Doctors spar on degree of Schiavo's awareness; sharp words by some

The Ledger.com ^ | Thursday, March 24, 2005 | MALCOLM RITTER

[Destro]

Published Thursday, March 24, 2005

Doctors spar on degree of Schiavo's awareness; sharp words by some

By MALCOLM RITTER
AP Science Writer

Is there any doubt that Terri Schiavo is in a persistent vegetative state? Yes, argue those fighting to keep her alive, including Gov. Jeb Bush. Doctors have sparred about this before in court, and the most recent ruling upheld the diagnosis.

The issue arose again this week when a neurologist, Dr. William Cheshire of the Mayo Clinic in Jacksonville, Fla., said in a court document that he believed it's more likely that Schiavo is in a "minimally conscious state" than a persistent vegetative one.

In a persistent vegetative state, a person is awake but not aware of oneself or the environment, and making only reflex movements. In a minimally conscious state, a person's behavior shows inconsistent but reproducible signs of consciousness. For example, a patient can occasionally follow simple commands, scratch the nose if it itches, or try to use an object like a comb for its correct use.

Cheshire was not available for an interview, the Mayo Clinic in Jacksonville said in a statement. It said that at the request of the state of Florida he observed Schiavo at her bedside and reviewed her medical history but did not conduct an extensive examination of her.

In his affidavit, Cheshire said Schiavo showed several behaviors "that I believe cast a reasonable doubt on the prior diagnosis" of persistent vegetative state. For example, he said, her face brightens and she smiles in response to the voice of familiar people such as her parents. Her eyes don't track moving objects consistently, but "she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time," he said.

"Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her," Cheshire said in the affidavit.

But the first part of that sentence, in fact, "starts to meet the criteria for vegetative state," said Dr. Gene Sung, director of the neurocritical care and stroke section of the University of Southern California.

Sung, who has not been involved with the case, said of Cheshire that "unfortunately his feelings, and possibly his religious beliefs, are affecting his medical decision." The Center for Bioethics and Human Dignity, which notes on its Web site that it was founded by Christian bioethicists, lists Cheshire as its director of biotech ethics.

Sung said the original diagnosis was based on repeated examinations by "very distinguished neurologists" and he called himself as comfortable with that diagnosis as he can be without examining Schiavo himself.

Dr. Roger Albin, a professor of neurology at the University of Michigan who also was not involved in the Schiavo case, agreed. "I don't think there's any reason to doubt the diagnosis... I don't think her evaluation could have been done better."

He also said he's not aware of any evidence that a person could emerge from years in a persistent vegetative state and enter a minimally conscious state, especially in a case like Schiavo's, where blood flow to the brain had been temporarily cut off in 1990.

The diagnosis has been a court matter, both in 2000 and in 2002. In the latter year, a Florida judge agreed with four neurologists that Schiavo was in a persistent vegetative state. Brain scans and examinations were conducted in 2002, but no new neurological evaluation has been ordered since, and the medical record has been closed.

Testimony in those cases included statements from Schiavo's treating physician, Dr. Victor Gambone, who said in 2000 that he agreed with the diagnosis. Schiavo's daily caregivers told him they could not get any response showing an appreciation of her surroundings, he said.

In 2002, Dr. Ronald Cranford, an expert on persistent vegetative states who was brought into the case by Schiavo's husband, testified that key centers of Schiavo's brain probably had no viable neurons left. She was not actually fixing her gaze on her mother, as had been suggested, but rather showing a reflex action seen in patients in a vegetative state.

(Cranford said Thursday he still has no doubt the diagnosis is correct and that Cheshire is "flat-out wrong.")

Two other neurologists also agreed with the diagnosis, including one appointed by the court to examine and evaluate Schiavo.

But doctors representing Schiavo's parents at the 2002 hearing had a different conclusion. Dr. William Hammesfahr, a Florida neurologist, said his examination of Schiavo found she is "definitely aware of her mother" and communicating through following instructions and in looking at people. And a radiologist said a brain scan in 2002 showed more normal appearance than one in 1996 and said there was a "significant probability that she would improve" with certain treatments.

But the court was not given any objective data to support that latter assertion, said Dr. Timothy Quill, director of the Center for Palliative Care and Clinical Ethics of the University of Rochester Medical Center, writing in a commentary published online this week by the New England Journal of Medicine.

Hammesfahr has been a figure of controversy. In 2001, the Florida Department of Health accused him of falsely advertising a neurological treatment and exploiting a patient for financial gain. The treatment is "contrary to current neurological knowledge," the department said. Hammesfahr denied the accusations, and in an interview Thursday he said the probation and fine against him were overturned on appeal.

On Thursday, Dr. Lawrence J. Schneiderman of the University of California, San Diego, a specialist in bioethics of medical futility and end-of-life care, said in an interview, "He's a quack, to put it the politest way I can."

Hammesfahr said he believes Schiavo can be helped by treatment and that numerous other neurologists, some of whom actually examined Schiavo, agreed.

"I'm not the only person who has said she can be rehabilitated," he said. "Are we all quacks?

---

Associated Press writer Allen Breed in Clearwater, Fla., contributed to this report.

[GOPJ]

Here's what I'm finding. People with money want to leave that money to their families, not to a hospital or a rich doctor, or nursing facility for care that extends a persons misery not their life. They don't see that Terri's situation is different. And if they do see that possibility, they don't want her case to rob them. She becomes a threat to their ability to pass on resources to loved children and grandchildren. They don't "get" the differences.

People without money don't understand why someone would want to off another human without so much as a look at the situation. And because they have nothing invested personally, they don't "get it" either.

Then there's some who operate from principle beyond "what's in it for me". And that group has to find the compromise. Because, the incentives are strong on both sides. And these choices have bad unintended consequences.

[Aussie Dasher]

Unless Jeb uses his Executive powers - and soon -, they can argue about it at Terri's post-mortem

[Diogenesis]

Judgenfuhrer Greer: "That woman is owned and ready for disposal.
Do you see anyone from NOW disputing that? No.
The 'b&tch' is just an inconvenient potential witness
to my wife's and my legal donors' Hospice malpractice.
It is my Judicial right to exterminate the evidence and victim by upcoming cremation?
My Order today gives Florida Judges the privilege of 'First Night', too. You lose, now kneel."

Factoid of the hour - While at FSU, [Judgenfuhrer and Murderer]Greer was a housemate of future Doors lead singer Jim Morrison

HEALTHFUL DRINKS AND WARM MEALS SINCE THE ORDER-TO-MURDER-AN-INVALID BY JUDGE GREER
Murderer-At-Will Judge Greer 35
......................... Terri Shiavo 0
.......................... Lee Malvo 26
.......................... Scott Peterson 25

[Samwise]

Michael's a batterer. No wait, her parents are money grubbers. Terri's a vegetable. No wait, she can respond. Terri wants to die. No wait, she wants to live. Greer is the devil. No wait, he's a man of principle.

Enough. Give her some water and Jello. No wait, she might choke to death.

[Diogenesis]

'Thou shall not kill'

Exd 20:13 .... no wait .....

'Thou shall not kill'

Deu 5:17

[wiggen]

If one dr said theres a chance for her against overwhelming numbers on the other side,then i'd admit Terris supporters(myslf included) could be wrong. But so many feel otherwise,i just know this is more about narrowing the definition of life.And to all those who side with her husband,who've appeared on T.V. saying theres no money involved...just watch and see after this is over. A book..a made for T.V. movie. You can bet Mikey will profit. As will felos

[Diogenesis]

It's not about movies. It's about the lawyers making money through the Hospice NOW as they siphoned the $$$$$$ to the Judgefuher.

BREAKING: BUMP for DOCUMENTS TYING MS's LAYWERS TO THE HOSPICE

More info on the tangled web the Florida Judiciary has woven here

[Samwise]

"For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, "

[Bahbah]

Dr. Ronald Cranford...Something wicked this way comes.

[GarySpFc]

Hammesfahr has been a figure of controversy. In 2001, the Florida Department of Health accused him of falsely advertising a neurological treatment and exploiting a patient for financial gain. The treatment is "contrary to current neurological knowledge," the department said. Hammesfahr denied the accusations, and in an interview Thursday he said the probation and fine against him were overturned on appeal.

You forgot to include in your previous e-mail to me that the fine was overturned.

[wiggen]

Sure,i totally agree with you. But mikey had to be promised plenty to continue and not take the money offered him to just walk away.Why the denial of tests and therapy otherwise? Once his wife has passed on,he will reap the promised rewards.I'm sure he's not thought of the rewards he'll reap after he's gone.Satan to mikey,"Hungry yet lil fellow? Thirsty?"

[Destro]

Actually it's 'Thou shall not murder' - the English translators goofed.

[Destro]

The fine was not overturned - what was overturned was his fine for unorthdox treatments. The doctor was fined for bilking patients of money.

[tkathy]

"Here's what I'm finding. People with money want to leave that money to their families, not to a hospital or a rich doctor, or nursing facility for care that extends a persons misery not their life. They don't see that Terri's situation is different. And if they do see that possibility, they don't want her case to rob them. She becomes a threat to their ability to pass on resources to loved children and grandchildren."

Very well said. I would rather pass on our fairly limited resources to my children than give it to medical devices companies. I am seriously worried about big government bad laws being passed that might limit my freedom of choice.

[Destro]

The fine for false billing was not overturned - what was overturned was his fine for unorthdox treatments. The doctor was fined for bilking patients of money.

[Bear_Slayer]

QUESTION:

Have you ever seen a carrot sit up and smile? Scratch and itch? Vocalize "Ahhh Wahhh"?

To be a vegetable is to be alive in the sense that plants are alive. The organs work, but that's all. The only function the brain has is to keep the heart beating, the lungs breathing and the kidneys processing fluids, &etc.

Terri is not PVS. She isn't. I don't believe she is in any vegetative state; persistent or otherwise.

She has a damaged brain. Nothing more.

To kill her would be murder.

[Huck]

It doesnt matter how they classify her mental state. Whatever it is, they have decided Terri would rather die. Call it pvs or not.

[Saundra Duffy]

"I'm not the only person who has said she can be rehabilitated," he said. "Are we all quacks?

If I were able to LOL right now, I would, but I'm not.

I thought it was interesting how the media jumped on the Mayo Clinic doc who evaluated Terri at her bedside on March 23 and stated that he felt Terri is not in PVS. Anyway, the media jumped on him cuz he's a CHRISTIAN. Horror of horrors. A CHRISTIAN. Like that means your opinion cannot be trusted, even if it's your PROFESSIONAL opinion. Has the country really sunk this low?

And did you see Christopher Hitchins on TV? He is so filled with hatred toward Terri, her family and pro lifers he practically foams at the mouth. It was excruciating to watch. Poor guy; I truly feel sorry for him. No peace and no love.

Heavenly Father - We look to Thee for help for our little Sister, Theresa Marie, in the Name of Jesus Christ, our Savior. Amen.

[GeekDejure]

'Thou Shalt Do No Murder'***

***(unless your name is Shiavo/Greer/Felos)

.