Is Terri Schiavo Dead? Eat, drink, and vegetate

Reason ^ | 10-23-03 | Ronald Bailey

[ambrose]

October 23, 2003

Is Terri Schiavo Dead?

Eat, drink, and vegetate

Ronald Bailey

Terri Schiavo has been in a persistent vegetative state since 1990. Her husband wants to withdraw the nutrition and hydration her body has been receiving and allow her body to die. Her mother, father, and sister—and now Florida Governor Jeb Bush—want to continue supplying her body with food and water until... what? She wakes up? Dies of pneumonia?

What is a persistent vegetative state? According to the National Institute for Neurological Disorders and Stroke people in PVS "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." People suffering from PVS can generally be distinguished from afflicted but cognitively intact patients who suffer from "locked-in syndrome" by the fact that "locked in" patients can track visual stimuli and use eye blinks for communication.

According to most neurological experts, Terri Schiavo is definitely PVS—her eyes do not really track visual stimuli and she cannot communicate using eye blinks. However, Terri Schiavo's parents have posted several short ambiguous video clips online which are meant to show that Ms. Schiavo responds to stimuli. But what they show seems to fit an AMA's report of how PVS patients can respond to environmental cues without being aware. Specifically, the report notes, "Despite an 'alert demeanor', observation and examination repeatedly fail to demonstrate coherent speech, comprehension of the words of examiners or attendants, or any capacity to initiate or make consistently purposeful movements. Movements are largely confined to reflex withdrawals or posturing in response to noxious or other external stimuli. Since neither visual nor auditory signals require cortical integrity to stimulate brief orienting reflexes, some vegetative patients may turn the head or dart the eyes toward a noise or moving objects. However, PVS patients neither fixate upon nor consistently follow moving objects with the eyes, nor do they show other than startle responses to loud stimuli. They blink when air movements stimulate the cornea but not in the presence of visual threats per se."

Ms. Schiavo has been in this state for 13 years. What are her chances of recovering at least some awareness? Minnesota neurologist Ronald Cranford told the Washington Post, "There has never been a documented case of someone recovering after having been in a persistent vegetative state for more than 3 months. However, the journal Brain Injury reported the case, of a 26-year-old woman who, after being diagnosed as suffering from a persistent vegetative state for six months, recovered consciousness and, though severely disabled, is largely cognitively intact. However, it is generally agreed that if a patient doesn't become responsive before six months, his or her prognosis is extremely poor. A report on PVS by the Australian National Health and Medical Research Council finds that "patients in a state of post-coma unresponsiveness may emerge from it to become responsive," that "the probability of emergence becomes progressively less over time," and that "there is general agreement that emergence is less likely in older people, and in the victims of hypoxic brain damage." Terri Schiavo is the way she is because oxygen was cut off to her brain for 14 minutes; in other words, she suffered severe hypoxic brain damage.

So is Terri Schiavo still alive? The odds are way against it. It's time that her long-suffering parents and the grandstanding politicians let her go in peace.

[ChemistCat]

The most important thing Terri never got was assistive communication. Technologies exist that allow someone who can do no more than move their eyes or give a deliberate puff of air to communicate. NONE OF THIS was ever made available to Terri. It could be that she could have told us how she got to be in this situation, and what SHE wanted done about it now that she is.

Or it could be that she can't. At any rate, it should have been TRIED.

Her husband doesn't want either of those things to happen because it might interfere with his plan to be her heir and marry his new honey. To me this is the clincher. I have not seen ANYONE refute this one point. Assistive communication has never been tried, and if anything Terri's family has said is true, THOSE TECHNOLOGIES WOULD HAVE WORKED.

[TaxRelief]

When the going gets tough, George hedges.

[mylife]

I don't think anyone really expected MS to inherit a million. He may have in the beginning thought she was hopeless and saw that money slipping away. Perhaps he thought she'd die soon, but she didn't. Now after all is said and done, Felos has about 400,000 of it. Another attorney has 80,000 of it and MS has nothing, unless one might consider Felos kicked back some of it. Personally, my take would be that after all this time, it's become personal. MS against the Schinlers, the source of all his present poverty.

What percentage went to the medical bills?

[Calpernia]

Dr. Webber's affidavit made it to court. But the court denied Dr. Webber the petition for examination. So how could he testify on her behalf if he wasn't allowed to examine her?

http://216.239.41.104/search?q=cache:JjKVj3NpP54J:www.flcourts.org/pubinfo/summaries/briefs/01/01-2678/Filed_02-13-2002_JurisBrief.pdf+Dr.+Webber+%2B+Terri+Schiavo+%2B+Court&hl=en&ie=UTF-8

One such doctor, Webber, claims that anon-vegetative “Mrs. Schiavo has a good opportunity to show some degree ofimprovement [cognitive and physical items such as speech recovery] if treatedwith this type of therapy [cardiovascular medication style].” 800 So.2d at 644.

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Page 8
1While the court describes Webber’s treatment as “new,” closer examinationof the opinion reveals that this does not mean the subject treatment was discoveredor utilized subsequent to trial. Rather, it indicates that the treatment was available atthe time of trial but not considered. Webber, as to the alleged efficacy of this“treatment” on the ward, bases his opinion on his “years of practice.” The courtstates that the 2000 trial focused on the ward’s intent “and not on whether anyavailable medical treatment could improve her condition,” and describes thetreatment as “new evidence of additional medical procedures.” 800 So.2d at 644. While the record definitively shows that the alleged treatment pre-dated the trial bymany years, (see Motion for Stay), Petitioner cannot rely on the record, as the samecannot be used to establish jurisdiction. Nevertheless, Petitioner contends that theopinion itself is sufficient to show that the subject “treatment” is not a “change incircumstances ‘arising after’ the entry of the judgment.”3The trial court summarily denied the petition for examination and 1.540(b)(5)motion. 800 So.2d at 643.The appellate court reversed the trial court, holding that only Dr. Webber’sclaim “raises the motion to the level of colorable entitlement requiring anevidentiary hearing.”1800 So.2d at 646. The court also orders the diagnostictesting of the ward and her examination by five doctors prior to the evidentiaryhearing. The court does not limit the hearing to Webber’s alleged treatment, butpermits discovery--examination and testing--and a hearing on the other allegedtreatment for which no colorable entitlement was shown. The court’s rationale forpermitting the same is that “the opinions of the remaining doctors may have beenlimited by their inability to examine Mrs. Schiavo or obtain necessary diagnosticinformation...” 800 So.2d at 646

[Republic]

"Better a damaged brain than this writer's dead soul."

MANY DITTOS!

[Republic]

The most important thing Terri never got was assistive communication...

I agree. Please see my entire post #240 for a professional verification of your point. It is well taken.

[ClancyJ]

How horrible. I understand completely.

I never know what problem I will face or have to handle when I go visit. I've learned to keep my own records of her medications, to question, to complain. I've been told many times to complain. I do but I hate it.

My mother cried a lot and she didn't know why. I mentioned I wanted the doctor to check on giving her antidepressants when he visited. Then it turned out the psychiatrist was there and I talked to her. She advised she would check her.

Well, she got them. When the doctor visited on Thursday, he prescribed an antidepressant. The psychiatrist prescribed one on Friday. Unfortunately, the page in the chart was full on Thursday so the page turned and Friday the chart had a new page. Doctor No. 2 did not check on the prior page to see that an antidepressant had already been prescribed. She prescribed another.

The nurses gave her the medications prescribed never questioning the orders. My mother was literally out of her mind for three days. She told off the doctor, refused any food or water, was off the wall - there were six medical people in there at one time trying to help her and half of them had tears in their eyes.

They continually reassured me that she would not be harmed just had to flush the medications out of her system but she would not take fluids. The doctor finally threatened her that she was going to the hospital that afternoon if she did not drink. This same doctor when questioned in the hall, got irate at ME and said it was my responsibility to question and complain about her care.

I even called in the family from out of town feeling like she was in really bad shape. After they got there that night, she pulled out of it and you would never know she had been that bad that afternoon.

Now, how often would something like that happen? Each week, each shift is a new world.

[Calpernia]

I agree. She hasn't received anything. I was just hoping George Wyeth would respond to his post before he 'hit the waves'.

[Bubba_Leroy]

Am I paranoid-is this the proverbial slippery slope-or do others here see that as a possibility?

I'm afraid it is more of a probability than a possibility.

[jwalsh07]

ANd that question has not been answered. You know how I know that? Because you won't address any of the issues surrounding it when I ask.

[huck von finn]

On remand, this court anticipated but did not require that Dr. Webber, who had claimed in his affidavit that he might be able to restore Mrs. Schiavo's speech and some of her cognitive functioning, would testify for the parents and provide scientific support for his claim. However, Dr. Webber, who was so critical in this court's decision to remand the case, made no further appearance in these proceedings. Instead, the parents provided testimony from Dr. William Maxfield, aboard-certified physician in radiology and nuclear medicine, and Dr. William Hammesfahr, a board-certified neurologist. Michael Schiavo, Mrs. Schiavo's husband and guardian, selected Dr. Ronald Cranford and Dr. Melvin Greer, both board-certified neurologists, to testify. The fifth physician, selected by the guardianship court when the parties could not agree, was Dr. Peter Bambakidis, a board-certified neurologist practicing in the Department of Neurology at the Cleveland Clinic Foundation in Cleveland, Ohio. He is a clinical professor of neurology at Case Western Reserve University. His credentials fulfilled the requirements of our prior opinion. Through the assistance of Mrs. Schiavo's treating physician, Dr. Victor Gambone, the physicians obtained current medical information about Theresa Schiavoincluding high-quality brain scans. Each physician reviewed her medical records and personally conducted a neurological examination of Mrs. Schiavo. Lengthy videotapes of some of the medical examinations were created and introduced into evidence. Thus, the quality of the evidence presented to the guardianship court was very high, and each side had ample opportunity to present detailed medical evidence, all of which was subjected to thorough cross-examination. It is likely that no guardianship court has ever received as much high-quality medical evidence in such a proceeding. On the issue that caused this court to reverse in our last decision, whether new treatment exists which offers such promise of increased cognitive function in Mrs.Schiavo's cerebral cortex that she herself would elect to undergo this treatment andwould reverse the prior decision to withdraw life-prolonging procedures, the parents presented little testimony. Dr. William Hammesfahr claimed that vasodilation therapy and hyberbaric therapy "could help her improve." He could not testify that any "specific function" would improve. He did not claim that he could restore her cognitive functions. He admitted that vasodilation therapy and hyberbaric therapy were intended to increase blood and oxygen supply to damaged brain tissue to facilitate repair of such tissue. These therapies cannot replace dead tissue. 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.

http://216.239.41.104/search?q=cache:Il7CENonq2QJ:www.2dca.org/opinion/June%252006,%25202003/2D02-5394.pdf+schiavo+schindler+browning+florida+supreme+court&hl=en&ie=UTF-8

[TaxRelief]

Reason is only as good as the premises that are available. Adding one premise frequently changes the logical conclusion. It is immoral, however, to deliberately ignore or omit any premise that might affect the outcome.

(This comment is not directed at you.)

[texasbluebell]

I find it so hard to understand why a trained nurse wouldn't start CPR or at least call 911 on finding his wife not breathing.

From what I remember, he only trained as a nurse after Terri's collapse.

He told the courts that he wanted to become a nurse to take care of his wife, so he was awarded money I believe for his education, but in the end did he not pass some exams to finalize his degree.

(At least this is what I've read -- if inaccurate, someone please post otherwise.)

[FITZ]

For what is worth, remember that the Schindlers have been associated with quacks before.

Even if they are completely wrong ---- the Schindlers ---- what is the real harm in letting them just have their daughter back? Terri either has some consciousness or she has none --- in the latter case, she's not in any real pain or suffering if she continues living. Otherwise she does still feel something and should not be left to starve to death as her husband wants. Possibly --- but I have my doubts ---- Michael has some emotional thing going on about what he believes were here wishes ---- wishes she never apparently expressed strongly to anyone else --- not even to her own parents, nor felt so strongly about that she had those wishes put into writing. So her life would be at the mercy of Michael's "thoughts" or "memories". Even at the mercy of what Michael only thought she wanted --- but did not actually want.

In any case she doesn't seem to be in any great suffering by living, she is taking up just a small space on this earth, she requires minimal care, a little food and water --- she doesn't really require expensive nursing care --- IV's and meds or surgery or expensive machines -- so she's not much a burden on us taxpayers. She'll die in time --- whether that's 5 years, 10 years or 25 years ---- but how much time do any of us have?

[jwalsh07]

Thanks. You're doing a great job of unearthing the facts and summarising the salient points. Superb.

[Calpernia]

And I state again, "But the court denied Dr. Webber the petition for examination. So how could he testify on her behalf if he wasn't allowed to examine her?"

How much do you know about Forensic Medicine, Huck?

[ClancyJ]

So, now we are to the point of ending a person's life if

1. They are brain dead
2. They are in a near-vegatative state
3. They are suffering
4. They are in a coma

Gee, how very fast the progression I feared occurs. See what a power play it is to play God - with some other person's life?

This is why we have to call a stop to this now. There are too, too many that for any number of reasons will chose to end the life of others - for their own monetary benefit, to prevent suffering, to rid the world of "clutter", environmentalist beliefs, for prevention of overcrowding.

We have to come back to the simple truths - Thou Shalt Not
Kill. Now we can understand why.

[FITZ]

Next will be the call to stop feeding children with Downs Syndrome. They are never going to get better. Why bother feeding them?

Geez ---- once we all hit age 20, you could say we're all kind of going down that slope ---- none of us is really getting better ---- not ultimately. It's too easy to look at someone in a lesser physical or mental condition and imagine you could never live like that ---- but sometimes you might change your mind on that. You wouldn't know it until it happens if you would. I picture myself needing a wheelchair ---- and I can't imagine my life like that --- but would I really want the alternative which is death?

You have forever to be dead ---- so why rush it?

[Babalu]

I certainly can't speak for others, but the only expectation I have is that Michael Schiavo leave Terri alone TO LIVE, and that Terri's parents be able to take guardianship of her, for as long as she continues to live.

If she gets better, then that's just icing on the cake. Of course, Mr. Schiavo just might not be to happy about that.

[yesnettv]

I would love to read the medical charts, too.