So today Terri Schiavo is scheduled to have her feeding tube removed. Will it actually happen? I have no idea. (Update: Zuzu in the comments reports that Terri’s feeding tube has now been removed.) But even if her feeding tube is removed today, her body won’t die for a week or two, so this issue isn’t over.
Today, two Houses of Representatives – Florida’s and the country’s – passed laws intending to save Schiavo. Neither Senate went along, however. The newest delaying tactic is to subpoena Terri to testify before Congress (and forbidding anyone from removing her feeding tube in the meanwhile). Currently it appears that her feeding tube will be removed regardless. The subpoena seems to me almost a mockery – Terri can no more answer congress’ questions than she can fly counterclockwise around the Earth to turn time backwards. Several bloggers, who feel the same way I do, are pissed off by this latest development, and by the perceived cynicism – see Schussman.com, Stone Court, and Rude Pundit (who, I should warn you, lives up to her/his name).
But I realize that folks on the other side don’t look at it the same way. Some activists are going on a hunger strike to protest; I’m appalled, but I nonetheless admire their idealism and dedication. I hope they don’t harm themselves.
* * *
I hesitate to publish these next images. I’ve decided I’m going to, because the physical condition of Terri Schiavo’s brain is essential to any serious discussion of Terri Schiavo’s condition. By including these images, I don’t intend any disrespect to Terri Schaivo whatsoever.
On the left is a CT scan of Terri Schiavo’s brain (source). On the right, for comparison’s sake, is a CT scan of a healthy human brain. (You may also find it useful to look at these medical illustrations of the human brain, here and here.)
As I understand it – and goodness knows, I’m no doctor – the sparsely detailed dark areas in Terri’s CT scan (both the large dark area in the center and the smaller dark areas around the edges) are where Terri’s brain has been replaced with brain fluid. To quote myself: 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.
* * *
I’m not convinced that there is any legitimate doubt on this point. A National Review article (hat tip: Bob Hayes) quotes a few doctors arguing that CT scans are “useful only in pretty severe cases”; but what has happened to Terri Schiavo’s brain is, in fact, very severe.
When people argue that a CT scan could not possibly tell us anything about Terri Schiavo’s condition, logically they must believe one of the following two things:
1) CT scans cannot reliably detect when someone’s cortex has mostly turned to liquid.
Or:
2) That someone’s cortex has turned mostly to liquid does not tell us anything important about their condition.
I don’t think either of those propositions are defensible; therefore, I don’t think the proposition “a CT scan can’t tell us anything about Terri Schiavo’s condition” is defensible.
Finally, the National Review article implies that there’s some sort of death-cult conspiracy between the judge and the doctors to hide Terri’s true condition. I think that sort of conspiratorial thinking is ridiculous. But in any case, for it to be correct, it’s not only Michael Schiavo, the judge, and the two doctors hired by Michael who would have to be in on it; two court-appointed doctors and at least three more judges (pdf link) must be in on the conspiracy too. Not to mention all the other medical experts who have commented on the case and disagreed with the National Review’s conclusions (see the neurologists quoted in this article, for example). How far does the conspiracy go?
* * *
I thought this Abstract Appeal post – explaining why the question of “would Terri Schiavo have wanted to be kept alive?” wouldn’t normally come up during the malpractice lawsuit – was particularly well done. In general (and I know I’ve said this before), Abstract Appeal is the absolute-must-read blog for Terri Schiavo related news.
* * *
UPDATE: I’ve edited the post to remove an argument that I didn’t think I could stand behind; I’ve put the argument in the comments for posterity’s sake. I’ve also “promoted” an argument I made in the comments to the main post.
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Michael refused permission for an MRI when her parents had her examined. I’m looking for a source.
OK, I went direct to the source; I have an inquiry in with Fr. Johanssen to see what his source is for saying Michael denied the MRI.
One other points:
a few doctors arguing that CT scans are “useful only in pretty severe cases”?; but what has happened to Terri Schiavo’s brain is, in fact, very severe.
Nope. CT scans are useful for trauma cases. Terri didn’t have a brain trauma. She had an oxygen deprivation. The neurologists cited by Johannsen specifically mentioned that in oxygen deprivation cases, you need an MRI and/or PET to get a good understanding of what the level of damage to the brain is; a CT scan doesn’t get it done.
I must also note a bit of circularity in your reasoning: you say her brain injury is severe, but that’s exactly what the MRI would definitively establish.
(And in any case, given even the tiny chance that her cerebral cortex is somewhat present, wouldn’t it make sense to do the one test that would establish that definitively? Since your whole case that she should be killed rests on your belief that she’s already dead from a lack of a cortex, why not go the extra mile and check?)
First of all, I stand by what I wrote. They said that it’s useful in severe cases. They’re assuming Terris’ case is not severe when they suggest it’s therefore not useful in her case, but I think looking at the CT scan blows away that assumption.
My reasoning is only “circular” if you assume that it’s impossible to make a diagnosis of a severely degraded brain from a CT scan. I don’t think that’s true.
Finally, I’d agree with you about doing an MRI – if both sides would agree that MRI results would establish anything “definitively.” But I don’t believe that the folks at Terrisfight.org and their allies are wiling to agree that any level of evidence whatsoever could show that Terri is gone.
If we did an MRI scan, it would certainly show the same thing the CT scans show – that Terri’s brain is degraded far beyond any hope of recovery, and far beyond the point where she has any ability to think, feel or experience. And the result? There would soon be an article in the National Review saying that an MRI wasn’t certain enough, we must delay further until we can have a f-MRI done. And then, if an f-MRI is done, we’ll be told that another test must be done in order to have certainty. And so on. The strategy for the Terrisfight.org people is not to genuinely seek new information, but to try and seek delays under any pretext whatsoever.
So do I have anything against doing an MRI? No. I wish one had been done years ago (for all I know, one was). But I do think that after fifteen years, it’s legitimate for the court to recognize that what’s going on now is not a genuine desire for new information, but delay for delay’s sake.
One more comment: When you say “an CT scan is not useful in Terri Schiavo’s case,” you must logically be saying one of two things:
1) If someone’s cortex has turned mostly to liquid, a CT scan will not be able to dectect that.
2) That someone’s cortex has turned mostly to liquid is not useful information that tells us anything about someone’s case.
I don’t think either of those propositions are defensible; therefore, I don’t think the proposition “a CT scan is not useful in Terri Schiavo’s case” is defensible.
It’s not so easy to understand why Terri’s doctors didn’t perform an MRI, if preforming an MRI is a no-brainer
That’s kind of an unfortunate turn of phrase, isn’t it?
The NYT is reporting the feeding tube has been removed.
You’re right. Geez! I’ve rewritten that sentence in the post – thanks.
Thanks for the breaking news as well.
You’re right. I should say “a CT scan is not sufficient”.
I imagine that there are those who will not accept any test as sufficient; however, there are a number of people concerned for Terri who do not hold the hard-line RC position that you never end a life. For those folks, an MRI would provide a much better indicator. (And an openness to those tests would do a lot to dispel the idea that Michael Schiavo is hell-bent on ending Terri’s life.) In other words, it would bolster the strength of your position regardless of the outcome.
Just got a message from Fr. Johansen re: the MRI:
“My sources for the information regarding the lack of MRI for Terri are: the Schindlers, their attorneys: Pat Anderson (till last fall) and David Gibbs; statements by George Felos, testimony from Dr. Cranford (the chief medical witness for Michael Schiavo) himself, who argued in court that an MRI would not be necessary, and e-mails from Cranford himself. Needless to say, I can’t share the Cranford e-mails because I don’t have his permission to do so. The mere fact that Terri has thalamic implants contraindicates an MRI until they are removed (which Michael has refused to do in spite of a doctors instrctions to do so.)
The Schindlers did ask for an MRI at least three times, and each time Michael refused. Judge Greer refused to order an MRI for Terri, though the doctors for the Schindlers asked for one at the 2002 evidentiary hearing.
As far as news reports about this issue go, there aren’t any. The MSM has proven singularly uninterested in facts about her case that don’t fit into the “right to die” mold. As far as I know, my NRO piece was the first published article to make this fact known. “
Keep in mind that Michael Schiavo hasn’t been the decision-maker for years. Even if he decided to change his mind and advocate for Terri’s body to be kept alive, that would not change anything at this point; he’s under a court order. Similarly, even if they switched to a different guardian, that would not change anything; the new guardian would be legally required to remove her feeding tube.
I’m not sure if Michael could order an MRI without the court’s permission, at this point.
The question I have is one of timing. That the Schindlers have asked for an MRI is well-known and well-publicized; I don’t question that.
What I’m wondering is if they asked and were refused at a specific time (duirng the preparation for the trials regarding Terri’s medical condition). I’m not sure if you’ve answered that question.
In any case, why did this claim that it is impossible to diagnos PVS without an MRI not come up much, much earlier – say, a decade or more ago?
That said, however, I myself would have no objection to an MRI being performed on Terri, assuming the practicalities (paying for the surgury to remove her implants, etc) could be fairly worked out. I see nothing wrong with being sure. However, I remain skeptical that there are many people at all on the National Review’s side who would find an MRI, or any other level of evidence, sufficient.
In any case, why did this claim that it is impossible to diagnos PVS without an MRI not come up much, much earlier – say, a decade or more ago?
I believe that it did, Amp. But once you have the judge say “no” and the appeal gets denied, there’s not a lot of point to trying to keep the issue going. Remember, the Schindler’s didn’t start out to try to change the culture on euthanasia; they started out trying to keep their daughter alive. Continuing to fight the MRI battle after it was lost would have been a misallocation of their resources ten years ago; they moved on and fought on other fronts. A decade ago, this case was not in the public consciousness; nobody cared other than Michael Schiavo, the Schindlers, (possibly) Terri, and a few hardcore activists on either side.
Before a decade ago, there was a time when Michael Schiavo and the Schindlers were in perfect harmony. If an MRI is so absolutely essential, why was no MRI done before there was any conflict?
In any case, you’ve convinced me enough so I’m removing that section of the post, and I no longer stand behind it. I have to admit, there’s a real possibility that I’m mistaken and you’re correct. Here, for posterity, is the bit I’ve removed:
You can’t do that! That’s playing fair and being a reasonable person! I cry foul.
Give it up, please. You and other people with knee-jerk reactions to the right-to-lifers are helping to bring disgrace on progressives.
YOU don’t know the truth of the case, and don’t pretend like you do with all of this bogus crap of “evidence.”
You are supporting KILLING of the disabled, and it is hypocritical in the light of pretending to be against the death penalty and of against war.
Shame on you and all of the others who carry a torch for slime like Michael Schiavo and George Felos.
Well, that evened things out a little.
“As I understand it – and goodness knows, I’m no doctor – the sparsely detailed dark areas in Terri’s CT scan (both the large dark area in the center and the smaller dark areas around the edges) are where Terri’s brain has been replaced with brain fluid.”
Are you sure it is brain fluid? You can’t just make shit up, then go into a big rant about science. A more hypotheitcal thought derived from the pictures would be: whats all that blueness on the brain she has, as opposed to that heathy shade of grey brain? Or them dark blue areas, yep shes braindead alright, darkblue is bad, but to say that the dark blue areas equals brain fluid is getting way ahead of yourself.
Very interesting and relevant post and dialogue. I am a Blogger for Terri and although I don’t focus so much on these specifics of testing and the argument about what it would show…I do know PVS is unfortunately a largely clinical diagnosis…Recent research has shown a large number of people are misdiagnosed with PVS and are more likely MCS (minimal conscious state) I do believe the fact Michael/Greer wouldn’t allow more testing fits in with a very ugly pattern of negligence in getting her adequate treatment and care. How can it be Ok as a guardian to NOT file required and appropriate financial and health care papers yearly? I have a very difficult time in thinking it is a good legal decision from the bench to mandate her starvation & dehydration based on hearsay…part of the hearsay from a husband who was the only one with her the night of her collapse, the only one who ever stood to gain anything from her death, and the only one who could potentially lose a whole lot if she ever recovered…For myself the case comes down to more than just a right to die case…it comes down to Terri’s right to her own representation, facts, and accountability. It comes down to a gestalt that desperately needs correction.
I think Susan is getting into the personal insults zone here. Aren’t commentors supposed to remain polite?
Anyhow, I know of a doctor of clinical psychology who’s had training in neuropsychology who states that without a cerebral cortex (Of which there’s no argument Terry is lacking), there is no real chance for higher brain functions. There’s no tissue there for it to happen in.
And PVS is largley a clinical diagnosis. That’s correct. But in this *specific* case, it’s a diagnosis based on there being no cerebral cortex. None. It’s been replaced by spinal fluid.
I could diagnose old computers as being possible to fix, but if there’s no CPU, I’d be counting on something outside of the realm of physics to provide for the fix. In Terry’s case, it’s similar. There’s no CPU, and no amount of wishing will make one appear.
If Terry is not in a PVS, then there is no such thing as a PVS. But if it is a *possible* diagnosis, then she’s in it.
Just a thought. If Terry is going to get better some day, why not cryonicaly freeze her? Then she can (a) be declared legaly dead, and (b) have a better chance of coming back to life.
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What would an MRI establish that the CT hasn’t? I speak from medical ignorance here.
Also, what about the parents’ claim that Terri is actually showing brain function in her physical reactions? Are they just deluding themselves, or what?
Is anybody else as bothered as I am that the “let her die” solution consists of unplugging the feeding tube and letting her starve to death over the course of one or two weeks? Jesus Christ, I don’t care how brain-dead she may be, that’s inhuman! If it’s immoral to just give her an injection for euthanasia the way you’d do for a terminally ill dog or cat, it’s certainly immoral to remove a feeding tube. I’m appalled.
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Crystal Clear said:
I think you are refering to this paper:
Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit
However if you look at the paper, you’ll see that it doesn’t apply to this case at all – one of the key messages is:
Since these methods weren’t the ones used to diagnose this in this case, it’s not relevant.
Crystal Clear, you also make a number of accusations, none of which you ack up. Please provide us with impartial sources for your statements.
Simon, my understanding is that an MRI would provide high-quality images of Terri’s cerebral cortex, which would definitively establish its condition. This is important because if the cortex is in fact completely gone (as many believe), then there really is no hope of any kind of improvement in her condition. If it’s in bad shape but there’s still substantial tissue, however, then there is at least a fragmentary hope that she is still alive “in there” and could maybe one day awaken. The CAT scan images don’t go into much detail; as seen here, they’re basically colored blobs. That provides some information but not a complete map.
I’m not a doctor or a medical imaging technologist; this is just what I’ve been told. It seems reasonable.
Upon closely examining that CT scan of Ms. Schiavo’s brain, or what remains of it, I do believe that I can discern an miraculous image of the infant Baby Jesus. Do the husband and the parent’s know about this? They could put it up on eBay and recoup their medical expenses and then some. Probably even get more for the actual brain itself.
Simon —
Is anybody else as bothered as I am that the “let her die”? solution consists of unplugging the feeding tube and letting her starve to death over the course of one or two weeks? Jesus Christ, I don’t care how brain-dead she may be, that’s inhuman!
I know about this from personal experience with my mother, who did have a Living Will documenting her wishes. She was a healthy, active 73 year old who had a brain aneurysm in 2000. The doctor performed emergency surgery, with a 50% chance she would die during surgery, and if she did not die, a 10% chance that she would recover *some* functioning with extensive rehab. She did survive, but tests done immediately after the surgery showed that parts of her brain had been irreparably damaged. She was unable to respond to even the simplest verbal commands or move independently; she had reflexive responses to pain, and occasionally would moan.
We did not want to do anything to prolong her life in this state. The *only* choice available was to remove her feeding tube, and we also chose to remove hydration (except for keeping her mouth moist) so her death would come more quickly. Given her brain damage, we had no idea if she was “suffering” — but probably not. The US does not allow euthanasia by lethal injection, which would have been the quickest way and in my opinion the most humane. We were told it would take 2 days to 2 weeks for her to die, so we moved her to a hospice facility. Family members took turns staying in the room with her round the clock, and she died 4 days after being moved. My brother was with her, and he said that her death was extremely peaceful; over the course of 45 minutes she breathed less and less frequently, until she ceased breathing entirely.
There is nothing uncommon about what happenned here. If someone in a Living Will states that they do not want their life prolonged by “artificial means” that usually means removing a feeding tube, or, hopefully, not putting one in in the first place. My mother got one because when she arrived at the hospital, she was semi-concious. If the brain stem is functioning (as hers was), digestion and respiration are unimpeded, so a person can be kept alive with a feeding tube and artificial hydration for months or years. There simply is no other choice than this “inhuman” one that would have allowed us to respect her wishes.
Jesus Christ, I don’t care how brain-dead she may be, that’s inhuman!
Even if we postulate a soul, the brain clearly links consciousness to the body. If the brain can no longer perform this function, consciousness goes away. As someone said on Pandagon, this is an ex-parrot. I regret that foolish laws forbid shutting down the dead body quickly, to spare the feelings of the living. But as for the former occupant of the head in question, I doubt she’d care if we buried her old cells before they stop breathing.
What are thalamic implants, how would they be removed, and what would be the consequences of removing them to perform an MRI?
Even if we postulate a soul, the brain clearly links consciousness to the body. If the brain can no longer perform this function, consciousness goes away. As someone said on Pandagon, this is an ex-parrot. I regret that foolish laws forbid shutting down the dead body quickly…
Um. But see, not everybody accepts this premise. Until somebody dies and returns from the dead (again, from my POV ), we don’t know that for sure.
OK, I have the answer to my first question: thalamic implants are to prevent Parkinson-style tremors. I guess, without them, the shell of Terri Schiavo would have uncontrolled spasms – and in a body with no muscle control, not even a swallow reflex, uncontrolled spasms are clearly a Bad Thing.
But I can’t find much info about removing them. All I can find is that the problem is, the implants are made of silicon, and can fall apart during the surgery, leaving silicon shards behind in the body. Apparently, this is major surgery and requires a specialist who’s very very good at it.
So: the consequences of major surgery seem pretty dire; and if any silicon is left in the body, that compromises the MRI.
And, since Michael Schiavo no longer has the legal authority to authorize the surgery, and the Schindlers have no legal standing at all, the question of removing the implants to get a good-quality MRI seems moot.
Robert, are you saying that some people believe consciousness does *not* reside in the brain? Where do they think it lives, in some ineffable ether dimension?
That’s got to be one of the battiest things I’ve ever heard. Is “brain death”
a fiction, then? Are acephalics actually viable beings? Are JFK and RFK still alive somewhere, functioning just fine, thanks, despite having their brains blown out?
Casey, did you find that out on the internet? If so, would you mind sharing the links, if you still have them? If not, can you let us know what the source of your info is?
It’s not that I doubt you; it’s that I think I might want to be able to refer to that info in the future, and I’d like to steal your work if possible, rather than finding my own references. :-)
What little I know of the relevant issues I’ve learned from philosophers instead of neurologists, but I was under the impression that CT scans were essentially 3D X-rays, showing the physical structure of the brain, while MRIs were 3D images of brain activity. If this is the case, to find out whether part of the brain had turned into spinal fluid (which is not as dense as brain matter, and therefore distinguishable using X-rays), a CT scan would be more useful than an MRI. Furthermore, the picture shown is only a partial snapshot of the 3D model of Schiavo’s brain the CT scan produced, which would be more detailed than just colored blobs.
On what thalamic implants are:
http://www.aafp.org/afp/20000515/tips/6.html
On removing them (not a medical article; a blog thread by people with experience of them):
http://neuro-mancer.mgh.harvard.edu/ubb/Forum86/HTML/000015.html
I just googled ‘thalamic implants’ and ‘removing thalamic implants’, and picked the references that looked most pertinent. Warning: you’ll get some Save!Terri! sites.
Actually, after a bit of googling, it looks like I’m confusing CAT scans and CT scans. So never mind!
What premise do you mean, Robert? We don’t start from the assumption that the brain controls consciousness, we conclude it from abundant evidence — drunkenness springs to mind. Having a liquid cortex would affect the mind more than alcohol, don’t you think?
David Neiwert have a good psot about some of the more dangerous people the case is attracting – it can be found in this post:
Bo to the rescue
I don’t think there is any guilt by association1 here in regards to the people who tries to keep her in the vegetable state, but it is interesting to see what kind of people rally to their side.
1I don’t disregard guilt by association as a concept, as I believe it is appropriate in some cases, however in this case, I don’t feel it is so.
And yet more googling reveals that CT and CAT scans are two different words for the same thing. It seems to be possible to create a 3D model of the physical structure of a brain or other organ from a CT scan, but I can’t find any indication that this is normally done, let alone whether it was done in Schiavo’s particular case. Someone with better knowledge of the subject or research avenues really ought to take over from here lest I should make a (bigger?) fool of myself.
I sent an email to my family yesterday, stating that if I were ever in a condition like Terri’s, and they didn’t let me die, I would find a way to haunt all of their asses.
I did ask them to do the impossible, though, and have someone shoot me up with something so that it wouldn’t be as traumatic on the physical body that was left, as well as the living people having to watch. Unfortunately, that’s not an option in the US.
A medical ethics class I took once discussed euthenasia, and this point has always stuck with me… (convoluted, but try to follow me here)
IF Bob is watching over his 2 year old cousin, and the kid is taking a bath – and Bob decides to reach in and hold the kid under water so the child drowns… OR… Bob is watching him in the bath, and the child slips and hits his head and is under water… Bob knows that if he doesn’t act, the kid will drown and die.. but he doesn’t act and passively watches as the child dies…. Which action is more ethical? Either one?
So, if you agree that it is ethically the same to actively cause death, and to purposefully allow death when you know it will happen, and could prevent it…… Why – when someone is in a condition where it is there wish to die, do we only allow the passive allowance of it, rather than active participation in the carrying out of their wish to die?
And for the rude posters that decided to flame the comments, particularly with comments about “us” wanting to kill this person but being against war… can I just say – what on earth is your point? my ability to refuse medical treatment, either on my own, or through those whom I have given the right to decide it, has NOTHING to do with the death penalty or war. It has to do with the rights of people in this country to make medical decisions for themselves, and for those they are charged with doing so for, such as their spouse.
This has been the most extensively litigated and court reviewed case regarding “right to die” that I can think of, and yet, people want to believe that every court appointed doctor, and every judge is “in on it” with supposed “slime” like Michael Shiavo? Psh.
I hope to hell that if I’m ever in a state like Terri’s, that someone who cares about me, will fight to make sure I don’t simply exist like that. Honor my life and who I was, back when I was “in there”, and let me leave with dignity.
Or, like I said…. I’ll haunt your asses.
Philip —
CT and CAT are (as you say) essentially 3-D reconstructions from xrays. Of MRIs, there are two sorts: one is purely structural, and gives you the same sort of info as CT, only with much better spatial resolution; the other is called fMRI (for “functional”) and does a better job of imaging cerebral blood flow, which correlates (we think) with brain activity. In that sense fMRI is a lot like PET, except without the radiation.
fMRI would give us a very good idea about what structural damage there is to a brain, as well as some good indications of activity in it. But it sounds like the thalamic implants would make any sort of MRI problematic. PET would still be an option if you were interested in a good idea about brain function.
Like Ann, I had to make a decision to discontinue life support for my mother. She’d had a massive heart attack yet hadn’t recognized the symptoms, so it was two days before she got help. By then, her heart was so damaged that even surgery couldn’t repair it.
My siblings and I made the decision to let her die. She had very little chance of recovery and would have required a ventilator and machines to run her heart. Even though she’d never had any specific conversations with her about it, we all knew that she wouldn’t want to live that way. Several of us were there with her when it happened, as were her brother and my father’s sisters — one of whom, a Catholic nun, agreed with our decision. She went quickly, though it was clear that the actual end was painful for her (she was gasping as her heart stopped).
This is a decision that all kinds of people have to make every day. It’s a difficult one, but in my case, it was not something that I regret. I doubt anyone would say, “Hey, if I ever turn into a vegetable, make sure you keep me alive and hooked up to machines as long as possible.”
My family allowed my father to die. He was comatose, and evaluated by a team of specialists who concluded he had no chance of recovery of function from “galloping Alzheimers” (in a week, he went from hosting a wedding to being a total care patient in a nursing home — unable to walk, talk, go to the bathroom, or feed himself).
Feeding tubes are an INTERVENTION — they are NOT “natural.” If the body ceases to function, death is “natural.” Feeding tubes did not exist 25 years ago. They require a tube down the throat or through a surgical slit in the body, to provide nourishment when the patient cannot or will not eat or be fed.
OUR FAMILY’S CHALLENGE: It was painful and difficult to let go. Some siblings hoped our father would “come back” — but the specialists’ report convinced us all that he would continue to live in a semi-vegatitive state, and would deteriorate. My father had a living will and had frequently expresed the wish not to be kept alive in a semi-vegatitive state; prior to his last illness, he had left notes all over saying “if but for a vegetable – NO!”
Only after the specialists report of his deteriorated state, and a family mediation guided by a skilled psychiatrist, did all siblings and spouse (step-mother) agree to: no feeding tubes, no antibiotics, no recussitation, no hospitalization.
EASY DEATH: We did not permit feeding tubes to be inserted at the nursing home. My father was given water, and food as long as he could feed himself or be fed. When he got pneumonia (called “the old man’s friend”), he was not given antibiotics, and he died comfortably.
My father died as he would have if no extraordinary interventions had existed. Thankfully, our family agreed to allow him to die. If there had been a dispute, the nursing home and hospital would have kept him alive.
Marc is quite right about the imaging. MRI, whether functional or structural, is no good with implants because the electromagnet used is so powerful that anything metal in your head would come flying out your head (that’s only a slight exaggeration). PET could still be an option if you wanted to do functional imaging, although it would help to have some specific question to ask of the brain, and I’m not sure what the right question would be – “Is there any brain there” is not really a functional question.
But there’s something being lost in this discussion of brain imaging methods. The fact that an MRI would give a better structural picture of Terri Schiavo’s brain does not at all mean that the existing CAT scan isn’t good enough for present purposes. I see much serious armchair scan-reading in this thread that signals ignorance of the subject. Let me tell you: if you are sufficiently familiar with brains and brain images, you do not need an MRI to tell you how severely the brain in the pictured CAT scan is damaged, nor do you need to see more slices than the one depicted here. This single image shows a very severely damaged brain. The large “blue blobs” in the middle are ventricles, also present in healthy brains (you can see the two little dark crescent shapes in the brain on the right) that have expanded to such a large size because the overall brain volume is so low. Cranial space that would otherwize have been filled by gray matter is now filled with cerebrospinal fluid. And yes, that’s what the blue space is: cerebrospinal fluid that is filling up space left behind by necrotic brain tissue that has been scavenged and removed by the body. The white squiggly things are white matter – connective tracts that have the loose, uncoiled look about them that they do because, again, the grey matter that once compressed them is no longer there, so they “float” loosely in CSF. The gigantic ventricles, expanded white matter, and undifferentiated blue space in that scan all point to the same thing: massive loss of grey matter in the cerebral cortex. You don’t need an MRI to tell you that, it’s clearly visible in the CAT scan.
It is true that given the poor resolution of this image, it’s possible that some cortical tissue has been spared. But that doesn’t matter. Whatever wisps of cortex we might be missing in this image are not enough to sustain behaviors that could differentiate Terri Schiavo from any other vertebrate. All the neural equipment you need to do ocular following and emotional responses is subcortical. All the neural equipment you need to be a self-aware, reasoning, behaving human being is cortical. And since i gather this image was made some time ago, the present condition of the brain can only be worse.
There is no way any qualified brain doctor or scientist could look at this image and suggest that significant recovery of function is possible. The fact that we could have all this discussion on the subject is a triumph of politics over science. Tragic for Terri Schiavo, and really for us all.
On the matter of what differentiates a CAT or CT scan from an MRI, and from a PET scan, some technical clarifications.
CAT or CT scans are done using a large number of low power X-rays. I believe the frequency of the X-ray emission is also different than that of a conventional chest or abdominal X-ray. X-rays, as you probably know, are very small wavelength light radiation, having a higher frequency than ultraviolet and lower than gamma radiation. Their wavelengths are 100 picometers to 10 nanometers. Each narrow beam is attenuated by a different amount, and the amount of transmission is recorded. There is an important mathematical theorem of Radon (nothing to do with the element or radiation, just a guy’s name) which relates these measurements to the overall density of the space measured. This, if anything, is the “magic” of a CAT scan. Basically, it’s like finding the plums in a plum cake by proving with chop sticks and noting if resistence is encountered and noting the orientation of the chopstick with respect to the cake. Because CAT scans are sensitive to density gradients, they can see and map more than conventional X-ray imaging, which depends upon strong attenuation of X-rays by various tissues, bone vs soft tissue.
MRIs are Magnetic Resonance Images, and the technique is Nuclear Magnetic Resonance Imaging (NMRI). This technique surrounds the subject or sample in a strong and controllably oriented magnetic field. This field causes the hydrogen nuclei in water, located throughout the subject, to align with it. A radio frequency (RF) energy pulse is applied perpendicular to the magnetic field, raising the energy states of the nuclei. Once raised, some of them spontaneously relax, emitting an RF signal, albeit one at a different frequency than the driving pulse. These transmissions are detected and mapped, and form the basis for reconstructing the interior of the subject. MRIs have much greater resolution than CAT scans, particularly for neural tissue. But they have the disadvantage that resolution is limited by motion, so the best subjects are either inanimate or dead. Unfortunately, people breathe. I would guess the removal of thalmic implants, if it does induce seizures or tremors, would make an attempt at MRI useless for this reason. Often, to shorten the time for imaging, contrast dyes are administered to patients.
Brain activity can also be measured using PET scans, which are interesting and new. They involve injecting a number of radioactive materials in the body which emit positrons, and these emissions can be tracked and mapped to reconstruct density and detect changes. PET scans of the human brain are interesting because their result is a movie of changes going on in the brain, and are the basis for studying centers of cognition, motor control, creativity, and emotions.
It’s worse than even that, Cerebrocrat. It’s a full-scale assault on the stability of our medical, legal and political institutions.
Congress, in calling for yet more court review, is saying that anytime a court reaches a decision it doesn’t like, it can pass a special bill ordering a new court review – theoretically, Congress can keep doing this until some court, somehere, reaches a decision it likes. Which leads to the question: Can Congress also order that a decision it likes not be appealed? The GOP is already working on saying “Yes,” by pushing for a bill that would remove certain policies and laws from Court jurisdiction by a simple majority vote in Congress.
Doctors, patients, researchers…everyone… will have to start looking over their shoulder for politically-motivated interference in their work, their decisions, their lives.
CaseyL, while this may be a focused assault upon the medical, legal, and political institutions, and I agree about its implications for medical process participants, I think it’s simply institutionalizing a U.S. culturewide move away from seeing reason, knowledge, and the intellectual as being important for making decisions and setting policy.
Instead, I think it is enshrining the rule of mob and emotion as the ultimate authority under the banner of “personal values”. I don’t expect this will diminish until the public realizes what’s going on. Historically, and especially in democracies, once such a trend materialized there have always been politicians who sought to exploit it, as long as the minority who trotted out their sentiments were sufficiently loud and threatening.
I think the risk is much bigger. I know there have been people throughout U.S. history who have always claimed this, but here I believe the Constitution itself is under attack. If there is no due process and no rule of law, the Consitution is meaningless. If someone’s personal religious beliefs, whatever they might be, can justify going outside the Constitutional framework, then there’s a problem. Civil disobedience is one thing. Violence and manipulation of mechanisms of government to the neglect of important business is something else.
At least Congress deferred to the U.S. Supreme Court on the subpoenas for Committee appearances. Frist’s statement before that application was made amounted to a Constitutional crisis.
I’m cynical enough to think that the federal budget is in trouble in Congress and BushCo and the Congressional leadership don’t want people to see that, or give CNN and the rest of the media clowns any spare cycles to cover the gun China is holding to our heads called the Current Account Deficit. Hence, they produce a distraction.
If someone’s personal religious beliefs, whatever they might be, can justify going outside the Constitutional framework, then there’s a problem. Civil disobedience is one thing. Violence and manipulation of mechanisms of government to the neglect of important business is something else.
It’s fine when I do it, horribly destructive when people I don’t like do it, in other words. When I do it’s civil disobedience; when other people do it, they’re manipulating the government.
These issues are difficult and complex; they aren’t made easier when people pretend their side is made up of angels, and the other side of devils. (Hi, Kip!)
Liberals – human liberals, not demons, with flaws and strengths in abundance – made the bed they are currently having to lie in. Roe v. Wade may not have been the first extra-Constitutional ruling, but it’s certainly the one that started the trainwreck we’re in the middle of now.
Robert,
*I* am a conservative and I strongly support Roe v Wade for the same reason the father of George H Bush did, and for the same reason that the REPUBLICAN justices in the Supreme Court which made that ruling did: Because otherwise it is an unwarranted infringement on individual liberty, an enlargement of the role of government.
People can *voluntarily* choose to bring conceptions to term rather than abort them. And the logical practice for people who consider abortion murder is to urge widespread birth control. But that doesn’t happen because it’s fundamentally a *religious* practice.
But government support of birth control programs is also an unnecessarily government intrusion.
As far as individual beliefs go, one book says “The law of the land is the Law.”
How can a Supreme Court ruling *POSSIBLY* be “extra-Constitutional”?
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How can a Supreme Court ruling *POSSIBLY* be “extra-Constitutional”??
By not being rooted in the Constitution. Just as an act of Congress, or of some other governmental body, can be extra-Constitutional.
If the Supreme Court rules that it’s OK to hunt blacks for sport, is that a Constitutional judgment, or an extra-Constitutional judgment?
Just because an entity is the authority on a subject, does not mean that it is impossible for them to go against the black-letter law of that subject. Cops do illegal things all the time, even though they’re the guardians of law.
Don’t mistake supporting abortion rights for believing that Roe v. Wade was good law. You can do one without the other.
By not being rooted in the Constitution. Just as an act of Congress, or of some other governmental body, can be extra-Constitutional.
If the Supreme Court rules that it’s OK to hunt blacks for sport, is that a Constitutional judgment, or an extra-Constitutional judgment
Technically, whatever the Supreme Court rules is Constitutional. There are Constitutional remedies, ranging from impeachment to modifying the Constitution.
I find this hankering about Roe v Wade incredibly offensive because it is an attempt to short-cut the Constitutional amendment route. THAT is, in my book, treasonous. There is a process. If the Courts’ determinations are so offensive, use it. It’s been done before, notably with Prohibition, whatever the merits or faults of that Amendment were, which are irrelevant to this case.
The obligation to defend and protect the Constitution doesn’t go away simply because existing remedies are politically impossible. That they are means the electorate doesn’t believe strongly enough to make the change and the loud minority are just that.
Technically, whatever the Supreme Court rules is Constitutional.
If that is the case, then we have no Constitution. A document whose text can be ignored at the whim of its interpreters is not a governing document, it’s a cover sheet for fascism.
I find this hankering about Roe v Wade incredibly offensive because it is an attempt to short-cut the Constitutional amendment route.
That is the exact criticism leveled against the ruling by conservatives, Jan. If the people want a right to abortion, the people are/were perfectly free to create one via the legislative and amendment process – as they were doing before the Supreme Court short-circuited these democratic functions and imposed a nationwide rule. Abortion rights activists were unwilling to settle for the imperfect remedies provided by democratic processes, and instead sought a uniform imposition, and they got it.
I quite agree that there is an obligation to defend and protect the Constitution. One of the things it needs defense against is the legions of people, from all political philosophies, who want to override the mechanisms it creates for immediate partisan ends, such as abortion rights, or the rights of people in comas.
Finally, I don’t think it’s productive to label broad swatches of political activism “treasonous” because you don’t like them. Treason is taking up arms against your nation, or giving aid and comfort to its enemies. The justices who imposed a foundationless abortion right on the nation weren’t traitors; they were just bad judges.
I don’t think it’s productive to label broad swatches of political activism “treasonous”? because you don’t like them. Treason is taking up arms against your nation, or giving aid and comfort to its enemies. The justices who imposed a foundationless abortion right on the nation weren’t traitors; they were just bad judges.
The justices were all appointed through a political process mandated by the Constitution. The Constitution has no means of recall apart from impeachment.
Yes, I agree “treason” was too strong, sorry. But certainly it’s not “preserving and protecting” the Constitution. But not everyone, apparently, has that responsibility.
Why isn’t it possible to believe that the Constitution and legal precedent and argument over the past couple of 200 years defends the right of a person to do with their body what they want more than it protects pregnancies? The Supreme Court was considered the last bastion of reasoned moderation controlling the whims of a mob, something which was apparent in France at the time it was being formulated and signed. If the justices were supposed to be accountable to the public, they would have been elected.
That is the exact criticism leveled against the ruling by conservatives, Jan. If the people want a right to abortion, the people are/were perfectly free to create one via the legislative and amendment process – as they were doing before the Supreme Court short-circuited these democratic functions and imposed a nationwide rule. Abortion rights activists were unwilling to settle for the imperfect remedies provided by democratic processes, and instead sought a uniform imposition, and they got it.
As I’ve indicated, in my view these are not “conservatives”.
If that is the case, then we have no Constitution. A document whose text can be ignored at the whim of its interpreters is not a governing document, it’s a cover sheet for fascism.
No governing document can have portions which are not amendable and be flexible enough to survive. The Constitution has basically three, in order of decreasing time scale. (1) A Constitutional convention which can be called by the people. (2) A Constitutional amendment done using the process we are familiar with. (3) The interpretation of the Courts, ultimately the Supreme Court. The absence of constraints in Article III on the Supreme Court, even the failure to define “judicial power” means that it was intended to be expansive and open.
In contrast, Article I, Section 8 enumerates what Congress can do and what it can’t. The Constitution does not even define what “judicial Power” is, apparently thinking it was understood. Article III, Section 2, clause 2 does say In all Cases affecting Ambassadors, other public Ministers and Consuls, and those in which a State shall be Party, the supreme Court shall have original Jurisdiction. In all the other Cases before mentioned, the supreme Court shall have appellate Jurisdiction, both as to Law and Fact, with such Exceptions, and under such Regulations as the Congress shall make. Sounds like there’s an opening for legislation there.
It strikes me that the purpose of declaring what you want to be done in the event you’re permanently incapacitated is to ease the pain of those who love you. Terri Schiavo, the human being, has been dead for many years. I can only imagine how painful it is for Michael Schiavo to be forced to bear the abuse of the body of a human being he loved.
Regarding the CT vs MRI debate. I am an RN and have read hundreds of CT and MRI reports. There are some cases where there is diffuse damage that cannot be picked up by a CT. With massive damage like this an MRI is not needed, the extent of the damage is clear-pretty much total.
I very much agree, Brian.
What I fear is that the same rationale and legislation that can intervene and intrude so much in Schiavos’ case can also make DNRs and Living Wills illegal, “for the higher good”.
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If the people want a right to abortion, the people are/were perfectly free to create one
There is not, technically, a ‘right to abortion.’ It’s a right of privacy, following in the line of cases like Eisenstadt and Griswold, and is weighed against the state’s interest in fetal life.
I don’t think the Scalia wing of the court would say “Gosh, if the people want to give the fetus a right to life, we’re not going to find it in the Constitution, they’ll have to create it.”
“Please don’t use my daughter’s suffering for your own personal agenda.”?
That is such a joke!
Yeah, right, Randall Terry, at her side, not having an agenda.
Regarding “… the Scalia wing of the court…”, does anyone have a link to a place or know how these things play out in the Court interior? I know the place is secretive, and I know Scalia has expressed sentiments like those offered in defense of keeping Schiavo’s feeding up, but does anyone know how the dynamics actually go internally?
One thing I respect about all the judges is that they do follow a process and do respect argument. I can’t see a High Court jurist making things up as they go along, ever. I also don’t see them voting in the same way that political parties vote, that on one issue or another they’ll break with what are seen from the outside as their “bretheren” and either go maverick or join “the other side”.
This is the one notion that very much consoles me about any attempt to “pack the Court” with Roe v Wade opponents: Social conservatives may end up regetting the day they do it because the same character might fiercely defend the rights of gays to marry or pornographers to do their thing.
I don’t think the Scalia wing of the court would say “Gosh, if the people want to give the fetus a right to life, we’re not going to find it in the Constitution, they’ll have to create it.”?
That’s because the right to life is already well-established.
But, Robert, not a definition of what constitutes life. Surely, in the original version of the Constitution, slaves were not considered to have protectable life. That had to be added in by amendment. Why would the framers have a right to life originally envisioned for pregnancies?
Why would the framers have a right to life originally envisioned for pregnancies?
Because everyone starts as a pregnancy, obviously. If there is a right to life, it extends backwards from the time of one’s natural death to the moment of one’s coming into existence.
Surely, in the original version of the Constitution, slaves were not considered to have protectable life.
Not true. Slaves were considered human beings, just human beings with a very limited number of rights. (And those few not protected very well at all by the legal system – but they weren’t rights-less non-humans.)
That had to be added in by amendment.
Nonsense. What was added in by amendment was a creation and extension of former slaves’ political rights. Although, in your exceptionally deferential formulation of what the Supreme Court can legitimately do, I don’t know why you see a need for an amendment. Surely they could have just declared it “by interpretation”. Heck, there’s a lot stronger contextual support for human equality in the Constitution than there is for the bizarro “privacy” right which gives us the power to end life, but doesn’t give us the power to actually shield our privacy.
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I have to admit that I didn’t read every post here. Please forgive me if I’m repeating info that’s already been shared. I thought I’d give you my impression – for what it’s worth. I’m a veterinarian, and thus not qualified to interpret the results of a human CT scan; brain structures in humans and animals are not so different, though.
You need to understand a bit about how a CT scan is performed to know what you’re looking at. The scan shows pictures of a body in slices, and my first question is, can anybody verify that we are looking slices from the same parts of Terri’s brain and the normal brain?
Here’s why I think we’re not.
Those dark areas in the center of Terri’s scan are the brain’s ventricles. These are areas present in every brain which serve as collecting areas for cerebrospinal fluid (previously referred to as “brain fluid”.) Terri’s ventricles appear to be dilated, which is not uncommon when there has been injury to the brain. The picture of the normal brain has almost no dark space in the middle – no ventricles are represented in that slice. If this image was from the same area of the brain that Terri’s image depicts, there would be more black space in the center of the normal brain. And if these ARE the same slice, that’s not a normal brain.
Second, the cortex of the brain is on the outside, adjacent to the skull. Maybe you remember that a great childhood insult was to tell someone that they were “smooth”….this is a reference to the wrinkles (or lack thereof) that a brain develops from infancy to adulthood? The more wrinkles, the smarter the person. Sorry, I digress. A CT scan is a poor tool for assessing the presence of a cortex – you can tell from the images posted that even the normal brain lacks sufficient detail to permit one to assess it’s cortex.
Okay, there’s where my expertise ends. I will add one more thing – I have read that most neurologists agree that a PET scan is the only diagnostic tool of value when assessing a patient with possible PVS (persistent vegetative state). A PET scan has not been performed on Terri, and without this, I’m not sure anyone can make an accurate pronouncement of what kind of thought or perception she is able to make.
Anniebird
Slaves were considered human beings, just human beings with a very limited number of rights.
No they weren’t. They were property. The only rights they had were those embued to them in the same sense one does to a car when it’s taken care of, to preserve its value.
I see the same conflict continues here. We have two completely different views of the Constitution, of the purpose of the United States, and of its future. This will never resolve. There are two nations, and as it appears, one feels it only wins when the other feels it loses.
There is no point in discussing further.
I could conduct a positive proof, but that would require seventeen pages of citations. God knows I talk enough; let’s essay a negative proof, instead. Quicker.
Here is a quotation from the Dred Scott decision, in which the appalling Chief Justice Taney, writing for the majority, said (regarding enslaved black Americans): “On the contrary, they were at that time considered as a subordinate and inferior class of beings, who had been subjugated by the dominant race, and, whether emancipated or not, yet remained subject to their authority, and had no rights or privileges but such as those who held the power and the government might choose to grant them.”
Taney, as is well known, went on to decide that the government in this case had not granted blacks the specific right to have standing to sue in Federal court.
If black people were rights-less, then please explain Justice Taney’s statement that they had whichever rights the government had granted to them.
(Shifting to the modern context, this is one reason a lot of non-crazy people believe that governments don’t grant rights – because of the shameful history of governmental mistreatment of blacks, among others, as exemplified by Taney’s hateful formulation. Rights are instead Creator-given (hey, just like they wrote in that wacky Declaration of Independence thingammy).
We have two completely different views of the Constitution
Indeed. Mine is rooted in on my best effort at an understanding of the historical events that actually occurred. I have no information as to what yours is rooted in; I would invite you to expound on it.
…of the purpose of the United States
In my view, the purpose of the United States is to make true the words written in its founding documents. Again, YMMV – tell us about it.
…and of its future.
Beats my pair of jacks. Hoping and praying for the best.
There is no point in discussing further.
Well, that’s up to you. Ask Amp; I’ll generally argue anything at anytime with anyone. (“Yes, yes, it’s very sad that she’s died. Lovely flowers, by the way. Now, about Social Security…”)
There was mention that the parents had requested an MRI, and the reasons why it wasn’t done.
Was there ever a request for a PET? If the CT results are as claimed, I could certainly believe that a PET isn’t needed — but I can’t think of any reason (other than expense) not to have one done…
Karrie — I couldn’t agree more. The sharp distinction we make between action and inaction at time borders on lunacy, and the end of human life is one of those times.
Can you imagine the outcry if your local Humane Society began euthanizing stray cats and dogs by locking them in a cage with no water?
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With regard to Scalia’s take on this matter, when the Cruzon decision was handed down, Scalia sided with the majority, stating that these kinds of issues are the perogative of the state…
I would have preferred that we announce, clearly and promptly, that the federal courts have no business in this field; that American law has always accorded the State the power to prevent, by force if necessary, suicide – including suicide by refusing to take appropriate measures necessary to preserve one’s life; that the point at which life becomes “worthless,” and the point at which the means necessary to preserve it become “extraordinary” or “inappropriate,” are neither set forth in the Constitution nor known to the nine Justices of this Court any better than they are known to nine people picked at random from the Kansas City telephone directory; and hence, that even when it is demonstrated by clear and convincing evidence that a patient no longer wishes certain measures to be taken to preserve her life, it is up to the citizens of Missouri to decide, through their elected representatives, whether that wish will be honored. It is quite impossible (because the Constitution says nothing about the matter) that those citizens will decide upon a line less lawful than the one we would choose; and it is unlikely (because we know no more about “life-and-death” than they do) that they will decide upon a line less reasonable. (emphasis added) Cruzan v. Director, MDH, 497, U.S. 261 (1990)
as quoted in the Wolfson report (Wolfson was the person appointed by Jeb Bush to act as Guardian ad Litem on Terri’s Schiavo’s behalf, and his report is probably the best one-stop-shopping choice for those interested in the historyand issues involved)
http://abstractappeal.com/schiavo/WolfsonReport.pdf
Given the precedent established in Cruzon, and the fact that the US Supreme Court has already rejected a request to consider an appeal of the Florida court decisions, the likelihood of the Federal District and Appeals Courts intervening in this case is relatively small, despite the weekend passage of special legislation giving the lower federal courts jurisdiction. (State court decisions are appealable only to the US Supreme Court unless Congress specifically provides the lower Federal courts with jurisdiction.) And despite the rabid desire of the far right for Federal court intervention, I don’t see the Supremes wading into this controversy, given their expressed desire to avoid such decisions and preference for allowing these questions to be decided by state legislatures.
There is sobering and rationale as part of their ethics policy at the American Medical Association.
Also of interest is AMA policy regarding “Physicians’ Political Communications with Patients and Their Families and Communications Media: Standards of Professional Responsibility.
This is probably old news, but USA Today is offering a link to a PDF file giving the Wolfson Report on Terri Schiavo in full. It cites the Cruzon case mentioned in the excellent post by P.Lukasiak above. (It may mention more. Haven’t read it in its entirety yet.)
Also, FindLaw has updated their profile on the Schiavo case, capturing the maneuvers of the weekend and today.
Based upon the quote from Cruzon, sounds to me like I was wrong about Judge Scalia. mea culpa!
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I came by this post because I noticed it was being linked from several other blogs I regularly read. Heck, the images used above are being used on some other blogs, if I saw them correctly. I think, in the end, they’re more noise than signal in this case.
There are a lot of reasons to argue for and against removing Terri Schiavo’s feeding tube, and a lot of perplexing questions that the situation brings up. However, these CT scans aren’t really useful in the way a lot of the commenters are using them.
First, check Anniebird’s previous comment. It would be interesting to know whether the CT scans were taken from the same level. If we do not know, then we are going to have trouble comparing.
Second, let’s acknowledge that the brain is spongy and can get squeezed into smaller areas. Check hydrocephalus for an example. Here is an example of a brain with excess fluid, compared to the same brain after a shunt is installed to drain it off. The brain can be harmed when there is excess fuid, but it isn’t necessarily the case that there is less brain tissue. Can we tell how much brain tissue there is from the above scan? Not really. Her doctors might be able to.
Third, the cerebral cortex is not a synonym for the entire brain. It’s the outer shell part…the one we worry about. A lot of the stuff in the middle is connective tissue. Can we tell about damage to the cerebral cortex from the above scans? We still can’t. Perhaps her doctors can tell something.
Declaring someone to be in a persistent vegetative state is a complex diagnosis that requires several tests. Doctors and medical specialists who have actually examined the records and Terri Schiavo are in the best position to do so. Might they disagree? As someone with personal experience with severe injury, yes, doctors will disagree even in the most severe cases.
In our case, making broad statements based on a couple of images may make us feel better, but it doesn’t exactly add to the debate. It’s good we can debate the broader issues, rather than the bits of physical evidence we have.
If Terri’s in there somewhere (seems unlikely, with a liquified brain), it’s even more morally reprehensible to keep her alive.
I dare you to think about being trapped for 14 years – unable to move, unable to communicate…
As a retired radiologist I would have little more than a semantic argument. The ct image shows severe loss of brain cortex. The process was generalized affecting all portions of the brain. There is some fluid surrounding the brain . The huge collection of central fluid represents dilated ventricals. They dilate to take up the space as “nature abhors a vacuum” In my opinion there is virtually no chance of recovery.
Several people here are missing the point. If “20 judges” (UK TV news this evening) have already looked at this question, the other 249,999,980 people in the US have to pretty much decide that enough is enough. Otherwise, you’re going to have to have a plebiscite or referendum to decide every little issue.
Discussions about what might or might not help to refine the prognosis, and what might or might not make Terri better are all redundant. The argument now is no longer about this young woman and her wretched family and husband, it’s about whether America becomes even more of a militant religious society than it already is.
People suffer strokes that wipe out big chunks of brain. Relatives have to decide if the drip is to continue, and if so, what it should contain. If there is more than morphine and the patient receives nutrients that will keep their organs going, the process of death can be drawn out at great expense.
Neurologists give the families their best professional judgment, and patients with far more brain tissue that Terri Shiavo are allowed to die by the decision to remove life support. It happens all the time. Some people with badly damaged brains might actually improve, but how many are really going to ever be themselves again? It’s a judgment call by the family. No doubt physicians, who may even hope to free up hospital beds, can influence these decisions.
The actions of Congress and the President suggest that the relationship between the doctor, patient and custodial relative is not so sacred. But how many people would like the public to debate whether a person in their family who was terminally ill with cancer should go for another round of chemotherapy, just because there is always hope.
Imagine people to whom you have no relation whatsoever suggesting that you wanted your terminally ill spouse or parent to die faster so that you could cash in an insurance policy. Horrible.
When the President and Congress got involved it made the whole thing even worse, since they made an exception out of a situation that was not really unique, except for the media coverage.
Furthermore, all of this compassion from politicians for people with brain injuries, is it real? There are probably service men and women back from Iraq who are medically not much better off than Terri. How many congressional vacations are cancelled for them? Why doesn’t President Bush have them round to dinner at the White House?
Drd Scott was a textualist gem. Employing the methods of jurisprudence embraced in the critique of Roe as activist. It was a case in which the justices faithfully applied the Constitutional text. There is no argument that the text of the Constitution at that time.
The attempted distinction above conflates natural law and postivistic law. To oversimplify, natural law holds that there are inherent rights granted to the Creator outside of the reach of secular government. Justice Scalia and his cohorts like to invoke this doctrine, especially of recent, but they don’t really mean it. The critique of Roe above embraces positivistic law, i.e., judges should not find right not set forth in statutory Constitutional text.
There are a thousand subissues, but one point is irrefutable. One cannot coherently critique Roe as outside the bounds of apprpriate judical restarint while criticizing Dred Scott which was restrained.
This weird mess just arrived in Europe, where the general view is that American political culture is exhibiting a terminal pathology far more significant and dangerous than Mrs Schiavo’s. Current American politics seems like a Civil War moderated by Jerry Springer. Maybe there will be some sort of Reconstruction after a few years. But for the moment we’re scared as hell of those Republican mullahs in Washington, with all their money and weapons and powerful friends and infantile worldview. What can we do to support the rule of law and reason against your crazy new theocracy?
It appears most thinking people understand that she is not normal.
However, she is alive as are many disabled individuals who can’t hear or talk.
It is my opinion that letting her starve to death will cause her pain. If she can’t hear or talk, how does anyone know she feels pain. And, how does anyone know if a starving person feels pain in the process of dying.
Unless you have starved to death how do you know if its painful.
The issue of the Federal Court & Judge:
All criminals found guilty of a capital crime and sentenced to die are allowed to appeal to a Federal Court & Judges.
Why should this case be different? Shouldn’t Terri have equal treatment?
My Opinion, if you want to kill Terri, which is what is happening, it should be the Court’s decision and done with an injection.
If she can’t receive the same and equal treatment as a Murderer why should she be starved to death.
I doubt that it is anymore of an expense to the Govt. by having the Schindlers take care of her than, it is to keep and maintain a Murderer sentenced to life imprisonment.
Life has sentenced Terri to life imprisonment, why must she be starved to death?
Any doctors out there willing to bet their professional reputation that consciousness can be restored? This maybe and perhaps crap is sub-professional. Ask me an engineering question and I’ll give you a straight answer, not a lawyer’s Weasel words. How about it? Put up or shut up.
There are a thousand subissues, but one point is irrefutable. One cannot coherently critique Roe as outside the bounds of apprpriate judical restarint while criticizing Dred Scott which was restrained.
RKF, as a Constitutional conservative, I would have to say that Dred Scott was, in terms of method and propriety, properly done for its day. Remember, there were two dissenting opinions in that case, McLean and Curtis, and there’s been a couple of Constitutional amendments and quite some case law collected since that time which, if it were retried, might affect the outcome.
And Justice Daniel, concurring with the majority, said a very interesting thing:
Note that it is the virtue of rational argument that while overall conclusions might be incorrect, individual parts are correct.
Richard asks Life has sentenced Terri to life imprisonment, why must she be starved to death? As some ethicists noted in the many discussions held today on this topic, withholding food is ethically equivalent to removing respirator or dialysis support for patients dependent upon them. This patient cannot eat, cannot swallow. Indeed, nothing shows Randall Terry’s disingenuity and ignorance more than that widely printed quote he made the other day, that Schiavo’s parents “can’t even give her an ice chip”.
You, Richard, represent the sympathy of vitalism, that the “real Terri” is trapped in this body like a ghost in a machine. It seems a few people can’t understand how someone can see continuation of this flesh and blood puppet for whatever reason is ghoulish and incredibly disrespectful of the many good things Terri Schiavo once was but is no more.
I’m surprised noone has commented on this. Has anyone read the motion filed today by Schiavo’s parents for a temporary restraining order, declaratory and injuncitve relief? I dig the reattachment of the tube and the taking of custody, even if I disagree, but what’s all this nonsense about:
I’d say there’s a lot more going on here than saving someone’s life. I’d say this theory of continuation of spirit is an attempt to “save Terri” from a life in which she apparently rejected Catholicism. Equivalently, it might be seen as a device to inflict on someone who did not want to be a Catholic as an adult, having rejected the religion of her upbringing, the ultimate personal outrage.
Youre a complete ass. Why dont you educate yourself on catholocism before you make totally ignorant and uneducated comments such as that!
This weird mess just arrived in Europe, where the general view is that American political culture is exhibiting a terminal pathology far more significant and dangerous than Mrs Schiavo’s.
You know, given all the political nutbarism European countries have going on, it’s tedious when they cluck about fractious America. We’re a big country, people. We have our Jean Le Pens and our Alessandra Mussolinis just like you do.
I must admit that I have not thoroughly reviewed all of the above comments but there appears to be a common thread implicit in many of them. I am referring to the unstated assumption that Terry Schiavo as a “person”? exists. The issue is not one of being “normal,”? as stated above. The fact of the matter is that the “person,”? who did inhabited the body of what we see before us, has long since past into eternity. My training as a doctor in clinical psychology with study and work in the neurosciences coupled with a graduate degree in Christian philosophical theology leads me to conclude that the “personhood”? of Terry, in the most true human sense, no longer exists. Nothing can be done to the person of Terry along the lines of “letting her starve to death.”? Nor can Terry feel pain. We know that Terry does not feel pain as the brain structures responsible for sensing pain no longer exist. While it is true that a portion of the brain is functioning, that portion has little to do with these areas of concern mentioned above by Richard and some others. What is left of the brain structure has little to do with consciousness. A brain structure with the absence of cortical functioning, with only the lower brain stem operating to perform some basic biological functions cannot at a neuropsychological level be considered to meet standards of personhood in any meaningful sense. Irrespective of the brain image above, the examining doctors serving as forensic experts to the court left little doubt about this matter.
Let me be clear. “Personhood”?, inclusive of the potential for such, is understood to connote a potential for personal relatedness. Conceptually this encompasses three dimensions: first, subjective processes of self-relatedness and self-representation; second, inter-individual relatedness and three (for me) relatedness to God. Interesting is the fact that in the biblical sense the concept of the “soul”? arises out of personal relatedness and is a property of human cognition. This is not to say that a person is simply a pack of neurones. But when these basic elements no longer function or can be stated to exist, we as a human community can only impute personhood. I have no problem with imputing personhood as in some areas when dealing with the unborn. However, it is one thing to do this at the beginning stages of life, so as to protect it. But, it is quite another thing when no future capacity for human relatedness exists, as in this case. I understand that this is what is debated by the family, also misguidedly by many well meaning religious people, but when your computer’s hardware (hard-drive) goes out or is damaged in such a way that the screen only flickers in random nonsensical ways, do you hang on to it hoping that your software will run?
While I personally believe that Terry exists, my faith and training tell me that her existence is already in eternity, that the “soul,” deprived of relatedness here, has now been embraced by the eternal.
There are three densities on x-ray ( A CT scan is done with X-rays) black is water or air, white is metal or bone, and finally grey is soft tissue. On the normal CT you can see all three of these densities -in the proper places. In Terri’s you can see all three of these but they are in the wrong places. ie this is grossly abnormal anatomy.
Why, thank you, JustMe.
Actually, I’m quite familiar with the tenets of Catholicism, thank you. And quite familiar with the idea of someone, having been raised a Catholic, choosing to pursue another religion, or no religion.
Jan Theodore Galkowski Says:
March 20th, 2005 at 6:03 pm
“Please don’t use my daughter’s suffering for your own personal agenda.”?
That is such a joke!
Yeah, right, Randall Terry, at her side, not having an agenda.
The real agenda driving Schiavo’s new friends:
March 21, 2005 … The following memo listing talking points on the Terri Schiavo case was circulated among Republican senators on the floor of the Senate.
This is an exact, full copy of the document obtained exclusively by ABC News and first reported Friday, March 18, 2005, by Linda Douglass on “World News Tonight with Peter Jennings.”
S. 529, The Incapacitated Person’s Legal Protection Act
Teri (sic) Schiavo is subject to an order that her feeding tubes will be disconnected on March 18, 2005 at 1p.m.
The Senate needs to act this week, before the Budget Act is pending business, or Terri’s family will not have a remedy in federal court.
This is an important moral issue and the pro-life base will be excited that the Senate is debating this important issue.
This is a great political issue, because Senator Nelson of Florida has already refused to become a cosponsor and this is a tough issue for Democrats.
The bill is very limited and defines custody as “those parties authorized or directed by a court order to withdraw or withhold food, fluids, or medical treatment.”
There is an exemption for a proceeding “which no party disputes, and the court finds, that the incapacitated person while having capacity, had executed a written advance directive valid under applicably law that clearly authorized the withholding or or (sic) withdrawl (sic) of food and fluids or medical treatment in the applicable circumstances.”
Incapacitated persons are defined as those “presently incapable of making relevant decisions concerning the provision, withholding or withdrawl (sic) of food fluids or medical treatment under applicable state law.”
This legislation ensures that individuals like Terri Schiavo are guaranteed the same legal protections as convicted murderers like Ted Bundy.
Ok, just what in the record makes you think that that Terri Schiavo chose to “pursue another religion, or no religion.” Or are you arguing that Michael, as her guardian, gets to decide that too?
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BTW – The reason there has been no MRI is because Terri Schiavo had a intrathalmic (I believe that is the term) stimulator implanted early in her treatment. This piece of equipment is metallic and MRIs are counterindicated when a patient has one. The obvious reason for this is the M in MRI is “magnetic.” If a MRI was to be performed, the implant would be pulled on – which would be bad if the implant is in a patient’s brain.
Since Mrs Schiavo supposedly doesn’t have severe brain damage, you’d think the parents would not be pushing a treatment that would likely kill her (and often break the MRI machine).
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“k, just what in the record makes you think that that Terri Schiavo chose to “pursue another religion, or no religion.”? Or are you arguing that Michael, as her guardian, gets to decide that too? ”
The court took up the issue of religion during the trial and the appeals. Terri had no religious advisor to speak on her beliefs about what she would want done, or even that she’d been Catholic before going to the hospital. (The parents like to say that she does have a religious advisor, but the friar in question The parents claimed that Terri had been secretly going to Mass with them, but could provide no substantiating witnesses to support this position . . not a single person who could say they’d seen Terri at Mass once during the time shortly before she was admitted to the hospital.
Thanks, Jeff, for replying to sj. To properly reply would have had me digging through the case history before I did, and have not had time today to do anything like that.
Richard says “The issue of the Federal Court & Judge:
All criminals found guilty of a capital crime and sentenced to die are allowed to appeal to a Federal Court & Judges.”
He seems to be unaware that the Federal courts, up to the Supreme Court, have been asked to review the cases and they have all already decided that there was no reason to interfere with the decisions of the State courts (just as they usually do with death penalty cases). If a second round of federal courts decides the same thing, will you then call for a third round? At what point is a matter settled?
This began, and is perhaps ending, with food. The parents claim Terri regularly attended church with them before having dinner at their house on Saturday nights, while her husband was working late shifts. Her husband claims to know nothing of this arrangement, or anything but sporadic attendance, and the lower court noted, for example, that unlike a regular communicant she had no confessor or spiritual counsellor (who might testify in court to her beliefs). As I understand it, only her immediate family have testified to anything more than a nominal religious observance. But they claim that after the Pope last year controversially called removing artificail nutrition and hydration always and in any situation ‘murder or assisted suicide’, they know their daughter now wants to live like a good catholic in 2005 ““ they even claim the courts, since the Pope’s speech last year, now risk adding punishment and suffering in the afterlife (which the court, unlike the President, considered outside their jurisdiction) to their daughter’s woes.
There are many complex reasons for the eating disorder which (barring the parents’ theory of the 1990 oxygen starvation being a result of attempted murder by the husband) precipitated the 15-year persistent vegetative state. But aren’t difficult relations with parents (who cannot distinguish a child from their own restrictive image of her – and her body) often a key factor.
That’s the stereotype, but I tend to attribute it to our pernicious culture of mother-bashing. Speaking from experience, I think the causes of eating disorders are a lot more complex.
I’m sort of baffled by the impulse to bash either Schiavo’s parents or her husband (or her, although as far as I can tell only Rude Pundit has done that.) I can’t really see any villains: just a bunch of people reacting differently to an incredibly painful and difficult situation. Whether you think her feeding tube should be removed or not, it seems to me that we should have sympathy for everyone directly involved. The people exploiting the situation are a whole different story.