[I’m “promoting” this comment left by “Cerebrocrat” in the Terri Schiavo News thread. –Amp]
Cerebrocrat wrote:
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.
(Please see the comments for Cerebrocrat’s description of his background).
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Out of curiosity, what are your qualifications for assessing brain imagery, Cerebrocrat?
Hey, I got a promotion!
Robert: a perfectly fair question. Here’s what I’m not – I am not a medical doctor, and I do not evaluate human brain images as part of my daily work. I AM a recent behavioral neuroscience PhD, a research fellow in a neurophysiology lab at a major institution, and I took clinical neuroanatomy in the medical school of my graduate institution as part of my coursework; neurology rounds and clinical evaluations of CAT and MRI scans were part of the curriculum. In addition, the jewel in the crown of my graduate program was a research-dedicated MRI, which meant that many of my peers did imaging work and I had to sit through countless (zzzzzzz) departmental colloquia featuring functional brain imaging. So, no argument from me – I am not the most qualified person to evaluate Terri Schiavo’s status from one small CAT picture on the web; that would be someone who evaluates scans professionally (or at least, regularly). But part of the point of my post was that I don’t have to be – I know how brains work (I mean, up to a point, obviously), I know what healthy ones and sick ones look like, and I know what I’m looking at when I look at a brain image. Schiavo’s damage is so severe that it doesn’t take an *expert’s* eye, but merely an *educated* eye, to understand the basics of her status. That’s why I’m so amazed that her prognosis is being discussed as if it were controversial.
OK. I appreciate your answer. It seems clear that you know what you’re talking about.
I believe that most of the questions concerning Terri’s prognosis are rooted, not in politics, but in the adversarial nature of the Schiavo-Schindler relationship. Us reg’lar folks don’t know what to believe, and we have both camps saying contradictory things. It then becomes quite natural to believe whatever coheres with our own preferences for the case.
Looks like any strong argument for Terri will have to be rooted in philosophy or religion, and not in science.
Agreed. I actually know very little of the backstory to this case and didn’t start paying attention until I started seeing that picture on the web, and hearing people suggest that ocular following was evidence of cognitive function. I don’t know about the Schiavo-Schindler relationship, and I don’t know (though I have my leanings) about the philosophical argument to be made here. But I do know that if that CAT-scan picture is really hers, then the pre-heart-attack Terri Schiavo is gone, and she isn’t coming back.
Us reg’lar folks don’t know what to believe, and we have both camps saying contradictory things. It then becomes quite natural to believe whatever coheres with our own preferences for the case.
*Sigh* You said a mouthful. (keyboardfull?) Such are the perils of undermining consensus discourse as a political strategy.
I am not a doctor, theologian, or political scientist. I can’t help but feeling that Congressional action on this matter is just pandering to the religious right.One step closer to a theocracy.
A quick joke:
How many lawsuits does Mr. Schiavo have to win, before he can exercise his rights as an American…
Ah, thanks. That cleared up a lot of my confusion.
Interesting reading, but beside the point, in my opinion. We can talk about what sort of brain function she has or does not have, we can talk about whether or not her husband abused her, we can talk about which family members should have the right to make end-of-life decisions, but all of these questions – while interesting! – are moot, in my opinion.
For me, what it comes down to is: If someone’s body or brain lives, is it right to starve her to death?
I don’t believe so. And the rustling I’ve heard recently about the family asking permission to offer food or water to this woman and being denied – that’s just unconscionable, IMO.
Sarahlynn, I totally agree. Terri Schiavo’s parents should definitely be allowed to force food and water down her throat. Hell, Bo Gritz and his band of loonies should’ve been allowed into Terri’s room to feed her that nice loaf of bread they had.
“For me, what it comes down to is: If someone’s body or brain lives, is it right to starve her to death?”
There are a lot of issues here that aren’t going to go away. Medical technology has blurred the boundary between life and death, causing us to make decisions we didn’t use to have to make. Usually we think of death as a person losing the condition of being alive. Here, IMO, we have a situation in which the condition of being alive still exists, but the person is gone.
The greater evil is to allow this one case to create precedent and law that would take these decisions away from families in the future. Schiavo’s case isn’t as unique as the GOP is letting on, I suspect.
“And the rustling I’ve heard recently about the family asking permission to offer food or water to this woman and being denied – that’s just unconscionable, IMO.”
To me it’s only cruel if Schiavo’s body still has enough neurons wired together for there to be pain (and if so, isn’t keeping her alive also keeping her in a condition where there is pain?). It would be kinder to euthanize her, but we don’t allow that in this country.
If keeping her in pain is the problem, then surely that calls for painkillers, not euthanasia?
I don’t know. I’m undecided about the situation, because I’m not against euthanasia in appropriate cases, and though I don’t know how to interpret the brain scans, I’ll take cerebrocrat’s word for it. But I’m unhappy about the fact that she would effectively be starved/dehydrated to death, whether it’s painful or not, that just seems wrong to me. Stopping medical treatment when there’s no hope of success is one thing, stopping food and water quite another, IMO.
To those of us whose ethical ideas are at least partially consequential, this sort of thing is important because it helps us figure out what the consequences of our actions are. The brain scans and other diagnostic procedures performed on Terri tell us nothing we do will have any consequences for her, because she doesn’t exist anymore as a conscious being. But our actions will have other consequences, such as whether people can expect that the law is taken seriously by the government, whether people can expect their expressed wishes about their bodies to be respected posthumously, whether Terri’s parents will get to do what they want to, and so on. You’re right that the scans are moot now in that their utility was to figure out whether Terri was in a PVS, and they have filled that purpose. Most of the legal debate since then has been over other issues.
The question has been argued in court for years, and the persisting answer is yes, the right thing to do is to let Terri’s body starve to death. You’re also right that starvation is inhumane. Even though Terri isn’t aware of it, her family is and it’s probably tearing them up inside (all the more so because at least some of them believe she is still conscious). It would be far more humane if it were legal to give her an overdose of painkillers or something along those lines, but US law forbids it just as it requires that she die.
I can’t say for sure whether the law is right on what should be done with Terri’s remains because I’m not that familiar with what’s been going on in the courts and whether things were handled fairly. But I’m pretty certain the law is wrong regarding assisted suicide precisely because letting someone die slowly of starvation or dehydration is cruel (but less cruel than letting them die even more slowly of a terminal disease if the person doesn’t want to).
“Stopping medical treatment when there’s no hope of success is one thing, stopping food and water quite another, IMO.”
Yes.
I dunno . . . in this case, maybe food and water share some aspects with medical treatments, especially in the way they’re being provided? I’m not big on the whole starving to death bit either, but mainly because of the pain and suffering issue.
Just a sad, sad thing all around.
For anyone for whom it is an issue starvation being a bad way to die, rather than a belief that no one should be allowed to choose before hand to be allowed to die when they are in a PVS, there was an interesting short NYTimes article.
Apparently, dehydration (if paliated by having your mouth kept moist) is a fairly painless and peaceful way to die, and is frequently chosen by people who are near death from terminal illnesses. Apparenly, because such people are often fully aware and capable of communication, the actual experience of dying from refusing water has been well documented.
Maha said:
See, I don’t like the idea that I’m possibly agreeing that a woman’s life should be sacrificed to protect the rights of all the rest of us, but I do think that her husband, who is legally next of kin, should be allowed to exercise his rights.
It’s because I’m terrified of the government interfering in this case and setting a precedent. If they have precedent, it makes intereference the next time so much easier, and I can’t imagine the power to interfer with end of life decision isn’t something a government would abuse in the long run.
wouldn not abuse in the long run.
Sorry about that.
Withholding food happens all the time, (I think I read 4000 cases a day) and does not involve pain (unless the person is conscious and unmedicated, as in the case of people starving in Sudan, for instance). My best friend with terminal colon cancer had her nutritional support withdrawn after she’d slipped into a coma.
There’s a good chance this will happen to you someday, too, or to a loved one when you’re older and have to make those decisions about your own parents. Better to find out the facts now.
“To me it’s only cruel if Schiavo’s body still has enough neurons wired together for there to be pain (and if so, isn’t keeping her alive also keeping her in a condition where there is pain?). It would be kinder to euthanize her, but we don’t allow that in this country.”
More facts gone unreported it appears. A nurse/caregiver has written that Terri would let them know when she was in pain…and it was a consistent pattern because she complained of menstrual pain. There was some “expert” on one of the cable news programs who also seemed to agree with many here…that “she ought to be let go, but perhaps just not in this way….this may be a situation for Dr. Kervorkian and his little kit”. We have reached the summit of our “disposable” society. Another unreported fact is a statement by another caregiver that she was feeding Terri by mouth at the time the husband ordered the feeding tube installed. She said she was forbidden to continue by Michael and was scared of him. He thus created the very means that he then used to base his desire to kill Terri on. Others reported they had to take out restraining orders against him because he was so intimidating when they tried to help Terri in any way. Where are all those probing, investigative reporters for the truth to come out re: all the collusion, conflicts of interest, and denial of presentation by witnesses by this court??
“And the rustling I’ve heard recently about the family asking permission to offer food or water to this woman and being denied – that’s just unconscionable, IMO.”
I think that the reason she was given the feeding tube in the first place was because oral feeding/drinking posed a high choking risk for her. That could be one of the reasons (if not the main reason) these are continuing to be withheld.
Cerebrocat, I would like to ask for clarification of one assertion in your first (and excellent) post. You say: “All the neural equipment you need to do ocular following and emotional responses is subcortical.” With respect to emotional response, I think I recall that aggression is mediated by the medulla oblongata, but I thought emotion – happiness, sadness, etc. – was mediated by the cortex. Also, I would like know your interpretation of the story in which Barbara Weller (attorney for Terri’s parents) told Terri that “this could all be over if you would only say ‘I want to live’,” causing Terri to become agitated and to look directly at her and to say “Ahhhh whaa…” Ms. Weller says that Terri displays contextually appropriate expressions of emotion, as well.
Of course, I’m limited to stories gleaned from the internet, so it’s hard to know if there is really any significance to any of this. Your impressions would be very interesting. Thanks! Anniebird
Terri will not starve to death, if this is any consolation to anyone. Instead, without fluids her kidneys will begin to fail, cascading into multi sytem organ failure. Ultimately her heart will fail brought on by electrolyte imbalances; which consequently was the cause of her brain damage, and was brought on by her own doing. She will be made comfortable, although it would be hard to believe that she feels any looking at that CT scan, and she will pass with dignity. I would hope that my family would have the strength and respect for me to initiate palliative measures should I ever need them.
I don’t know what Cerebrocat would say about Ms. Weller, but my own take on that story is that Ms. Weller is speaking directly from her anal orifice.
Bush had 152 prisoners executed as governor
whose brains were in alot better shape for rehab than Terri’s. Didn’t faze him at all.
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I’m a med student…so I have a little knowledge on what we’re seeing.
Her ventricles–which carry CSF fluid around in the brain have expanded tremendously to fill the space left by the atrophied cortex. It’s a condition called hydrocephalous ex vacuo and happens in various situations including severe hypoxic brain injury. Essentially, fluid has replaced what used to be brain (the brain hasn’t technically “liquefied”–but close enough).
I’m not sure it’s fair to compare the two images of Terri to “healthy” because I’m not sure we’re in the same plane (notice the skull has a hole, or sinus, in the front on the one on the left but not the one on the right). But Terri’s brain is definitely SEVERELY damaged.
This entire case and the intensity of government involvement is a very sad and frightening ordeal. It also makes me angry. I’m sorry for all involved especially Terri.
My wife and I have been procrastinating for years on making a living will. This case has put us in overdrive to complete the task.
My worry now is that the government may decide to interfere with the living wills next.
Thanks for the opportunity to vent,
Schizophreniac
I guess the only way we will really know is with an autopsy after death, as a singificant number of doctors (not the ones appointed by Michael) have either suggested that rehabilitation for Terri is possible (what they mean by Rehabilitation is something else I guess). Six have determined that PVS does not exist at all. However, ther has been some talk that Michael intends to cremate Terri, and requests for other arrangements for burial have been turned down.
Other problems that exist is that the judge threw out the testimony of a freind of Terri’s who stated that after seeing a movie on Karen Ann Quinlan around 1982, Terry expressed a good deal of anger and stated that no one had the right to terminate life (pretty much in keeping with the fact that Terry was an active, practicing Catholic). Judge Greer threw out the testimony because he stated that it could not have happened because Quinlan died in 1976. He was incorrect. Quinlan died in 1985, when Terri was 21-22 and abut 18, just freshhly graduated from high school when the conversation occured. Unfortunately, though Greer was told of his mistake, he never reversed his dismissal of the testimony. Not unusual with Greer who has made other errors based on his legal opinion which resulted in disaters. In 1998, he turned down a womans request for protection from an abusive spouse. She was murdered by the spouse two weeks later. Greers LEGAL reason was that her request didnt mention PHYSICAL abuse, just abuse so by law he had to turn down her request.
On the other hand the doctors who have diagnosd Terri for the courts have a history in these cases. Cranford is basically a pro euthanasia figure, one of the foremost in the United States who has diagnosed every patient ever brought before him for a medical opinion by courts as having PVS. Since studies by the British Medical Association have determined that as many as 43 percent of the patients diagnosed with PVS and who have stayed in the condition for longer than 6 months have been found to be misdiagnosed. More problems with this case. A funny anecdote is that whenm presented with the profile of an un named patient, who could manipulate colored blocks and a joystick, Cranford gave his opinion that this was PVS. The profile was for Dr Steven Hawkings. I thought that was interesting.
As far as whether she will feel pain, whever I hear this I am reminded of my dental appointments. The dentist is correct when he says it wont hurt.
It wont hurt him. Oddly enough the same claim has been made for the use of lethal injection, but recently there have been studies that indicate that even when deeply unconscious, there is evidence that the person is experiencing a good deal of pain and terror.
As to legalities of governments and interference and constitutionality, this I always find of concern because every act comitted in Nazi Germany was completely legal under German law at the time.
The real problem in this case is that there diagniosing awareness is considered close to impossible without spending a long period of time observing the behavior of the patient on a daily basis to determine if any eye tracking, apparent emoting, and other behavior that could indicate awareness and cognition is random or purposeful. That sort of observation has not been done.
I’m not a doctor and I haven’t studied this sort of thing at school, but even I can tell that there is something severely wrong with Terri’s brain by that image. I don’t see how anyone can argue otherwise.
Hello, I’m a nurse anesthetists and work in Birmingham, Alabama. I live in the Bible belt, born and raised a Christian and I consider myself VERY conservative on politcal issues.
What Cerbrocrat has said, and what Jeremy has just said above me in a more technical sense, is right on point. This woman’s brain is SEVERLY damaged; the cerebral cortex is almost completely gone.
There is not a medication, therapy or experimental science that will ever change her condition. Like an arm or leg that has been amputated, the body can live without parts of the brain, but it will never regenerate. The only problem with my analogy is that although a person can actually function without an arm or leg, that’s not the case without a brain. There’s no such thing as a cortex prosthesis. She will be this way for the rest of her life.
I make my political and religious stance for a reason, that this is not a political issue; even if it has been made into one. This whole argument is about one single point, whether she would have wanted to live like this. Her husband (and some others) has said that she would not; her family says that she would. If all of you honestly were true to yourself, I would be willing to wager that at least 90% of you would say you wouldn’t want to live this way. Every person I have talked to, even the ones who have objected to letting Mrs. Schiavo die, have said they personally wouldn’t want to live like that. I know of dozens of family, friends, and co-workers who have just recently or are about to put this very thing into writing. Attorneys may end up the big winner when this is all said and done, but I digress.
The point here is that so many people would never want this for themselves, but somehow they want it for Terri and assume Terri would want to live like this. To me this is crueler than letting her die. I believe it is for the family’s own selfish reasons not to let her go, not the husband. If the husband wanted to be selfish, he would have been better suited to take the money and run 14 years ago, divorced her, walked away and just let here parents think he was an a$$. The money is all gone now, only about 50 grand remains, so what is his motivation at this point? To be the most hated person in America? It just doesn’t make sense unless he truly believes there is no hope for her and he knows she wouldn’t want to live this way.
I was asked today by a gentleman, “If it were your daughter, would you let her go.”? I said yes and he responded with, “well, then you don’t love her.”? I said, “Sir, it is because I do love her that I would want her to go home and be with the Lord, not suffer here on earth.”?
As a parent it is only human nature to want your children to outlive you; I know I want mine to outlive me. But people have to put aside their own selfish wants to realize what is best for their child, and what that child would truly want in a situation like this.
So put aside all the conspiracy theories, the selfish motivations, the moral and emotional arguments and ask yourself, would you want to live like this?…and then ask yourself, do you honestly think Terri would?
there are procedures still in it’s infancy that has been used to repair the brain, curing parkinsons disease and repairing brain damage.
these are adult stem cells, with multiple venues to extract from for celluar therapy for the brain including the brain, nerves, nasal lining, and possibly elsewhere. these cell populations can be expanded in culture and reinjected, and by the very definition of a stem cell know what cell type to become and where to go to.
we all will see a big change in medicine in the next 5-15 years with either celluar therapies itself or drugs targeting stem cells and cancer. It could be here faster if the FDA was not so slow, and somehow when europe beats us in adult stem cell therapies the media will be blaming bush/republicans instead of the FDA. 3 years wait just for an IND in one unrelated product, after it was safely perform on over 1500 patients.w
Was shocked to see CAT. Exactly right. Virtually no brain left. That does not change her humanhood or personhood. However, the facts are that Mrs. Schaivo is getting what she wanted and while I never thought I would agree with Democrats, I do on this…the courts were enforcing Living Will statutes. They do not have to be in writing. By not having one in writing, this woman elected her spouse to be her surrogate, by default. She made a choice by not having a LW in writing for him to do what he is doing. Therefore, the government and her parents had no rights to become involved. Am very disappointed in all of them. Her parents are totally irrational and I question as to if they are demented they way the get right up in her face, are are telling her they will take her out for breakfast, state she is trying to speak to them. …am also very disappointed in the Christians, a class of persons to which I belong. They are not behaving in a thoughtful manner, they are not helping the family cope with loss and facts, and they are hurting tens of thousands of people who are in the midst of these situations right now. I am sure this patient is getting pain medication and is not suffering. The brain damage and the inability to swallow are terminal when looking at this situation, for certain. It is only a matter of time before the patient would not have been able to absorb nutrients from the tube feeding, and all tube feeding patients aspirate and get pneumonia. While I was skeptical of Michael S. at first, after seeing the scan, I believe he is doing the right thing in this case. But I believe it would have been better for him to walk away and let this poor deluded family have their way. This is a very sad state and I wonder why the doctors let this get to this point. I hold them and the vindictive family responsible. After hearing what the father said about his willingess to allow multiple amputations (in a scenario) to keep her alive even if she had been on a ventilator, I am distrubed. He not interested in her pain and suffering. Also, all this stuff about Culture of Life, is a crock. Show me all the homeless, mentally ill, foster kids that all those people who are protesting this care for first hand, and I will change my mind. This is not a culture of life. It is a culture of competing camera happy control freaks. Such is the Culture of Life. Have the “ministers” with all their opinions, call on their followers to not threaten the life of Mr. Schaiver! Is his life less worthy than Terri’s? This has become cult-like at this point and as a conservative Christian, I think it is frightening,.. giving evangelical Christians a back eye. PLEASE COME TO YOUR SENSES. And remember, it is not about if you or I would want to live like this, it is that she appointed her spouse to make these decisions, by default. Have all of you who are talking about this written your LW, had it witnessed with certified signatures,..probably not.
While the bugkiller can claim his piety, while bush can claim his complications, while the righteous can claim their divinity, what remains is that the freaking republicans have decided to reach out and slap the Courts, the States, and the Individuals upside their heads and dictate what they can and cannot do.
From this non-precedent case, how long will it be before they try to force a woman to carry that fetus to term? How long before they tell you where you can live? How long before they tell you what kind of education you can get and where? How long before they tell you what god to worship? How long before Guantanamo moves Stateside?
They can hold you prisoner without any Constitutional Protections, if they so choose. They can torture you if they so choose, so what makes this case any different, except in degree? The law is supposed to be equal to all, remember Gore vs Shrub and “equal protection”, and the quaint notion that exceptions prove the rule is just an absurd palliative to ease our consciences and the bitter burning sensation that reality can and does produce.
But now, the republican dictated Congress has said otherwise. They have said that some are more equal than others. And that’s supposed to be okay, and a fair swap to save the life of this truly messed up woman.
But it’s not okay. It’s as wrong as you can get. Sure, the circumstances make it appealing and troubling and tragic, emotional and cerebral (how ironic is that?), and golly, good teevee, but the circumstances can’t obviate the fact that this decision, this reprehensible, to me, action by the republican Congress (and don’t tell me about the Democrats, it’s frist and delay and rove and santorum el al, as sanctimonious as ever) is a direct assault on the very basic tenets that this country was founded on, and that millions have died for, and bled for, and sacrificed for, the notion that we are all equal under the eyes of the state, that no one person is above the law, or below the law.
The Federal State has no business in this case, because this case has no business with the State. It’s a personal tragedy, and its only the gross selfishness of the parents that has made it the spectacle that it has become. Or does the Catholic Religion have more primacy in this country than the Constitution? Maybe that’s the crux of the matter. Maybe that’s why the republican controlled Congress has decided to trample all over the laws and rights of this nation, so that they can push their stinking religiosity on the people of this land?
Could that be it? Or could their abuse of this woman and this families extremis be cover for something else, something uglier and dirtier? We’ve heard about the talking points circulating in gopper circles, and bush’s approval ratings stink, and Social Security Privatization is having a rough go, maybe the faithful need a pep talk? Maybe this is just a cold, crass manipulation by rove to prop up the ol bush family evil empire?
Terry Schiavo has, literally, nothing to do with this case, but this case has everything to do with you and I. Megans Law was written because of Megan, but not just for her, but for Society as a whole. Laws are written for Society, not for, and I know this comes as a shock to big corporations or businesspeople that seek to get laws written just to benefit themselves, individuals.
Laws don’t dictate our behaviors, they dictate the consequences of our behaviors on our Society. Run a stop sign, pay a fine; it’s a monetary reminder that hurts a little, but warns us that we might kill somebody Mr. Janklow and suffer a much larger hurt.
I could go on, but I’ve gone on long enough. Thanks for listening!
By the way I am am a hospice and palliative care nurse and I feel certain that if she is not getting the best plan for the removal of the tube (such as gradually reduced feedings and fluids) it is because of the in and out ordering by the courts. The situation is beyond sad and gives hospice a black eye too. We don’t “kill” patients in hospice, but the disease or injury state will do that. Very sad, but people are too vested in their words and deeds to turn back now. The proverbial game of “I’ve got you now you now, you >>>>”. PS the planes don’t have to be the same in the CATs, hers is the worst I have ever seen.
“there are procedures still in it’s infancy that has been used to repair the brain, curing parkinsons disease and repairing brain damage.”
I knew as soon as I made my statements, someone would say something about stem cells.
I have done extensive research on stem cells for the last few years, after my brother was paralyzed from the waist down in a car accident. The potential of stem cell research has been talked about for a while, but the data supporting that potential is largely nonexistent. As of today, there is absolutely NO evidence that cells generated from stem cells can be safely transplanted back into a human (or animal for that matter) to restore the function of damaged or diseased tissues. Not even in Europe where the research is given carte blanche to find anything, has anyone been able to produce evidence of success. To simply throw away any requirement for evidence under the guise of a promise only causes people like the Schindler family to have a nonsensical dream. This is probably part of the reason why the family has continued to fight this, because if you ask enough doctors, one of them is going to tell you something you want to hear.
For the sake of argument, let’s say there is enough stem cell research to help make progress with someone with Parkinson’s. Let’s say everything about stem cell research comes true. It is unfathomable that it could regenerate a brain like Mrs. Schiavo’s; it is nearly a scientific impossibility. And let’s say that 1/1000000 of a percent chance that they could, Mrs. Schiavo would still never be the same. The cerebral cortex controls Intelligence, Personality, Motor Function, organization, and many sensory interpretations and the WHOLE thing has to be regenerated…come on you know this is a fantasy.
Brandy brought up a point that i’ve considered (and not sarcastically). The Bo Gritz show and the parents wanting to bring her food and water made me wonder if she was even capable of chewing and/or swallowing, or was this for show. If they had tried to give her food and she choked to death, then, following on their presumption of life, wouldn’t they risk arrest for murder (or some variant)? Beyond the ethical dilemmas this thing poses (or purports to pose), the various angles are fascinating.
I will be the first to admit that stem cell research with embryoes and cloning is a complete farce and fetal has issues with cells being not functional, but you should not be so easy to dismiss stem cell research using (preferably autologous) adult and cord blood. Moreover their quantities are not at issue since adult cells can be proliferated with growth factors either in vivo or ex vivo. these types of transplants, although population proliferation is about 15 years old and still not fda approved, have been going on for some 50 years and have been effective, it is not until more recently that there focus has changed to more than just bone marrow transplants. But yes, whether it is blood, bone, brain, collegan, epithelial, heart, liver, kidney, nerve, pancrease, whatever, adult cells have been effective. just a matter of convincing the FDA nazis that they are safe and effective.
the use of stem cells to heal the brain, to mind, has been done, at least 13 times that I am aware of. 5 for parkinsons around the globe and in china 8 for brain damage..
An important point that bears repeating is that Michael Schiavo has no rights in the matter of Theresa Marie Schiavo. He is a nominal party, an “interested party” under the Florida statutes and a witness.
I read remarks like “How can the courts allow a philandering husband to kill his wife” and the like all over the net, and hear similar remarks on cable news. It is infuriating.
It was not Michael Schiavo, but the trial court, that determined to discontinue the life-prolonging procedure. The court based its decision on evidence. Although they have repeatedly made claims in the press/media, the Schindlers have not been able to produce any competent, credible evidence to contradict or undermine the trial court’s decision.
I recommend reading all of the Florida state court decisions. The Schindlers make a lot of claims in the press/media, but when it comes time for the hearing, they can’t produce the witnesses or evidence. The courts have really bent over backwards to give the Schindlers every opportunity to produce evidence to contradict the two key conclusions: Theresa Marie Schiavo is PVS and there is no hope of improvement, and she would not have wanted to continue this kind of existence. They have failed.
There is another infuriating refrain. Over the weekend I heard several pundits refer to the Schiavo case as “unprecedented.” Only some one who is willfully ignorant would say such a thing. Not only are termination of treatment decisions common, but the NJ Supreme Court decision in the Conroy case, and the US Supreme Court decision in Cruzan, are 20 and 15 years old, respectively.
If the Republicans and the Radical Right want to change the law on termination of treatment, why don’t they just enact statutes that make it unlawful to do so?
“Life-prolonging procedure” is a statutorily defined term. See §765.101(10), Fla. Stat. (2000). It includes the methods to provide sustenance and hydration that are involved in this case.
If they want to eliminate sustenance and hydration from the definition of “life-prolonging procedure” why not amend the statute?
I guess it wouldn’t make for great political theater.
This guy knows more about CAT scans than all of you.
I find it scary that the “medical professionals” who posted their opinions can not spell. If Mr. Shiavo is sincerely devoted to his wife, why then has he had children with a woman other than his wife? It is very easy for all of us to have an opinion, but how many of us have been in this situation? How do any of you know that the picture of Terry Shiavo’s brain is real? The internet is a great tool, but let’s not believe everything we see. This is a tragic situation that we as Christians should be praying over. “Blessed are those who are persecuted for righteousness’ sake, for theirs is the kingdom of heaven” Matthew 5:10 (RSE)
The fact that Terri Schiavo’s CAT scan is on the web is distasteful. Why should all of us (including me) are discussing Terri Schiavo’s medical condition makes me ill.
However, I am willing to criticize myself to hold up a mirror to all of us and the lack of dignity that is in this discussion of her private medical condition.
BTW, whoever put her CAT scan on the web should be prosecuted or sued under HIPAA. If not, then HIPAA is a joke and it is just make-work for hospitals.
Your analysis is correct.
What you lack is experience.
You have not looked at thousands of CT’s of the brains of 70. 80 and 90 year-olds, and I have.
You show the image of a young, healthy brain and juxtapose Terri’s brain. That is misleading.
I will bet you any amount that I could pull one hundred cross sectional images of the brain from my patient population in Florida and that you would be completely unable to tell me which patients were functional or not.
The best you could do would be 50/50.
Many of the CT’s would be similar to Terri’s.
I’ll bet you.
Finally, what I said in my post was that I was shocked at the difference in how Terri’s brain was characterized in the media (a black hole filled with water) and what it looks like in reality. I never said she was going to regain anything.
Finally, if we are going to stop feeding everyone with a CT like Terri’s we’re going to have to rebuild the concentration camps and dump out all the nursing homes into them, because that’s what those patient’s brains look like. It isn’t ME in the armchair. I’m out in the field.
This is the best wrap-up I’ve seen on the facts of the case, by an impartial Fla. attorney. It explains why, for instance, Michael Schiavo would not have sued the doctors who misdiagnosed Terri’s bulimia if he’d actually tried to kill her, thus dispelling a favorite myth. Read it, it’s fascinating.
And please, learn to spell if you want to come across as an “expert.” (And playground language like “I’ll bet you” won’t be responded to. I’ll bet you!)
You say it is misleading to compare Terri’s brain to a healthy young brain, but doesn’t comparing Terry (a young woman) to a 75 year old indicate a state of decay that cannot be reversed? You say “I HAVE SEEN MANY WALKING, TALKING, FAIRLY COHERENT PEOPLE WITH WORSE CEREBRAL/CORTICAL ATROPHY.” But the fact is that the woman isn’t walking, talking, or coherent. As an experienced medical professional you should know that the clinical evidence must always be considered alongside testing. What we are seeing is irrecoverable decay on CT alongside extreme loss of function by any standard, and I know I wouldn’t want to be maintained for 15 years in that state. I do agree that it is very disturbing to see a slice of her CT scan appearing on the internet for us all to provide armchair diagnosis, and it is certainly a gross violation of HIPAA regulations. This whole case is disturbing.
Terri’s parents have invited comment by standing in front of cameras and promoting the whole thing at their website, so I’m not as shy about commenting as I would otherwise be. (Lizzybeth hit the nail on the head when she said that this whole case is disturbing.)
Terri’s parents are off the deep end. You have only to watch the film clips they themselves have posted to see that. Her mother, in particular, addresses Terri as one would talk to a baby, and seems to enjoy having a grown daughter she can boss around. (I have two grown daughters, and I can’t get anywhere with them!)
But Terri’s not in there any more. This whole question has been litigated and medicated to death, and that’s where all the signs come out. Court after court has reviewed this matter, and they all agree. Judge Greer did his job.
Some societies inspect bird entrails when facts are in dispute. Some inspect human entrails. Some calculate the position of the stars. Some throw dice. Some use trial by ordeal. We have trials before judges or juries, and what they say goes. And what the courts say is, Terri expressed a desire not to be kept alive artificially under these circumstances.
Which of us, after all, would not agree with her?
While there is value in looking at this CT scan, I am also reminded of a phrase I heard over and over again in vet school – “treat the patient, not the lab results”. Watch the videos of Terri. It sure looks like someone is still at home in there.
Anniebird
Remember kids, W signed a law in Texas that allows hospitals to shut off patients from life support after 10 days if continued support has been deemed ‘inappropriate’, if the patient’s estate/family can’t pay.
http://www.dailykos.com/story/2005/3/21/162132/268
“Culture of life” my ass. This is pure pandering to the fundies which now rule the Republican party.
In marriage, legal guardianship in disability falls to the spouse. Terry didn’t wish to be kept alive in such a state. All this conspiracy theory crap about the husband ‘wanting to kill her’ is just that: crap. He’s been offered TEN MILLION DOLLARS to surrender guardianship and just walk away, and refused. There goes yr money theory, and that’s pretty much the only one. He doesn’t stand to inherit any forture — it’s all been used up. Furthermore, he offered to donate what little is left to charity if her parents would stop litigating.
http://majikthise.typepad.com/majikthise_/2005/03/debunking_lies_.html
The woman’s brain is gone. She didn’t want to be preserved in such a state. Let it go.
anniebird, those clips are tiny pieces of hours and hours of filming, all of which were viewed both by the trial court and by the appellate court. Apparently, according to the court, that sweet smile Terri gave her mother was the same expression she had when the doctor touched her neck; furthermore, the “following the balloon” sequence could not be duplicated. These all might simply be coincidences.
The videos are four minutes selectively edited from over four hours. The judge reviewed the entire video and found no reason to believe that anyone was “at home in there”. She repeatedly failed to perform the requested commands, except for once in a while, which would happen by chance over the course of four hours.
What’s pathetic is the fact we’re “judging” this case which has been thoroughly reviewed by more than one court, without knowing the facts. We should all be disbarred.
I do not understand the issues. She’s has lost 90% of her brains. All she has is a functioning brain stem and a few neurons in her cerebrum. There are no discerable connecting neual pathways connecting the residual brain tissues. And, in addition, most of what appears to be residual brain is just scar tissue. Doctors, nurses and family make these decisions everyday. I would estimate that three to five thousands cases are decided each day in this country alone. It’s a consensus aggreement. If the doctors felt that the requests by the family was unreasonable, they would not abid by the wishes to withhold care. She will not bounce back to life. She is dead. But I sympathize with the family’s hope that this is not the case. It’s hard to let go.
The irony of this situation strikes home with me the most. In 1990 Terri herself denied her body the nutrition it needed to sustain her which led to her heart attack. I know bulimia is a closeted disease but surely Terri knew that she was putting her health at risk. No government official intervened then to help her eat and stay alive thereby avoiding cases such as hers. Perhaps Governor Bush and Florida legislators should enact a law that ensures that all people of their state have three meals a day either by feeding tube or mouth, and monitor those at highest risk to make sure they are complying. This would include people with eating disorders, people with diseases such as diabetes, people who are disabled, people who are poor, all children because nutrition is paramount to their healthy development and the elderly who may be too infirm to shop for and prepare food. And let us not forget the thousands of Americans who require medications to sustain their lives and who have presence of mind to say they want to live, but slowly wither away because they cannot afford them.
To focus everything on one woman without changing the situation for thousands who are or could be facing this same situation is the height of hypocrisy. No one of importance and influence cared about Terri Schiavo when she battled bulimia nor did they concern themselves with her during her first thirteen years of confinement. Ms. Schiavo has become a political football on both sides only when her case fit into an agenda. Where on earth is the dignity in that?
If one good thing comes from this, it should be that every single American write a living will so that you and your family decide your fate. As much as this or any other President might like to decide when you die, the reality is he can’t possibly know you like your family does and besides he’s pretty busy. I’d hate like hell to have to count on him to fly back and sign a law every single time a hospital was about to discontinue life support. But then again, I have an uncle in Indiana who is clearly dying of some disease. He will not seek medical help despite his kids threatening to take legal action. I am thinking a call to Mr. Bush is in order. Do you think he will respond?
I would appreciate it if one of the physicians here would address the statements of CodeBlueBlogdoc or whoever that it would not be unusual to find a CAT scan like this among functioning elderly people. Since he does not refute the explanation above, by numerous medical professions, that the blue in the scan is spinal fluid which has replaced brain tissue, I doubt his supposed expertise. But it would be nice if someone with more knowledge than I would take him on directly.
I find it amazing that people keep on saying that she still have brainactivity enough to be able to be rehabitated. How many courts have the case been trhough? I have heard the number 10, with 19 judges (conservative as well as liberal) reaching the same verdict. Do people really think that all those judges would have done that if there was the slightest glimmer of hope?
Let the poor woman die.
Maybe it will also help her parents finally start living their own lives again, though somehow I doubt it. Bitterness and self-delusion can be harsh poisons indeed.
Thank you Dr. Hansing, well said. 2 nights ago, I noticed the most prominant video being shown had a date stamp of 2001! How much has she deteriorated from that time?…Hum…As for those OC sufferers who are worried about spelling, this is an informal format of fast typers on busy schedules so a little latitude please, and what if I told you I am missing several fingers. I will slow down so you are not offended. I have 4 college degrees and another on the way, believe me I can spell and type, but, as I said..in a nutshell, typing not all that important here. That is the kind of judgemental attitude that gets us into some of the hot topics. There are people who want to be hypercritical and make judgements for everyone else to live by. I hope all turns out better for this patient, i.e. that she has a peaceful and quite passing. I hope her spouse is restored to humanhood by those who judge him, and I hope that her parents get serious counseling as they need it. They are not coping at all.
Terri’s parents are real victims here. One has only to view the videos to see that they are in deep emotional trouble. Whatever happens to Terri, I hope they get the help they need to put this tragedy in perspective.
NurseP, I wasn’t talking about you or anyone’s comments, but the guy’s site who posted the comment about being more expert at reading CT scans. My point was, if someone doesn’t take the time to clean up a permanent post, or worse, has a complete disregard for getting it right when it comes to spelling and grammar, why should I believe what that person claims is his “expert” opinion? I can’t help but infer he has a similar disregard for getting it right when it comes to the content of his posts.
I’ll be the first to excuse typos in fly-by comments, beleive me!
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As a lawyer involved with HIPAA, it is possible her CAT scan became public as a result of the litigation.
Otherwise, it seems incredible and definitely a violation.
Well, that’s my 2 cents.
“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. Life!!!
One person asked this question.
How many lawsuits does Mr. Schiavo have to win, before he can exercise his rights as an American.
A better question is
How many lawsuits does Mrs. Schiavo have to win, before she can exercise her rights as an American.
I just have a hard time believing that we are not erring on the side of Life.
Captain Obvious, the premise upon which all this is happening is that this is Terri’s choice to discontinue artificial feeding. That’s what the court held. That this is Terri’s choice.
So the real question is, how many lawsuits does Terri Schiavo have to win before she can exercise her rights as an American to make her own decisions, free from government interference?
I am impressed by the respect and education of those frequenting this site. I am once again disgusted with Congress’ myopic world view. What of the millions of africans with fully functioning brains being murdered? I just read that in the Congo children are being boiled to death and then eaten in front of their mothers. My friend is in Sudan right now attesting to death and ill health, killing 1/4 of all newborns. Does this woman’s life so overshadow all of the others? Courts and churches have dealt with this issue of end- of -life. Its time for our federal government to attend to the truely neglected.
We are so priviledged here in the USA that we can argue and spend so much public funding on extending such a “life” while so many others go ignored. I spent some time working with severely brain injured adults, some that have hope for new treatment, some I saw write incredibly intellegent letters to loved ones as they showed very limited signs of engagement, but terri is unfortunately different, as she has very little brain left.
Apparently Robert Schindler removed his mother from life support after she had pneumonia. Here’s the link.
I think these people have been hijacked by Randall Terry. Can we send in a SWAT team?
I was initially puzzled by the involvement of the famouse abortion opponent Randall Terry here, but I think I’ve figured it out. KathyF’s word “hijacked” is a good one. Mr. Terry, like so many other people, is seeking to use this family’s private and heartbreaking tragedy for his own political purposes, purposes that have nothing to do with Terri Schiavo at all.
All these people, including the members of Congress, should be ashamed of themselves, but I doubt that they are.
I’m an attorney, and I’ve read the recent federal court decisions. They seem soundly reasoned to me. These judges are trying to do their job, under very difficult circumstances. I can’t envy any of them the task.
If saving any life is so important, where were the Terri Schiavo supporters when a hospital removed the breathing tube of a Houston baby last week?
The hospital with a judge’s approval ended the life of this baby and yet the mother wanted the baby to be kept alive. Where was Mr. Bush? Where was Governor Perry? Where was Tom DeLay?
Here’s a quote from the article in the Houston Chronicle, “It’s sad this thing dragged on for so long. We all feel it’s unfair, that a child doesn’t have a chance to develop and thrive,” said William Winslade, a bioethicist and lawyer who is a professor at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston. Paraphrasing the late Catholic theologian and ethicist Richard McCormick, Winslade added, “This isn’t murder. It’s mercy, and it’s appropriate to be merciful in that way. It’s not killing, it’s stopping pointless treatment.”
I understand life sustaining measures that can be withdrawn under Texas law includes breathing tubes, medicines and nutrition/hydration. Good thing Terri doesn’t live in Texas!!!
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.
Since multiple witnesses have heard her speak and some have heard her put together a complete sentence that really makes the reults of your scan reading mute.
I think the Nazi’s were more compassionate during their medical sponsored eugenics movement. At least they would have had the decency to shoot her and get it over with. To completely deny any food or water, even by mouth is torture. I wouldn’t do that to my dog.
The solution to this problem is not in the courts. The problem is that higher courts of appeal never retry the case and if it was decided wrongly it will never be overturned for that reason, only for some technicality.
One solution in this case is to throw out the testimony of lawyers like Cranford[who was the doctor who rendered the PVS diagnosis for the court] and who are really just shills for the euthanasia lobby. Cranford is a featured speaker for the formerly named Euthanasia Society of America. They have a conflict of interest. They want their patients to die.
Other doctors, I’ve heard it is thirty-three in number, claim she is responsive, in a minimally conscious state and will respond to therapy.
Dr. Hammesfahr disagrees with your scan reading. Who is Dr. Hammesfahr?
The federal government has recognized Dr. Hammesfahr’s clinical expertise, naming him Reviewer and Chief Reviewer for evaluation and funding for new clinical research programs. Dr. Hammesfahr has been identified as “the first physician to treat patients successfully to restore deficits caused by stroke.” – Judge Susan Kirkland of the Florida Department of Health. November 2002
After having gone over her complete medical files and after spending ten hours with her he claims she could probably be walking and talking.
The solution for this problem is in law enforcement. The Schindler family did try to have Michael prosecuted for attempted murder but were told that since the four year statute of limitations for attempted murder had run out, no prosecution attempt would be persued. However there should be no statute of limitations on protecting Terri from Michael.
If the Police in Florida or the DCFS or some Florida department responsible for protecting our life and liberty finally gets their act together and does the job they failed to do years ago, Terri will finally get the therapy she deserves and that the courts awarded her, and she will point out the reason she collapsed 19 years ago. And that is what this whole affair is about.
THANK YOU, THANK YOU, THANK YOU. I havewanted to go hold a sign to say “…let Terri go home to God and Peace.” If these people are Christian as professed don’t they WANTher in a better place. I appreciate Michael’s quiet way. No circus for him. Bet when it is over we here more from him. I want to give him my support. I have told my husband many things many times (even early in our marriage) that I never told my parents – and THEY were not so controlling as her parents.
GO MICHAEL!! I truely believe you have your wife’s best interes at heart. Nita Shaw – Plant City, Fl
I’m too busy to respond to the specifics of your post, and I apologize for that. However, I think Dr. Hammesfahr is essentially a snake-oil salesman.
To support this, I’m going to reprint here some comments about Dr. Hammesfahr’s appearance on Hannity & Colmes, which I originally posted to a different forum. (Normally I don’t like it when people do this; call it a privilege of being the site owner).
This is almost certainly a lie, although it’s one that Dr. Hammesfahr has been at pains to spread. The Nobel Prize committee keeps who the nominees (other than the winner) were secret for many years. It’s very doubtful that Dr. Hammesfahr – who hasn’t been able to get his research results published in peer-reviewed journals, and is not a very accomplished doctor compared to the extraordinary accomplishments of most Nobel Prize winners – was nominated.
What Dr. Hammesfahr did was ask his Congressman (who I bet he donated money to) to write a letter on his behalf to the committee, which the Congressman did. That’s not the same as being nominated, and it’s dishonest of Dr. Hammesfahr to claim he’s been nominated.
Although Dr. Hammesfahr has claimed – when he’s not under oath – to have cured patients with conditions similar to Terri’s, when he was under oath he refused to give the name of a single such patient.
He’s a quack, a liar of the first order. He’s not just a witness-for-hire (as, arguably, one of the doctors Michael hired was); he’s a snake-oil salesman who routinely lies about his own qualifications and achievements, and who preys on the pain Terri’s parents are feeling to give them false hope and get a ton of free TV exposure. If anyone in this whole mess deserves public disdain, it’s Dr. Hammesfahr.
There’s nothing unethical about being paid for your time. Good doctors are busy professionals, and doing a trial takes up time that can’t be spent on treating patients or running a practice.
By the way, the last doctor was the neutral doctor chosen (and compensated) by the court. And many more doctors have commented in the press.
This is a flat-out lie; it’s including people who said nothing more than “I would be willing to examine this patient.” None of the doctors he’s referring to have actually examined Terri; the vast majority are making comments based on seeing a few out-of-context video clips.
Here’s the fact: CT scans show that Terri’s cortex is nearly entirely gone. She can’t think, or feel, or exist in any cognitive way at all without a cortex – it’s simply not physically possible. And there is no way known to science to make a cortex regrow once it no longer exists.
To believe that Terri is in any mental way alive, you’d have to believe one of two things:
1) That CT scans are incapable of telling when a cortex is missing.
2) That someone without a cortex can nonetheless have higher brain functions.
I don’t think either of those two propositions is defendable.
I read every one of the 17 affidavits from “doctors” (not all were really doctors) that Terri’s parents have released to the public; not one of them addresses the medical issues at hand; and most of them, contrary to what Dr. H. claims in the Foxnews segment, don’t state as a fact that Terri Schiavo can be rehabilitated.
You’re listening to a con man.
David, you want to have another trial, largely because you don’t like the way the first one (actually, there have been two) came out.
But our legal system has a legitimate interest in finality. That is, once a trial on the merits is held, and an appellate court has found (as the Florida courts have found here, more than once) that the finder of fact did nothing improper, there is the end of it. Appellate courts do not exist to re-try cases on the facts, only to examine what you call “technicalities,” by which I think you mean legal errors. If every litigant or advocate of a litigant who disagrees with the results of a trial (and that would be everyone who ever lost one) could go back and have another one (and another one? how many?) our courts would be even more hopelessly clogged than they are.
I have no idea whether Judge Greer, the finder of fact in this case, made the correct decision. I was not present at the trial, and I have not even reviewed the trial transcript. The Florida appeals court did so, and said that even IF they were to try the case anew, they’d come out the same way he did. But of course no one is going to try this case again.
I know all this sounds terribly cold when someone’s life is at stake. But our courts make life and death decisions every day. Since we’re all fallible, they make mistakes. However, this system works very well for us overall; at least no one has yet suggested a better one. We cannot operate this society – we cannot operate ANY society – without some principles by which decisions are made. We have a rule of law here, or try to. There are a number of people who would like to re-try the Schiavo cases by public acclaim, but I submit that this is not a procedure which would contribute to the justice we all need every day.
Also, we’ve been dragged a bit off the point here. The real question is not whether Terri is or is not in PVS. I submit that this issue has been emphasized because some want it to look as though we’re just murdering this woman because she’s incapable of recovery, and so forth.
Actually, the main issue before the trial court was Terri’s own wishes in this matter. Given that any substantial recovery is unlikely/impossible in her case, what did she say she wanted done if such a thing were to happen? Her husband brought forth not only his own testimony, but the testimony of witnesses, that she said she would not want to be kept alive artificially, by tubes, in that case. This is her protected Constitutional right, in the State of Florida, and everywhere else. The right to refuse medical treatment, even life-saving treatment, goes way way back in our legal system; in fact it pre-dates the Constitution.
Now, Terri was only 27 when she collapsed, so she didn’t go into great detail, and regrettably she didn’t write this down. However, her oral statements are binding in this matter. It makes sense that her husband would be the one who was closest to her on this. I certainly would never have kept such opinions from my husband only to confide them to my parents, and there is no evidence whatever that Terri did so.
But all this is to re-hash yet again decisions which have already been made. It has been found by the trial court (and therefore we must take it as fact) that she made such statements, that these are her wishes we are carrying out. It is her right, not her parents’ right, not the right of congressmen, not the right of doctors or abortion agitators or anyone else whoever, to make that decision. As it is my right, and yours. Even if someone else, or everyone else, thinks us misguided.
Please take this opportunity to write your wishes down in legal form, whatever the form is in your State. You can undoubtedly find forms on the internet. The younger you are the more important it is. The elderly, when seriously ill or injured, tend to die quickly anyway. The young can linger on for years, and put everyone in a terrible dilemma. Like this one.
We all have to recognize the issue of grief. This includes the grieving process of Terri’s husband as well as the grieving process of her primary family. Normally, grief is a private circumstance. There is a place for grief counselors. Having read many scans myself, I must concur that what we understand as normal human existance has fled this patient.
However, the news media has not been helpful. We need to make distinctions between three different circumstances: (1) Total dependency, though awareness, (2) Locked in syndrome, and (3) Vegetative State. The news media has been commenting that if the Vegetative state is a fact, Terri should be allowed to complete he life, otherwise, not so, at least that is the impression I get from them.
One can be totally dependent, unable to eat independently, dress, move, talk, etc., and be very aware. I for one would not want to live that way. Secondly, “locked in syndrome” occurs with severe brain injury. I have seen one such patient, who could not respond to any type of prodding, but he cried when “Little House on the Pairie” came on. It had been his favorite TV program. This is not a vegetative state. At the same time, many would not want to continue living in this state either. The point is that the “vegetative state” is not the only condition to allow basic life processes to expire. Finally, we must distinguish between consciousness and self-Consciousness. She is not likely self conscious.
Finally, I am terrified by the manner in which our Congress rushed to a vote and Bush endorsed this. It demonsrates that “governing at the consent of the governed” is outmoded. Those who lie about being in favor of states rights simply want their own way, however they get it.
I have read of hydrocephalus patients who had so much pressure applied to their brain that all you would see on a scan was a a tissue paper thin covering of brain on the skull and these people were fully functional. How can you possibly tell the many nurses who have heard many appropriate words and appropriate expressions and even sentences that they couldn’t possibly have done so?
Re: HAMMESFAHR, I have no idea why a doctor who is the only man to have come up with a way to significantly improve stroke victims shouldn’t have been nominated for a Nobel Prize. Perhaps you should go ask Neurologist Dr William Scott Russell.
please go to http://www.terrisfight.net/
court documents
William Russell
Not only does this doctor claim Terri is certainly not in PVS but he went to Dr HAMMESFAHR when he himself had a stroke and was cured of complete expressive aphasia in half an hour. It would seem the neuralogical community does not share your opinion of Dr HAMMESFAHR.
BTW if you think the federal government made a complete quack the chief reviewer for neurological research projects you have me beat in the ‘cynical of government’ department and that really takes some doing. Congratulations!
Susan
I would like your opinion on this case…
“¢ Marjorie Nighbert signed an “advance directive” before she was hospitalized for a stroke in 1996. This document stated that she desired no “heroic measures.” Based on this, her family requested that her feeding tube be removed. When Ms. Nighbert begged for food, the courts deemed her “not medically competent to ask for such a treatment,” and the hospital physically restrained her in bed so that she could not pilfer food from other patients. She died ten days later.
There is a reason presidents and governors have the pardon. Sometimes the courts and the legal system is so egregiously wrong that you have to throw out the garbage.
If we don’t get this under control hospices will be little more than death camps before the euthanasia lobby is happy.
One unfortunate result of this episode is that ‘living wills’ are getting an undeserved boost.
What living wills do is get you while you are young and still feel you are immortal, to agree to be euthanized. If you are a lawyer maybe you can survive the toolkit and avoid that.
For the rest of us go here for a safe alternative.
Phil
If you did do that to your dog you might be facing a year in jail and a $10,000 fine in some states.
David,
Was Ms. Nighbert’s case actually taken to court? I’ve heard this anecdote before, but the form I heard it in had the hospital making the decision, not a court. (Sometimes, in the alternative, her family.) (She also has a number of different names, depending on who’s telling the story.) Do you have any references I could follow up? I’ve become quite skeptical of anecdotes I read on the internet. For all I know, this woman might never have lived at all, let alone had the experiences you describe. On the other hand, your story may be true in every detail. I’d just like to find out where you got it, and verify it if possible.
IF a court decided this, they must have heard quite a bit of evidence on both sides, none of which I have seen, so I can hardly give an opinion on Ms. Nighbert’s state of mind or competency, assuming there ever was such a person. Do you think courts just flip coins or something? I’m by no means saying that courts are never wrong, but court decisions are almost always the result of the dedicated effort of a number of intelligent, well-meaning men and women who, believe it or not, are trying very hard to arrive at justice. They don’t just pick answers out of the air.
If you don’t like the way we make decisions in this culture, your suggestion would be what? I’m all ears. Newspaper polls? bird entrails? astrology? casting lots? consulting oracles? Name it, and probably someone somewhere has tried it, maybe with better results, who knows.
Also, as to Advance Directives, the California form (which was drafted by the California Medical Association) simply has several blank lines for the person to fill in with his or her opinion. Why this form should require a law degree for “survival” is beyond me. I am not familiar with the forms used in other States.
Send your Will To Live link to the President. He signed the Texas law that gives hospitals and doctors the power to withdraw life sustaining measures for patients who are terminally ill or have irreversible medical conditions. This law also provides an advance directive form that Texas citizens can use. Apparently, he thought this was a good idea at the time.
I wonder who will pay for the sustained medical care for the hundreds of thousands who don’t have health insurance. Their lives are valuable too….aren’t they? Many can’t even afford food let alone prescription medicines. How on earth can they afford to be on a feeding tube or ventilator or have nursing home care to the tune of $100 a day? In Texas, if you cannot afford to pay, that is taken into account when they decide to end life support.
Oh what a tangled web…we could push for socialized medicine to level the field but that smacks of liberalism which won’t sit well with the right. I guess that means those who can afford the “will to live” will live and those who can’t probably don’t matter much anyway.
I AM A RADIOLOGIST AND READ HEAD CT’S AND MRIS ALL DAY EVERY DAY AND I AGREE WITH CEREBROCRAT AND SUSAN. I TOO REFUSE TO BE A HUMAN PETRI DISH IF I WERE TO BECOME A VEGGIE. MANY OF YOU WHO ARE PROTESTING ARE IN DENIAL OF YOUR MORTALITY. WELL, GUESS WHAT, PEOPLE DIE EVERY DAY.
WHAT WOULD YOU DO IF YOU GOT ALS? WHICH TUBE WOULD BE YOUR LAST BEFORE YOU ULTIMATELY DIE?
Susan
I found that account at an official Catholic website. I have found this elsewhere as I google it now…
Cerebro
You’ll find the advice from the American Academy of Neurology cautionary I am sure.
Which makes me wonder why they didn’t just say take a quick look at a brainscan?
BTW thank you Dr Cranford for your 45 minute diagnosis/death sentence. How you’ve ill-served humanity.
David,
Unfortunately the author you quote does not include any references, so it’s hard to chase this Nighbert story down. I’m familiar with the site (I’m a Roman Catholic myself) . Some accounts say she did sign an Advance Directive, some accounts say she didn’t.
I was involved in a similar case myself, so let’s discuss that. At least we have the facts. A 93 year old client of mine was stricken with a very serious stroke, which deprived her of the ability to swallow. (This isn’t necessarily a “pretext”, you know. Patients like this can and often do aspirate food or liquids, which triggers pneumonia as well as other complications.) She had always been vehement on the subject of nursing homes: she didn’t want to go to one. Period. She said it over and over, and signed directives to that effect. Independence was an extremely high value for this individual. (She was still driving on the freeways, and driving well, by the way, right up until the day she had her stroke.) Because of the severity of her stroke, she would never have left some nursing facility or other for whatever time was left her, which, considering her age, wasn’t going to be long in any case.
Unfortunately, she did awake from her stroke a day later, and although she could not speak, she repeatedly asked for water – by mouth – by writing notes. Did she “change her mind”? Was she competent? Should she have been given artificial hydration? I don’t know. I was the lawyer, not a family member, though I sat with her too during the subsequent days. I’m not sure she recognized me, or any of us, so I’m not sure how “competent” she was, whatever that means. Her family obviously loved her dearly (I did too, to tell you the truth), and they very much believed they were doing the right thing to deny her hydration. In due course she died. I remain troubled by this case.
In the alternative, though, I easily picture her coming to in that nursing home, and really hating all of us for not following her wishes.
I’m not sure what you intend to prove by the Nighbert case, assuming that it ever happened. That Advance Directives don’t deal with every contingency? That nurses can be unsympathetic? That courts can be wrong? That families make mistakes, or can be badly motivated? No one disputes any of these statements.
None of these are easy questions, and I’d be the last to suggest that they are.
Write out your wishes for yourself, and hope we never need them.
It’s true; the majority of PVS cases are subtle and difficult to diagnos. I believe that one reason for that is the majority of PVS cases involve people whose brains are in much, much better shape than Terri Schiavo’s, making a brain scan irrelevant for diagnosis, meaning that all you have to go on are more subjective criteria. If most PVS cases had brain scans that looked like Ms. Schiavo’s, it would become an easier diagnosis to make.
Here’s the paper you’re referring to; I think people should read the paper itself, rather than trusting a clearly biased source like the National Review. If you’ve read the paper, you know that the misdiagnosis of PVS is generally caused by visual or physical handicaps. “Many patients who are misdiagnosed as being in the vegetative state are blind or have severe visual handicap; thus lack of eye blink to threat or absence of visual tracking are not reliable signs for diagnosing the vegetative state.”
Two-thirds of the falsely diagnosed patients were blind or nearly blind; alost 90% of them had severe physical problems which made it difficult for them to communicate (one of them was only able to communicate through a slight shoulder shrug). There’s no evidence at all that these problems are involved in Terri Schiavo’s case. Nor does the paper report any cases – not a single one – being misdiagnosed because of a misunderstood brain scan, or any misdiagnosed patients with scans showing a brain as severely atrophied as Terri Schiavo’s.
Does that prove that it couldn’t happen? No, of course not. But neither does the paper prove what you (I assume) want it to prove. Nothing in that paper supports the consulsion that it’s likely Terri Schiavo has been misdiagnosed.
To me that was a crime too. If she didn’t want to go to a nursing home why didn’t that ‘loving family’ take her home? It would have been inconvenient? See the word: loving. They didn’t know how to change her chux pads? Remember all that diaper changing when you were little? Of course you don’t.
My wife’s mother had a severe stroke which she never fully recovered from. For a year she couldn’t say more than ‘didema’. Up to the time she died she still took great effort to complete a sentence. Great effort.
She also produced the world’s most wonderful person during that time and had a deep love affair with her husband and my hero who really meant ‘for better or worse’.
If you are part of a system that would deliberately kill such a person change the system while you still can look in a mirror without a drink.
Ampersand
Has Cranford ever diagnosed a patient as not having PVS?
It’s not a a matter of misdiagnosis with him, it’s like a religion of death calling for ever more sacrifices.
I happen to like NR and this quote…As one neurologist put it, if a patient shows “any response to the outside world, the patient isn’t in a PVS.”? All it takes, according to Dr. Jones, is “only one examiner to discover the presence of higher brain function and the naysayers’ opinions are, by the very definition of PVS, null and void.”?
In related news I also appreciated Jeb Bush’s news conference just now where he revealed a neurologist by the name of Dr. Cheshire, observed Terri, lengthy videos of her and her case record. He has concluded that she is not in a persistent vegetative state. Rather, he felt she was minimally conscious if not functioning higher.
Well, David, you may well be right about my 93 year old client.
However, taking her “home” was not an option, largely because of the complexity of the care she would have required, which could only have been provided in a skilled nursing facility. If my client had suffered her stroke a hundred years ago, she would have died, just as she did die; the technology to keep her alive hadn’t been invented yet. Perhaps not using that technology is the equivalent, as you are asserting, of “killing her;” I am not certain on that point. This is without reaching the question of whether we were following her wishes or not.
I’m an attorney, not a clergyman. It isn’t my job to make tough moral decisions for my clients.
I’m still wondering what you’re trying to prove by the discussion of such cases. That our legal system is wicked? You have yet to suggest any alternatives. That I am a bad person? That well may be, but I can’t see how that is relevant to Terri Schiavo’s situation.
Susan
There is a difference between high tech expensive heroic measures and simple food and water. I have to rely on people’s basic consciences to see that [as untenable as that hope is becoming]. I was hoping the example would shock people’s consciences back towards healthy ethics.
Both cases are not ‘pulling the plug’, they about cold-blooded murder, legal as they may be somehow.
I have read this entire thread over the course of three days. I have read one of the the court cases that ruled in favor of the husband. I have read many articles about this case so I submit the following opinions (premised in part on the assumpiton that the CAT scan above is real:
1) Shiavo’s parents because of their selfishness or stupidity have practically destroyed the memory of their beloved daughter. How would you like to be remebered? As a vegetable or a vibrant human being?
2) An animated corpse–and that is what Terri is basically–has no rights.
3) I am totally disgusted by what the Bush’s and congress have done. It is unconstitutional and does not bode well for the future.
4) If these are “real” Christians protesting against removing the tubes, what is wrong with sending Terri to heaven, or is it because they really don’t believe it in their hearts and minds?
5) The Shiavo’s (husband’s family) have contributed to this by still referring to the corpse of Terri as a person–she is not.
6) I agree that starving Terri’s body to death is wrong only because
it causes pain to the family.
These are my opinions on the matter.
You are no angel, demon maybe.
1&2 You need a stroke victim in your family for the educational value it would provide you, if you are capable of spiritual growth. They sure wouldn’t need you tho.
3 They delayed things until jeb could get his law enforcement establishment to do the job they had been neglecting for several decades. That is all. No you won’t find every heroic measures legal case going before congress. No this doesn’t presage mob rule taking over the country.
4 Human life is sacred. Christians have never had a death wish to get to heaven early.
5 Why you can’t read her face as she looks into her parents’ eyes is a mystery to me.
David, if you want to continue to be welcome to post here, you’ve got to take it down a few notches. Calling other folks demons is definitely inappropriate.
1&2 You need a stroke victim in your family for the educational value it would provide you, if you are capable of spiritual growth.
Wow. What a vile, hateful thing to wish on anyone. And I refuse to believe that disability exists to educate the non-disabled. It’s just a creepy argument.
“Mrs Marjorie Nighbert, an 83 year old lady who was in a nursing home after a stroke. She was deprived of a feeding tube by a Court order on March 23rd 1995. A nurse heard her ask “Will you give me a little something to eat?”?”
All of the discussion of the Schiavo case has me thinking about the experiences I had with both of my parents. And they remind me that things are not always what we assume them to be.
Both of my parents were in their 80’s when they died due, in great part, to the superb medical care of their primary physician and of all the other medical personnel who had participated in their care through a series of medical crises over the years.
My dad had suffered a series of small strokes over the years and had developed a degree of dementia, dementia that became most obvious when he was hospitalized for other health problems. However, prior to his last stroke he was still living at home with my mother, ambulatory and able to eat on his own. At times he would choke on his food but he was able to cough and clear his throat and continue eating. He required assistance with dressing and bathing which was provided by home health care workers. They also prepared meals, did light housework and errands and ferried my parents to appointments when I could not do so.
Dad had a mild stroke which caused incontinence and less interest in eating and in his surroundings in general. After several reports to the family doctor from a nurse from the health care service, Dad was hospitalized. He slept alot and was confused but spent some time sitting in a chair and ate the meals served to him. A swallowing test showed abnormalities in his swallowing response.
The doctor ordered “nothing by mouth” . We found out about the order when we arrived for one of our visits. Of course we immediately asked how Dad would receive food and water. An IV? A feeding tube? The nurse said no feeding tube had been ordered. It took a moment for things to settle in: We were being told that Dad was going to be deprived of food and water until he died. I remember flashes of possible scenarios during our remaining visits with Dad. Would he ask for food? For water? Would he understand what was happening? What would I say? This was a man who could STILL talk, who could sit in a chair and put food in his mouth.
Once over our shock, we GOT an order for a feeding tube and for therapy to improve his swallowing response. Dad was moved to a nursing home. He was kept on a feeding tube while the therapy continued, all the while asking us to bring him coffee or something from McDonald’s. A month or so into his nursing home stay, he was mistakenly served a full meal meant for another patient. HE ATE IT ALL WITH NO ILL AFFECTS.
Dad died about 5 months later, still fed from his feeding tube. He had gradually become unable to speak clearly, unable to move. He required turning every 2 hours and occasional suctioning to remove fluids from his throat. I was with Dad when his body finally shut down. He was made comfortable and he died peacefully. It was time.
The QUESTION I still have when I look back concerns the order to withhold food and water from my dad, in essence, to kill him. The order was given WITHOUT consulting my dad who, though definitely confused, was still conscious of his surroundings and his natural need for food and water. Nor was it issued after discussing the order or its consequences with us, his family. At the time I had NO idea such a life and death decision WOULD be made, much less followed, without discussing it with the patient and his family.
Our experience was a quick lesson in the importance of final directives, something we weren’t familiar with seven years ago. It was only because of our being able to get those in place, very quickly, that we were able to legally request the feeding tube and at least an ATTEMPT at restoring my dad’s ability to eat. And he did not have to die of dehydration/starvation while still being aware of what was happening.
I’m sorry for the length of this post but please allow me to tell my mom’s story before closing.
A month after Dad died, my mom was in the hospital. She was recovering from dehydration that occurred while she was in a nursing home. (She had fallen 2 days before my dad’s funeral and broken her hip. She was in the nursing home for therapy and was doing well therapy-wise.)
About to be released from the hospital, my mother developed Flash Pulmonary Edema. I was called and told to get to the hospital immediately. Upon arriving at the hospital I found the nurses tending to my mom in her room. She had an oxygen mask and was being given Lasix and morphine. I could hear the fluids in her chest. I went to her side and leaned down to her. She said to me, with obvious difficulty “I not want go Tom”, referring to my dad. This said to me SHE DIDN’T WANT TO DIE.
A nurse and I spoke in the hallway. I found out that a DNR order had been placed by Mom’s doctor that day. That order was being followed.
The problem was this: My mother HAD LEGAL DIRECTIVES ON FILE. We had been sure that the nursing home had them with her records on her admission there several weeks before. I had the legal authority to make the decision about DNRs and such. When I told the nurse this, and what my mom had said, she immediately began making arrangements to move my mom to intensive care.
It was a frightening night. I was told by a doctor that he had never seen someone her age (not to mention someone having survived several heart attacks) in her condition that night survive. While watching over Mom, I asked a nurse to look in her records for the directives. She found them, filed at the BACK of the voluminous records on Mom’s treatments. They had been at the nurse’s station down the hall from Mom’s room.
Once again I learned an important lesson: Hospitals don’t necessarily check to see whether or not directives are on file. The PRIMARY physician may not necessarily know, or ask, if directives are on file. (The doctor’s PARTNER was associated with the nursing home and had ordered Mom’s care there). And if a DNR is ordered, it is followed. A patient that wants to LIVE may be allowed to DIE simply because someone HASN’T BOTHERED to check on what that patient wants, to see if directives are in place.
My mom DID survive that night. She was moved to several different floors during her recovery. A sort of sad comedy occurred with each move as my sister and I met with the head nurse on each floor, clarifying our wishes as to what was to be done should Mom have another medical crisis.
Mom lived 3 more years, years she and I both treasured. With home health care she lived in her home and with me until the last 5 months of her life. Those were spent in the hospital or in a nursing home. She had been slowly developing dementia. She lived contentedly in the Alzheimer’s wing of a nursing home her last 3 months. She finally died in her sleep from her 5th heart attack.
The point of all this? Be aware. Do not make assumptions. I don’t think that there was any intentional malice in any of the doctor’s or hospital’s actions. But looking back, 7 and 4 years respectively, I am still appalled that a decision could be made to discontinue food and water without consulting a patient or the patient’s family. I am appalled that, inspite of final directives being present, that those directives could be “lost”, and a woman who wanted to live be allowed to die. And that is exactly what would have happened if I had not been home to receive the call from the hospital.
In the sense, that is what it would take. Of course I am not wishing that on him.
Florida DCFS petition. I especially liked page three.
David, Robert can disagree with you without being morally bad, and his disagreement doesn’t necessarily mean that he needs any more “spiritual growth” than you or anyone else. He just disagrees with you, OK?
One of the most distressing aspects of this case is the way it has caused people to talk to each other. I’ve noticed this on several sites, of all persuasions.
For example. Michael Schiavo is not necessarily a bad man, even if someone thinks he’s mistaken about Terri’s wishes or is otherwise badly motivated. It is possible, nay, likely, that he is sincerely trying to carry out what he believes were her wishes. Because someone thinks this a bad thing does not mean that he beat her senseless (an idea which has no evidence going for it) or that he’s after the money (which is gone anyway). At any rate, none of us have met this man, and we are most unqualified to judge his motivations.
I think Terri’s parents need some help and some grief counselling, but that’s just my opinion. I’ve never met these people, and one cannot but sympathize with everyone concerned in this tragedy, most emphatically including them. The whole thing is heart-rending. Because I do not agree with the tack they’ve taken does not make them “selfish” necessarily.
The overall fact of the matter, and this is not confined to this one case, is that, yet again, our knowledge has outrun our wisdom. A hundred years ago, Terri would have died the night she had the heart attack. As wonderful as the advances of medical science have been, there are downsides, and one of them is distinguishing between what we can do and what we should do. They’re not always the same.
Are we entirely certain that competence is a prerequisite for the revocation of advance directives? My understanding it is only necessary to demonstrate competence to create one.
Thank you for your educated explanation. I’m not a doctor or a scientist but I did learn about brain damage when my mother was ill. I can clearly see that there is not enough brain present for Terri to have more than minimal reactions. That “she” is alive does in no way suggest that she is aware of being alive. I have seen her on TV a good deal and I just don’t see that much awareness. I think it would be mercy to let her go. Death for her is not painful even if she were aware of it and I can’t see anything to suggest that she is aware of anything, more than superficially.
Susan
Where do I start? There is so much circumstantial evidence. I understand circumstantial evidence isn’t perfect but if the evidence doesn’t prove attempted murder it sure proves beyond a shadow of a doubt that he doesn’t love Terri nor is he a fit guardian.
A number of doctors have pointed out that her injuries on her bonescan are very consistant with long term physical abuse and brutal strangulation. Dr Hammesfahr stated he had only seen injuries like her neck injuries one other time and that was a case of strangulation. Her best friend has disclosed Terri was planning on divorcing Michael. Michael was abusive and controlling. He kept track of her odometer readings. He splurged on himself and berated her if she spent anything on herself. He tried to keep her from family and friends. He made it difficult for her to get access to the family car. Immediately after the ‘event’ he attempted to assault Terri’s sister. He kept quite good care of her until he was awarded money for her therapy and then he demanded no therapy whatsoever be done for Terri. He bullied the nursing staff. He would frequently ask staff “is that B/tch dead yet?”, “can anything be done to accelerate her death?”, “is she dead yet?”. He would become thrilled at any negative news about her health. He would brag about what he would be able to buy after she died. He abused the first girlfriend after Terri, he stalked her, he ran her off the road. He made a faux pas on Larry king saying “We didn’t know what Terri wanted but this is what we want”.
But if you think he is a poor put upon husband who only wants what’s best for Terri you can have your opinion.
David, you don’t know any of this of your own knowledge, unless, unknown to me, you know Michael Schiavo personally. You’re just repeating stories you’ve heard.
You spend too much time on the internet. Try getting outside more.