inflame public sentiment about the case, based not on truth and fact, but based on misimpressions largely fueled by the televised news media's misleading portrayal.

Coda

Shortly after the death of Terri Schiavo, the American public was treated to an award-winning film (Good Night, and Good Luck) in which legendary newsman Edward R. Murrow described the paradox of television, a paradox that certainly affected coverage of the Schiavo case. In a 1958 speech to the Radio Television News Directors Association, Murrow observed that:

This instrument can teach, it can illuminate; yes, and it can even inspire. But it can do so only to the extent that humans are determined to use it to those ends. Otherwise it is merely wires and lights in a box. There is a great and perhaps decisive battle to be fought against ignorance, intolerance, and indifference. This weapon of television could be useful.20

REFERENCES

NOTE: The frequent use of Mrs. Schiavo's first name, Terri, in this narration is to prevent confusion and in no way is intended to minimize the significance of her or her case.

1 In re Browning, 568 So2d 4 (Fla) 1990.

2 Cruzan v Director, Missouri Department of Health, 110 S Ct 2841 (1990).

3 MacNeil, R. Quoted by Postman, N. Amusing Ourselves to Death: Public Discourse in the Age of Show Business. New York: Penguin Books, 1985, p.105.

4 Boorstin, D. The Image: A Guide to Pseudo-Events in America. New York: Harper & Row, Harper Colophon Books, 1964.

5 MacNeil, R. "The Mass Media and Public Trust," in Occasional Paper, no. 1. New York: Gannett Center for Media Studies, 1985.

6 Mankiewicz, F. and Swerdlow, J. Remote Control: Television and the Manipulation of American Life. New York: Ballantine Books, 1978, pp. 97-98.

7 The term "objectivity" may have created a semantic divide between journalists and philosophers. The latter use the term "objectivitism" to describe doctrines that stress the objective reality of all that is known or perceived. The differences may appear minor, but give rise to many debates between the media and philosophic communities.

8 Ryan, M., "Mainstream News Media, an Objective Approach, and the March to War in Iraq," Journal of Mass Media Ethics 21(1), 2006, pp. 4-29.

9 Rosen, J. Getting the Connections Right: Public Journalism and the Troubles in the Press. New York: The Twentieth Century Fund Press, 1996, p. 29.

11 Postman, op. cit.

12 Douglas, M., "Duke Righteous meets Terri Schiavo," Journal of Mass Media Ethics 21(2 and 3), 2006, in press.

13 In Re: Theresa Marie Schiavo, Incapacitated. Report to Gov. Jeb Bush and the 6th Florida Judicial Circuit 1 December 2003. Jay Wolfson, as Guardian Ad Litem to Theresa Marie Schiavo.

14 Kenney, R. and Dellert, C., "Cases and Commentaries: An Ethics of Caring and Media Coverage of Terri Schiavo," Journal of Mass Media Ethics 21(2 and 3), in press.

15 Caplan, A., "The Schiavo Case Was One of the Greatest Failures of the American Media," Journal of Mass Media Ethics 21(2 and 3), in press.

16 Ibid.

17 Boehlert, E., "A tale told by an idiot," Salon.com, March 31, 2005.

18 Squires, T., "On Schiavo case, TV struggles for balance," St. Petersburg TimesONLINETAMPA BAY, April 1, 2005, downloaded January 19, 2006, www.sptimes.com20050401news_pfTampabayOn_Schiavo_caseTV_s.shtml.

19 Douglas, M. op cit.

20 Murrow, E. R., addressing the Radio Television News Directors Association, October 15, 1958.

* Robert M.Walker, M.D., is in the Division of Medical Ethics & Humanities of the Univ. of South Florida. His E-mail address is This email address is being protected from spambots. You need JavaScript enabled to view it.. Jay Black, Ph.D., is in the Dept. of Journalism and Media Studies of the Univ. of South Florida St. Petersburg, and is editor of the Journal of Mass Media Ethics. His E-mail address is This email address is being protected from spambots. You need JavaScript enabled to view it.. This article is adapted from a chapter to appear in Ethics, Politics, and Death in the 21st Century: The Strange, Sad Case of Terri Schiavo, edited by Kenneth W. Goodman. Copyright c 2007, Cambridge Univ. Press, and reprinted with permission.

The above article was published in Media Ethics, Spring 2006 (17:2),pp.12,25-29.