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.

[Luke Skyfreeper]

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.

OK, well, let's assume this writer is correct, and Terri really isn't "there."

In which case, "letting her go in peace" doesn't have a lot of meaning either.

In other words, no harm is done by continuing to feed her, except the continued expense of her upkeep. Schiavo was given the money for that. Granted, he's probably blown it all by now, but I'd be willing to bet the funds for Terri's upkeep could be found somewhere.

If she isn't there, then she doesn't give a damn whether her body is maintained or not, so there's no harm in maintaining it, whereas there could be great harm in failing to maintain it: the murder of a human being. In this case, it's... money on one side... versus... the (arguable) life of a human being on the other side.

Undoubtedly I don't know all about the case, but from what I at least think I know, it seems clear to me where Mr. Schiavo's priorities lie.

[MarMema]

I beg your pardon. I am quite sure that I am far more knowledgeable about these things than you.

Therefore, most of the "Kill Terri" types here refuse to understand what her condition means. That seems to include you.

[JennysCool]

Writers who are so uninformed that they miss the other side of the story -- that Michael Schiavo may well be a money-hungry nut who may have had quite a lot to do with causing Terri's condition, and is desperately trying to "dispose of the evidence" -- are most definitely irrelevant.

[FITZ]

Good link!! But you left some parts out. I'm sure you didn't mean to:

Is there any treatment?

Once an individual is out of immediate danger, the medical care team focuses on preventing infections and maintaining a healthy physical state. This will often include preventing pneumonia and bedsores and providing balanced nutrition. Physical therapy may also be used to prevent contractures (permanent muscular contractions) and deformities of the bones, joints, and muscles that would limit recovery for those who emerge from coma.

[TheAngryClam]

Want to bet that when the Terri Troopers show up, someone notices that this is from Reason Magazine and turns this into a WOD thread?

[GodBlessUSA]

The medical fact is not confirmed in Terri's case. They wouldn't allow her to be diagnosed and treated. Terri’s family wanted other doctors to examine her but weren’t allowed. Terri’s condition was neglected for most of the thirteen years. Her medical files are closed to her parents. So the article's point is moot. See the earlier post on FR that states Doctor's agree that Terri may not in vegetive state.

[T'wit]

>> Thos looks to be the moost comprehensive compilation of facts posted thus far

Why moost thou thos? Are you a cow?

[HiTech RedNeck]

I suspect that the recent law sparing her will be ruled unconstitutional

Given the SCOFLAw's bravura performances, that's not a bad way to bet, but whether the SCOTUS backs that up is another story. The ghouls who want her death are predicting a quick injunction on Monday, which sounds farfetched since the results would be irreparable harm to Terri.

[FITZ]

You missed this too. I'm just helping you:

"Some patients may regain a degree of awareness after persistent vegetative state."

[ambrose]

Quite possibly. As you know, anyone taking illegal drugs should be locked up for life - unless it was prescription drugs taken by a conservative talk show host. I am so proud of my fellow 'conservatives', aren't you?

[The Old Hoosier]

her eyes do not really track visual stimuli

That's not what I saw on Fox News.

[US admirer]

Death by dehydration seems peaceful, nurses say
Last Updated: 2003-07-24 9:15:26 (Reuters Health)
By Gene Emery

BOSTON (Reuters) - Terminally ill people who opt to end their lives by forgoing food and drink appear to die at least as peacefully as those who end their lives with doctors' help, according to a survey of Oregon hospice nurses released on Wednesday.

The survey -- the first systematic look at what seems to happen when dying patients intentionally refuse food and fluids -- suggests that people facing death have a simple, serene and legal way to end their suffering.

Proposals to legalize physician-assisted suicide have sparked intense controversy in the United States. The practice is only legal statewide in Oregon, where patients wishing to die must get their doctors to prescribe a lethal dose of barbiturates.

The Oregon nurses' survey, published in this week's New England Journal of Medicine, looked at an alternative to physician-assisted drug overdoses.

The Oregon Department of Human Services says such overdoses can cause complications like gagging, vomiting or bowel obstruction. Supporters of physician-assisted suicide disagree that the ingestion of drugs causes a painful death.

Study author Linda Ganzini said that until now, some doctors considered voluntary death by dehydration to be a gruesome way to die. But Ganzini, director of the Palliative Care training program at the Portland Veterans Affairs Medical Center, said the study should change some minds.

"We are not at the point of saying this is a reasonable alternative for everyone," Ganzini told Reuters in an interview. "But it is a possibility for many more patients."

'LITTLE SUFFERING'

Ganzini noted that in hospice patients, the normal thirst and hunger mechanisms may not be intact. If a healthy person were to stop eating and drinking, he would likely suffer more than the terminally ill, she said.

The nurses in the study rated 102 deaths among patients who refused food and fluids, and 55 deaths where the doctor prescribed pills that killed the patient.

On a 10-point scale where zero reflected the most comfort, the nurses typically rated the peacefulness of the dehydration deaths as a two, compared with a five for physician-assisted suicides.

On suffering and pain scales, the nurses said patients who voluntarily stopped food and fluids seemed slightly more comfortable.

"According to the nurses' reports, most deaths from voluntary refusal of food and fluids were peaceful, with little suffering, although 8 percent of patients were thought to have had a relatively poor quality of death," the researchers said.

Study authors conceded that there were several limitations to their research, however. For one, the death reports from hospice nurses were based on memories and perceptions that may have happened up to four years previously.

Most of the patients -- 85 percent -- died within 15 days of giving up food and water.

[MarMema]

If a healthy person were to stop eating and drinking, he would likely suffer more than the terminally ill, she said.

[TheAngryClam]

These "you missed this" posts make it appear as if ambrose unfairly edited the article, which he did not.

Knock them off.

[FITZ]

Those really were pretty good links you posted:

Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements

[MarMema]

Study authors conceded that there were several limitations to their research, however. For one, the death reports from hospice nurses were based on memories and perceptions that may have happened up to four years previously.

[Dan Cooper]

You cannot face the "lets make her suffer for another 13 years" crowd with firm medical FACT,...

If she is suffering, doesn't that mean she is cognitive? If she isn't cognitive, how could she be sufferng?

[TrebleRebel]

Exactly.

I still don't know which way I would go.

Does her family keep her alive, only to lose her years later from multiple organ failure, amputation due to decubitus, difficulties in dehydration and nutrition, respiratory failure?...

The ONLY thing I am sure of is that I thank God I have not yet been faced with this decision for a loved one. God made that decision for us over the course of 9 months.

[HiTech RedNeck]

"We are not at the point of saying this is a reasonable alternative for everyone," Ganzini told Reuters in an interview.

Just give 'em a few more years and they will.

Sort of lends a new meaning to the expressions "take a powder" or "oh, dry up."

[The Old Hoosier]

To pin a label on her condition, and say, "ha, it means this, that and that, so we should starve her to death," is to ignore the individual facts of the case. And the television footage on Fox News. This case really comes down to whether third parties can decide to terminate the lives of severely retarted people.

Moreover, is it ever right to starve someone to death under any circumstances? I can understand letting someone die when some truly extraordinary means could save them, but to make it a crime to feed or hydrate someone?