Not only was that wrong of me, but it’s the sort of thing I usually try hard to avoid. Again, I apologize to Robert Johansen, and I’ll try to do better in the future.
I know I said that I wouldn’t be posting about Terri Schiavo again. Well, I was wrong. I’ve seen so many references to Rev. Robert Johansen’s National Review article about Terri Schiavo – and the article itself is so irresponsible, full of distortions, outright lies and character assassination – that I can’t resist commenting on it.
At the start of the article, Rev. Johansen claims that Terri has been badly cared for. The proof? She’s had decubitus ulcers (or, as most of us call them, “bedsores”), which Rev. Johansen claims are “a classic sign of neglect.” But in fact bedsores are difficult to prevent absolutely; even a patient receiving excellent care can occasionally develop a bedsore (Christopher Reeve died from a bedsore-related infection). In just a single year, 13% of nursing home patients develop bedsores, and it’s been 15 years for Terri.
If anything, Terri’s relative lack of bedsores prove that she’s been well-cared for. From the neutral guardian ad litem’s report (pdf file):
[Terri’s parents] made allegations that [Michael] was not caring for Theresa, and that his behavior was disruptive to Theresa’s treatment and condition. Proceedings concluded that there was no basis for the removal of Michael as Guardian Further, it was determined that he had been very aggressive and attentive in his care of Theresa. His demanding concern for her well being and meticulous care by the nursing home earned him the characterization by the administrator as “a nursing home administrator’s nightmare”?. It is notable that through more than thirteen years after Theresa’s collapse, she has never had a bedsore.
Rev. Johansen also suggests that the fact that Terri needed dental care (she’s had a few teeth pulled) proves she’s badly cared for. But Terri was a bulimic (although Rev. Johansen doesn’t mention this) ; bulimics can have have tooth rot problems for years to come, due to having destroyed teeth enamel. Even ordinary adults can have tooth problems; given Terri’s history, that she’s had teeth pulled isn’t evidence of anything.
Terri’s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging).
That Terri has never had an MRI is Johansen’s major complaint. Johansen goes on to quote a number of hand-picked neurologists who say that they’d never diagnose without an MRI, and wrings his hands a lot over the moral horribleness of ever making a diagnosis without an MRI.
The problem? Johansen appears to have bungled his research. Two separate sources – one from a doctor who has examined Terri, and one from a right-wing website strongly opposed to letting Terri die – confirm that an MRI was performed on July 24, 1990. According to the right-wing website’s timeline, the MRI showed “Profound atrophy w/ very atrophic appearing cortex. Mild white matter disease, anoxic/hpoxic injury.” Nothing in that makes a diagnosis of “permanent vegitative state” surprising.
It’s true that no more MRIs have been conducted since 1990. One reason for this is that Terri had experimental implants put in her brain in 1990, which make it impossible to perform another MRI. Rev. Johansen implies in his National Review article that there’s no good reason not to remove the implants, but this is questionable. As an internet writer argued on Metafilter:
Taking out a thalamic implant involves going deep into the brain (the thalamus is basically located right in the middle) to take the implant out. Going to the thalamus means going through brain tissue on the way to the thalamus…which usually involves destroying some tissue on the way to the thalamus. It’s likely that tissue would be destroyed in this surgery…and if the whole point is to keep whatever is left of her brain intact, this seems like a mistake.
Obviously, I’m not claiming some writer on the internet is a medical authority (neither is Rev. Johansen). But what this writer says is both logical and consistant with what I’ve read elsewhere. More importantly, there is no such thing as risk-free brain surgery; and few responsible doctors would recommend brain surgery that was not necessary. And this surgery simply isn’t necessary.
As Dr. Cranford wrote, explaining why no MRI or PET scan was recommeded after 1990:
An MRI was never recommended because, in this case and other patients in a permanent vegetative state, the CT scans were more than adequate to demonstrate the extremely severe atrophy of the cerebral hemispheres, and an MRI would add nothing of significance to what we see on the CT scans. Plus the MRI is contraindicated because of the intrathalamic stimulators implanted in Terri’s brain. A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG’s were more than adequate to diagnose PVS to the highest degree of medical certainty.
At this point, based on an MRI, years of CT scans, multiple EEGs, and their own neurological examinations of Terri, eight different board-certified neurologists (Dr. James Barnhill, Dr. Garcia Desousa, Dr. Thomas Harrison, Dr. Jeffrey Karp, Dr. Vincent Gambone, Dr. Melvin Greer, Dr. Ronald Cranford, and Dr. Peter Bambakidis) have concluded that Terri is in a Permanent Vegitative State.
Although other neurologists – usually based on nothing more than seeing out-of-context video clips of Terri – have questioned this diagnosis, or suggested that further examination might be useful, these doctors have never done a neurological examination of Terri; and they have not looked at her MRI, her CT scans, her EEGs or her medical records. Of those who have made public affidavits, none address Terri Schiavo’s medical issues in any serious manner (Rivka, who has a doctorate in clinical psychology and has completed a year-long practicum in clinical neuropsychology, has a detailed critique of the affidavits).
Considering only the opinions of board-certified neurologists who have examined all of Terri’s medical records and who have given Terri a neurological examination, eight have determined that she is in a persistant or permanent vegitative state (PVS). Only one – Dr. William Hammesfahr – has said otherwise. However, Dr. Hammesfahr appears to be something of a con man. For example, he frequently claims to be a nominee for the “Nobel Peace Prize in Medicine,” a claim that’s simply not true. He has repeatedly claimed that he has cured patients with conditions similar to Terri Schiavo’s – but he was unable to name a single such patient when put under oath. In 2003, the Florida Board of Medicine found that he had charged a patient for providing medical services he hadn’t actually provided, and fined him over $50,000 (mostly in adminstrative costs). Although he says he can perform cures other neurologists would find miraculous, he has never published evidence of his amazing results in a peer-reviewed journal. (His theories have, however, earned Dr. Hammesfahr his own entry on quackwatch.org). Nor has he ever explained how it is that a MRI, multiple CAT scans, and multiple EEGs of Terri’s brain can all be so mistaken.
This is not the record of a doctor whose opinion should be taken above the opinion of eight of his peers. And aside from Dr. Hammesfahr, every doctor who has personally given Terri a neurological examination has found that she’s in a PVS.
Of course, Rev. Johansen might respond that in his article, he showed that Dr. Cranford, a highly-respected neurolgist who testified that Terri is in a PVS, has a record just as checkered. There are two essential differences. First of all, Dr. Cranford is just one of eight neurologists who have examined Terri and diagnosed her PVS, whereas Dr. Hammesfahr’s opinion stands alone. More importantly, what I’ve said about Dr. Hammesfahr is actually true, while what what Rev. Johansen said about Dr. Cranford is not.
First of all, Rev. Johansen points out that Dr. Cranford has been involved in many legal cases involving the question of withholding medical treatment (including feeding) from PVS and other severely incapacitated patients. That’s meaningless; Dr. Cranford is a prominant expert, so of course he’s been a witness multiple times. Rev. Johansen also points out that lawyers don’t call doctors as witnesses if the doctor’s diagnosis doesn’t suit their case, but that doesn’t say anything one way or the other about a testifying doctor’s credibility. (My father has frequently been hired as an expert medical witness in lawsuits involving hearing loss; he examines the patients and makes his diagnosis, and then the lawyers decide to call him to the stand or not. Nothing about this process means that expert witnesses are being dishonest; this is simply how our legal system works).
Rev. Johansen’s misinformed attempts at character assassination aside, is Dr. Cranford’s diagnosis unreliable? Rev. Johansen says it is:
In cases where other doctors don’t see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford’s assessment.
If true, this would be a very serious charge, and a legitimate blow against Dr. Cranford’s credibility. But it doesn’t appear to be true. According to Dr. Cranford:
The record is very clear that I did not testify that Robert Wendland was in a PVS, and the same applies for the case of Michael Martin in Michigan. Both these patients were clearly not PVS (see Broder AJ, Cranford RE. Mary, Mary, Quite Contrary, How Was I to Know? – Michael Martin, Absolute Prescience, and the Right to Die in Michigan. University of Detroit Mercy Law Review, 1995; 72:787-832. and Nelson LJ, Cranford RE. Michael Martin and Robert Wendland: Beyond the Vegetative State. Journal of Contemporary Health Law and Policy, 1999;15:427-453). In all the major right to die cases on a national level in which I have testified or been heavily involved with (including Brophy, Rosebush, Torres, Cruzan, Busalacchi, Ellison, Butcher, Martin, Wendland, and now Schiavo), my neurological diagnosis and the final opinions of the courts were identical (except for some legitimate differences of opinion on the degree of cognitive functions in Wendland). So my record stands for itself.
I’ve found and read a copy of Dr. Cranford’s 1999 article about Robert Wendland. Reading the article, it is perfectly clear that Dr. Cranford considered Mr. Wendland to be in a minimally conscious state, and not in a PVS. Consider this quote from Dr. Cranford’s article:
In other words, being kept alive in the minimally conscious state may be far worse for the individual than being maintained in the vegetative state. Judge McNatt was painfully aware of this aspect of his ruling: “It still can be debated whether [Mr. Wendland’s] life is being preserved or he is being sentenced to life [by my order].” In Mr. Wendland’s case, the “life sentence” is to an indefinite term in a prison of solitary confinement, unable to reach out to other persons, unable to express himself, unable to even move, possibly deeply frustrated by being stranded in a diminished life he never wanted, yet able to suffer to an extent ultimately known only by him. With the minimal degree of awareness that gives him the capacity for pain and suffering–the precise extent or nature of which is unknown to others–the minimally conscious patient potentially poses a much stronger case for allowing death than the vegetative patient does due to the principle of mercy.
Dr. Cranford is an expert, well aware of the difference between a “minimally conscious” patient and a patient in a PVS. Nor would Dr. Cranford ever describe a PVS patient as “frustrated” or “able to suffer.” Contrary to Rev. Johansen’s claim, it’s clear that Dr. Cranford described Mr. Wendland as being in a minimally conscious state, not PVS.
In addition, I’ve read both California Supreme Court decisions relating to Mr. Wendland’s case; neither one supports Rev. Johansen’s implication that there was controversy over if Mr. Wendland was in a PVS. Neither one of them supports Rev. Johansen’s implication that Dr. Cranford’s diagnosis was disagreed with by the Court.
In short, Dr. Cranford’s claim is consistant with the available evidence, whereas Rev. Johansen’s is not. Unless Rev. Johansen can produce real evidence to back up his claims about Dr. Cranford, it appears that Rev. Johansen’s most serious accusation is either incredibly irresponsible reporting or a flat-out lie.
Rev. Johansen also cites a medical review article:
Because of these difficulties, the American Academy of Neurology has made it clear that it can take months for a physician to establish with confidence the diagnosis of PVS. A 1996 British Medical Journal study, conducted at England’s Royal Hospital for Neurodisability, concluded that there was a 43-percent error rate in the diagnosis of PVS. Inadequate time spent by specialists evaluating patients was listed as a contributing factor for the high incidence of errors.
The main factor – listed in “key points” at the top of the article – that led to misdiagnosis was a severe loss of eyesight: “Many patients who are misdiagnosed as being in the vegetative state are blind or have severe visual handicap; thus lack of eye blink to threat or absence of visual tracking are not reliable signs for diagnosing the vegetative state.” There is, as far as I can tell, no evidence at all that Terri Schivo is blind or near-blind.
Nor is there any evidence that any of the patients discussed in the British Medical Journal article have CT scans or EEGs that look anything like Terri’s; none of the cases discussed in the article are described as including a misreading of scans or EEGs. Nor were any of the misdiagnosed patients examined and diagnosed by eight different neurologists, and in turn examined by at least two Courts. In short, Ms. Schiavo’s case is not at all comparable to the cases discussed in the BMJ article.
It’s notable, however, that the article – an extremely expert discussion of diagnosing PVS – no where supports Rev. Johansen’s claim that PVS cannot be diagnosed without a MRI and a PET scan. Apparently, it doesn’t bother Rev. Johansen that his hand-picked “experts” are out of harmony with the British Medical Journal article Johansen himself cited.
* * *
Reading though this article, I’m stunned by the amazing indifference to truth Rev. Johansen displays. Maybe he’s convinced himself that it’s moral to bend the truth (or to lie) in service of a higher cause; maybe he’s simply so dedicated to his cause that he’s convinced himself of things which simply aren’t true. But even if his motives were good, all he’s done is to further lower the debate into lies, half-truths, and character assassination. Nice job, National Review.
Some links via Respectful of Otters. Also, check out this op-ed piece by a “lifelong Republican” doctor outraged at some of the fake medicine that some conservatives have practiced recently.
UPDATE: And also check out Riffle’s thorough post on Dr. Hammesfahr. Apparently, the good doctor has created his own “journal,” in which he publishes articles by himself.
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Great job on this. It’s amazing how much disinformation is going on. Distressing.
Dr. Hammesfahr is even worse than you point out above. He appears to have set up a faux-journal where he publishes, since he can’t get published in real medical journals.
http://riffle.blogspot.com/2005/03/hammesfahr-redux.html
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Excellent job – it’s beyond unfortunate how inaccurate the information distributed by the “keep Terri alive” faction is. Thanks for your research and reporting on this.
Excellent article. I just wanted to offer one additional observation: that even the doctors cited in the NRO article, who allegedly call for an MRI to diagnose Terri’s case, themselves concede that a CT scan can be determinative when it indicates massive damage.
Dr. Morin: “A CT scan is useful only in pretty severe cases… For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.”? Dr. Zabiega: “In order to see it on a CT, you have to have massive damage.”? Apparently, neither of these doctors was shown a copy of Terri’s CT scan, or was aware of the fact it DOES, according to all credible medical testimony, show precisely the kind of massive damage they were talking about.
Very interesting article, thank you very much for it. I would also like to point out that Rev. Johansen should be careful about accusations he is going to throw at someone, even in a moment of passion, because he could very well be setting himself up for a major lawsuit for slander and character/reputation assasination.
People need to realize, if you are going to accuse someone of anything, you better make sure you have your facts right, and that you are above suspicion yourself.
I would sure be interested to see the skeletons hiding in the closets of all these people who would love to deny people their basic rights on how they want to live, or die.
I think it is sad that both sides drag out all the “expert” opinions regarding PVS, when the REAL issue is whether Terri Schiavo actually expressed a desire to die in this situation.
Even Judge Greer in his 2000 decision (allowing Michael Schiavo to have the feeding tubes removed) noted the reliability of the government-appointed Guardian ad Litem’s conclusion that “Micael Schiavo alone, due to his potential conflict of interest, was not able to provide clear and convincing evidence to support the granting of his petition.”
Why is there a question as to the proper course of action when: a) there is no financial burden on the family, b) Michael Sciavo has clearly moved on (with his common-law wife and children), and c) there is no conclusive evidence that Terri Schiavo prefered death in her present circumstance.
Should we not err on the side of caution? Once she is dead, there is no turning back.
Interesting article, but if Dr. Cranford is correct, then what does it matter that Terri is PVS? Dr. Cranford would potentially support extinguishing life support even if she wasn’t.
This seems to make the debate over her PVS condition a bit disingenuous.
Doesn’t anyone find it disturbing that Dr. Cranford’s default position that someone in a minimally conscious state would potentially be frustrated and fearful as opposed to happy to be alive? If he doesn’t know either way then what’s the point of him offering a position? I certainly hope judges that permit him to testify on that are seeking out the basis he has for rendering that opinion.
If you just have to guess as to how someone values their life, as opposed to being able to ASK them, and you contend that your guess should be determinative of whether that person lives or dies, then you’d better have something to back it up.
Having read now the Wendland and the Martin opinions I can say I’m seriously disturbed that anyone would testify, PVS or not, that the cognitive functions demonstrated there were meaningless.
Consider this from Martin:
This testimony and affidavit cannot be viewed in a vacuum. There was also testimony from two of Mr. Martin’s co-workers, stating that Mr. Martin’s present condition is not the type referred to in conversations with them before his injury. Dr. Kreitsch testified that Mr. Martin seemed content with his environment. Dr. Kreitsch, several therapists, and several lay witnesses testified that Mr. Martin could respond to simple yes or no questions by nodding his head. They also testified that he indicated a no response when asked if he ever felt that he did not want to continue living.
This is also from Martin:
“But the bioethics committee concluded that
“the persistence of [Mr. Martin’s] condition and the level of functioning were equivalent to a persistent vegetative state for purposes of considering the removal of nutrition support . . .”
While not vegetative, Michael has minimal cognition and essentially no ability to communicate. Additionally, as one physician testified, when lay persons express a desire not to be a “vegetable,” they usually are not referring strictly to a persistent vegetative state. Rather, the popular understanding involves a “spectrum of things, but the commonality of that is, independence of life . . . things in terms of basic needs of human body, -bathing, eating and able to void.””
If it had ever in any way been up to Dr. Cranford to decide, then you’d be correct, perhaps.
However, it’s not Dr. Cranford’s decision. It was the decision of the Court – and, the way things played out in court, whether or not Terri Schiavo was in an irreversible PVS was relevant.
With a womans life on the line and conflicting evidence from both sides, some updated testing (e.g. PET, MRI or fMRI) would help clear the air rather than this morbid wait for the woman to die in order for an autopsy to be performed. It is disturbing that Judge Greer is being so inflexible when it comes to conducting these additional tests when the record states that the last CT scan was performed in 2000 and the last MRI in 1990. The brain, like any other organ is capable of some regeneration, and contrary to the dogma for many years, neural stem cells have been identified to exist in the adult human brain.
I am appaled to see the Terri’s family begging the husband to relase her in their charge. I see no reason why he should not immediately do this.
The point is that while a scurrilous charge has been lobbed against Dr. Cranford, the truth as he appears to admit it is far more distasteful.
My interest in the Schiavo matter has always been more in what this case would mean for the future than what it means now. I’m not particularly interested in Dr. Cranford’s qualifications here because he was one of many offering a substantially similar opinion on Ms. Schiavo and because, while I personally have doubt that the evidence adduced constitutes clear and convincing evidence of what Terri’s decision would be here, I’m willing to admit reasonable minds can disagree.
As you yourself once pointed out:
” Terri Schiavo is dead, and has been dead for years; to compare her condition to folks who are alive and disabled is, it seems to be, an insult to disabled people everywhere. (Obviously, many disabled activists disagree with me).”
It is an insult, and yet, as noted in the Martin dissent, experts advocating the termination of Martin’s life support had done just that. A doctor that would indicate that a man who can answer yes or no questions and shows the cognitive functions demonstrated in that case yet still would maintain that those functions are the “functional equivalent” of PVS isn’t showing a lot of respect for that diagnosis or what it means.
Irrespective of its application to this case, the PVS diagnosis doesn’t seem to matter much to Dr. Cranford in the larger scheme of things.
Links to both the Martin and Wendland opinions are available on the web, by the way.
It is encouraging to see so much accurate information in a single location. For whatever reason, I have been following the case fairly closely over the last two weeks and have gone back to read far more of the primary source information than I should have. I would like to further address two issues-
1) Further testing to clarify diagnosis
Most importantly, this debate is a red herring. She is how she is, judged by all reputable neurologists to be incapable, now or ever, of interacting with the world. It is a stretch to assume, after 15 years without improvement, that anyone would chose to live in one condition but not the other.
Even if there is any relevance to the discussion, consider for a moment whether there is any utility of doing further testing in Mrs. Schiavo. Only a small number of studies have looked at functional imaging (PET, function MRI, etc) in persistent vegetative states; these studies only offered potential explanations for why a person was unconscious (i.e., which wires were out). There are no published studies telling us such imaging techniques actually are diagnostic or prognostic. There is no proof that a “positive test”? would predict anything. If you don’t know what the results of a test mean, it is a useless test.
In fact, a working party of the Royal College of Physicians stated that distinctions between minimally conscious state, chronic vegetative state, and other similar clinical entities “are made primarily on clinical grounds. Brain imaging… often helps to clarify the cause (emphasis added) of these clinical syndromes, but the findings on imaging are not specific….Sophisticated techniques used to assess cortical function – positron emission tomography (PET), electroencephalography (EEG), magnetoencephalography (MEG) and evoked potential (EP) studies – can be used to shed light on the physiology of the VS, but are not yet routine diagnostic tools. Their use is not required for diagnosis of the VS, which remains essentially clinical.”? (The vegetative state: guidance on diagnosis and management. Clinical Medicine 2003. 3(3):249-54.) To translate- to establish the diagnosis, you need to perform a physical exam, not order a bunch of tests. Multiple physical exams have been performed by neurologists and all, save one with flimsy credentials, agree she is in persistent vegetative state.
2) I cannot count the number of times people have made comments like “I am appaled (sic) to see the Terri’s family begging the husband to relase (sic) her in their charge. I see no reason why he should not immediately do this.”? There is a very easy answer to this- she would not want to live this way. The court, in the first trial, expressed surprise at how little discrepancy there was in the testimony regarding whether Mrs. Schiavo would choose to live this way, concluding there was “clear and convincing evidence”? she would not.
The disabled should not be considered pieces of meat to pass around. Always “erring on the side of life”? steals away freedom from those not able to voice their wishes- “To presume that the incompetent person must always be subjected to what many rational and intelligent person may decline is to downgrade the status of the incompetent person by placing a lesser value on his intrinsic human worth.”? (Massachusetts Supreme Judicial Court, Belchertown v. Saikewicz, 1977) If the incompetent retain their freedom of choice, then we must develop a mechanism to judge their wishes.
Our system, prior to recent legislative interventions, required that an independent arbiter be presented “clear and convincing”? evidence of the patient’s wishes. I am not sure there is a better way to protect both the lives and freedom of those unable to protect themselves.
Any way you slice it, the court is starving and dehydrating a handicapped woman to death–essentially because she is handicapped. No rational person would base a life/death decision on an alleged, unwitnessed comment made while watching a TV program. The idea that Terri Schiavo gave consent to be starved/dehydrated to death is absurd–at least on the basis of the evidence I have read. I think the court accepted that “evidence” because Terri Schiavo’s life was seen as less valuable than that of others. If we happen to kill her by error, it’s no big deal.
As a psychologist, I’ve evaluated quite a few individuals with severe mental and physical handicaps. It can be extremely difficult to assess a person’s cognition, and when there are severe physical limitations, it is always a guess. I’ve not seen the CT scans or (1990)
MRI, and would not be qualified to read them if I did. I am struck however, by Dr. Cranford’s oracle like ability to give definitive statements about a patient’s inner life. Despite the acknowledged complexity of diagnosis (of course, he would likely claim it is simple) he did not spend extensive time examining this woman. I suspect it is because he was uninterested in looking for reasons to support keeping her alive. He is on the record as advocating the euthanasia of such individuals, and clearly believes they are now “dead” and are no longer persons.
Some individuals are offended when it is noted that this rhetoric is reminiscent of the Nazi era. If you are offended by such comments, at least do some research on that era and you will see that talk of “life without meaning”, “vegetative life”, etc. was essentially identical to the current rhetoric. As Dr. Wolfensberger, an expert on mental retardation has noted, it was largely the medical establishment (including physicians and psychologists) in the 20’s and 30’s that promoted the eugenics movement. Prominent members of academia and medicine supported and promoted the killing of mentally handicapped and mentally ill individuals, before the Nazis appropriated the technology to execute Jews.
This same language that is being used now, was used then. Words have meanings and consequences. This rhetoric has led to the killing of handicapped people in the past, and if it goes unchallenged, will have similar consequences in the future. That’s why this is no trivial matter. Killing innocent life is never a small matter. This public killing of a handicapped individual is not a small step, but quite a large one. Those with compassion for the “weak and disenfrachised” should carefully consider the precedent which is being set. At the risk of being labeled a religious fanatic–God help us all.
Tom,
you are doing the disability rights movement an incredible disfavor if you connect a persistent vegetative state to the “handicapped”. As a handicapped person I don’t want to be lumped in with a mindless shell. And it’s interesting that you had to throw the Nazi-bomb despite that there weren’t even any PVS patients in the 1930’s. With that level of medical technology, if someone suffered an injury back then that would lead to a PVS today, they died before they could even evolve into a PVS. Dilemmas around permanent unconsciousness are an ancillary result of better intensive care.
Hitler didn’t give a rat’s ass about quality of life and living wills. To liken his “get rid of everyone who can’t get me to Moscow” politics to this politicized family dispute is unhistorical and, indeed, offensive.
So why should we listen to you? Don’t mean to be rude, and I’m certainly not qualified to read them either, but I do see the difference between petitioning a court to examine the circumstances of what Terri Schiavo would have wanted, holding not one but two separate evidentiary hearings, and the Nazis’ wholesale, unilateral determination to start killing “inferior” beings. False analogies like this are usually thinly disguised insults.
Of everything I’ve seen and read about this terribly sad story, the armchair diagnoses and and substitutions of judgment as to what a reasonable person would believe are particularly offensive. The idea that Judge Greer “wanted her dead” is ridiculous — he was randomly assigned this case. He had no dog in this fight (as we like to say in Georgia). He listened to a great deal of evidence, not only from Michael Schiavo but friends and family as well, as to what Ms. Schiavo would have wanted under these circumstances. The evidence that we have read is not the evidence Judge Greer and the subsequent courts have had before them. If the record reflected that Judge Greer simply viewed Ms. Schiavo as disposible, subsequent review would have revealed such a bias and ordered a remedy for it. The fact that utterly no court of appeal that reviewed the case found such error means none existed — unless you’re implying the entire Florida court system, Eleventh Circuit and Supreme Court *all* believed Ms. Schiavo was disposible because she was handicapped.
You’re absolutely correct when you say “[w]ords have meanings and consequences.” “Compassion” is a good one. My brother had colon cancer which ultimately claimed his life. We openly discussed with him his wish that, if his condition deteriorated to a point where he was either in pain or so significantly impaired that the quality of his life was no longer worthwhile, we help him die. My family agreed then, and I believe now, that sometimes “compassion” means understanding that the interests in promoting the quality of life might outweigh the interests in promoting the quatity of life.
Otherwise-healthy normal 26 year olds don’t think they’re ever going to die, and the importance of a living will just isn’t something they think of. But to believe that a husband and wife, late at night in bed, looking forward to the future, never discussed what might happen if one of them were hurt or killed is naive and presumptuous.
Here’s a disturbing precedent — the intrusion of the President and Congress into a previously-well-defined areas of personal privacy, in a manner that far exceeds the constitutional authority of either one, is a good one to start with. Especially when that particular issue had been decided in the appropriate forum (state court) and the intrusion by Congress and the President was based on their personal disagreement with the outcome — not matter that the outcome was based on state law and, according to all reviewing courts, correctly determined on that basis.
Want to be afraid? Be afraid of that.
In case you hadn’t noticed, that’s exactly what the expert’s advocating termination of Mr. Martin’s form of life support argued. The man could answer a yes or no question as to whether he wanted to live or die and the experts deemed him the “functional equivalent” of a PVS.
Don’t tell anyone in the disability rights movement what they can and can’t say when the “experts” are making calls like that.
Ted, can you provide a link to real documetation of that claim about Mr. Martin? (“Real” = not fundimentalist Christian or National-Review-like.)
Ampersand, this is a wonderfully informative post, and you make some very telling points, but I think you should’ve taken a step back and look at the bigger picture before you made this one:
You say that removing a thalamic implant involves risk to brain functioning, and you invoke that as one reason not to do it for Terri Schaivo. Concern for her brain functioning seems a little misplaced when the main threat to her, which proved fatal, was deliberate starvation. Even life-threatening procedures are sometimes done on patients who would otherwise face death.
Dr. Ronald Cranford in his own unedited words:
Commentary: When a feeding tube borders on the barbaric
The More You Suffer, The Longer You Live
Also notice, from the same site you linked, that Cranford only trusts one PET scan center in the entire U.S. to give a proper PVS diagnosis.
One must wonder what Dr. Cranford finds wrong with the other hundreds of PET scanners in the U.S.
Notice Harold Brenner’s post above, #10. He acknowledges that an MRI was done in 1990. The day after posting the above, March 31, 2005 he started a poll at the immortality institute’s forum http://www.imminst.org/forum/ where he has power of editing, deleting, moving and locking down threads as an moderator, entitled “Euthanasia? What choice for yourself?, If YOU had PVS…”
Here is a statement he makes in the first post describing the poll, “Assume that the diagnosis is as clinically nebulous (or not according to your own opinion) as the one for Terri Schiavo. You have not had the opportunity to be tested using MRI, fMRI or PET. ”
He repeats in his second post to that thread “Terri was never given MRI, fMRI or PET scans.”
In another subsequent post he states “Nothing but the truth pal – don’t ever forget it. The excuse against the MRI’s was the metal stent that she had been fitted with. There we no MRI’s – only CT scans. ”
After calling him on this lying, and now I see he was even aware of the truth at least one day before starting that poll on Imminst’s forum, I have been subject to continual harassment by Harold Brenner, aka prometheus at that forum with a new member coming in to the forum directly to level empty insult at me across posts and subjects. After I brought attention to this to the forum moderators, he was given a warning by Don Spanton who is also a moderator at the forum and most of the offending posts removed. I discovered the forum is not secure from the making of extra false IDs. I alleged that it was possible that Harold Brenner had made the false persona to attack me. He did not deny it and endorsed the new members wanton chaos. The new poster stopped posting and Harold resumed posting. Harold has moved five of my posts to out of the public eye at that forum, ones entirely not related to Terri Schiavo. He has locked down a thread where I was complaining that the forum had a harmful troll amongst its moderators and needed to address how to get rid of at least his moderating powers. At the close of that thread, http://www.imminst.org/forum/index.php?act=ST&f=26&t=7057&s= I got him to reveal that he was aware of the 1990 MRI but he would not address the other lie I accused him of, equating Terri Schiavo’s case to euthanasia. He then locked down that thread.
I took to listing Harold Brenner’s real name along with his alias, prometheus, when ever I referred to him in my posts. One of the moderators, appears there are about ten altogether, who also appears to be most prolific in exercising his moderation powers as Harold, has staunchly devended him mainly through ad-hominem insults and spinning interpretation to seek to degrade me and others, an infringement of Imminst’s user agreement as stated in their constitution. The rest of the moderators have not added much except jaydfox, who has also resorted to the ad hominem insults without addressing the evidence I shared that the forum had been corrupted, had accepted some one who with this thread he had made on Terri Schiavo, demonstrated that he was against Imminst’s stated purpose “conquering the blight of involuntary death.” Note the word “involuntary.” The courts decided that it would not be Terri Schiavo’s volition to be kept in the state she was in. Harold Brenner’s forced opinion (with his strong arm powers as a moderator) with promulgation of false information, the lies related above, states that there should not be voluntary death. Being against voluntary death is the same technically and logically as being for involuntary death. It is the more general blanket idea that one should not have control over one’s own destiny. That opinion welcomes dirty tricks. Forcing an opinion on others is not reason. It finds lying, censoring, denigrating character, obfuscating issues, and any other tricks you can think of to force a perspective rather than seek mutual understanding on the basis of evidence.
Be careful. These people are extrememly deceiving and seek positions of power and control in the media. Those who seek to force their opinions over the rights of others will stoop very low and they will have support by others who cater to the idea that power should decide fate over compassion, reason, morality or intelligence.
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— I guess that makes it murder.
Harold, if it was the case that all patients in vegetative states are alike, then you might have a point. As it is, however, you’re just talking nonsense.
Harold,
Did you actually read or hear the report. This was a study on one person who had suffered traumatic brain injury (unlike Terry Schiavo) fairly recently (unlike Terry Schiavo) and who has hope for recovery. This is a good first step towards understanding the vegetative state for certain types of brain injury but, as the authors themselves have said, it is not indicative of brain function of all people who are in a vegetative state. In fact, in the report that I heard a doctor was saying that this woman may be in the process of coming out of a vegetative state.
If you’re referring to the pathology report, yes I did read it thoroughly when it was published on the net and I was not swayed by it. I certainly did not expect a healthy brain! She was vegetative for physiological reasons.
Gross anatomy of note: bilateral and occipital lobes were worst affected by the hydrocephalus condition. Bilateral lobe reduction is observed in the elderly and is associated with some cognitive impairment and hearing loss. The occipital lobe is associated with processing visual information. The medulla oblongata was reduced in size. This is associated with involuntary functions such as breathing etc. The mamillary bodies were shrunken. These structures are part of the limbic system and are found to be reduced in size with chronic alcohol abuse and there are congenital defects associated with autism.
Microsopic anatomy of note: the frontal and temporal lobes were mostly unaffected – I repeat the frontal and temporal lobes were mostly unaffected. The frontal lobes are associated with learning, volition, problem solving, planning, etc. The temporal lobes are important in the processing of memory.
I can go through an analysis of the structures versus the severity of the damage according to the pathologist’s report but I’ll stop here. The point is, that if someone had a choice in preserving some functional tissue then, in my view, the frontal and temporal lobes would be what should be salvaged since this, in effect is where the person’s character mainly can be said to reside. This is not where memory is located, of course, but certain aspects of their personality central to the style of how they deal with the world are processed there.
This woman was indeed vegetative in the sense that she had lost a great deal of brain matter related to a broad scope of function. This was persistent in that there was no appreciable change to her condition since she sustained the injury. She could not perform most autonomous functions and there was considerable controversy as to her ability to interact with her environment. However, were she to have been given the opportunity of an fMRI diagnosis given the relatively intact frontal and temporal lobes then it is very possible that she would have demonstrated sufficient stimulus vs response not to permit the state enforced death by dehydration order which I cannot ethically or scientifically view as anything other than murder.
Harold,
I was referring to the report to which you originally referred – the one about detecting awareness in a person in a vegetative state. I was in no way referring to any report on Terry Schiavo. If it were otherwise, my comment would have made no sense at all.
In that case, as per the fMRI data has indicated (and, yes I have read that report too), it may be possible to eludicate if there is any stimulus vs response supportive of congitive function despite severe sensory and motor impediments as would be the case with the degree of cerebral damage that TS was found to have sustained according to the pathology report.
Take home message: fMRI should have been attempted as a last resort to to elucidate if there was any cognitive activity commensurate with consciousness. The technology was available but evidently this option was not exercised.
A most interesting medical discovery that supports the notion that despite extensive loss of brain matter (due to hydrocephaly) it is possible to adapt:
Go visit the press release.