UPDATE (April 5th): This thread is now closed. For further responses and comments, please use this thread, instead.
The following topics have now (as of 5:30pm Tuesday, pacific time) been banned from this thread:
1) Evidence or arguments intended to prove that the Schindlers are badly motivated or bad human beings. This includes any further discussion of them selling an email list or wanting an inheritance or anything like that.
2) Evidence or arguments intended to prove that Michael Schiavo, his lawyers, or Judge Greer are badly motivated or bad human beings. I think y’all know the sort of thing this includes.
3) Nazism and comparisons to Nazism, or reasons why comparisons to Nazism are inappropriate.
I will delete any further posts including any of the above subjects.
Since the post about Terri Schiavo’s CT scan now has over 400 comments, which is a bit of a huge file, I’ve decided to close comments on that thread. People who want to respond to a comment in that thread, or who want to make a comment on the Schiavo case in general, may do so in this new thread.
Please don’t post here to suggest that Michael Schiavo, or Judge Greer, are evil people who are conspiring to murder Terri. Please refrain from comments suggesting that the Schindlers are evil people, as well.
To get things started, I’ll quote in full the most recent (as of this moment) two posts from the thread I’m closing, both of which I thought were excellent.
Susan wrote:
Thank you, Barbara, for your clear formulation.
It seems to me that the people who want that feeding tube re-connected take one of two positions, and sometimes both:
- They think Terri has a duty to live that transcends what she would have wanted, as you say, or in the alternative, a duty to follow the speaker’s position on this instead of her own, and/or
- They think the court was wrong about what she wanted, for a variety of reasons, either that Judge Greer is a vulture or that Michael Schiavo has evil eyes or whatever.
Both positions can be defended, but I’d like to see a defense up-front.
As for thinking the court was wrong, I donno. I disagree with a lot of court decisions (especially when I lose!), but that’s the way we do things here, and for obvious reasons we don’t re-litigate things just because the loser is unhappy with the outcome. All the appellate courts are convinced that Judge Greer did a responsible job. I’d invite skeptics to read the Second District’s first opinion on this matter. What’s the theory here? That all the state and federal judges who’ve reviewed this are vultures? This wades us deep into conspiracy theory, deeper than I personally wish to go.
If you think Terri has a duty to live regardless of what she thinks, or that your opinion is to be preferred to hers, I’d be interested in hearing why.
A minute or so later, Sally posted the following. Since it was posted so quickly, I think it may have been intended to be a response to an ealier post of Susan’s, but it’s nonetheless an apt reply to Susan’s point about the courts.
Sally wrote:
I think the difference, Susan, is that I have less faith than you do in the courts’ ability to determine Terri Schiavo’s wishes. The court is relying on eyewitness testimony about conversations that happened many years ago. People’s memories are notoriously selective, not because they’re consciously distorting anything, but because we remember things by slotting them into certain narratives, and we tend to select out the memories that don’t fit into those narratives. Michael Schiavo and his brother and sister-in-law believe that Terri would want to die, and it seems likely that they’d select out any memories that would contradict that narrative.
I realize that all we have to go on here is hearsay, but it makes me nervous. It would make me nervous in any court case: I’m really wary of convictions based only on eyewitness testimony, too.
And secondly, the courts don’t float above society: they’re subject to the same prejudices as everyone else. And one of those prejudices is a widespread belief that some lives are not worth living, that some people are just empty husks who are a burden on society, that medical care is a zero-sum game, and if we keep those people alive, we’re taking treatment away from someone more deserving. When judges weigh evidence, they have those prejudices in the back of their minds. I don’t have a lot of faith in the courts as neutral actors here. And given that they are biased, in the ways that everyone is biased, I tend to think we should err on the side of not killing people.
Robin-
I am not in Florida, nor am I privy to any information not found on the abstractappeal.com website, or in other public notices on the web. If you had read the court documents posted on the abstract appeal website, you would have found that the information about her attempt at pregnancy, was directly related to the charge of malpractice, against her physician. This was all laid out in court.
The hospice I am associated with, is in a very rural, very impoverished community — demographically the county is one of the worst in the country, in terms of poverty levels, unemployment, and education. We have no endowment to support indigent patients, nor an industrial base to provide large corporate gifts, as does the hospice that is taking caring of Terri. I’ve seen their IRS filing (also public info on the web) and believe me, it’s like comparing apples and oranges, in terms of finances. Our funds must be raised each and every day. I suspect that a higher percentage of our patients are indigent, and I can just about guarantee, that our patients remain in care longer on average, because a large number of our patients are chronically ill. And so our need for funding for these patients, is probably more urgent then theirs. I have no explanation for how or why they’ve supported her care, but can probably understand the spirit behind it.
But let’s be honest here. You are not interested in any of these things. You ask for citations, and discount them when they are provided. You claim to have studied the court documents, yet time and again, you demonstrate a complete lack of knowledge about the most basic facts of the case. You are unwilling to consider scientific evidence. You back away from statements you’ve made by claiming they’ve mysteriously appeared from some other source on your computer.
So there really isn’t any reason to continue this dialogue.
A tube to provide nourishment and hydration is artificial life support. In my opinion, life savings drugs are artificial life support as well, because artificial means : humanly contrived often on a natural model : MAN-MADE.
Man-made my friends. What would have happened to Terri had this happened to her before this contraption had been invented 20 or 30 years ago? Intravenous feeding would have been used, arguably even more artificial, and she certainly would not have lived 15 years on intravenous drip!
And Robin sounds a little like that Robert Henson fellow, avoiding facts and creating issues that are tangenital to the discussion.
My humble opinion–if the court papers I have read are true–that Terri Shciavo ceased to exist 15 years ago. I pay no heed to what is NOW being said by the Schindler family, since they admitted in court that they believed she was in PVS.
I go further and say, that even if Terri had left a living will that stated she WANTED to be kept alive in such a state that it would be incumbent on the family alone to bear the burden not society. I do not like Bush but I am all for the law he signed in Texas. Probably the only thing I have ever agreed with him on.
Atheist-
Agreed. I’ve wondered, if feeding tubes are so damned natural and risk-free, why we don’t all get one.
I think we all need a reminder of what a portion of Cruzan v Director said:
That’s from the concurring opinion of Justice Antonin Scalia.
[Personal attack on Robin, deleted by Amp. That was way over the line, Alan.
And yes, I make an exception for myself, sometimes; as you say, it’s my blog. I thought my comment was a comment on the general state of the debate; the poster I was criticizing was an example of how nasty and ridiculous the “Michael is evil” debate has become. In contrast, your post was (in my opinion) purely an attack on Robin, with no relevance to larger issues.
I hope you’ll stay around, but if you don’t like the moderation here, of course you’re free to leave. But if you want to discuss this question further, please do it via email – alas at amptoons dot com – and not on the threads.
–Amp]
[Post containing Michael-is-so-evil comments deleted by Amp]
Robin,
Never mind that it wasn’t Canada in the time you are refering to. Furthermore, there is this place caled Quebec, where they still speak French and want nothing to do with the Queen. Also never mind that it was the only place in Canada, Quebec that is, at that time that existed in any shape or form. Never mind the French there fighting against the British and supporting us in our revolution. I could go on and on, for days, but I think Alan J Denis has summed it up nicely.
Time to move on…
Adios
[Personal attack on Alan deleted by Amp.]
What is now called Canada did indeed belong to the English – not the French – at the time of the American Revolution. The French ceeded all claims to England at the end of what we call in the US the French and Indian war – mid 1750’s. That particular part of the North American continent was indeed called Canada at the time and is referred to as such repeatedly in extant documents, many of which you can buy at Borders in republication. Hunt up the Deerfield Captive narratives – there are a number of them.
The part of North America that remained French territory after that time was the big bit in the middle that we bought in the Louisiana Purchase. All of that lies within the borders of the United States. If you take a peek at Canadian history you will see that Quebec was hardly the only province extant during the Revolution. The east coast was very well settled. Many of the Tories that left or were driven out at the time of the revolution settled in Nova Scotia.
The French nationalist movement in Quebec is rather new – or at least they have been making waves only for the last 30 years or so. When I was a child, Canada was quite literally ruled by England as one of the Dominions. The King/Queen of England remains the titular executive power in Canada, Australia, New Zealand and a number of other former British Territories. Queen EII was the Empress of India until near 1960. Canada was released from Dominion as a single, united country. If the French speaking peoples of Quebec want to break the bonds that is their business, but until that happens the Queen is their Queen, like it or not.
Emmetropia says
I am perfectly willing to accept scientific evidence. However, absent current testing – the newest is a decade or more old – then I am not about to accept as “scientific evidence” a diagnosis that is at best iffy. When a patient has malaria or strep throat or liver failure there is direct, clear, indisputable evidence that can be quantified and duplicated. That is scientific. PVS is a syndrome – a diagnosis that we apply to a given set of criteria rather than a given set of numbers. Some MDs see that criteria, others do not.
Had you bothered to refer to the original post that I was quoting in the “birth control” post you would have clearly seen that the statement I stated was not mine was in fact NOT MINE.
Amp,
99% of my post was a verbatim highlight of Robin’s rather caustic statements attacking physicians. I am not a physician.
In a single 14-word sentence, I questioned the potential bias and/or emotional stability which framed her comment.
So … what precisely was the “way over the line” part?
Thanks,
Alan
BTW, I DID e-mail you on this subject several hours ago.
Isn’t the whole point of this family’s tragedy that it really isn’t our business, or Congress’s business, or anyone’s business but thirs. And we have a legal system, and a rule of law to deal with things when the family disagrees. The judiciary has done its job as best it can. We may not all agree with the decision, but you must agree that after all th is litigation, it’s been argued so much, and the decision has been consistent.. And people of good will can and do disagree, without being evil incarnate.
I didn’t agree with the FLA courts when they stopped the counts in Bush v Gore. But I supported the ultimate deision not because I liked it, but because it was the system working, imperfect though it may be. I happen to agree with the courts here. Same standard should apply, though, for all concerned. We don’t get to pick and choose and adhere only to the decisions we agree with.
Lots of people have to undergo these choices, fortunately outside the spectacle of the media and the politicians trying to convert a tragedy to political benefit. A pox on ’em, and on partially informed people trying to second guess those who actuallyknow the facts. We should all go make our medical powers of attorney and tell our own kin our wishes, and leave this fractured family in peace. (tho’ what do you want to bet someone will try to shoot Schiavo. Sometimes there is a really frightening mob instinct in America.) 80% of the population, I read, thinks that Congress and the media should just butt out. Now THAT I agree with.
Amp,
Let me frame my question to you another way.
Are issues regarding bias and stable emotions somehow not pertinent to these discussions?
Or is any suggestion that one who comments on the Schiavo case might possibly be subject to bias or emotionalism somehow “over the line?”
Thanks,
Alan
As opposed to your highly-informed, absolutely certain position, I presume.
Numerous very highly regarded certified neurologists have actually examined Ms. Schiavo and diagnosed her. They are all in agreement.
A handful of dissidents with suspicious agendas have said they don’t believe it, and a million residents of the bloviosphere have come up with their own diagnoses and conspiracy theories, based on ten minutes’ worth of medical education and an inch-square JPG. Very impressive.
Supporters of the Schindlers always argue as if none of this had ever come up before. But it has, repeatedly, endlessly. Most of the important court documents are available online. Please read them. The decision of the court was not taken lightly, not the first time nor in the umpteen revisits. The experts spoke at the trial.
The Schindlers had their chance in court too; many of them. That they are now resorting to outright charlatans and kooks in their most recent filings is unfortunate. The last motion dated March 24 had affidavits from a man who has invented a machine to translate thought waves into speech (though of course Ms. Schiavo has no thought waves); a doctor who makes at least one substantial error of fact that even I, a casual lay person, can detect (that the swallowing reflex indicates higher brain function), and who — again — has presumed to make a diagnosis based on watching TV; and a doctor in California who has diagnosed spousal battery by watching Fox News. His credentials include ten pages of appearances on local TV news programs.
The court quite rightly dismissed this farrago of nonsense.
The question is settled, and it was heard fairly. Exhaustively even.
It is unimaginably tragic that the Schindlers have allowed their grief to paralyze their ability to think clearly; after fifteen years their inability to accept the truth is heart-rending. But just because they have convinced themselves that their daughter is communicating with them doesn’t make it so.
On the other hand, for people who know nothing of the case, who have never met any of the participants, have read none of the court documents, are unaware of the most basic facts, to make this same mistake is not tragic; it’s farcical.
What is happening outside that hospice in Florida is a farce. It’s an affront to every decent person no matter what they believe. Convicted rapists sending their children in to be arrested? Raving kooks waving bibles and shouting obscenities at the neighbors? Crowds demanding that the governor and the president send in soldiers to carry her away, in the face of the courts and the police? 60 dying patients being denied their last few weeks or days of sunshine because of the screaming lunatics in the yard? Jesse freaking Jackson? It’s obscene.
Right you are, Steve!
Cerebral cortex liquefied. Cognition gone forever. However sad and tragic, it is irreversible truth of fact. Of course, it’s only every unbiased neurologist and brain scan that supports this.
Then again, these morbid sorts who want Terri in diapers, unable to comb her own hair, chew food, feel joy or pleasure, read, hear touch, taste, feel, speak for — oh, I don’t know — perhaps ANOTHER 15 years or so … these protesters are doing what Terri wants, right?
I have worked with many, many doctors over the years and trained more than a few. In the “old days” – not that long ago BTW – doctors knew laboratory medicine, pharmacy, xray and did most of it themselves in their office. As the medical field has become more and more complex no one human being can no it all – including MDs. That is specifically why you go to a lab for medical tests, imaging for xrays, PET, CAT, MRI and pharmacy for your meds. When you are diagnosed with leukemia it was not the MD that discovered it. Maybe – and that is a big maybe – he suspected. Just as often some sharp-eyed scientist behind a microscope in hematology found it out of the blue while looking at your blood smear.
Today’s MD no longer learns laboratory medicine in medical school. That is why the lab reports all say HI or LO., dirty urine, etc. If you have a quantifiable disease it may be the doctor who delivers the diagnosis to you, but it the laboratory that has the expertise that defines the diagnosis for him.
In the 50s there were only three or four antibiotics, virtually no psychotropics and little else. Fit in a chest in the office quite nicely. Today just the book that illustrates all the drugs is nearly 4 inches thick – and it doesn’t include anything that has come on the market in the last year. Many of them require certain levels in your blood stream that must be monitored in a certain way. Nearly all of them act adversely with something else. No one MD can keep up with all of that. Most do not know more than the most common on adverse interactions and know only that a given drug must be monitored, not how to monitor it or even necessarily what the correct parameters might be. Pharmacist does that.
Imaging is so specialized and the machines so complex that the person who performs the testing for a PET may not know how to do a CAT. Your average MD likely could not find the on button.
Respiratory therapists draw blood gases in most places. An average MD may not have drawn a blood gas since medical school unless he works in ER.
An MD that specializes in OB/GYN may know nothing whatever about malaria other than some long-forgotten line from a textbook far away and long ago. An MD that spends his working life with the elderly would be hard pressed to beat a cop or firefighter if he had to deliver a baby.
Complex world, too much information – more than even the most brilliant can process. Today’s MD is NOT a God. Your doctor is your interface, your coordinator. The good ones know that – and if you work with them you can tell. The really good ones try really hard to learn the salient points they need for their practice from the true experts on their support teams – the lab, pharmacy and imaging folks. The superb physicians will go so far as to walk into the lab or the pharmacy or imaging and say “I’ve got this patient, this is what I see, what do you think?” when presented with a puzzle.
All those good, very good and superb ones are rare. I know exactly 4 that I would call superb. Most MDs come out of Med school with very swollen heads that don’t contain much – the God syndrome. They treat the experts in the support network as peons and all too often their patients too. MANY of them simply never get over it. Dangerous disease – leads to an awful lot of error and misses.
Familiarity breeds contempt. I am not the first and won’t be the last to state that I would NEVER take the word of an MD over the word of the RN or CNA that provides patient care directly when it comes to a conflict over a patient’s condition. Many – in some places virtually all – of non MD medical personnel feel exactly the same, as do many, if not most, of the very good and superb MDs. Neither would I take the word of an MD that I knew to be a victim of God syndrome over the word of a “superb.” Medical people watch how doctors do their jobs. They know the outcomes, the success rates and the failures.
If you find that derogatory or as you state a “caustic attack” – oh well. That does not make me biased or emotionally unstable in any way. It simply means that I, like everyone else, judge the ability of the people that I work with.
I will assume for the sake of argument that “Uncle Ho” in the previous thread and “Robin” are right about the Judge mistakenly believing that Quinlan died in 1976.
The reason that he threw out the testimony by Terri’s friend that Terri made a “no plug pulling” statement after watching a movie about Quinlan in 1982 was because she could not have seen that movie in 1982. Quinlan did die in 1985, but she was taken off a respirator in the mid to late 1970s. At that point she breathed on her own, and continued to do so, in a coma, for the rest of her life. The TV movie about Quinlan (the only movie about her listed on the IMDB) aired in September 1976.
It is theoretically possible that the movie re-aired, or that it was recorded in 1976 by one of the very early (and expensive) VCRs. But it is also possible that the thrown out testimony said it was on TV and that there were no re-airings.
Convicted rapists sending their children to be arrested? My, my!
If you want to talk kooks, the doctor on which the court primarily relies diagnoses nearly every patient he consults on as having PVS. Felos, the husband’s lead attorney, thinks he can talk in his spirit to people in PVS and that it is his mission to release them. Even written a book.
Doctors diagnosing from a TV screen – well glory be! I hate to be the one to tell you, but that is exactly how physicians consult in many of the more remote areas of the US. Patient sits in front of a camera and it is broadcast to the consulting doc online. OOPS.
I have appreciated this forum very much. I have seen very thoughtful comments and insights by Dr. Ted, by a neuroscientist, a neuropsychologist, a lawyer, a mother, daughter, granddaughter, pharmacist, and many others. But the raw emotion by some is an example of the lowered inhibitions some people can develop when they deal with others through non personal forums. Because of that there are some people who will not reallly contemplate on the concerns and knowledge of others. Maybe this is a good time to stop and think before typing whatever blurts out. Again, I implore all of us to think not only of science and physiology, but of the need to make sure that legislators don’t knee jerk reaction to this by passing legislation that will make it impossible for MDs to determine medical futility, for loved ones to make decisions for people who cannot communicate their desires in these issues, and certainly…please, we do not need more legislation that will require concensus before decisions can be made or upheld. We need to avoid changing the entire health care delivery system based on an occasional dispute. And that is what this is.. a family dispute that has become the forum for politics and self-interest groups on both sides. I keep seeing emotional arguments disguised as ethical arguments. They are not the same. Emotional arugments are not very effective methods for the engagement of critical thinking and the critical thinking is what is needed the most. Is it possible for us to lift the discourse up a notch to concepts that require critical thinking? Also, I appreciate the personal experiences and antedotes. Without them, we have little to think about. The human experience is profound and the discussions are hollow without that. Thank you all again because it helps me to see so many people who care enough to spend time on these issues. Thank you also for the kind remarks to my posts. God bless those of you who appreciate hospice nurses and staff. Night, night.
From my understanding, it’s not quite correct to say “cerebral cortex liquified”. The cortex has shrunk dramatically, and the space which it used to occupy is now filled with cerebro-spinal fluid. This fluid is not liquified brain stuff; it’s the normal CSF. There’s just way more than normal of it, because of all the space it has to fill. Space where her brain used to be.
And of course there’s those EEGs.
But don’t take my word for it; I’m no doctor. Take the word of the doctors who have examined her.
That’s all I’m saying; too quickly this discussion has turned into competing nitwits, of whom I am one, with instantly-formulated medical opinions they are not even remotely qualified to make. I mean, come on — a JPG on MSNBC and you’re a doctor now?
The real doctors have had their say, and the court acted accordingly. There has been a fantastic amount of baloney put forth on the internet, but all of the deliberate lies, the pathetic fantasies, the conspiracy theories, the raving nutjob opinions (“the CAT scans were switched!” “she can talk!” “I was watching the news and I have proof — she has an arachnoid cyst!” “people don’t need brains to live normally!”) that I’ve heard have been from one side and one side only.
Leaglebeagle wrote:
Everything that I have read on this issue states that the judge specifically stated he discounted the testimony because he had believed that Quinlan died in 76, at which time Terri would have been only ~12.
Reruns are nothing new – we used to get a ton of them before cable TV :) That was ALL you got in the summer.
This problem can be relieved in many patients with the installation of a shunt – plastic tube that carries the excess away. Standard procedure in infants with hydrocephalus. Not uncommon anymore in adults either. My mom was the first adult to get one of these after a couple of cerebral hemorrages and brain surgery to repair the damage. She was initially “vegetative” – PVS did not exist back then – but after the shunt had full recovery.
You might also note that an MD who specializes in geriatrics posted on the other page that he could line that up with CATs of a hundred of his patient and you couldn’t pick it out. The difference being the old folks weren’t vegetative.
Thought ya’ll might be interested in this information from an article by Fang (2003) This is from the website for the American Society for Gastroenterology. I have put my comments within parenthesis).
“PEGs are frequently placed in persons of advanced age, neurologic impairment, or incurable disease. Patient survival after PEG placement is poor and reflects the underlying comorbidities of the patient rather than problems with the PEG. In large-scale retrospective studies, mortality rates at 30 days were 22% to 24%, at 1 year 50% to 63%, and at 3 years 77% to 81%. (this is a huge morality rate and that is what I have been trying to communicate on the blog, Terri has lived a very long time on the tube and could not sustain that forever…she is terminally ill)12,13 A retrospective cohort study of nursing home patients found no difference in survival between patients who were hand-fed and those who had PEGs. (though the rationale for PEGS in patients is often the weight loss that goes with end of life deline and debility) Available data does not suggest that PEG leads to significant improvement in rates of aspiration pneumonia, survival, pressure sores, infections, overall function, or palliation.14 (So they are inserted at times, giving false hope to loved ones and facility caregivers).
Outcomes are far better for persons receiving PEG for malabsorption, after stroke, and in patients with cystic fibrosis. Prospective randomized studies compare PEG with nasogastric tube feeding in patients with acute stroke and demonstrate that PEG-fed patients have reduced fatality rates and treatment failures, and improved nutritional status, convenience of nursing care, and earlier hospital discharge.f (here comparing tubes through nose and those through stomach, this is not saying that tubes should be permanent or are problem/risk free). Review of retrospective data demonstrates that 10% to 20% of patients will have recovery to oral feeding after PEG placement.15”. (The bibliography is listed at the end of the article on the ASGE website. The malabsorption mentioned can be improved with special formulas, but not all malabsorption problems can be solved. The main thing to remember is that eventually the gut will not tolerate the TF. Please note the part about aspiration and neuro impairment which is a main reason why many people recieve the tube. In other words, a lot of controversy might be avoided if the tubes were not placed inappropriately in the first place). (I am not saying Terri’s tube was intially inappropriate as sometimes evaluation for prognosis is needed. I am speaking in general terms, not rights or wrongs, just things to consider on a case by case basis.) Really night night, I think.
Yes, I’ve heard of that — doctors in remote areas sit back and watch snippets of Fox News as their only diagnostic tool.
Right.
Mr. Felos believes in life after death. He thinks he can communicate with the spirits of both departed and not-yet-born people. That clearly makes him a “diabolic servant of Satan”, as one of his more articulate critics puts it.
Right.
Dr. Cranford’s diagnosis has been supported by numerous other doctors and was closely examined by the court. The Schindlers were given every opportunity — far more than the law allows — to contradict them, but have been unable to do so. His views about the rights of vegetative or terminally ill patients to die with dignity are shared by the vast majority who have had to deal with that situation. You may disagree with him, but you can’t seriously argue that his neurological credentials are in question.
If you are unable to draw any conclusions about the character of the protesters outside the hospice from what we have all seen there, then I can’t help you. There is a travesty taking place in Pinella Pines, but it’s not in any of the hospice rooms. It’s out on the lawn.
Steve writes:
And don’t forget patients in PVS who can beg him to release them (his words.) Why do you denigrate the religous beliefs of the protestors – beliefs that a good chunk of the population would consider reasonably normal – and yet have no problem with Mr. Felos rather radical ideas, far different than any mainstream religious teaching, that some might interpret as sociopathic and delusional?
I’m a Civil Rights and Vietnam era girl :) Those protesters outside the clinic are tame. One thing my mother taught me really early on was to never judge a book by its cover. It takes courage to stand up for what you believe in that manner. They should be admired rather than ridiculed.
With all due respect to the court, I would venture that Judge Greer simply does not have the knowledge to “closely examine” Dr. Cranston’s findings. His acceptance of them simply means that he liked Cranston best or those were the findings he wanted to accept. That acceptance does not actually lend any credibility to the truth of those findings.
I have not investigated Cranston’s credentials in great detail. I do know that his exam was performed years ago and that medical diagnosis of a given syndrome often changes over time. I have seen it written at a number of at least reasonably responsible sources that he is known for consulting on PVS and that he diagnoses virtually everyone as having PVS. I have also read – though I cannot attest to the truth of the thing – that someone to test him wrote up a case study of a patient and asked for his diagnosis, which was PVS. The patient that had been written up was in fact Dr. Stephen Hawkings, who of course does not have PVS.
I do know that there are several good physicians in the US Senate that examined what documents and video is available and have questions about the accuracy of the diagnosis. And it is being reported that more than 30 doctors disagree with the diagnosis. They cannot all be quacks.
From everything that I have seen, there is enough doubt that has been raised that surely a new examination by a disinterested party should have been called for prior to this judgement.
More on these deeply principled “culture of life” people in Florida:
http://www.foxnews.com/story/0,2933,151540,00.html
A woman missed being by her grandfather’s bedside as he died because of the protestors. After he repeatedly told his only grandchild that he did not want to die alone. His last days were spent locked inside, unab le to move freely about the grounds.
Animals.
Robin, Terri is not disabled. She is essentially dead. Think of nothingness that is what she feels and thinks now. One hundred years ago Terri would have died within weeks,not lingered on for 15 years. Disabled people who have profound cognitive impairment can still feel, they have emotions even if they can’t learn;this is not Terri. Terri is unaware of anything including herself. Re tube feeding a few of the residents I work with use this,this is a viable option for someone with Retardation who is at risk of aspiration.It is not viable for someone who is essentially dead for 15 years.
It’s quite likely that upwards of 50% of the “protest crowd” have a very slim grasp of the facts and had no strong opinion about this case — or these types of cases — a year ago. Many in the protest crowd simply enjoy the act of rebellion — anti-establishment anything. And as you pointed out, Steve, often protesters are comprised of exploited youngsters.
I was thinking about what a cruel insult these particular protesters effectively deliver to every parent, spouse, child or guardian who has made the heartrending decision to withhold life support from a vegetative loved one.
Very sad and aggravating, indeed.
Mr. Schindler, Terri Schiavo’s father…
[Rest of post deleted by Amp. Nothing personal, Steve, but please reread the posting rules for this thread.]
The protestors reportedly only start up with the loud praying, acting out in the street, sign waving, etc. when the camera crews are there, and leave as soon as they do.
That’s from the poor sucker who has an auto-repair shop next door, which business is being destroyed by these salty nut bars.
Randall Terry, Jesse Jackson, Bo Gritz, Rick Santorum.
Bill Tierney, a former military intelligence officer who has publicly bragged about committing torture in Iraq, and how “sadism” is both inevitable and “fun”. He’s there too, tears streaming down his cheeks.
http://billmon.org/archives/001784.html — follow the links and be amazed.
No word on when the Ringling Brothers will get there.
Is it possible for an entire country to be mentally ill?
If you know you can’t attest to the truth of something like that, why on Earth do you repeat it?
The lie about Hawking – and it is a lie – is derived from a misreading of a National Review article, in which the author claimed that Dr. Cranford had misdiagnosed a patient in a state allegedly similar to Hawking’s as having PVS. And that was a lie, too – Crawford didn’t diagnose the man as having PVS. I discuss this question a bit in this post.
To some extent, I think you’re right; the Schindlers chose a very poor expert witness, who would strike almost any objective person as not being credible. In that sense, the Judge probably did like Cranford – and a couple of other doctors who testified – “better.” But credibility is a perfectly logical and reasonable reason to like one witness better than another.
As for the doctors in the Senate, give me a break! Of course they’re hacks; they’re professional politicians. Plus, are we supposed to take the word of doctors who haven’t even examined the patient?
Of the nine neurologists who have personally given Terri a medical examination, eight agree. The ninth – Dr. Hammesfahr – has no credibility. It’s simple desperation that you’re trying to tell us that doctors in the Senate who have never examined Terri have more credibility than eight neurologists who have.
Interview of Dr. CRANFORD on CNN
Let’s take a look at what Dr. Cranford has to say. He examined Ms. Schiavo in person for 42 minutes and it was a 2002 (3 yrs old, right?) CAT scan that he reviewed. I think he does rather nicely in this, given that his interviewers are so uninterested in getting to the facts.
I did, and I reread them again before I posted. I don’t think my post was in violation of those rules. I did not call Mr. Schindler a bad person in any way; in fact I went out of my way to suggest that he is motivated by grief. The story I linked to is very important, I think, in understanding how crazy the situation has become.
And Judge Greer would agree with you. That’s why he didn’t just ask one doctor. He asked a lot of them. And Greer’s opinion has been reviewed, and upheld, more times than just about any court decision I’ve ever heard of.
You mention “30 doctors” but who the heck are they? People that Hannity & Colmes were able to persuade to come on TV? There’s an infinite supply of THOSE kind of “experts”. But the doctors who actually know something about the case agree: Terri is gone, and has been for 15 years.
The “good doctors” in the senate: they’re neurologists, right? They’ve examined Ms. Schiavo, haven’t they? They’ve examined the court papers, right? There’s no possible chance that maybe they’re grandstanding for the public, is there?
Felos’s spiritual views are pretty much bog-standard new age stuff. There’s nothing that weird or radical there. I think it’s a load of rubbish, but his religion isn’t in question here; his argument before the court is. It was successful, what is it, eleven times now?
What I am trying to get across, Robin, is that neither you nor I know enough to say “there is enough doubt that has been raised that surely a new examination by a disinterested party should have been called for”. That’s absurd. You’ve spent how many hours examining the case — I’m talking about real evidence here, not posting on blogs. You have how much legal training to understand them? Or medical?
But other people have.
This was not a hasty decision; nor was it an unusual one. Feeding tubes are removed all over the country every day. It’s the humane thing to do in some circumstances. It’s usually a difficult decision; always a painful one. But this case is in fact the most settled, the most clear, one of its type to ever come down the pike.
It’s a thing of beauty, and I think Dr. Cranford will find, like Jon Stewart before him, that when people stop being so cowed by these shouting morons on TV, and tell them to their faces exactly how full of crap they are, that the majority of normal people in this country (I pray it’s a majority) will stand up and applaud the for it.
And it’s not a left-right issue; there are shouting morons of all or almost all political stripes on TV. They disgust me. And I think this issue is going to turn a lot of people off them for good.
In addition to the eight of nine doctors who have examined Terri Schiavo and agree re: Irreversible Brain Damage and PVS, the South Florida Sun-Sentinel asked three independent neurologists to view and comment on the T. Schiavo brain scans.
“This is as severe brain damage as I’ve ever seen.”
— Dr. Leon Prockop, Professor and former Chairman of Neurology, University of South Florida College of Medicine
“I doubt there’s any activity going on in the higher levels of her brain. I’m almost certain it has no neurons [brain cells responsible for thought] in it.”
— Dr. Walter Bradley, Chairman of Neurology, University of Miami’s Miller School of Medicine
“Neurons do not grow back.” “The chance that this person is going to recover is about zero.”
— Dr. Michael T. Pulley, Assistant Neurology Professor, Shands Jacksonville Hospital, affiliated with the University of Florida Medical School
Just a thought: If there was any real, credible neurological evidence to refute the nearly universal medical opinions in this tragic case, wouldn’t you think that honorable docs from around the world would long ago have descended on Pinellas Park with a credible case to espouse?
I mean, if there wasn’t this murderous conspiracy, and all.
I’ve read through almost all of the posts and felt the need to say something. I’m young but have expressed my wishes to my family about what I would want if I was diagnosed as terminal. I would not want to be kept alive through machines. I’ve worked in the medical field for about 10 yrs, I also live in Texas.
My cousin was diagnosed as brain dead late last year. He was barely out of his teens. It’s very hard to make the choice to turn off life support when you are looking at your child — and who for all intent and purposes seems to be alive — but you have to do the best thing for them and sometimes it’s letting that person go. My aunt DID NOT murder my cousin when she turned the machines off. A brain that is denied of oxygen for too long dies. You can not jump start a brain. Without our brain we become a shell.
Yes a person can be kept “alive” indefinately through the marvels of science and medicine. But is a person alive when a ventilator is breathing for them, when a dialyis machine is doing the job of the kidneys, when a feeding tube is releasing nutrients directly into your stomach? Before I get jumped on, I realize that all of the above are not the case for Mrs Shiavo. If it is true what her parents have said they would do in regards to her treatment is she were to get worse (ie amputation and heart surgery) someone needs to despertly help these people. I’m not saying they are neccesarily bad but they are in need of grief counseling. Can they honestly say in their heart that Terri would be the same if all that was left was a torso and a head? Could they honestly and willingly say that would be better for their daughter? If she can feel the pain of starvation wouldn’t she feel that pain too? Would you want your own child to be in that situation?
I’m not sure what type of feeding she was receiving. But as part of my job I have made feedings for patients in comas and PVS. They are called TPNs and basically its a bag of medication. It’s not a hmaburger and fries. It’s composed of insulin, magnesium, potassium and the like.
If food or water was pushed down her throat and she choked and died, would that be murder? It’s been reported that she said “AHHH WANNA” when asked if she wanted to live. What if she was trying to say “I want to die”.
And as far as the CAT scan …. hello HIPPA? The release was a major violation. And the hospice nurses. I’m a pharmacy tech and if I saw a patienrt’s rights being violated I would contact the state medical board. If it is true what they saw are they being proscuted for their major violations and derelcition of duty?
AN infant was buried in Texas a few weeks back. His life support was turned off. Where were his protestors? Where was the pro-life attorney ?
Let her go home to heaven where she can be whole again.
These conflicting comments are interesting.
“But even the very best of neurologists has absolutely no real clue as to whether or not Terri is present inside that head or not.”
“All too many of them are little better than quacks that I would not allow to treat my stuffed rabbit.”
— Robin on March 29th, 2005 at 6:18 am
“I do know that there are several good physicians in the US Senate that examined what documents and video is available and have questions about the accuracy of the diagnosis. And it is being reported that more than 30 doctors disagree with the diagnosis. They cannot all be quacks.”
— Robin on March 29th, 2005 at 11:25 pm
Robin, I have to go to work and actually get something done today, but you are wrong about what the court said on Karen Quinlan. You are truncating what it said, and merging its findings with regard to what Terri said at the time the Karen Quinlan lawsuit was being decided (when Terri really could have been no older than 13) and what one of her friends might have heard her say later during the airing of the movie. This finding was also colored by the fact that the friend’s testimony (or her memories of its alleged certainty) changed substantially between her deposition and her trial testimony. Please go read the initial decision again. The judge also refused to credit other testimony in favor of discontinuation of life support as being relevant to the issue.
Okay Robin, you win. I do not have the time, nor the energy to keep this up and find every single selective case that supports my conclusions. As for what you said about Canada, you are correct on every point. MY point was merely to point out that gross generalizations are being thrown around here like nobody’s business. To that end, you forgot to mention the Quebec Act, signed by King George (if my memory is correct), that essentially left the French untouched by English rule here in Quebec. Whatever you might read in a history account about Quebec cannot replace the social history of the place, which has always and will always be French. The past 30 years have been known as the Second Revolution or the “Silent Revolution”. I assure you that the First Revolution has never stopped.
I’m leaving, thanks to Amp and many other, but especially Nurse Practitioner, Susan and Barbara. I have been enlightened by your sharing of reliable info. Amp has another discussion waiting to go under “Scientific American throws in the towel” which, if I may, I would like to invite people to for a discussion of evolution (I imagine I am overstepping my bounds on your post, so cut away if you will).
This discussion seems to have deteriorated into personalities and politics. Some of the issues and principles that are still open to discussion are:
– how is a person’s proxy decided when none has been appointed (actually, there are laws that have been made to determine this- in TS case her husband is the legal decision maker)
– how do we as a society make decisons on how to allocate resources (note tht I don’t say scarce, as we have lots of mondy for some things but none for others)
– how do we define life
– and a biggie for me that I haven’t seen discussed: once we have a technology, do we have to use it, and if we start to use it are we obligated to continue to use it or can it be stopped- either because it is deemed futile (by whom- a whole other issue) or not practical
For example, woman have babies (some exceptions, but biologically true for the population women) Becasue she can, does she have to? Once she starts, does she have to keep doing it? If there is technology involved, does it need to be continued at all costs, just becasue we can, rather than determining what she (the individual) wants (her autonomy and self determination).
This is not as well constructed as I would want as I am really late for work. I hope that this blog can continue to discuss some of the issues, rather than the politics and personalities of the current players.
Bravo mary !
As for how we define life…I heard an interesting story awhile back, I think it was Stephen Hawking, who, simply for the sake of argument, asked, “Are computer viruses alive?” If not, Why not?
I apologize, but I think you lost me on the baby anaolgy. But, when there is a new technology, are we obligated to use it? I haven’t thought this through, but I would say the only obligation is the oath that doctors take stating they will do everything in their power to save and preserve life. But it does pose all sorts of questions doesn’t it?
Mary in post #143 says:
how is a person’s proxy decided when none has been appointed
Michael Schiavo went to the court long ago and said,in essence: look, I want YOU to decide for us whether to pull this tube. He presented his side, the parents presented theirs, the docs presented theirs, and the COURT ruled to pull the tube.
Also, I believe that Florida has a default process that is similar to that used in many other states to appoint a proxy. A spouse, if there is one, is usually ranked first, and so on. Really, Florida followed a pretty well established legal process. The judge did not make it up as he went along. If you think the Florida process was flawed, what would you put in its place?
The only issue I have with this whole process, is that I wish, once the decision has been made to allow her to die, that we euthanize her rather than starve her. I think we can at least do it in a somewhat dignified manner
I think this is an important topic, especially so far as it relates to the use of feeding tubes, Mary.
New medical technology, originally intended for discrete patient populations, tends to be applied for wider use as time passes. That is the reality of an economic system which seeks to maximize profits.
The use of feeding tubes, which had a narrowly defined use initially, are now regularly used for Alzheimer’s patients in nursing homes, essentially as a cost-cutting measure. Their use reduces the staff time needed to feed patients, who as their condition’s decline, take longer and longer to feed at each meal. While I would argue that something is lost in this use of technology, physical life is being maintained. Given the astronomical rate of Alzheimer’s, chances are good that many of us here, can expect to have a tube inserted at some point.
While some see only the good that feeding tubes provide, in terms of their ability to prolong life, there is also an inherent profit motive in their use. While the Pro-Life sector might argue their position from a moral point of view, and insist that the state always err on the side of life, there remains
a dark side if this position is adopted by the state.
Would the intrinsic moral value of “life at all costs,” be modified if Halliburton was awarded a sole source contract to provide those feeding tubes?
The analogy of the brother who suffered brain death and was on a ventilator is a good one for this. Sure the ventilator makes breathing occur, but that cannot last indefinately either. My sympathy to this family. However, the most important commonality is the no EEG (brain wave) activity in that case and Terri’s. When one looks at the Harvard criteria for brain death, that is a key factor. For those wanting to address the question as to whether or not we should use the technology of the TF (PEG), please read my previous post about tube feedings. That is a great question. It will not have a yes or no question common to all patients.
Feeding tubes although viable in some cases still cause a lot of health problems. Personally I know residents who are tube fed due to risk of aspiration who regurgitate and swallow what they have brought up. So they are still at risk of aspiration and some have died from this. Tube fed people will also put on a lot of weight if the amount they are fed is not monitored carefully. Some PMR residents will pull their tubes out if not strictly monitored (not on purpose they just see it and yank on it) causing it to be inserted again. The tubes also disintegrate and have to be replaced. Tube sites can become infected even if scrupulous hygiene is maintained; they are after all a foreign body.
I don’t really know the particulars of how this law applies in this case, but by analogy with law regarding suits for defamation of character and such, Terri Schiavo Incapacitated and her parents and, unfortunately, Michael Schiavo, have all become public personae because of the publicity initially sought by the Schindlers. As any public person, their expectations of privacy are significantly modified if specific steps are taken to compromise them and their is no opposition. Mr Schiavo may retain some defensible expectations of privacy, but not the Schindlers and, unfortunately, not their daughter, who can’t say or defend with anything.
I think everyone has tried to over theorize this whole event. I would like to use a few examples of what we have been seeing and how we would react to these with different circumstances/situations.
1. A mother has a 6 month old baby, she decides it is a burden and doesnt want to care for it(even though someone else would love to care for that child). So she stops feeding and hydrating her baby. The baby can’t say I am hungry, I want to live. So the baby will die because it doesn’t have the ability to express what SHOULD be done by the people surrounding it.
I just want to say I pray for Terri. When this is all said and done this argument will be abandoned and Terri WILL be forgoton(mainly by the people on the side of death) and life for us will move on(well until maybe something likes this happens to us).
I remind these same people that we are in a temporary residence on earth and how we act to what happens in our life, and how we believe here, constitutes how we will be recieved when we die. Killing someone because one man wants her dead is not the right choice for any rational person, especially when there are people that would care for the person that is sick. The questionable thing in all this is, there is only 1 person that indicates she didn’t want to live this way but everyone else that knew her disagrees. I am awaiting the ruling and vote this morning from Florida.
A New Mexico Guy
I just wanted to add that my wife works with the mentally disabled and there are people way worse off than her that ARE in the public. That have to have the saliva sucked out of their mouths so they don’t choke and so on.
Strictly speaking, people, this is not and cannot properly be a medical discussion, as Robin and others keep asserting. It is not our job to, nor can we, even those of us who are neurologists, re-diagnose Terri Schiavo.
This is a discussion of the law, or should be.
The question of the diagnosis (which is somewhat secondary) and the question of Terri’s preferences (which is primary) were both settled in a court of law. Much has been made in some quarters of Judge Greer’s failure ever to visit Terri, but actually such a visit would have been most improper, and possible grounds for the reversal of his decision. (For the same reason, a juror who, on his or her own, who goes to visit the scene of the accident in question is automatically disqualified.) The rule is, the evidence is all presented in court, and only what comes into the court is to be considered.
The Schindlers had the opportunity to call neurologists of their choice, and they did so. All the neurologists called by the Schindlers agreed about the severity of the brain damage here; two however thought that some therapy might be helpful, though nothing could restore Terri to anything like normal functioning. One was a man widely thought to be a quack. The two neurologists called by Michael Schiavo, and the fifth, a man appointed by the court, all agreed – actually, all five of them agreed – that the brain damage was very severe – and further these three did not think that any therapy would make much difference to Terri’s functioning.
Am I a neurologist? And even if I were, have I examined this patient? I’m not even Judge Greer, who made the decision. He did make a decision, and now we’re all bound by that, whether we like it or not. That’s how we do things here. Robin, if you have a better idea, please feel free to share it, but know that most of us are not ready to turn all decisions in this country over to your unfettered personal certainties.
This case is about two things:
1. Terri’s wish, which it has been found was to disconnect that tube, and
2. The rule of law.
Those who are so violently emoting around how horrible all this is, at this blog, on site and elsewhere, are quarelling with one of these two, usually both. That is, they wish – and I think this is the height of arrogance, by the way – to override Terri’s own wish in the name of some principle or their superior wisdom or something, and they do not accept the rule of law. I devoutly hope that none of these people get loose if I am ever in this condition. So far, it looks as though the rule of law will prevail regardless of this irresponsible hysteria, and for that we should all be grateful.
People who dispute the rule of law, who wish to substitute Their Own Preferences, are really frightening, for obvious reasons.
However, interestingly enough, this case further provides a springboard for a discussion of wider import, like the very interesting question raised by Mary, to wit, just because we have a certain technology, are we thereby required to use it in every case? I’d say No, but that throws us into a position where we have to make some very difficult moral decisions, decisions which we were spared for the thousands of years during which the Terri Schiavos of this world simply died outright of the initial trauma. I’m hoping we have the wisdom, because we’re going to have to make the decisions, whether we want to or not.
medical tests, records and CAT scans fall under PPI. Protected medical information which is supposed to be just that. It doesn’t matter if she is a celebrity. I really don’t see her family suing on her behalf because her information was posted on the web. It shouldn’t matter if you’re Tom Cruise or just a patient in hospice, no one (the genreal public) has the right to view your personal medical information. I sincerelty doubt her husband gave authorization
Brad, I sympathize with your position. Wouldn’t it be kinder just to euthanize her? The only reason I can think of that this is not being done is that it would open a door to behavior which I’m not at all sure we are wise enough to control.
Perhaps that door will be opened, or is open already. That we affirmatively kill some patients. But I’m troubled by it, as I think most people are.
A word too for Mary Schindler. This woman is clearly off the deep end, and probably has been for years, but what she’s been through would derail nearly anyone, I think. It’s a pity that both of Terri’s parents were not able to keep their balance here, and to accept what happened to their daughter now 15 years ago. The articles I’ve read say PVS is like that: the body is there, the eyes are open, random gestures and vocalizations are made, and love and memory fill in the rest. It’s a fantasy, but an extremely compelling one. I don’t doubt for an instant that Mrs. Schindler is telling the absolute truth when she says that every night when she closes her eyes what she sees is Terri’s face as she is starving to death.
Terri of course sees and feels nothing, as she has for many years now. But her mother is suffering unspeakably. I hope Mrs. Schindler finds comfort and peace when this ordeal is over.
victoria, it is possible that this scan was entered into evidence in court, in which case it is a public record. Such introduction waives any confidentiality.
Being one that has study HIPAA quite extensibly, and seeings how I don’t exactly know how the information was leaked, there is something called “incidental disclosure”. If 2 Medical professionals are discussing health information of a patient and someone in the room(having no medical participation in the case) over hears it then it is deemed an “Incidental disclosure”(Which by the way should be documented). It can trickle from there, but becusse the information was not intended for the person that overheard it the blame falls on the person that re-iterates that information on to more people. My guess is a family member, press, police or someone not affilitaed with the Hospice heard, saw etc. the information and pased it on.
Has anyone looked ito the possability of an annulment of Terry’s marrage by
the Catholic Church? There by reverting gaurdianship to the parents
Susan, I agree that we may not be, at least as yet, capable of controlling the affirmative killing. However, we need to get to that point.
My own discomfort eased when i realized, that is what we are doing anyway, we can just do it better.
Our legal rights (at least the federal ones) are basically negative, not positive affirmations. We have the right to be free of abridgement, intrusion, or government action that interferes with certain basic rights. We don’t have an affirmative right to demand the right to basic needs, such as health care, or even food or water or anything else. So, I can demand that I not be required to ingest food. I cannot demand that I be supplied with life ending medicines. In Terri’s case, IMHO, I do not think anyone including her husband would agree to be the direct agent of her death.
As for Terri’s records, in addition to having become public via inclusion in an apparently unsealed court record, the federal law referred to above did not go into effect until much of the material in the case had already been disseminated outside of the hospital or health care provider that had created it. I would also say that, notwithstanding how obnoxious disclosure is to Terri’s right of privacy, in many ways the parties (esp. Michael Schiavo) would likely be doing themselves no favors by refusing disclose it.
Terri’s parents have shown little regard for her privacy by posting those awful videos on the internet.
One of my own grown daughters says that whatever else is done, if something like that happens to her, she absolutely prohibits the internet posting of pictures of her grunting and flopping about.
Yes yes I know they thought it was in a good cause. But this whole business makes me uneasy whenever anyone mentions privacy.
I’m uncomfortable with PAS and euthanasia because of the profound potential for abuse.
Plus, it’s harder to justify them using the most important justification for refusing medical treatment: the right to sovereignity over one’s body that includes the right to refuse any medical treatment. Medical treatment is recognized as invasive; if the patient doesn’t consent to it, it’s battery. You can make a more tangential argument around the right to determine when to end one’s life and exit one’s body, but it’s different from having the right to allow one’s life to end naturally.
But patients do have the right to opt for treatments that ease pain even if they could potentially bring death sooner: enough morphine to slow respiration, for example.
“grunting and flopping about” – You remind of that sicko on tv that said something about “Slobbering all over myself”. Have some respect.
Is potential for abuse enough to say we shouldn’t do it at all though?
My compliments to Ampersand for this excellent blog. The discussions here were outstanding and so were the links. I am not American and had not followed the case until recently. I have read plenty of material here and am grateful for very, very many contributions.
I’d like to raise a point that I have not seen yet debated. Why Terri should not die at her home. I understand she has been in the hospice so long, that for all practical purposes the hospice is her home. And of course to her it would make no difference. However, she is not using medical technology that would not be available in any bedroom, and it would be easy for the hospice to provide personnel for the short period that she is left. This would first of all allow privacy and quiet for every other guest (and visitor) at the hospice. Would make it easier for the police (they’d have to control way, way less people that ask to enter the building). Would, of course, be inconvenient to the Schiavo’s neighbours, but it is now inconvenient to the hospice’s neighbours. As for the partner and the children of Michael, they could of course stay at friends for a few days, or choose to stay at home, it is impossible for me to give any advice on that, but I am sure their life these days is disrupted and it seems to me the extra inconvenience would be small. I am sure lots of people at the hospice would be grateful to be able to go out in the sun with a wheelchair without having to pass through a metal detector and without seeing the slogans and prayers of noisy protesters.
Just a note:
The correct terminology is as follows:
HIPAA (Health Insurance Portability and Accountability Act)
PHI (Private Health Information)
EPHI (Electronic Private Health Information – which is what the CAT scan would fall under)
Being a public personality does not change the rules on PHI & EPHI. Only the patient and/or the patients legally recognized guardian can make the decision to make PHI available to the public.
Yes, Jake, but the law has been in place for less than two years. My understanding is that most of the information floating around was disclosed prior that time. Also, if it goes into court without a protective order, it really isn’t protected anymore, at least not in the hands of non-health care types.
Mrs. Schindler’s most recent (mini) press conference had her openly imploring the following into a media microphone and on broadcast TV camera: (Not verbatim, but very close, as I recall)
“Michael and Jody … I’m begging you … you have your own children … give me back my child.”
I think it continues to be purposeful to examine the specific statements that people make in this case. It is frequently revealing with respect to motivation, bias, perspective, etc. One can’t help but notice a couple things here.
First, the mere act of Mrs. Schindler verbalizing her entreaty directly at Michael implicitly propounds to demonize the man. It’s the same pathetic PR strategy that Schindler family clergyman, Brother O’donnel, utilized last week when he would implore: “… Please, Michael … have compassion …” Part of the intended effect is to present/paint the petitioner as “persecuted” and the respondednt as “controlling and lacking in compassion.”
Second, Mrs. Schindler doesn’t beg for Terri to have the opportunity to enjoy more of her own (Terri’s) life, or speak to the basic pleasures, activities and contributions that Terri has yet to experience and look forward to. Rather, it is “…Give ME back MY child.”
With respect to anyone who has suffered the loss of a family member (I know what it’s like), it’s not callous for us to yearn for unselfishness in our fellow travelers during this life — even at the most difficult times. It’s not cold-hearted to suggest that, after 15 long years, Mrs. Schindler might consider TERRI’s state of existence and TERRI’s possible end-of-life wishes as a significant priority over her (Mrs. Schindler’s) maternal instincts.
Although much easier said than done … if you love someone, set them free. Let her meet God and have command of her every faculty imaginable.
Before hastily assuming that one knows everything there is to know about Terri Schiavo based on the condition of her brain, give some humble and thoughtful consideration to this Boston Globe article by a neurologist at Harvard Medical School:
Susan wrote:
Susan, I had written a reply to a post you made yesterday that somehow magically disappeared, but since you ask let me put in a final $0.02.
This case greatly disturbs me, as I am sure is clear. I am sure that some feel that I don’t have enough “respect” for Terri’s wishes as put forth by her husband. Others I am sure feel that I don’t have enough respect for the law. Be that as it may –
This is always a horrifying decision for a family to have to make. I know, because my family has had to make decisions like this, most recently for my 4 year old great neice, who died on my sister’s – her grandmother’s – birthday. That, like the Schindler-Schiavo battle, was a pretty acrimonious situation. The funeral was absolutely devastating, let me tell you. Truthfully, I am surprised that no one ended up in jail.
My heart breaks for everyone personally involved in the Schindler-Schiavo tragedy. And that is exactly what it is – a horrible personal tragedy that has become a national tragedy involving every single one of us.
I wish with all my heart that these folks had worked this out between them long, long ago. I wish that the feeding tube had never been put in in the first place all those many long years ago. I am specifically not against not initiating treatment in hopeless situations or withdrawing life support – which I define as breathing assistance ie a ventilator, kidney dialysis, pacemaker, etc. – when all hope is lost. Turning off the ventilator is what we had to do for my great neice. But my great neice died of an incurable fungal infection in her lungs. We had no choice. She would never have recovered and to continue treatment was only prolonging her obvious agony.
It is my belief, however, both as one who has gone through this three times (once I was removing my own self from a ventilator) and as a medical professional quite used to reading the charts and the numbers that food and water are not “life support” and should not be defined as such, as they are not in some states.
A patient that is on a ventilator will either breath on his own when it is removed or he will die in pretty short order. Our little one died in under ten minutes from the time the vent was turned off. A patient on kidney dialysis generally has to be dialyzed every couple of days. There is not too much leeway between failure to do the dialysis on time and death. Note that Terri will not die until after her kidneys have failed. A patient that requires a pacemaker won’t live long without one and there are worse ways to go than a heart attack.
As we are all witnessing, death by starvation and dehydration is a LONG process. In a dying cancer patient this kind of death may very well be kind – often cancer patients have no hunger or thirst anyway. For you or me, our pet dog, a starving child in Africa it is a cruel and horrendously painful process. Were any of us anywhere in this land to starve our pets or our animals in this way we might very well go to jail. We are not allowed to starve and dehydrate the most horrendous of killers, sentenced to death and truly deserving of such, or our prisoners of war. Not a single meal can they miss. Death row inmates are usually even allowed to order a “last meal” of their choice. So, my very first problem with this is the manner in which it is being done. I believe this to be a crime against humanity, no matter how “legally” it has been done. That it has been judged “legal” makes it neither morally or ethically correct.
I have many problems with this judgement, many of which I have stated repeatedly. If I had to choose, as a medical professional, given all the he said/she said on both sides, I would insist that there be a new evaluation done by some independent neurologist specifically not associated with any of the various parties that have been involved in this long and bitter war – including all the various organizations that have provided funding on both sides.
Part of the reason that I would insist on that evaluation is because I know just how rapidly medical knowledge changes. Sheer impossibilities this week will bc common this time next year. Even if the CAT we have all been looking at was taken in 2003 it is old. However, my understanding is that no brain imaging has been done since Terri was taken out to California early on ?93 for the experimental brain implants. There was some discussion early on page 1 of the fact that the metal in her head would prevent many types of imaging. If that is the case, this CAT is downright ancient. For all you will hear that brain and nerve tissue don’t regenerate, stranger things have happened. Both Christopher Reeves and I were living proof.
The second half of the reason that I would insist on a new evaluation is that I do not believe that enough has been done by the judge to insure that all parties feel that they were treated fairly and that their concerns were adequately addressed. It is readily apparent that a huge part of the problem goes back to the initial war, whatever that was about. In our legal system parents of an adult child may not have legal rights equal to the husband’s but they most certainly do have moral rights that are the equal of his. Those moral rights should have been accomodated by this court.
Unfortunately, that has not been done. During the time that my little neice was ill and dying, the two families had an ongoing custody battle – very acrimonious – initiated by the mother’s abandonment of the child at the cancer treatment center. Our judge, no matter how bitter the feud, would never in a million years have allowed my sister as guardian to take some – well, many, actually – of the actions that have occurred in this case, apparently from the very day that Felos became involved, starting with the initial notification of the court action to terminate the feeding tube. That was more than 7 years ago. Our judge did not care how conniving or scheming the other party was purported to be from either side. Our judge also specifically did not allow a single red cent of my neice’s assets to be spent on anything at all other than items that directly benefited her. Over his dead body anybody would have paid a single dime in attorney fees out of my neice’s funds, as has been done in this case. And our judge made sure that my neicce had her very own, independent Guardian ad Litem that was a practicing attorney to represent her interests. I believe that had that been done in this case it might have led to a better outcome all around.
There is one other thing that our judge specifically did NOT allow. While he sealed the records from the public, all financial records and all medical records had to be available to the non-custodial mother at all times, on request. I believe that the Schindlers should have had equal access to those records, despite Michael’s guardianship. I think many questions and appearances of irregularities might have been avoided.
I do not believe that Attorney Felos should have been allowed to represent Michael Schiavo, specifically because he has a special interest in right-to-die cases. I would say the same were he associated with right-to-life. I believe that the interests of fairness, justice and judicial equality demand that in situations like these the attorneys involved must be as independent as possible of prejudice. I know that normally one is entitled to the attorney of one’s choice, but I believe in this kind of situation limitations must be placed. Special interest groups have fanned the flames on both sides here over nearly a decade. I think if we want to insure an outcome that everyone is comfortable with then the special interest groups and special interest lawyers need to be kept away.
I am not an attorney – perhaps some one can help here – but it is my understanding that ever since that PVS diagnosis way back when, the Schindlers have been required to prove that Terri could and was improving, not just that she was in some other type of minimally concious state. I believe that to be unfair and unethical when you are talking about the life of an innocent human being. To my mind, the Schindlers should have been allowed to go back to the court at any time – once a year or so – if they felt a new evaluation and judgement was required, just as child support recipients/payees are allowed back in court anew should income change. Terri, after all, is not a criminal.
I stronglybelieve that when the husband announced his engagement to another woman, cohabitated with her and fathered children by her, he should have been removed as the guardian. Our laws give primacy to the spouse in these situations based on “sanctity of marriage.” Our laws also do not allow a man – any man – to have more than one wife at a time. I believe that at least some of what we are basing the whole “marriage” argument is so archaic that it goes back to the days were chattel right along with the pots and pans and that they need to be rewritten. As far as I am concerned, when a custodial spouse commits an action that would otherwise lead to grant of divorce that custody should be removed from the offending spouse. However “modern” we would like to be, our legal structure is based on marital relationships that are understood to be monogamous. We make no legal allowances in divorce court for loving two women and we should make none in spousal guardianship either.
When We the People through our courts are thrust into this kind of decision, a decision that will lead to the life or death of a human being, however disabled that human being might be, that we must never make our judgement on quality of life.
In the absence of any kind of written statement or video and violent disagreement between the parties as to what the wishes might have been, then I believe that we must not choose death as the wish of choice unless it is based on testimony from more than one person who is not related to either party in the conflict. I am greatly disturbed that all of the testimony given credence in this case as to Terri’s wishes comes from the husband himself, his brother and his sister-in-law. Can we say conflict of interest three times fast?
This plea is further nonsense because Michael has no control over the situation at this time. Terri’s tube was disconnected by court order in response to the court’s determination of her wishes. Michael Schiavo can no more violate the court’s order than Mary Schindler can.
Mary Schindler is completely off the deep end, and has been for some time. My sympathies are with her, but I cannot countenance her attacks on her son-in-law, who is probably suffering also.
I’m hoping Terri’s mom recovers eventually, and perhaps even makes peace with Michael, after she’s had a chance to calm down.
Daniela, I like the idea of taking Terri “home,” but Michael by all accounts has been sitting by Terri pretty much non-stop, and given the antagonism (!!) between Terri’s parents and her husband, I’m wondering if having her in their home might be too explosive a situation. Certainly if I were the police chief, and hence charged with preventing assault and battery in this town, I’d instantly nix the idea of setting up this situation.
In response to Jack V….
It has been judged that Terri did not want to live in this state, regardless of whether she may or may not have an extremely limited capacity to connect to her outside world.
What difference would it make? Even if Mr. Schiavo fell under a bus, his wife’s feeding tube would not be reinserted. He didn’t order it pulled out, the court did. The COURT is her guardian now.
[Criticism of Terri’s parents deleted by Amp.]
Robin wrote:
Can we say “Amp has asked over and over that this sort of speculation about family members motives not be posted on his blog?”
Alan:
It’s not cold-hearted to suggest that you please respect my wishes not to put these sort of discussions on my blog.
Robin,
For — oh, I don’t know — maybe the hundredth time within this forum, virtually every credible neurologist has agreed regarding Terri’s diagnosis and prognosis. They have agreed to the view diametrically opposed to yours.
The only exceptions have been neurologists hired by the Schindlers or their surrogates, and religious zealot physicians.
Personal storytelling and laborious tangential rants will never change the facts and lawful procedures in this case.
But, suit yourself, by all means.
Yet another implied diagnosis from a guy who wasn’t there. When they tested the electrical activity of Ms. Schiavo, they found none. And they play music for her all the time and she has no reaction.
So many of these reports are just “well, you know, I had a hangnail once, but I recovered, so let’s not give up on ol’ Terri just yet, okay?” It’s not the same thing, and we do not need to rely on analogy when the actual patient in question has been examined by many reputable doctors, who all agree.
Terri died in 1990. Her earthly remains will be carried away to rest finally in a day or two.
However, I strongly urge all those who disagree with me to continue to rant and wave signs and threaten the lives of judges and compare grieving families with Nazis as long and as hard as they can, because by so doing you are destroying the very movement you claim to support. This phenomenon is well-known on the left; it’s about time the right got a taste of it. I hear Florida may be getting ready for a wholesale clearout of pandering Republicans next election, as they recoil in horror from the freak show in Pinellas Park. That would be good news for all decent Americans trying to live normally in crazy times.
Susan –
At this point reinserting the tube is probably moot. She apparently has not been producing urine for a couple of days, so if not yet in kidney failure then that is right around the bend. After that the tube is too late.
I think I would like to see the court overturn a lot of what is going on anyway – including ordering the tube post haste. I think the only way we will ever resolve the acrimony over this event even as a society is if a brand new hearing is held.
As for removing Terri to her home, she doesn’t really have a home. Michael shares a house with the fiance and kids, the parents and sibs are virtually strip searched even to visit. The judge would have to issue a court order and that isn’t going to happen. I **really** wish that he had been a bit more even handed and thrown them a couple of bones.
Re Mom being off the deep end – ANY mother would be under these circumstances. This is downright horrifying if it is a choice you make yourself, or an event that you cannot control. I have four daughters – one near Terri’s age – that I have birthed and nursed and fed and loved all the days of their lives. I cannot even BEGIN to imagine the horror and helplessness of having to watch your precious child dying in this way.
Acrimony be you-know-whated, this could have and should have been made far and away much easier for them, over and above the husbands objection and it should have been.
Well, Robin, welcome back, and I’m glad we can talk calmly now.
And again,
And again,
But really, Robin, to whom would you expect Terri to confide her wishes but to her husband? And it just so happens that the sister-in-law was Terri’s best friend. (This often happens. When young people are thrown together by friendship, they do tend to intermarry.) Being Terri’s husband and her best friend is a conflict of interest? To whom else would I, a grown woman, tell such things? To my mother? Give me a break. You’re invalidating everything I tell my husband as soon as my mother puts up a stink?
In any case, the court found the testimony “clear and convincing.” So for our purposes, that’s what it is. Hence, this is what Terri wanted, according to what she said.
I submit that if the court had found the contrary, you would not be challenging this testimony, or this way of determining her wishes. In other words, your real problem here is that you disagree with the verdict. That is certainly your right, but if you don’t have anything better to offer I think you can understand that most people will ignore you.
Florida law specifically disagrees with you, listing ANH as artificial life support in the relevant statute. If you are unhappy with this, and you can vote in Florida, you should have a word with your representative. Be prepared, however, to be defeated if the majority of voters in Florida disagree with you, since we do live in a democracy.
We’re not up to regenerating the entire cerebral cortex yet, so far as I know.
If either of you regenerated your cerebral cortex, please contact the New England Journal of Medicine immediately.
Luckily for us all, the State does not yet dictate whom we can hire to represent us. I devoutly hope that day never comes. Your impulse to totalitarian state control is showing through, Robin. Don’t go there, I implore you.
On the basis of their subsequent behavior, I really don’t think there is anything either man or God could do to satisfy the Schindlers, short of getting their way. There are people like that.
In general here, you and much of this discussion is missing the point. Terri did not say, “If I am in PVS pull the tube, but if I’m minimally conscious, don’t.” She wasn’t a doctor, and those diagnostic categories probably hadn’t even been set up then. I haven’t read the trial transcript, but I imagine that what she said was more along the lines of, “If I’m so bad off as not to be able to enjoy life, if I’m seriously brain damaged, don’t just keep the shell alive.”
It is by no means certain, in fact it is quite unlikely, that even if the Schindlers could prove that Terri was “minimally conscious” that anything in the verdict would change.
This is all about what Terri wanted.
Amp, my good man,
I’m afraid you’ve lost it. You have effectively eliminated from your blog all critique — even thoughtful and polite critique — of Michael Schiavo, Judge Greer, Mr. or Mrs. Schindler … who else?
What is left to discuss … HIPPA, … Medicare minutiae?
I notice you are selective in whom you sensor, however. When Susan at #172 states that “Mrs. Schindler is off the deep end, and has been for some time,” you won’t delete. You won’t censor a few other of the female contributors regardless of their statements.
You may have morphed this into a uniquely “Meld with Amp’s opinions and sensibilities” blog. You have turned an open forum concept into Amp’s private (and censored) party.
I wish you courage and fairness.
Alan
I have a couple of random thoughts:
I have to take exception to the notion that Terri is being starved to death. The definition of stavation does include lack of food leading to death, but an integral part of the definition is that there is suffering associated with it. Terri does not hae the brain cells to process the any sensation and turn it in to an emotion that she feels or interprets as unpleasant. So I would argue that while the lack of food is leading to her death, the suffering that occurs is on the part of her loved ones and those who are empathetic enough to imagine what is would be like. And that’s what it is- someone who is capable of experiencing emotions is attributing them to a person who is not able to experience them. This is such a foreign idea to us- it’s like trying to imagine not being. And because she is embodied, all the behavior that is seen is interpreted by our own “filter” of how we read nonverbal communication.
This may be one reason for the administration of medications like morphine- we (the medical staff) are “doing something” that is intervening in what may or may not be percieved as suffering to those capable of having the emotion. Does Terri need it- no, but those watching her die might need the assurance that if there is even one funtioning neuron that might feel pain, it’s receptors are blocked. Just a note on one of the hospice myths- that morphine slows the respirations and hastens death. Opioids (the class of drug that morphine is in) do cause respiratory depression. However, that is with initial doses and it is a side effect that the body overrides after a few doses. After that, even large doses do not cause clinically significant respiratory depression. I have prescibed huge amounts of morphine for opioid experienced (as opposed to opioid naive) patients and it has been other side effects that have been what limits the amount given. Unfortunately, this is still argued and I’ll provide references if desired. The stories of people dying soon after morphine was started are more a reflection of waiting to the very end to start the drug.
Finally, I don’t have answers to the questions I ask and in even trying to answer them, generate more questions. Susan says says it very well:
I’m hoping we have the wisdom, because we’re going to have to make the decisions, whether we want to or not. Forums like this that foster discussions of different points of view and allow for correction of misinformation are important. Our understanding of life is rapidly changing (just mapping the human genome) and things that were accepted as truth will need to be reexamined. And whatever we decide, it will never fit all situations or all people.
In reference to Robins post..
” I do not believe that Attorney Felos should have been allowed to represent Michael Schiavo, specifically because he has a special interest in right-to-die cases”
Why would anyone possibly hire a lawyer who will deend your own position? Maybe Michael S. should be made to hire a right to life lawyer and the Schindler’s to hire a right to die lawyer !
Susan, I understand very well that the situation is explosive, and you may be right that the police chief may not want to find himself in that situation. (Or maybe it would be easier? Aren’t there more limitation on demonstrations in residential areas than in “public places”?) Still, the world has to keep revolving around this little story. Terri is not the first human being to die, in fact, every human being has already died or will die. Specifically, about everybody in that hospice is going to die soon and they and their families have precisely the same right to privacy and quiet than Terri and her family has (in fact, we might argue, they have slightly more, because some of these people are conscious.) Do lots of people, coping with their own serious problems, have to be inconvenienced to accommodate a few persons that, sadly, have turned a terrible event into ? I don’t know enough the laws and regulations of Florida local law so I can’t comment more specifically, but I do think it was awful that someone died alone, which he stated many times he did not want to, because his relative was outside, without her driver’s licence, attempting to explain to security personnel and police and whatnot. Another thing, which is besides the point and also besides the police chief’s powers and also besides the hospice’s personnel powers and even beyond Michael Schiavo’s, but still let me say it: I think it was awful to arrest children “trying to bring water to Terri”. I’d have liked an officer to escort these children in the room with their water, and give them a little spoon. And have the children see Terri, and see that she can’t swallow much and besides hear a doctor or a nurse explain them about aspiration pneumonia. I am sure those kids would not have forgotten.
As everyone can tell, it’s Mary Schindler I feel for, even though I think she’s wrong. Maybe that’s because I have grown daughters myself. How terrible for her.
I certainly don’t think the wishes of her adult daughter should be overridden to make her happy (since I certainly don’t feel that way about my own mother, nor do my daughters feel that way about me, quite properly in all cases) but I hate to see how much she is suffering. It’s truly heartrending. I hope she finds her way to peace when all this is over.
I am not speculating about family members ir their motives here Amp. In medicine and law there are strict ethical guidelines for personnel in those fields that are intended to avoid the appearance of conflict of interest – and hopefully the real conflict of interest. Intended to preserve integrity. Prevents things like lawsuits and overturned judgements. I am simply saying that these are the three people that he credited and whatever the judge based that on, right or wrong, it LOOKS like conflict of interest.
Whatever you think of the parents, it looks to many eyes that they are being treated badly. Might leave a hole big enough to drive a Mac through for a wrongful death suit.
Many of the provisions of this judgement seem unduly and very harshly directed towards the parents. I think the Judge would have done better to bend over backwards, especially in this particular order, to appear merciful and even-handed towards the parents. In fact, had he thrown them a bone now and then in the way of certain things we might not be seeing this tragedy now.
Robin, I have no difficulty agreeing that additional protections for people in Terri’s condition might be appropriate, but there is a clear danger that such “protections” will make it more difficult to carry out a person’s legitimate wishes rather than assuring that those wishes will be honored. A burden can be set too high as well as too low.
The state could forbid the use of funds that were awarded for a person’s care from being used for legal fees, if it so chose. It could certainly ask for testimony from unrelated persons, but I would not favor this — who else do we share our most intimate thoughts with? The sister-in-law is not a blood relative of Michael’s and had nothing to gain financially. It was undisputed that she and Terri had been extremely close friends. The better resolution would be to probe very deeply the memories and context of those memories to adduce inconsistencies that are the hallmark of fabricated testimony. In addition, unrelated people may also have personal conflicts, even if the outcome they desire is motivated by something other than their relationship to the petitioner. So that doesn’t make sense to me — as in, it’s a measure that would just as likely impede as it would be to further the just resolution of these matters.
Terri was provided with a GAL who was an attorney who made recommendations to Judge Greer. This attorney was not Felos, and admitted to being biased against removing the ANH, nonetheless, he was not disqualified for the first hearing because the judge thought that anyone knowledgeable about the subject would likely have feelings in one direction or another. There were two rounds of medical examinations, one prior to the first and the second prior to the second evidentiary hearings. It was the second in which each party chose two experts, and the court ended up appointing the fifth, because the parties’ couldn’t agree among themselves. Even thoug the judge was surprised by the development, he permitted the parents to revisit the issue of whether Terri was PVS — he thought that they had in fact conceded it, but he didn’t hold them to it. If I’ve gotten some chronologies wrong, I’m sorry, but the point I’m trying to make is that I do think that Terri’s parents were treated fairly, and as an attorney I can’t begin to think of any case I’ve ever been involved in where the parties were permitted to litigate and relitigate the same issues. Which is another way of saying that I do think the court was exquisitely sensitive to the fact that the outcome of its decision could be, truly, irreversible.
As to whether Michael should have been given control — let me just say that, although the judge probably had a number of reasonable options (including appointing the GAL, which he did), I do not think giving guardianship to the Schindlers would have been reasonable. I am not bad mouthing them, but if Michael is biased, they are clearly biased in favor of a specific outcome.
I also do not see the qualitative difference that you do between dialysis, ventilators and ANH (particularly the surgically implanted kind). You are removing something that you know is essential to that person’s continued life. The fact that breathing and kidney function are never something that are under a person’s voluntary control (theoretically unlike feeding) just doesn’t seem to me to be a relevant difference from the perspective of the party removing the support. If someone came into their room and removed the support without permission it would be murder regardless of the character of the support. None of these functions is voluntary to the injured party — feeding is no longer voluntary for Terri.
Sue wrote
I pointed out to someone a few days ago that if you are smart you will discuss this particular issue with your mother. As one scenario, what if you and hubby are injured simultaneously, you are left a mess and Mom gets to decide?
On top of that you know, Moms get old and daughters get stuck with the hard decisions. Unless it is a book, a living will is a guideline. You should talk to your Mom about what she wants too, since you are in all likelihood stuck trying to figure out what that might be.
Moms are for putting up stinks – even when daughters are all grown up. Someday you’ll put up a stink too :) Meanwhile, enjoy your mom. When she’s gone you’ll wish she were here to fight with and put up a stink. Wish mine was stinking at me right now – sometimes I get tired of being the Mom.
Courts and juries have been dead wrong hundreds if not thousands of times. When we are talking about ordering a death – even a civil order – then we should apply the same standards that we apply to a criminal death and take evert possible care to get it right. Otherwise the judicial system is just going through the motions – and there is already too much of that.
Then you would be submitting and assuming incorrectly. Had the judge given all credence to the Schindlers while disallowing the sole witness on Michael’s side I would feel exactly the same. Right judgement or wrong judgement, this LOOKS bad.
I do disagree with the judgment. I absolutely disagree on moral and ethical grounds with the manner in which this is being carried out and am ever so glad that I neither work at that hospice nor am manning the police lines. I would simply have to quit my job. This is one order I would never participate in under any circumstance.
Remember though, I also have objections to the manner in which this has been conducted by our judiciary. I carefully my objections. Primarily, I believe that while this may still been contentious, things would never have reached the level that they have had the judge bent over backwards to make the Schindlers feel that he was being fair and trying to grant some of their needs/wishes too.
I would still object to the way in which this affair has been carried out by our judiciary if the decision had gone the other way, things were on the opposite feet. In exactly the same specific points as I outlined.
Well, heck, girl – if you don’t want to read for understanding and want to ignore me, that’s cool. I won’t die.
There are two George’s posting. I’ll use a different name in the future.
This was answered in regard to the impact on the case at hand in post 175, but I’ll also note that no action of a Church can dissolve a civil marriage.
One note to Robin: I would NEVER let my mother make any decisions for me. You assume all mothers are June Cleaver. Well, some are more like Mary Schindler, for whom this is ‘all about her.’ Many of us have mothers like that and recoil in horror from the thought that given a spotlight, they could well become addicted to the publicity and forget the best interests of their daughter as a result.
[Note – please try to make your points without criticizing or discussing the motives of Terri’s family members, from now on. Thanks! –Amp]
No. I also don’t believe that there is a right to suicide. And my support for the right to allow death is based much more on bodily integrity than in a right to decide when your life ends. If forced medical treatment weren’t a violation (here, for example, we’re talking about having a tube inserted into your stomach), I might not have that much of a problem with it. And it holds the same potential for abuse: someone can be manipulated into allowing death just as easily as they can be manipulated into causing death.
But I can’t imagine a scenario under which forced medical treatment wouldn’t be a violation of bodily integrity. It’s like those abortion hypotheticals that involve removing fertilized eggs via transporter nanoseconds after conception and putting them in robot incubators to develop: if every defining characteristic of pregnancy changed, would your feelings about pregnancy change? At some point, the number of alterations that would be required to make a hypothetical into reality are so many that the question becomes tautological: if everything were completely different, then yes, everything would be completely different.
Anyway, back to the topic: Rivka at Respectful of Otters has written some awesome posts about the “Right to Die,” euthanasia, and PAS. She has searchable archives. Most of what I’m gonna say is really just a less-eloquent retread of her thoughts.
Everyone, no matter how healthy, no matter what their prognosis, and no matter how lethal refusal of treatment would be, has the right to refuse medical care. There’s no double standard; a 19-year-old Jehovah’s witness who needs a blood transfusion and a 60-year-old with MS who needs a respirator have the same right to say no.
There is an enormous double standard around suicide, both PAS and euthanasia. No one is arguing that a perfectly healthy 19-year-old has the right to take a lethal dose of barbituates. Lots of people support the right of a 60-year-old with MS to take a lethal dose of barbituates. Many more people have less of a problem letting that person die, even though they would be aghast at the idea of our society allowing a healthy 19-year-old to kill herself, let alone handing her a loaded gun.
And yet, the reasons that sick, dying, elderly, and disabled people have for wanting to kill themselves are the same reasons that healthy people have: they’re desperately lonely, they have nothing to occupy their time, they feel worthless, and they believe that their loved ones would be better of without them.
The first two problems are the result of the way that society treats ill, elderly, and disabled people: they are denied even the most basic social support. If going to the supermarket is a three-hour ordeal, and going to a restaurant is impossible, how much human interaction will you have? What will you do with your time? The second two problems are the result of the way that society feels about ill, elderly, and disabled people: they are constantly told that they are worthless and burdensome. And with a healthcare safety net like ours, sick, elderly, and disabled people get to be burdens on their families.
There is one motive that the sick, dying, and disabled have that healthy people don’t, of course: pain and discomfort. People talk about them as though it’s inevitable, but this is inaccurate. Most hospitals are not well-equipped to care for patients in chronic pain. Many doctors are afraid to effectively manage pain because they could very well get in trouble with the DEA. And caring for the elderly, disabled, and terminal is a low priority overall: it’s expensive, and it’s not like they’re going to recover. I don’t want to sound as though I’m bashing healthcare providers, but we as a society don’t provide them with the resources they need, and their patients suffer because of it.
Until all of these problems are corrected, the “Right to Die” is an abstract question: there is so much pressure to go ahead and die that the possibility of making an independent, informed, self-interested decision is so slight as to be hypothetical.
Barbara –
I can think of a number of laws on our books that apply only to specific groups of people. I think it would be possible the raise the bar substantially in cases like Terri’s without changing the present proposition for everyone else. Maybe something through Social Service or Adult Protection.
I agree with you about testimony regarding someone’s wishes. That is one of the biggest issues that I have with this case. And I don’t think memory probing in any way would really help. Down the road we would just end up with allegations of invented memories.
Unfortunately that GAL was removed from the case – at Michael’s request from what I have seen reported. I believe that given her condition and the acrimony and out-right warfare between the parties that she should have had a GAL right up to this very day.
RE the PVS hearings, I do understand that the judge has looked at this a couple of times. But you are talking medicine here and in particular a syndrome – a set of symptoms that cannot be quantified or otherwise scientifically proven. The PVS diagnosis is entirely in the eyes of the observer. Things change – and in medicine they can change from one day to the next. PCR – a technique that duplicates DNA – was invented in 1988 or89. It was in regular lab use by 91.
When you go to the doctors you get weighed and measured. They take your temp. Go back next week and they will do those things all over again. Things change. Patients magically recover against all the odds. New meds, new surgeries. It would have hurt nothing whatever to have a new and independent assessment within the month or two immediately previous to the death order – and might very well have avoided a ton of conflict. Not to mention, the public is then assured that you have done every single thing possible to reach the correct judgement in fairness.
This judge has known for a long time that he was dealing with a very high profile case that had nowhere to go but up. While you, as an attorney, may be satisfied with the result, the general public doesn’t have your inside knowledge. To lots and lots of ordinary people this LOOKS (note I am not saying IS) like the judge made up his mind long ago and the rest is nothing more than a footnote on the railroad track.
The judge should have known that was coming even if only from Court TV reruns and bent over backwards to insure that there could be no accusations that he was prejudiced in any way. As an example, he could have easily allowed them to take pictures or forced a Catholic burial in Florida rather than cremation. Lots and lots of what has gone on over the last 13 days and some of the extremely insensitive words from Felos have convinced a tremendous number of people that this was, well, frankly a railroad job. Again, I am not saying that it IS this – I am saying that it LOOKS like this to ordinary people. And it is ordinary people who vote, who can recall him from the bench, etc. The stink is not going to go away the minute Terri dies – the stink is just then going to begin, you know.
RE Qualitative difference – well, you know there are lots of ways to die. A nice big oak tree at 100 MPH doesn’t hurt much, or if it does it is over quickly. A patient that is going to die if you disconnect a vent will usually do so in minutes. Dialysis patients already have fragile systems and kidney failure. Not as nice as the first two, but not a thing of weeks either. It isn’t about whether a vent or a dialysis machine or a feeding tube are all equally defined as life support. It is about the results of discontinuing the life support.
When you remove a feeding tube from an individual that does not otherwise have some acute illness that will kill the body (PVS doesn’t count. Something like Aids) then you are looking at weeks until death occurs. To an AIDS patient that might not matter – often they cannot keep food down anyway. To an otherwise healthy individual – or let me use the word body here – this is a long, drawn out, excruciating death if that individual is sentient.
Now, if Terri really is a “vegetable” and truly can feel absolutely nothing at all of any kind, then she should feel nothing. There is no need for morphine – no pain. To soothe labored breathing doesn’t cut it – that speeds heart failure and thus the demise.
But what if the doctor is wrong? Doctors are wrong even more often than judges. Even experts. Even collectively. What if the very premise of PVS is wrong and those patients do feel pain? (I remember lots of things they didn’t used to use painkillers for that we wouldn’t think of doing today.) Remember, syndromes come and go. They are entirely subjective and constantly being redefined and subdivided. If any of those are the case, then we are not giving Terri a peaceful, easy death – we are (I hate to use the word) torturing her while she dies.
Would you want to be the one to authorize that? Or the one to carry out the order? Or the one to stand guard on the porch? Or the one to answer to a higer power? Not me.
A dog has no awareness of self either. Starve your dog and see where you end up. People can get 20 years for that up here.
I am reasonably sure that I would not want to see the Schindlers senior as guardians either. Done correctly guardianship for a profoundly disabled individual is at best very stressful. And they are clearly getting on up there age wise. I’m not so sure they could stand the stress. The brother seems a good egg though. And of course there is always a third party.
Here is the 11th Circuit decision denying the last minute appeal. Judge Birch’s concurrence is as good a primer in federal jurisdiction and the checks and balances inherent in our government as you will get. I would highly recommend reading it.
11th Circuit opinion.
Well, personally I’d trust my husband to look out for my interests much more than my mom. Not everyone’s parents are rational and trustworthy. ;-)
I’d disagree mightily with that. Dogs, cats and other mammals may not have reasonsing abilities (or only minimal reasoning abilities) but they definitely have self-awareness.
One question to participants here. If there is a post mortem autopsy as promised, will you abide by the medical findings? Or will you question them based on your own pre-conceptions of the case? And if you have reason to attack the bona fides of the Pinellas County Medical examiner, let us know now.
I’d like to get this out now.
Barbara, one more thing about that feeling pain:
Did you ever look at someone in a wheelchair and think something on the order of _ Ok, paralyzed, can’t move it, can feel anything, doesn’t hurt?
I used to think that. Many people do. But then about 20 years ago I got run over by a drunk. Long story shortened, I ended up with 4 broken cervical nerves and my entire upper right quadrant was paralyzed. They said broken nerves don’t heal and I would be paralyzed for life. My right breast rested on my hip, my arm dried up to a stick about 1-inch diameter and wouldn’t stay in the socket so I had to wear a leather halter thing to hold it there. I could have put that arm into bonfire and never once felt a thing. I had to learn to tie my shoes with my left hand and my teeth.
That was when I learned that I was almost right about those paralyzed people in wheelchairs. Can’t move it – check. Can’t feel it – check. No Pain – welll maybe not. I had such horrendous pain that I had a never ending supply of morphine, which did absolutely nothing but make me so stoned I didn’t care if it hurt.
That’s probably the biggest reason I am not willing to accept without doubt the premise that Terri can feel no pain. Feeling pain and showing a response to it are two different things.
BTW, the doctors were dead wrong. Nerves do sometimes grow back. Been typing again 19 years and turning cartwheels for 18 or so.
I believe/don’t believe; I think; To my mind; My belief: 15 times
I know; I’m sure; to my mind/understanding; As far as I’m concerned: 6 times
I would; I have; I had: 7 times
I am/was/were: 8 times
My; We/Our (personal references): 14 times
— Pronoun and phrase usage from a single essay: #171
So in essence, I’m reading that Robin is saying:
An attorney that specializes in right to life/death issues is in conflict of interest if he represents someone in a case of right to life/death issues?
And, in the case of New Mexico Guy;
You’re seriously going to sit here and compare a relationship of an infant and mother where the infant is healthy and developing to that of a 41 year old woman with severe, if not complete and irreversible brain atrophy and a mother that is unwilling to let her go? I can only say it’s pretty darn audacious of you to call others sicko’s if that’s how you really see it.
The entire post mortem autopsy thing is a smokescreen. The autopsy *may* show any broken bones, though from 15 years ago – iffy.
Neurologists have a hard enough time attempting to decide what is going on with a brain that they can test and image. One that is removed from the head, weighed and cut up will tell virtually nothing other than was there brain damage.
We already know that there is brain damage, at least some of which is due to that old surgery. What effect that brain damage had on Terri is impossible to determine from an autopsy. Particularly the effedct of a syndrome – which by definition has no diagnostic features that are not based on patients reactions/interactions. The best we can do is say something on the order of the patient died of a cerebral hemorage – that likely won’t apply to Terri.
RE the Pinnelas County Medical Examiner. Don’t know him. Don’t know of him. But back to how things LOOK here. Husband works for the county. Medical Examiner works for the same county.
For acceptance of results with few whispers of collusion autopsy would best be performed by the Chief Medical Examiner of the State of Florida, ideally with a third party pathologist expert who is not from Florida.
None of that has anything to do with my preconception of the case but rather my knowledge of autopsies –