Terri Schiavo Before dehydration
Posted on 03/26/2005 4:05:26 AM PST by 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.
PVSers do indeed make such gestures and noises by the way.
Ecclesiastics 3:1-8
There is a time for everything, and a season for every activity under heaven: a time to be born and a time to die, a time to plant and a time to uproot.
=======
If we plant a time thingy under Greer will that uproot him ??? ;-))
A time to murder and a time to be murdered. A time to starve and a time to be starved. A time to dehydrate .....Greer
I read that Terri is now bleeding from pores. If you think about what Jesus Christ endured in the Garden of Gethsemene, this will make your BLOOD BOIL and send shivers all over your body. This is absolutely unimaginable!!!
I have a living will. I have no desire to provide one more vacation home for my doctor. But here's the problem, people like us are put in a spot when dealing with Terri. We fear the unintended consequences of lawmakers generalizing. Disappointing judges made it worse. They're the people who should cut the gordian knot, not wallow in elitist fears. How could they not respect for a woman who easily could have been abused? Can't they see this case is different?
I stand with Terri. Terri, the person. Not "Terri the life at all costs and misery" concept.
I slept on a hospital floor to safeguard my fathers last request not to be hooked to machines to prolong his painful death from cancer. He asked all of us to make sure that didn't happen and we stayed at the hospital in shifts to protect him from overzealous nurses.
Terri's different.
Maybe freepers can figure this problem out -- the judges are an embarrassment- coming across as unthinking control freaks.
Good people will have to solve this. People like you. People like me. The great unwashed. There's a man named Hentoff or something like that who writes for the Village Voice. He seems capable of seeing both sides. I'm sure there are others.
Thanks for your comments. You're a good person -- and honest. Maybe with good people trying, a fair solution can be found.
You father did not want to be kept "alive" for another 15 or 30 years? How strange.
Books? Movie?
I personally will boycott any and all things connected with Terri, unless it is from the parents.
Note to self: before choosing another doctor, make sure he believes in God.
This is something that has bothered me about the way the discussion has developed. What does it matter, really, whether she's PVS or not?
On an emotional level, we can all get motivated by the idea that Terri could be rehabilitated to some minimal but gratifying level of communicativeness and response. But on an ethical level, it is ALWAYS wrong to deny a dependent food and water for the purpose of starving him or her to death, EVEN IF that dependent is unconscious and gravely and irretrievably disabled.
It is illegal IN FLORIDA for a guardian to fail to give the "protected" person food and water. This constitutes wrongful neglect (or abuse) on the part of the guardian.
The FLORIDA Constitution says that disabled people are entitled to equal protection of law.
Judge Greer has violated the ADA Cf 28 CFR, Ch 1, Subpart B, Sect 35.130 which states "Nothing in the Act or this part authorizes the representative or guardian of an individual with a disability to decline food, water, medical treatment, or medical services for that individual."
I think PVS is a junk diagnosis, anyway, because the criteria based on brain anatomy do not take into account the possibility that other parts of the brain can assume some of the functions which were lost by the damaged and atrophied cortex. It's analogous to the way my son, who has Central Auditory Processing Disorder (CAPD), has developed atypical neural pathways in order to process auditory information.
Mrs. Don-o
This is absolutely unimaginable!!!
=======
Yeah... and three vile, filthy, disgusting, despicable, deceiving,
lying, torturous, murderous servants of Satan are behind it from
start to finish: Michael Schiavo, George Greer, George Felos !!!
.
Heavenly Father - We beseech Thee to stop those treacherous evil men who seek to take innocent life by starvation and dehydration.
Child of God...
We pray those judicial sinners...
Do not cause the hour of thy death...
Amen !!!
You can go to a witch doctor all you want. I want a doctor whose medical knowledge is based on science.
If someone had hit my father and then made sure he couldn't get therapy to get better, he would have fought like a soldier. And so would my family. My father was old. He had cancer. He was in great pain. Terri is none of those. There was no ambiguity in my fathers situation. He wanted to die a natural death. He ate and drank up until the end. He didn't want to be sustained artificially. Can't you see the difference?
Strange.
Terri's family is doing the right thing. I'm sorry our judges are incapable of nuance. I believe with everything in me that Michael is lying about Terri's wishes. I believe only a fool would think of Michael as her "husband". And I believe people who think they are too cute to say what they really mean are childish.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.