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THE CRANFORD DIAGNOSIS

Doctors for Michael Schiavo have said that an MRI and PET are not necessary for Terri because PVS is primarily a “clinical” diagnosis, that is, one arrived at on the basis of examination of the patient, rather than by relying on tests. And the neurologists I have spoken to agree on the clinical nature of the diagnosis, while insisting that advanced tests nonetheless are a necessary part of it. But the star medical witness for Michael Schiavo, Dr. Ronald Cranford of the University of Minnesota, has repeatedly dismissed calls for MRI testing, and his opinion has prevailed.

Dr. Cranford was the principal medical witness brought in by Schiavo and Felos to support their position that Terri was PVS. Judge Greer was obviously impressed by Cranford’s résumé: Cranford travels throughout the country testifying in cases involving PVS and brain impairment. He is widely recognized by courts as an expert in these issues, and in some circles is considered “the” expert on PVS. His clinical judgment has carried the day in many cases, so it is relevant to examine the manner in which he arrived at his judgment in Terri’s case. But before that, one needs to know a little about Cranford’s background and perspective: Dr. Ronald Cranford is one of the most outspoken advocates of the “right to die” movement and of physician-assisted suicide in the U.S. today.

In published articles, including a 1997 op-ed in the Minneapolis–St. Paul Star Tribune, he has advocated the starvation of Alzheimer’s patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights. Perusing the case literature and articles surrounding the “right to die” and PVS, one will see Dr. Cranford’s name surface again and again. In almost every case, he is the one claiming PVS, and advocating the cessation of nutrition and hydration.

In the cases of Paul Brophy, Nancy Jobes, Nancy Cruzan, and Christine Busalucci, Cranford was the doctor behind the efforts to end their lives. Each of these people was brain-damaged but not dying; nonetheless, he advocated death for all, by dehydration and starvation. Nancy Cruzan did not even require a feeding tube: She could be spoon-fed. But Cranford advocated denying even that, saying that even spoon-feeding constituted “medical treatment” that could be licitly withdrawn.

In cases where other doctors don’t see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford’s assessment.

Expert witnesses in court are supposed to be unbiased: disinterested in the outcome of the case. Part of the procedure in qualifying expert witnesses is establishing that they are objective and unbiased. But given Dr. Cranford’s history of advocacy in the “right to die” and euthanasia movements, and given his track record of almost always coming down on the side of PVS and removal of nutrition and hydration, one might question his objectivity. Indeed, the Schindlers’ attorneys attempted to do so in the 2002 evidentiary hearing at which Cranford testified, but went unheard. Organizations such as the International Task Force on Euthanasia and Assisted Suicide submitted amicus curiae (friend of the court) briefs in the appellate proceedings in Terri’s case, demonstrating Cranford’s bias in detail. But these arguments also seemed to fall on deaf ears.

Some neurologists who also consult in legal cases were not surprised at the handling of Dr. Cranford’s expert testimony. In theory, they said, the expert witness is supposed to be objective, but, as Dr. Bell explained, “the way it really works is that an attorney carefully selects an expert that will give him the outcome he desires.” He related that he has been asked by attorneys to serve as an expert. “I have looked over medical records,” he said, “and told attorneys what I thought.” But on occasion, he said, his opinion was “obviously not what they wanted to hear” and “they moved on to another expert.” Bell acknowledged that Cranford is “a highly accomplished and experienced speaker,” but said that in him the court “likely found a highly prejudiced expert.”

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Dr. Cranford examined Terri on one occasion, for approximately 45 minutes. Another doctor for Michael Schiavo, Dr. Peter Bambikidis of the Cleveland Clinic Foundation in Ohio, examined Terri for about half an hour. When Dr. Bell learned of the cursory nature of these exams, he said: “You can’t do this. To make a diagnosis of PVS based on one examination is fallacious.” In Cranford’s examination, described by one witness as “brutal,” he discounted evidence under his own eyes of Terri’s responsiveness. At one point, Dr. Cranford struck Terri very hard on the forehead between her eyes. Terri recoiled and moaned, seemingly in pain. In his court testimony, Cranford dismissed the reaction and moan as a “reflex.”

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