does this look like a vegetable?
Posted on 03/22/2005 6:15:47 PM PST by FR_addict
First segments.... (BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT (voice-over): In a medical case as high profile as Terri Schiavo, you would think the medical experts would have all the answers. But just by listening to them and reviewing statements they gave to the court, it's easy to see why a final answer is so complicated.
DR. WILLIAM HAMMESFAHR, NEUROLOGIST: I spent about 10 hours across about three months and the woman is very aware of her surroundings. She's very aware. She's alert. She's not in a coma. She's not in PVS. ...
DR. RONALD CRANFORD, NEUROLOGIST: A vegetative state is a scary diagnosis. Unless you know what you're looking for, it looks like the patient is interacting. But Terri is not interacting.
GUPTA: Both of them are neurologists and their conclusions are based on diagnostic tests that are supposed to be objective. Yet, they tell different tales.
HAMMESFAHR: Her CAT scan has maybe 75 percent of the brain tissue still left. CRANFORD: I've seen her. There's no doubt in my mind, whatsoever, she's in a permanent vegetative state. Her CAT scan shows extremely severe atrophy to the brain. And her EEG is flat. It doesn't show any electrical activity at all.
GUPTA: And, most importantly, their opinions about a possible recovery?
HAMMESFAHR: With proper therapy, she will have a tremendous improvement. I think, personally, that she'll be able to walk, eventually, and she will be able to use at least one of her arms.
CRANFORD: There's no way. That's totally bogus. ...
(END VIDEOTAPE)
(Excerpt) Read more at transcripts.cnn.com ...
Pretty weak form of argument. Anyway, who in their right mind would request to be starved to death? That is just nuts on its face.
But in spite of the lack of advanced testing, such as an MRI, attorney George Felos has claimed that Terri’s cerebral cortex has “liquefied,” and doctors for Michael Schiavo have claimed, on the basis of the CT scans, that parts of Terri’s cerebral cortex “have been replaced by fluid.” The problem with such contentions is that the available evidence can’t support them. Dr. Zabiega explained that “a CT scan can’t resolve the kind of detail needed” to make such a pronouncement: “A CT scan is like a blurry photograph.” Dr. William Bell, a professor of neurology at Wake Forest University Medical School, agrees: “A CT scan doesn’t give much detail. In order to see it on a CT, you have to have massive damage.” Is it possible that Terri has that sort of “massive” brain damage? According to Dr. Bell, that isn’t likely. Sometimes, he said, even patients who are PVS have a “normal or near normal” MRI.
http://www.nationalreview.com/comment/johansen200503160848.asp
Has Zabiega seen the CT of Terri? Perhaps he would change his mind on the need for an MRI or PET.
If not, I'd like him to show CT scans of other patients similar to the one of Terri's you posted, with comparison MRIs and PETs, and accompanying descriptions of the patients and their progress in therapy.
BTW, do you have a source/link for the photo?
does this look like a vegetable?
ROFLMAO!! Check out this post!
One of my liberal axioms: the more people do a wrong thing, the less wrong it becomes. Therefore, if you've done something wrong, it's better to encourage others to do it than to discourage them from repeating your mistake.
Another liberal axiom: everything is relative. The existence of a good person makes everyone else worse by comparison, and that of a bad person makes everyone else better by comparison. Hence opposition to the death penalty but eagerness to kill Terri.
Flat EEG, is that Doctor out of his mind??
Isn't "kill" too strong a word for euthanasia?
Answer: No. The word "kill" means "to cause the death of." In 1989, a group of physicians published a report in the New England Journal of Medicine in which they concluded that it would be morally acceptable for doctors to give patients suicide information and a prescription for deadly drugs so they can kill themselves. Dr. Ronald Cranford, one of the authors of the report, publicly acknowledged that this is "the same as killing the patient." While changes in the law would lead to euthanasia being considered a "medical intervention," the reality would not change -- the patient would be killed. Proponents of euthanasia often use euphemisms like "deliverance," "aid-in-dying" and "gentle landing." If a public policy has to be promoted with euphemisms, that may be because the use of accurate, descriptive language would demonstrate that the policy is misguided.
http://64.233.167.104/search?q=cache:1lKdjasZdQUJ:www.liferesource.net/doctor_suicide.htm+cranford+hemlock+society&hl=en&client=firefox-a
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.
Expert witnesses in court are supposed to be unbiased: disinterested in the outcome of the case. Part of the procedure in qualifying expert witnesses is establishing that they are objective and unbiased. But given Dr. Cranford’s history of advocacy in the “right to die” and euthanasia movements, and given his track record of almost always coming down on the side of PVS and removal of nutrition and hydration, one might question his objectivity. Indeed, the Schindlers’ attorneys attempted to do so in the 2002 evidentiary hearing at which Cranford testified, but went unheard. Organizations such as the International Task Force on Euthanasia and Assisted Suicide submitted amicus curiae (friend of the court) briefs in the appellate proceedings in Terri’s case, demonstrating Cranford’s bias in detail. But these arguments also seemed to fall on deaf ears.
http://caosblog.com/archives/2005/03/20/bad-medicine/
"Flat EEG, is that Doctor out of his mind??"
Sounds like he is incompetent to me.
http://respectfulofotters.blogspot.com/2005_03_01_respectfulofotters_archive.html
After reading the 17 affidavits, plus the report of the examining physician on whose findings Schiavo's parents are basing their case, plus the rulings from the trial court and the court of appeals.
None of the 17 affidavits are by providers who examined Schiavo. Only one of the 17 providers claims to have reviewed her medical records. The remaining 16 providers apparently based their statements primarily on six snippets of videotape, totalling 4 minutes and 20 seconds, which have been posted on Schiavo's parents' website and broadcast repeatedly on the news. Several of them explicitly say that they viewed these clips on the net, and the others all refer to the same short samples of behavior (e.g., Schiavo's eyes tracking a balloon). Many of them say they read news stories about Schiavo. One admits to only seeing news stories and photographs. They all reference their experience with "similar patients," but without qualifying what they mean by "similar." For example, one doctor draws comparisons to catatonic patients - but catatonia simply refers to an absence of voluntary motion or interaction, and can be caused by any number of things. Another references stroke patients, and two more talk about patients with Alzheimer's. As Ampersand points out, not one of them mentions the specific degree and type of brain damage that Schiavo has, as documented by her CAT scans:
Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. [...]
Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.
Most of the affidavits mention sophisticated new neuroimaging techniques which have been developed since the 1996 exams, and recommend that Schiavo receive a functional MRI (which tracks blood flow in the brain in response to specific stimuli) or a neuroSPECT exam (another functional imaging test). They note, correctly, that functional tests are capable of providing much more information about the nature and extent of brain damage than structural tests like a CAT scan. Yet Terri Schiavo's cerebral cortex is not damaged, it is absent. The affidavits repeatedly fail to engage with this finding. Thus, we have Dr. Ankerman: "The long duration lack of speech seen after injury trauma is not always due to destruction of brain structure. Sometimes it is due to a state of brain dysfunction that is reversible." Dr. Uszler: "Standard MRI or CAT scans are anatomy scans; they tell you if the tissue is there and its current structure, but these tests do not tell you whether the brain is working." And, most incredibly, Dr. Terman: "If the results of her response to certain neurological tests, for example the fMRI, were similar to that of normal individuals with undamaged brains, such data might indicate that there is some potential for her rehabilitation."
I suppose that these statements are technically true. Speechlessness is not always due to destruction of brain structure, but if massive destruction of brain structure is present, that's certainly the way to bet. CAT scans tell you if tissue is present and structured normally, but not if it's working; however, if tissue is absent, you'd think its lack of functionality could be assumed. And yes, if Terri had the same fMRI results as a healthy person, that would bode well for rehabilitation - but as we sometimes say here at Respectful of Otters, it's equally true that if my aunt had testicles, she'd be my uncle. Terri Schiavo doesn't have a cerebral cortex. She's not going to have a normal fMRI pattern. She simply couldn't. So it's pointless to speculate about what it would mean if she did.
What about the "new treatments" which might help Schiavo? Many of the providers assert that she could be trained to swallow, and they're probably correct. Swallowing is a brainstem reflex, and Schiavo still has her brainstem. The muscles of her throat could be stimulated - Mr. Lakas suggests using electric shock - to produce an automatic swallowing response to liquid nutrition. It's hard to see how that would amount to an increase in quality of life, however, given the mechanical nature of the reflex and the likely increased risk of choking or aspiration pneumonia. What else? One of the doctors (Ankerman, again) recommends the off-label use of an Alzheimer's drug, based on unpublished anecdotal evidence that it helps catatonic patients (not patients in a persistent vegetative state). Another recommends hyperbaric therapy, about which the trial court judge had previously pointed out, "It is interesting to note the absence of any [published] case studies since this therapy is not new and this condition has long been in the medical arena."
Two others make unsubstantiated claims that Schiavo could somehow be taught to communicate: "By helping Ms. Schiavo to communicate she will be able to tell us things, such as whether or not she wants to die, and if she wants a divorce" (Ms. Hyink), "sometimes even if a patient can only answer "Yes" or "No" it is still possible to determine what that patient wants in terms of end-of-life medical care" (Dr. Terman). Indeed, if Schiavo were capable of speech or meaningful communication it would be much easier to determine her wishes. That hypothetical, however, is completely irrelevant to the case.
The 17 affidavits all put considerable weight on the fact that, in the video snippets on Schiavo's parents' website, she appears to be responding to stimulation. Her eyes track a balloon. She smiles in response to her mother's voice. The affidavits therefore conclude that Schiavo is appropriately responsive to external stimuli, and that she is at least minimally conscious - not in a persistent vegetative state (PVS) at all. Yet none of the exhibited behaviors are, in themselves, unusual for patients with PVS. According to the National Institute of Neurological Disorders and Stroke:
Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace, cry, or laugh. Although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands.
So the presence of smiles, grimaces, vocalizations, and eye movements alone is not relevant to the question of whether Schiavo has retained any degree of consciousness or may benefit from therapy. They may be in part reflexive - as when she "smiles" when her cheek is stroked - and they may be completely random. The key to the 4 minutes and 20 seconds of video is that Schiavo seems to be responding in a meaningful way to specific stimuli. All 17 experts who reference the videos take for granted that they demonstrate meaningful emotional or communicative responses. Could they really all be wrong?
Oh, yes. All you need to know to illuminate the question is that the six snippets of video were selected from 4 1/2 hours of tape. As do most people with PVS, Schiavo emits random behaviors and noises. If a person gives enough commands or makes enough interaction attempts over the course of several hours, by sheer coincidence some of Schiavo's random behaviors will appear to coincide with their commands. Both the trial court and the appeals court viewed the entire 4 1/2 hour tape, and both concluded that her responses were indeed random. As the original court decision pointed out:
Dr. Hammesfahr testified that he felt that he was able to get Terry Schiavo to reproduce repeatedly to his commands. However, by the court's count, he gave 105 commands to Terry Schiavo and, at his direction, Mrs. Schindler gave an additional 6 commands. Again, by the court's count, he asked her 61 questions and Mrs. Schindler, at his direction, asked her an additional 11 questions. The court saw few actions that could be considered responsive to either those commands or those questions. The videographer focused on her hands when Dr. Hammesfahr was asking her to squeeze. While Dr. Hammesfahr testified that she squeezed his finger on command, the video would not appear to support that and his reaction on the video likewise would not appear to support that testimony.
Hammesfahr's own report makes clear that he relied on a ludicrously low standard to conclude that Schiavo's responses were purposeful:
Interestingly, some of the commands, such as close your eyes, open your eyes, etc. she tended to do several minutes after I gave her the command to do so. She had a delay in her processing of the action. However, when praised for the action, she would then continue to do the action repetitively for up to approximately 5 minutes. As we had moved on to other areas of the exam, at times she was continuing to do the previous command, then at inappropriate times since the focus of the exam had changed.
He commanded her to emit some of her known behaviors, such as closing or opening her eyes. If she did, that was a "hit" - a sign that she had obeyed the command. If she did so several minutes later, that was still a "hit," apparently no matter what else he'd asked her to do in the interim. If she continued , long after he'd moved on, that was not a sign that she was unresponsive to his subsequent commands but, instead, a sign that she was responsive to praise. Almost any response, correct or incorrect, could apparently be interpreted to signal consciousness. Hammesfahr, like Schiavo's parents, wanted to be convinced.
Terri Schiavo's case is tragic, but not medically complicated. Nothing about it suggests any room for diversity of medical or neuropsychological opinion. The "experts" who submitted affidavits appear to know little about her case beyond what they were able to glean from cherry-picked videotape segments only a few minutes in length. They recommend sophisticated neuroimaging techniques which are not relevant to the question of the feasibility of rehabilitation when the cerebral cortex is gone. Frankly, I can't imagine what led any of them to believe they had sufficient information to submit an affidavit. But some of their statements offer disturbing clues.
Dr. Eytan would seemingly reject any pre-injury statement about the conditions in which a person would prefer to refuse medical treatment, "because we are all in the process of changing." In the greatest unintentional irony of the entire stack of affidavits, she remarks that "Ms. Schiavo is not the same person as she was when she made her alleged remarks about not wanting to live in a certain condition." By this logic, she would apparently argue to invalidate any Living Will or advance directive. Dr. Senno states that just because Schiavo hasn't had any higher neurological functions for the past fifteen years, that doesn't mean she won't suddenly develop them today or tomorrow. By that standard, again, no one could ever be removed from life support. These doctors reject the fundamental right to refuse unwanted medical intervention. Imagine being kept alive forever in a mindless, volitionless, decerebrate, unresponsive condition, regardless of anything you might previously have said about your wishes to avoid such a state - just in case some new treatment were developed in the future which might cure you. That appears to be the new standard these medical providers are advocating.
Here are the medical facts on what happens to a person who is "medically" starved to death:
"Removal of the G-tube would likely create various effects from the lack of hydration and nutrition, leading ultimately to death. Brophy's mouth would dry out and become caked or coated with thick material. His lips would become parched and cracked. His tongue would swell, and might crack. His eyes would recede back into their orbits and his cheeks would become hollow. The lining of his nose might crack and cause his nose to bleed. His skin would hang loose on his body and become dry and scaly. His urine would become highly concentrated, leading to burning of the bladder. The lining of his stomach would dry out and he would experience dry heaves and vomiting. His body temperature would become very high. His brain cells would dry out, causing convulsions. His respiratory tract would dry out, and the thick secretions that would result could plug his lungs and cause death. At some point within five days to three weeks his major organs, including his lungs, heart, and brain, would give out and he would die. The judge found that death by dehydration is extremely painful and uncomfortable for a human being. The judge could not rule out the possibility that Paul Brophy could experience pain in such a scenario. Paul Brophy's attending physician described death by dehydration as cruel and violent."
http://academic.udayton.edu/LawrenceUlrich/brophy.htm
All one need read to know that the kill-Terri doctors' findings were bogus was that they examined Terri for less than an hour apiece. A valid meaningful diagnosis of PVS in that timeframe is simply impossible.
Funny he didn't testify to any of that stuff in court with any evidence...like patient names that have been successfully treated. He couldn't come up with one. The guy used to or still does advertise in the National Enquirer and accepts cash only (since insurance companies aren't about to pay for his highly disruptable practices). Oh, and the person who nominated him for a prize denies it and he can't provide proof.
We've gone from naziism to this, huh? That didn't take long. Lol
Now that's rich.
And that's part of the reason for this blood feud. Neither one's hands are clean in this.
Link to CT scan: http://www.miami.edu/ethics2/schiavo/Schiavo_links.htm
Decent load of links to both sides of the Schiavo case, court documents, Florida law, and information about things like living wills.
Zabiega probably didn't see this CT scan (I don't know how long it's been in the public domain). I'm ignorant on matters of the human brain, but my girlfriend was a neurobio major at a prestigious university, so I've been running questions by her. She thinks that an MRI is more sensitive to detecting brain damage than a CT scan, so in a normal case of light damage a doctor might not see something on a CT, but the MRI later reveals problems.
Like the NRO article states, it usually takes massive damage to show up on a CT, but my girlfriend's of the opinion that the damage shown in Terri's CT meets that requirement, and is obvious and extensive. The ventricles have swelled to the point where they're taking up a big chunk of what used to be the cortex. I've been following things more from the legal side, and the level of damage wasn't being questioned by the Schindlers as much as the potential to repair or reverse that damage with experimental treatments.
An MRI would reveal more information about the state of the brain, but it's not necessary to answer the basic question of whether or not a large chunk of her brain has been replaced by cerebro-spinal fluid.
- Still hoping that whatever happens either way, it's what Terri would have chosen.
Where can I find the document? Thanks.
Let's cut to the chase. You've set up a straw man argument.
It's impossible to imagine being the type of person, you describe.
You are actually asking us to imagine what it would be like to be an outsider looking at us. You are not asking us to imagine us.
Does it make any sense that Michael Schiavo is working very hard to put to death a woman whom he says
Cranford has said people who are PVS have no constitutional rights.
According to Cranford's line of thinking == Terri is PVS and she has no constitutional right to ask to be starved.
Don't you get it???
The right-to-deathers have no "person" to defend.
Only the right-to-lifers have a "person" to defend....
Me too.
Dr. Cranford says PVS patients have no constitutional rights.(I guess he means they are non-persons)
According to his way of thinking, she has no right to be starved.
Michael isn't defending Terri's wishes. Michael is defending his own wishes..
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