This story has been updated.
MANCHESTER, N.H. — Former Florida governor Jeb Bush on Friday once again defended his decision to intervene in the case of Terri Schiavo, a Florida woman whose death capped an intense national debate about ethics and politics, but also suggested that Medicare recipients should be required to outline end-of-life care plans before accepting the benefits.
"I don’t think I would have changed anything," he said in response to a questioner during a "Politics and Eggs" breakfast here Friday. "I stayed within the constitutional responsibilities or authority that I had. We changed the law first and then a year later it was ruled unconstitutional and then basically didn't have the ability to do anything. The federal government then intervened and that was ruled unconstitutional. So, she starved to death."
Diagnosed as in a persistent vegetative state, Schiavo, 41, died in April 2005 after a 15-year battle over her husband Michael's decision to remove her feeding tube. Her parents, Robert and Mary Schindler, fought to keep her alive, a move that prompted Bush, the Florida legislature and Congress to pass laws intervening on their behalf. The legal process stretched from Florida courts to the federal judicial system, but her feeding tube was ultimately ordered removed.
In hindsight, Bush said Friday that he wished that Schiavo had signed an advance directive, or legal document outlining how she would have wanted her end-of-life care managed.
"The family could have sorted this out rather than hearsay be the driver of this," he said. "That would have been better. I think if we're going to mandate anything from government, it might be that if you're going to take Medicare that you also sign up for an advanced directive where you talk about this before you're so disabled that then there's fights amongst the family. I know for a fact that the Schindlers were more than happy to take over the care of this child. And I supported that."
He added that the Schiavo affair "was one of the most difficult things I had to go through, it broke my heart that we weren't successful of sustaining this person's life, so she could be loved by her mom and dad. But the courts decided otherwise and I was respectful of that."
Bush's suggestion to require Medicare recipients to sign off on end-of-life care is likely to revive a fight that occurred at the height of debate over the Affordable Care Act. Early versions of the legislation included a proposal to reimburse doctors for talking with Medicare patients about advanced directives and end-of-life care.
But that proposal was widely criticized and incorrectly characterized by GOP critics of the law, most famously Sarah Palin, who used a Facebook post to label the proposal the establishment of a "death panel."
Advocates have pushed for wider conversations about end-of-life care in part because it accounts for a large portion of Medicare costs. The Centers for Medicare and Medicaid Services estimates that about 28 percent of Medicare expenditures is spent on patients’ last year of life. In 2011, total Medicare spending was nearly $554 billion, according to government figures.
Bush faced a barrage of questions from a capacity crowd attending the storied breakfast series. Standing in an auditorium adorned with large photos of previous speakers, Bush said that the photos "Bring back really fond memories. Guy over there, guy over there," he said as he motioned to pictures of his father, George H.W. Bush and his brother, George W. Bush.
He added that his life story "is a little different than the story of my brother and my dad. This may come as a shock to you, but you have brothers and sisters so you may appreciate this, we're not all alike. We make our own mistakes in life, we're on our own life’s journey."
But later, Bush dodged reporter's questions about how he might govern differently than his father or brother or whether his views on foreign policy differ from them.
"The circumstances for today are different than they were in 2000, certainly different than they were in 1988," he said. "And so there's a whole new set of challenges, whole new set of opportunities. The world that we're in is radically different than it was when my brother was up here in 1999. And certainly like light-years away from the '80s. So ideas need to be about the future and I'll get a chance to do that."
Bush has previously said that the intelligence used to justify the start of the Iraq war was flawed, but he pushed back against a question Friday about whether his brother had made any other mistakes with his foreign policy.
"I'm not going to get into that," he said. "That's not particularly relevant in a world of deep insecurity, focusing on the past is not really relevant. What's relevant is what's the role of America going forward?"
Bush held court at a similar question-and-answer event Thursday night in Concord. But "Politics and Pie" provided sweeter fare and a more intimate setting.
During the event, he urged Republican senators to move along the nomination of Loretta Lynch to be the next attorney general by suggesting that the longer she waits, the longer Attorney General Eric H. Holder Jr. — a favorite target of Republicans — will remain in office.
Bush is scheduled to speak later Friday at a two-day summit hosted by the New Hampshire Republican Party and set to be attended by many of his rivals, including New Jersey Gov. Chris Christie, Wisconsin Gov. Scott Walker, Sen. Marco Rubio (R-Fla.) and former Texas governor Rick Perry.