17 Medical Affidavits about Terri Schiavo

In a comment on “Alas” last month, TZ and I had this exchange:

Amp: “What I haven’t seen is an explanation of how a woman who, according to cat scans, lacks the physical capability to have thought or emotion or feeling or experience, can be said to be having any sort of life.”?

TZ: “You’re making a statement on a highly complex clinical issue about which even experts in this matter disagree.”

It has not been established that “experts” do disagree. At her own (extremely good) blog, TZ writes:

Seventeen medical experts have reportedly filed affidavits questioning whether Terri Schindler-Schiavo is in a persistent vegetative state and supporting the need for additional neurological, neuropsychological, and other testing of her abilities, particularly with new technologies.

The affidavits are available on the web at Terri’s family’s website. Here’s a quotation from one of them: “She obviously is not in a vegetative state.”

“17 experts” certainly sounds impressive. Yet, if you visit creationist websites, you can find many more than 17 “experts” claiming that Darwinistic evolution couldn’t have happened. That doesn’t mean that it’s true that experts disagree about Darwinistic evolution; it just means that sometimes unqualified people claim to be experts, or advocates misunderstand or misrepresent what experts say.

The quote TZ provides is from Dr. David Hopper. Dr. Hopper does not comment on Terri’s cat scans at all; this is rather like someone arguing gravity doesn’t exist but not commenting on the issue of how it is everything tends to stick to the ground. He doesn’t disagree with the most essential evidence in Terri’s case; he ignores the evidence altogether.

Although Hopper claims to have a doctorate “in neuroscience” on his website, in his under-oath affidavit his only claimed Ph.D. is in counseling psychology. According to the bibliography he provides, he’s never had any research published in specialized neuroscience journals. In fact, apart from some allegedly “in press” articles, he hasn’t published anything in over a decade – and the majority of his publications before that point appeared in Somnology, a journal edited by – what a coincidence! – Dr. David Hopper. (Somnology, by the way, is the study of sleep disorders.)

Dr. Hopper is the sort of faux-expert who makes a big deal of being listed in a bunch of “Who’s Who’s” directories – never mentioning that virtually anyone can be in “Who’s Who” if they write a check to the publisher. He collects certifications – however lame most of them are – like they were baseball cards (hilariously, he reproduces 20 or 30 mostly irrelevant wall-decoration certificates and degrees with his affidavit). For most of the past decade his main academic position has been high school science teacher. There’s nothing wrong with teaching in high school, but it’s not a position held by actual experts in brain science.

* * *

How about the others? None of them apart from Dr. Hopper are ridiculous. However, regarding the specific issue discussed in my and TZ’s exchange, most of them are not experts. There are more speech pathologists and psychologists than there are neurologists. And the most qualified experts in this group, seem to take care not to state an opinion. For example, Dr. Kennedy – arguably the best-qualified neurology expert of the 17 – says that he’s willing to examine Terri with the most modern MRI technology. And that’s all he says.

I’ve read all 17 affidavits. I’m not a doctor, of course. But I know a lot about argumentation and debate. One of the most basic tenets of debate is that you have to address the opposing arguments. These affidavits simply don’t do that; like Dr. Hopper, rather than addressing the most crucial evidence and arguments in this case, they pretend that they don’t exist.

There are two issues here: Terri’s cerebral cortex, and the famous videos of Terri appearing to smile and react to her parents.

1. The Cerebral Cortex Argument.

The conclusion the court came to is that, based on medical testimony and Terri’s CAT scan, her cerebral cortex has basically turned to liquid. The cerebral cortex is the seat of all our higher brain functions. Without a cerebral cortex, it is impossible for a human being to experience thought, emotions, consciousness, pain, pleasure, or anything at all; nor, barring a miracle, is it possible for a patient lacking a cerebral cortex to recover.

There are only two logical responses to that argument, that I can think of.

A) An expert could argue that someone can experience consciousness without a cerebral cortex.

B) An expert could argue that Terri’s CAT scan was faulty, or was not read correctly.

Not one of the 17 experts clearly made either of the above arguments. Nor did they make some other argument I didn’t think of. In fact, none of them mentioned the term “cerebral cortex” at all. None of them even referred directly to Terri’s CAT scan.

Many of the 17 pointed out that there are more subtle tests than a CAT scan or MRI (several recommended an fMRI). However, it does not require a subtle test to detect that someone’s cerebral cortex is mostly liquid; nor do any of the experts suggest that a CAT scan is incapable of distinguishing between liquid and solid. (On the contrary, Dr. Uszler – an expert on medical scanning technology – states that “CAT scans are good for examining anatomy”).

None of the experts argued that any mental life is possible sans cerebral cortex. None of them argued that Terri’s CAT scan was inaccurate or misunderstood. Contrary to TZ’s claim, if these 17 affidavits are a fair sampling, experts don’t disagree about these matters.

However, two of the 17 – Dr Weidman and Dr. Uszler – addressed the cerebral cortex argument obliquely.

Dr. Uszler says that he hasn’t examined Terri, and has no opinion one way or the other about her case. He does say that “CAT scans are good for examining anatomy, but they do not tell you about brain function.”

That’s doubtless true in many cases, but in Terri’s case the CAT scan shows that her cerebral cortex anatomy has liquefied. It would be bizarre to claim that a CAT scan can accurately show that brain anatomy is essentially absent, but cannot support a claim that absent anatomy isn’t functioning. Nothing in Dr. Uszler’s comments addreses the specifics of Terri’s case, or argues that someone who lacks a cerebral cortex could possibly recover higher brain functions; nor does he argue that the CAT scan already done of Terri has been misunderstood or is faulty.

Dr. Weidman also addresses the question of the CAT scan, pointing out that his mother had cognitive functioning even after CAT scans showed “a significant decline in gray matter.” However, there’s a big difference between a “decline in gray matter” and a near-total liquidization. Unless Dr. Weidman’s mother’s CAT scan shows a cerebral cortex as destroyed as Terri’s – and he doesn’t claim it did – then the comparison simply doesn’t address the question of how someone without a cerebral cortex could possibly recover higher brain functions.

2. Those Famous Video Clips of Terri

So if none of the 17 experts address the cerebral cortex issue, what do they talk about? None of these experts have examined Terri, and only one claims to have looked at her medical records. What they discuss is the famous videos of Terri apparently tracking a balloon’s movement with her eyes, smiling at her mother, and so forth.

The court ruling addressed those videos. Although the out-of-context video snips featured on the terrisfight.org website, and on TV newscasts, seem to show Terri reacting to things around her, the full, uncut video shows Terri smiling and moving her eyes at random. In one instance, her eyes appear to track a balloon; that short sequence has been shown over and over. What they don’t show is the many failed attempts made to get Terri to follow the balloon. With clever editing, even random motions and reflexes – such as smiling and eye movements – can seem conscious. The intelligence and cognition on display isn’t Terri’s, but the film editor’s.

This is a well-known argument, brought up by past expert witnesses and relied on by Judge Greer in his decision. Yet not one of the 17 experts address this argument at all. Not one of the 17 experts reports having viewed the uncut films of Terri (and I doubt any of them did); in fact, several of them specify that they viewed the short clips available on the internet or seen on TV.

These 17 affidavits do not respond, in any way at all, to the court’s reasoning regarding the videos of Terri. Again, rather than addressing essential arguments, they simply pretend they don’t exist.

* * *

Obviously, I am not a medical expert. But you don’t have to be a doctor to understand that you can’t refute an argument if you don’t address it. These 17 expert opinions do not address any of the arguments for why Terri experiences no cognition, feelings or thoughts at all; nor do they address the court’s reasoning regarding the videos. They do nothing but repeat long-discredited arguments; which is great if the goal is to be able to say “look, 17 doctors say blah blah blah,” but not useful if the goal is to meaningfully discuss Terri’s medical condition.

UPDATE: Majikthise has more criticism of the 17 affidavits.

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122 Responses to 17 Medical Affidavits about Terri Schiavo

  1. 101
    kadamson says:

    Despite origins, mental health issues, opinions of the Schindlers or the Schiavos, apples, organges, etc…

    Imposing death by starvation or dehydration is universally recognized as inhumane. When it takes a human ten days to die because it is denied food and water – not because it is riddled with disease and eminently dying- it is inhumane.

    The fact is, the state intervenes in your medical decisions. There are zillions of examples. The autonomy of the individual in anything, including choice regarding medical treatment, is at the discretion of the state. You will fully understand when you use Medicare. An individual may prefer one kind of medical procedure for treatment but Medicare will only approve of another and the doctor will only comply with that.

    If a principle is of value it does not take a long, convoluted explanation to get to it.

  2. 102
    kadamson says:

    So, as a result of the death of Terrie Schiavo, puppies do have more protection. It is illegal to kill animals by starvation and dehydration.

    Would it be less inflammatory to say parakeets? Would it matter?

    The point is, we have arrived at what is inhumane for animals but we found a way to justify it for a human being.

  3. 103
    Ampersand says:

    Imposing death by starvation or dehydration is universally recognized as inhumane.

    Do you know what the word “universal” means? If so, then you must realize that it is not universally recognized that a death without any suffering at all — even if that death is via dehydration — is inhumane. If there were universal recognition, then everyone would agree, and there would be no controversy over the manner of Ms. Schiavo’s death.

    However, let me ask you this: Suppose that Terri Schiavo had been killed, instead, with an injection of anesthetic, followed by a drug that would stop her heart. (This is the humane death that many vets use to put pets to sleep). Or any other sort of “humane” death you can imagine. If the court had ordered that method of death for Ms. Schiavo, and the death had been carried out in that fashion, would that have been okay with you?

  4. 104
    Ampersand says:

    Amazed, I’d prefer that people not attack the Schindlers in the comments of “Alas.” There’s plenty to discuss without getting into character attacks on the Schindlers (or on Michael Schiavo, either). Thanks.

  5. 105
    Charles says:

    The thing that always bugged me about the “death by starvation and dehydration is inhumane” is that we actually have a huge amount of evidence that death by dehydration and starvation of an extremely inactive person who is provided comfort and amelioration of suffering (such as keeping the person’s mouth moist) throughout the process is not a bad death at all. People who are fully conscious and terminally ill routinely choose to die like this, and are able to report their experience throughout the process (and are also able to change their minds and say “No, I’d rather have water than die, let’s switch back to keeping me fed and hydrated”). People who go through this overwhelmingly report that it is not that unpleasant. It really is completely different than leaving a dog chained up in a yard with no food and water until it dies.

  6. 106
    kadamson says:

    “People who are fully conscious and terminally ill routinely choose to die like this, and are able to report their experience throughout the process ”

    Surely you see the irony in this statement?

  7. 107
    kadamson says:

    My opinion on the Terri Schiavo saga….
    She was a severely brain damaged and therefore disabled woman who was forced to succumb to death by starvation and dehydration.

    The way the case was tried, administering an injection was not an option. A drug induced hastening of death of is not legal for a non-terminally ill person. That is why her case was not tried as a “right-to-die” case. “Right-to-die” refers to terminally ill facing imminent death.

    Yet another example of the complexities and subtleties of the case.

    The end result, which I find tragic, is that a human was legally dehydrated and starved to death over a period of ten days. That is the plain and final fact. It is what we are left with. I am amazed that people want to make this ok. Her death was hideous.

    Consciousness is as yet undefined. Pain is like the ocean, only 1/10 understood. The bottom line is you have no idea what the death of Terri Schiavo was like. You can only hope.

    If that kind of death is ok for her, who else is it ok for?

  8. 108
    Charles says:

    You are nitpicking. Let me revise, and tell me how much it affects my meaning:

    “People who are fully conscious and terminally ill routinely choose to die like this, and are able to report their experience throughout all but the very end of the process ”

    The part of dying by dehydration and starvation that are claimed to be inhumane are not the last bit where you are fading out of consciousness, it is the long days where you are imagined to suffer horribly from dehydration and starvation.

    This is a reasonable thing to imagine, without any additional evidence, as being very hungry or very thirsty is extremely unpleasant, and dying of dehydration without an amelioration of suffering is a horrible death, as your mouth becomes extremely parched and all you can think about is water (people who have survived extreme dehydration without any amelioration have described trying to tear their tongues out because the tongue felt like a foreign object once their mouth and tongue was completely dry).

    However, the experience of dying of dehydration in a bed, with your mouth kept moist, has also been described (except for the last moments of semi-consciousness), and there is good agreement that dying this way is not a bad death for the days leading up to the last moments (and the last moments show no sign of being any worse than any other form of peaceful death).

  9. 109
    kadamson says:

    Not to “nit pick”, but
    1. Terri Schiavo was not terminally ill.
    2. I could write the manual on end-of-life procedures. Your description is elementary.

    How does anything you are saying justify this kind of death being imposed on someone not terminally ill, some one not making an end-of-life decision?

  10. 110
    Charles says:

    Ah, okay, that is a different question. I was objecting to the false claims that this was a horrible way to die (starvation and dehydration), which play off the idea of starvation and dehydration, rather than the actuality of starvation and dehydration under these circumstances. I suppose you can claim it was a horrible way to die if you believe that she had consciousness (despite having no cerebral cortex) and that we have no way of knowing if she wanted to die at the time when she died. I don’t believe that she had consciousness, so I don’t believe it was horrible in that sense either, but I can see why you would believe it was horrible that she was killed period if you believe that she had consciousness. It is the: “we wouldn’t let someone treat a dog like that” claims that I believe are rubbish.

    I have pretty much always stayed out of Terri Schiavo discussions, because I have somewhat mixed feelings about it, and my strongest belief about it is that it is none of my business. I feel like the greatest wrong in the entire process is the fact that I know anything about it. If I ever end up like Terri was, there are only two things I care about, that I not be a burden to people I love now, and that I not become the center of a media spectacle.

  11. 111
    kadamson says:

    “and my strongest belief about it is that it is none of my business.”

    “no man is an island…” and you are no exception. This is an issue that will become your business if expect ever to be incapacitated at any point in life. Who won’t be?

    I encourage you to find your awareness. If you do not, you most assuredly will be a burden to people.

    As to becoming a media spectacle, who has control over that?

  12. 112
    Amazed says:

    My apologies Ampersand.

    As for:

    “How does anything you are saying justify this kind of death being imposed on someone not terminally ill, some one not making an end-of-life decision? ”

    Terri Schiavo had expressed an end of life decision. Whether her decision was enforced immediately or adjudicated and then enforced several years later is irrelevant. She was most definately terminal in the absence of artificial life support and I don’t think it is possible to argue that plastic tubes are natural and not artificial.

    The end does not justify the means.

    Cutting through the skin, fascia, muscle and through the stomache wall is most assuredly an invasive surgical operation with all the inherent risks.

    There is no reasonable comparrison between spoon feeding an infant and cutting into someone to place a plastic tube into them.

    No life support = don’t keep me alive

  13. 113
    Myca says:

    “no man is an island…” and you are no exception. This is an issue that will become your business if expect ever to be incapacitated at any point in life. Who won’t be?

    I encourage you to find your awareness. If you do not, you most assuredly will be a burden to people.

    Amazed is exactly right: “Terri Schiavo had expressed an end of life decision.”

    Those who argue that she should have been kept alive are arguing that her wishes should have been countermanded by the state. That’s not something I’m comfortable with.

    That’s why it’s none of my business or Charles’ business or your business. It’s because it was her business, and the business of those she gave the right to make decisions for her.


  14. 114
    kadamson says:

    “Terri Schiavo had expressed an end of life decision”

    It was not an end of life decision. She was not terminal by any legal definition. If it had been an end of life decision it would not have necessitated the huge trial and spectacle it became. States recognize end of life decisions for the terminally ill. There are specific criteria to fulfill for a terminal illnes.

    She expressed a desire to refuse treatment. It resulted in death by starvation and dehydration. It is an ugly, tortuous death.

    It cannot be veiled over into a lovely ending for a lovely life.

    This case made it legal to end the lives of the disabled by dehydration and starvation. That is what happened. That is the way it is now.

    Your discomfort with the state countermanding personal decision will become trifold when it can recommend the ending a life that is not terminal by dehydration and starvation. This was life ending procdure previously thought too inhumane.

    Somehow you have rosied up this kind of demise with your prose. I assure you, the state will use this new means to its advantage, not to yours.

  15. 115
    Amazed says:

    If that kind of death is ok for her, who else is it ok for?

    That kind of question misses the point entirely. Deciding whether something is ok or not okay requires a personal judgement.

    The point is not what we would agree to or want for ourselves or our family members and friends. It is not about what we estimate a similarly situated or reasonable person would want for themselves.

    The point is not about imagining horrors or being repulsed by inflammatory but not necessarily medically accurate imagery or how strongly we object to such portrayals and descriptions whether they are factually accurate or not.

    The central issue is one of CHOICE and having personal decisions and self determination respected. Do you have to agree with another persons decision before it is carried out? I think not. Should it matter that others who don’t agree with the decision go to extremes with graphic, lurid, inflammatory descriptions? Should it matter how emotional and passionate the pleas are to ignore the persons expressed decision? Should it make any difference that the ultimate outcome of abiding by an individuals decisions about medical treatment is a hastened death? The person understood they were making a life and death decision.

    Terri Schiavo chose to be married to Michael Schiavo. He was her proxy. Putting aside any unproven and unsubstantiated allegations, manipulations, selective memories, rumor mongering and the rewriting of the history of their marriage the fact of the matter is that she entered into the marriage contract eyes open. If her parents are to be beleived she did so with strongly held religious convictions as well.

    As I pointed out earlier the supporters of the Schindler family absolutely avoided any discussion about CHOICE and about the right to refuse invasive, intrusive, scarring, painful, experimental or just plain UNWANTED medical treatments and surgeries.

    Is it possible to be a VICTIM when it is your own choice and your own decision? Is it possible to have your medical CHOICE and medical decision inflicted upon you like a punishment or a grave injustice?

    Did Terri Schiavo give up any right to self determination and personal CHOICE as a unique individual on the day that someone decided to associate her with special interest groups (the “disabled”) and their posturing and self agrandizing leadership?

    Is the ultimate fate of the universe or a particular special interest group (with a political agenda) affected by the decision and choice of one unique individual who never voluntarily joined that group or signed up to be a member?

  16. 116
    kadamson says:

    “If that kind of death is ok for her, who else is it ok for?”

    That question is the point.

    Her choice to refuse treatment has already been upheld.

  17. 117
    Amazed says:

    There is nothing “new” about individuals and families making choices about medical treatment.

    The only thing “new” here is that a probate court case was removed from the legal system and thrust onto the public stage by individuals that disagreed with the results of the testimony, expert testimony, fact finding and presentation of evidence. Legal appeals were lost. Ultimately the last recourse was the court of popular public opinion.

    A hospice was laid seige and made into a war zone without regard for the fact that more than one individual and more than one family was present and trying to cope under extradordinary and stressful circumstances. Many of the individual patients in that hospice and their families were facing EXACTLY what the Schindlers were facing- these circumstances are faced accross the country and all over the world without a spectacle. Without demonstrations. Without news trucks. Without busloads of out of state protestors because the local protestors were too sparse to make any real impression.

    This ONE case became a spectacle because making it a spectacle served the needs of a particular special interest group and their political agenda.

    A media circus was staged and expert manipulators showed up along with profiteers and opportunists of every sort imaginable and political and social agendas were furthered.

    This did not change the balance of power between the able bodied and the disabled.

    People profitted, money was collected, a “foundation” was started and money was funneled into its accounts.

    The world continues spinning. There is still greed and dishonesty just as there was before this case hit the media spotlight.

    Individuals and families were making CHOICES and DECISIONS about medical treatment including whether to continue medical treatment and whether to end medical treatment long before the Schiavo case.

    The only real difference between this case and all the others like it is that most families don’t start foundations and appeal for donations or get invited to showcase their tragedy and parade their suffering for an international audience.

  18. 118
    kadamson says:

    “making it a spectacle served the needs of a particular special interest group and their political agenda. ”

    To be fair, it served the needs of two particular special interest groups. And a foundation and a PAC were created.

    “This did not change the balance of power between the able bodied and the disabled.” The balance of power has always been skewed. Ask a disabled person.

    Only now, they can face a death we find illegal for animals less than human. What has become legal will morph so that it is legal in many more circumstances less valid than this one.

  19. 119
    Amazed says:

    More accurately the able bodied and the disabled continue to enjoy the right and the freedom to refuse unwanted medical treatment, surgery and even to refuse life support.

    Americans can rest assured that the courts will enforce their CHOICE and their right of self determination no matter who comes forward with a challenge.

    Friend, family, activist, powerful and well funded special interest group- no matter who brings the challenge the courts have demonstrated they will uphold the right of an American citizen to refuse unwanted medical treatments, surgery or even life support.

    Americans can rest assured that their CHOICE will be enforced even if powerful, influential and popular special interest groups ally themselves with the challenger.

    They can rest assured that the courts are willing and able to defend the constitution when politicians fail to understand it or support it and when special interest groups think they are powerful enough to overcome what it contains.

    That is why powers are separated. That was the wisdom of the founders of this old republic.

  20. 120
    Amazed says:

    Only now, they can face a death we find illegal for animals less than human. What has become legal will morph so that it is legal in many more circumstances less valid than this one.

    To be honest if a person was disabled AND paranoid the Schiavo case wouldn’t have effected their rights as a disabled person but it probably wouldn’t make them any less paranoid either.

    Whatever baggage a tourist brings in they generally bring out- and with a little extra weight added.

  21. 121
    Amazed says:

    In other words if I go to a beach hoping to find sand I’ll find a lot of what I am looking for.

    I think a lot of people found EXACTLY what they went to the Schiavo case looking for and once they found it they just refused to see anything else.

  22. 122
    kadamson says:

    “Americans can rest assured that the courts will enforce their CHOICE and their right of self determination ” Oh, yes the infallible court system. Like the one that made it legal for municipalities to claim private property for economic development of large corporations? According to the Supreme Court, that is totally constitutional. Wonder what else is?

    “and once they found it they just refused to see anything else. ”
    Sad but true. May your tour guide show you ever sandy beaches and calm water. Because it is tough out there without a lifeboat. As a result of the TS case, you still have a lifeboat but you are going to have bail like mad and when you stop it will sink.