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.

[TheAngryClam]

Go to the California recall threads.

You'll see plenty there.

[Old Professer]

Your position is one of relief of burden, then?

[FITZ]

That's why I've had a living will for years.

Here's my living will. Do not pull out the plug, do not pull out the feeding tube. I'll decide when it's time to go.

[Politicalmom]

Source that. There is NO proof of an eating disorder.

[sirchtruth]

I claim and retain MY right to "death with dignity"

What do you mean "YOUR" right?

Where did you get that right you think you have?

[ambrose]

Under the "new order" taking hold on the FR, you have to hate homos and favor government encroachment on our liberties, in order to qualify as a "conservative"...

[Old Professer]

I claim and retain MY right to "death with dignity"

Must we help you?

[TrebleRebel]

If you read ALL of my posts, you will see that I have no position. I know too well the pain in these situations, professionally and personally.

[gooleyman]

" I don't think this story is going to have a happy ending for the hundreds of Freepers who been actively supporting Terri and her parents."

---

You got crystal balls or something? How do you know how it's going to end? If it's a happy or unhappy ending, we'll deal with it that way. Until it ends, I, for one, choose to believe that the glass MAY be half full and not on it's way to empty. Like Terri snapped to her friend years ago, where there's life, there's hope. Don't go getting down in the mouth on us now DOG GONE-it...smile.

[FITZ]

Her family obviously believes there is some awareness ---- and it's all just on observations: (from one of the posted links)

The medical term vegetative is seen as potentially pejorative if misunderstood by families or carers as being synonymous with vegetable.

• The diagnosis of vegetative state depends on clinical observation of the presence or absence of behaviour that might indicate a functioning mind (Jennett & Plum 1972). As self-awareness cannot be measured, but only identified through an absence of purposeful responses to environmental stimuli, it has been suggested that the term vegetative be replaced by a clinical term descriptive of continuing unresponsiveness.

• Prediction of outcome may influence patient management (Murray et al 1993). Where the term persistent vegetative state is used inappropriately or taken to indicate permanence of an unresponsive state in an individual, it may lead to withholding of opportunities for rehabilitation and restriction or limitation of access to other treatments (Andrews 1996; Zasler 1996).

• The abbreviation PVS may be interpreted to mean either persistent or permanent vegetative state. Criteria for use of the qualifier permanent vary in overseas guidelines and some guidelines have suggested that there may be more than one type of vegetative state (Multi-Society Task Force 1994; Andrews 1996; Royal College of Physicians of London 1996). It has been suggested that use of the qualifiers persistent and permanent be avoided and that, instead, the duration of the vegetative state be specified (American Congress of Rehabilitation Medicine 1995).

• Medical use of the term permanent vegetative state is based on the high statistical clinical probability of the vegetative state continuing indefinitely. It has been suggested that non-medical understanding of permanent is absolute, rather than statistical. Reports of late emergence or possible initial misdiagnosis (Tresch et al 1991; Childs et al 1993; Multi-Society Task Force 1994; Andrews et al 1996) have heightened this concern.

[Old Professer]

Keeping her alive in that horrible state is cruel.

There is no objective way to substantiate this statement.

[MarMema]

In general, responses to the individual survey items were quite varied, representing inconsistencies in attitudes and care of dying LTC patients

CONCLUSION: Physicians have considerably divergent attitudes toward intravenous hydration for terminally ill cancer patients.

Many of those involved in palliative care have justifiable objections to the introduction of intravenous hydration in patients with dehydration-associated symptoms and advanced cancer. Researchers from the University of Buenos Aires carried out a randomized, comparative and prospective trail to determine the usefulness of hypodermoclysis in the control of thirst, chronic nausea and delirium...Both groups showed significant and equal improvements in relief of thirst and chronic nausea at 24 hours. After 48 hours, this improvement was maintained in the group that received hydration, but only for the relief of chronic nausea. Delirium did not improve significantly in either group during the 48-hour trial period.

Many healthcare professionals believe that dehydration is painful and uncomfortable for dying patients.

Occurrence of hyperactive delirium and the requirement for symptomatic sedation significantly correlated with hepatic failure, opioids, and steroids, while dehydration-related pathologies were significantly associated with hypoactive delirium. Complete recovery was frequently achieved in cases with medication- and hypercalcemia-induced delirium, whereas a low remission rate was related to hepatic failure, dehydration, hypoxia, and disseminated intravascular coagulation.

There is danger in referring to terminal sedation and terminal dehydration as alternative forms of euthanasia. We risk compromising care by putting additional pressures on health care professionals, patients, and families to avoid sedatives or administer fluids in the final days of life. In failing to distinguish between the deliberate use of such actions to hasten death from appropriate end-of-life care, the authors confuse the goals and approaches of palliative care, which is aimed at relieving suffering without hastening death, with deliberate forms of euthanasia.

[shhrubbery!]

Unless, of course, the brain scans of Terri that are in the (sealed) court record that show she has no cerebral cortex left are correct. That article depended on there still being a brain in there to have neurons firing.

Why don't Schiavo and Felos release Terri's scans if they're so sure there's 'no cerebral cortex' there? There's nothing to stop them.

But from what I heard, scans don't tell give the whole picture anyway. Are you aware that doctors said Karen Ann Quinlan had 'no' cerebral cortex left, based on scans? Yet, when the autopsy was done, her cortex was found intact. Even Karen Ann Quinlan, who was in worse shape than Terri is, may have had a shot at rehabilitation if it had been tried.

[APFel]

Somehow I doubt the person dies a peacefully as claimed. Going without water does some nasty stuff to the insides which I understand is quite uncomfortable. Sometimes ill patients are just unable to express their pain and therefore it is deemed "peaceful".

So, if "peaceful" is judged by the reaction the patient physically shows during their ordeal, I suppose if someone smothered her with a pillow it could seem peaceful as well. Maybe stuff her windpipe with packing peanuts. That'd be "peaceful" too.

No, starving or dehydrating a patient to death just absolves any one person from blame, that is all. Since it is done in a hospital setting with many people around, it is a-okay. Starve a parapalegic or brain damaged individual to death in your basement, and you'll be sent up for murder sure as pidgeon poop.

Sure, I understand that a lost cause is just that-- a lost cause. However in this case, there are many people, not just the immediate family, who have taken interest in keeping this woman alive, and I am sure the cost of sustaining her indefinately would easily be paid by her family or people sympatheic to her situation (the public at large, and probably more than a few FReepers). So, what is the damage here?

The zeal that her husband has to make sure she goes to her eternal reward is suspect. Despite the overwhelming coverage that this case has received, I don't have a clue as to why the husband wants to let her go so badly. My wife and I discussed this, and as a nurse, she has seen a few lost causes waste away from malnutrition or dehydration. She seems sympathetic to the notion, actually (I am trying to reform her, honestly I am). But a few days ago, a man a little older than I came to her ward who suffered from a bleed originating in the brain stem. Not fatal, but he would never, ever recover. He would live, but he would never be aware. She admitted that, while caring for him and dealing with the family who was hopelessly optomistic, she didn't know if she would let me go if I was lying there in that bed, in a state between life and death. This is a guy who, short of an act from God himself, would never utter another word. His brain was dead, but his heart still beat. The woman in Florida is displaying more signs of life and signs of awareness than this gentleman did (or ever would). Why wouldn't a husband, a loving husband interested in his wife's well being, abandon her while she needs him the most? He is in the position to show compassion, so where is it?

I have read the various threads on Free Republic and have been crushed by the other media sources that cover this case. I have heard the "murderous plot" theories and the rhetoric coming from the usual leftist suspects. What it all boils down to is... Does he love his wife? After all, my wife and I have dealt in hypothetics and we seem to agree that niether one of us could allow such a "treatment" to be performed on either of us.

So, hubby, where is the love? So, leftists, where is the compassion?

APf

[TheAngryClam]

Start here. This is one of many admissions that she had a long history of eating disorders, which contribute to potassium imbalances.

[shhrubbery!]

I've heard that some doctors consider Terri to be in a "minimally conscious" state. This is one step up from PVS. Sorry I can't remember where I heard that.

[Zipporah]

Seems this guy doesn't realize that Terri isn't in a vegetative state.. he's believing the propoganda.

[PleaseNoMore]

With all due respect, I will lose my hope when God no longer sits n His throne. My hope is not in anything earthly. It is in a miracle working Saviour who loves us more than His own life.

[CindyDawg]

Terri may never get any better than she is now but she has the right to have therapy to try. It saddens me that some here (not you) are name calling and ridiculing me for caring. No one wants to be handicapped but it happens. There is no sin in being disabled. IMO she has the right to live as much as you guys walking around with high IQs do and I feel that society has a responsibility to help others who can't , from babies to the elderly. Is that so wrong?

[Cicero]

Does this guy walk around town pushing little old ladies in wheelchairs under busses?