Posted on 04/28/2005 9:09:55 PM PDT by murphE
Over the past several weeks, it has come to my attention that significant debate has developed regarding the Terri Schiavo case. I have read various e-mail messages between Cathy Beal, Father Cekada, Father Dardis, Bishop Sanborn, and two letters appearing in the St. Gertrude the Great Church bulletin.
Let me begin by stating that I do not feel I have either the theological expertise (mine is limited to a minor in theology at Xavier University, a Jesuit college in Cincinnati) or moral authority to adequately address the theological aspects of this case. However, I do feel that my background as a neurologist with additional specialized “fellowship” training in both neurological critical care (the subspecialty of neurology which deals with patients in comas and other critical neurological illnesses) and stroke, at the Cleveland Clinic and University of Cincinnati respectively, put me in a position to contribute some thoughts on the medical aspects of her case. Since completing medical school, I have over 15 years of experience training, practicing, and doing research in these areas. I have also had the opportunity as the result of my training and expertise in these areas to testify as an expert witness in such matters in medical malpractice and pharmacological product liability lawsuits. I state the above not to be prideful, but to give you some tangible appreciation of the fact that, simply speaking, there are few people in the country with any better training background or practical expertise to understand in detail the scientific and medical aspects of the care of patients like Terri Schiavo, whom I deal with on literally an almost daily basis.
I have reviewed the CT scan images of Terri Schiavo’s brain, watched the video of her taken by her family members, and also reviewed some summary comments/ excerpts regarding testimony given in deposition transcripts in her medical malpractice case. These again are all things I do on a very frequent basis. They are, to be frank, part of how I make my living. Having clarified the context in which I share my thoughts with you, I offer the following thoughts on this matter:
1) Terri Schiavo was NOT in a persistent vegetative state. The video taken of her clearly and unequivocally demonstrates that, at least at times, she is in a minimally conscious state and capable of interacting in a rudimentary way with her family and environment, which by definition excludes her from being medically classified as comatose or in a persistent vegetative state.
2) The parts of Terri Schiavo’s brain which would allow her to perceive pain, here thalami, were clearly intact and visible on her CT scan images shown by her husband, Michael Schiavo, on national television (which I rarely watch, and by the way, I have never voluntarily watched “Oprah”)
3) The parts of Terri Schiavo’s brain which would allow her to perform complex cognitive function, or which would enable her to speak or understand speech, were clearly damaged.
4) The parts of Terri Schiavo’s brain which would allow her to swallow on her own were intact and, in fact, she did not suffer from medically significant dysphagia (swallowing difficulty). If she had, she would have been dead long ago from a condition known as aspiration pneumonia, an infection in the lungs which is the result of inhaling one’s own saliva.
5) The parts of Terri Schiavo’s brain which would allow her to move her arms and hands to feed or hydrate herself were clearly damaged.
6) The parts of Terri Schiavo’s brain which would allow her to experience discomfort and/or pain due to hunger were undamaged.
7) Other tests were available to better clarify the full extent of Terri Schiavo’s awareness or lack thereof, such as MRI scanning of her brain ( a more detailed picture of the brain than a CT (CAT) scan, EEG (a brainwave test), and evoked potential studies, which could decipher the extent to which she could hear or see. These studies were refused by her husband, Michael Schiavo.
8) Terri Schiavo did not receive or require intravenous hydration or nutrition (so-called “TPN” or total parenteral nutrition.
9) Oral or stomach tube feeding via an “NG” (nasogastric tube) (a tube put down one’s throat to the stomach) or (more commonly) via a “G-tube” are routinely used to feed stroke victims, both temporarily and indefinitely in patients with stroke or other brain injuries who cannot feed themselves, whether due to swallowing problems (which occur at least temporarily in most stroke victims). Such feeding and hydration are by modern medical standards considered as ordinary and unburdensome as eating and drinking on one’s own. Such feedings are, in fact, less expensive than what an average American spends on food and water, and are easily administered a few times a day by a family member, requiring much less effort than cooking three meals a day. Terri Schiavo’s husband, parents, or siblings could easily administer such feedings. They are by no logical measure extraordinary or unduly burdensome by any reasonable standard (moral, medical, or economic).
10) Terri Schiavo could have been cared for at home with some home health care assistance at modest to at most moderate expense which would not by any common sense standard be deemed economically burdensome.
11) Terri Schiavo’s stomach and intestines were fully functional and capable of digesting food, even normal food if it was placed in her G-tube.
12) Terri Schiavo could have received sequential neurostimulation therapy to her throat muscles, which may have further improved her swallowing function to the point that she may have been able to chew or swallow at least some types of normal food and/or liquid if placed in her mouth. This and other similar available measures were denied to her by her husband.
13) Terri Schiavo’s brain, while severely damaged, had not “failed.” When someone’s brain “fails” i.e. is irreparably and totally damaged, they are, by definition, dead. While we can keep people alive when other vital organs such as the liver, kidneys, lungs, and even heart fail (via dialysis, organ transplantation, etc.), not even 2005 era medicine can keep one alive if one’s brain has failed, because all other organs shut down within 5 days when this occurs, even when every maximal effort possible is made.
14) Terri Schiavo did not require, nor to the best of my knowledge did she ever receive intravenous nutrition (TPN), as was suggested in one of Father Cekada’s e-mail messages. Lifelong TPN, in contrast to tube feeds, is widely considered to be an extraordinary, burdensome, and expensive means of prolonging life, and are comparable to a respirator in that regard.
15) Terri Schiavo’s doctors did, in my opinion, probably commit malpractice by failing to order routine pre- procedure labs which would have disclosed severe electrolyte disturbances secondary to her bulimia.
16) Medical malpractice care awards/settlements are often grossly overinflated due to plaintiff’s attorneys hiring so-called “life care planners” who add up every conceivable convenience and treatment imaginable as “necessary” for the rest of the patient’s life. Their overestimates are typically further compounded by overestimating the patient’s life expectancy. Furthermore, all the money is paid in advance at today’s dollars, meaning the real money value of the award is much higher than the actual cost of such care in the vast majority of such cases. Terri Schiavo’s true care needs would certainly be far less than 750,000 or 1,000,000 dollars.
17) Attorneys representing patients and defendants in medical malpractice and other medicolegal matters often “shop around” for expert witnesses until they find experts who will give an opinion which suits their client’s needs. Thus, it is no surprise that George Felos, a well-connected euthanasia advocate, was able to find three physicians to testify that Mrs. Schiavo was in a persistent vegetative state. In fairness, likewise it is no surprise that Terri Schiavo’s parents and siblings’ attorneys found expert witnesses who testified that she was not. One should certainly be suspect of the testimony of an expert witness who has spoken to the Hemlock Society and concludes that Terri Schiavo is in a persistent vegetative state.
18) Terri Schiavo died of dehydration, not starvation. Dehydration kills one much faster than starvation, barring the exception of extreme malnourishment, which was not the case here.
19) Terri Schiavo had an average life expectancy despite her brain injury, and would not have died were it not for her being deprived of nutrition and hydration. The proximate legal and medical cause of her death in my opinion was dehydration.
20) Laws regarding who has legal authority over health care decisions vary greatly by state. In Pennsylvania, for instance, children and siblings have as much right to make medical decisions as spouses, unless a pre- specified durable power of attorney designating one of them pre- exists the illness, or unless a living will was written by the patient. Other states require a durable power of attorney to be obtained no matter what. Ex- spouses, unless they are made durable power of attorney, have no legal right to make medical care decisions in any state.
21) Discontinuation of tube feeds or any form of food in general causes intense hunger pains for 2-3 days, which Terri Schiavo would have had the capacity to feel and suffer.
22) Death by dehydration occurs slowly, eventually causing hyperosmolarity often resulting in shriveling, cracking, and bleeding of the mucous membranes. This causes pain, nosebleeds, and as consciousness begins to wane, patients often begin aspirating blood from the nosebleeds, thickened, mucus or saliva, or both, causing aspiration pneumonitis. The aspiration along with accumulation of unsecreted organic acids results in progressive shortness of breath which further compounds the mucus membrane injury. Observing this struggling to breath and choking is often very disconcerting to family members as well as potentially painful and discomforting to the patient. This is why such patients are often administered morphine, which both relieves pain and suppresses this so- called “air hunger.” This is also I suspect why the judge in the Terri Schiavo case barred pictures or video of her being taken while she dehydrated and starved. Much as those who are pro- abortion most detest the one thing which actually shows people what happens in the case of abortion (pictures of aborted babies), euthanasia advocates do not want people to see the visible suffering which often occurs in cases like Terri Schiavo’s.
23) Cases like Terri Schiavo’s are, thankfully, rare. This is why when they occur and ultimately result in legal battles, we hear about them on the media. Collectively, even if one were to assume each and every one of them were to result in a lifetime of tube feedings, would be far less of an economic burden on society than a new football stadium.
Cases like Terri Schiavo’s understandably evoke a wide range of emotional responses and theological arguments. Unfortunately, the Catholic Church, theologians, and bioethicists in general lag far behind in their scientific understanding of the rapid and increasingly complex advances in medical care, which often occur literally even prior to our ever having the opportunity to contemplate their moral and theological implications. It is in the spirit of attempting to help simplify and clarify some of the medical aspects of the Schiavo case that I share the above thoughts with those who are inclined to read them. Finally, I would advise each and every person to prepare a living will as you would a normal will so that your families might be spared the pain and anguish of having to decide what care measures you would want should a grave or terminal illness occur. Had Terri Schiavo done so, her family and many others would have been spared from the bitter, divisive, and expensive series of legal battles which followed, which were the real extraordinary burden to society in her case.
Respectfully,
James M. Gebel Jr., M.D., M.S., F.A.H.A.
No matter how much you think it isn't necessary, you have to remember the sarcasm tag.
One would think what one wishes today should supercede past directives. Apparently, in many of these situations THAT is not the case. Frightening to say the least.
Agreed. My assessment also, agfter having cared for such patients in the past and the assessment of many on this forum as well.
The last doctor to see her, the one from the DCF, diagnosed her into her third or fourth day of dehydration/starvation as semi-conscious, which to me made sense, especially when considering the video.
Unless thousands of people had stormed that hospice, the chances of saving Terri were nill.
After, what we experienced in this incident, it would be wise for people to devise a rescue plan, in the event of future such incidents.
And they whined about it incessantly. I cannot begin to imagine their dramatic posturing, had one of their own family members been called cruel names the way Terri was. They so reminded me of the democrats who whine about Republicans while they themselves commit far worse offenses.
Well I was mistaken about the author. But I sure as heck am not taking back a blessing or the hope you will continue to defend life.
There was such a plan by the Michigan militia. When their services were offered, David Gibbs, the attorney for the family, told them NO. He never even ASKED the parents.
They had organized ex-military from across the country! They had a SAFE HOUSE set up to take care of terri.
Don't get me wrong. I don't advocate the militia. It's not like I even know what they really do, to be honest, but they wanted to save Terri from an inhumane death and were prepared to do what NO ONE else would do.....nor what no one else did!
I would have said YES!
Thank you for the ping!
So was the good father out of the universe when the Pope John Paul II of blessed memory issued his statement about nutrition and hydration of PVS and/or minimally conscious patients ? Did the Cardinals who issued the e Vatican statement's on Terri Schiavo not have the nuanced theological training to grasp the whole picture. Hey if you don't feed someone they'll starve to death. Oh pretty simple after all.
The true horror is that this man may have a great deal of influence on the Parish's RE program. That scares me.
High school football players, who have had their mandibles shattered, have received sustenance via a straw for weeks. Terri was no different.
Terri's body never rejected physical sustenance, to my knowledge.
Withdrawal of such physical sustenance, however, was the direct means of her cold-blooded murder.
It is false therefore to claim that Terri Schiavo was the victim of "euthanasia" or "murder".
With the above statement in mind, it is my opinion that it is false for Cekada to even claim he's a Catholic.
And so the monster that is Euthanasia, most publically begins with the case of Terri Schiavo, her body being cremated to hide the truth of her condition and how it came to be. The parallels to Nazi Germany are chilling. One would have to be deaf, dumb and blind NOT to see it. Or evil.
Thank you for posting it! Thank you also for pinging me to this thread.
The Schindlers did not seem to want to be responsible for the ensuing violence.
Considering the outcome of events in Terri's case, I think people might view things a little differently the next time. And most unfortunatley, there will certainly be a NEXT time.
In the end, you have to inform yourself as best you can and follow your conscience. I think I would have to change parishes if I had a priest like that. I fear there are many more just like him. They've been in hospitals and seen it all and I suppose it is icky and nasty to deal with.
With me it goes something like this. Unto those whom much is given, much is expected. Naturally in poor countries the bar would be lower. The irony of starving a helpless, disabled, reasonably otherwise healthy woman in a country that exports mountains of food is almost overwhelming.
I'll take Father Pavone any day. I shouldn't be writing this, but I've been grievously upset ever since this happened. I cancelled my subscription to our local catholic paper long ago for several different reasons, among which were advertised, organized, led-by-priests pilgrimages to Medjugorje which were forbidden.
It was probably a smart move as the editor or assistant editor of the paper is now sitting in prison for having child porn on the church computer.
The upshot of that was I got second hand what the paper had to say about the case, and it seemed to follow the thinking of the priest of St. Gertrude's.
And it goes much deeper for me. My catholic therapist who is a trained nurse has participated in pulling feeding tubes. I told her that was murder. And I am the one who is the nutcase and on two meds.
If I were more sure that I was on the right side, I would definitely seek out another therapist. I also met another catholic nurse who befriended me who casually told me she accompanied a prominent local doctor to Egypt on a mission to perform tubal ligations on women there, rich, poor, I do not know.
I know I have had in the past and continue to have difficulties here, but this is what I have been dealing with and it makes me uneasy to the core of my being wondering who in the catholic world you can trust.
This is the mess that is the catholic church. And I saw another thread about Catholic Hispanics seeking God in the US. I'll tell you what a lot of them are doing. They are going Pentecostal and Evangelical. Some stick with the church. What kind of shepherding they will get is beyond me.
"Further, in my opinion, Mrs. Schiavo' s husband (as horrible a person as he seems to be) -- and not her parents -- had the sole right before God to determine whether these means should have continued to be used."
Cekada entirely IGNORES that Michael Schiavo had completely compromised his marriage to Terri, because he was in an extramarital relationship with another woman with whom he resided for ten years and with whom he bred two children when he refers to Schiavo as Terri's "husband." No husband in such a situation retains ANY rights, never mind "sole" rights, before God to make any decision regarding his spouse, let alone a decision of such uncommon magnitude.
Cekada's statement is complete and utter blasphemy. Sole right before God my eye! Despicable!
You raised a pertinent question regarding Terri's swallowing abilities, so I thought I would fill you in on how the guardian's denial of her basic therapy and care contributed strongly to her declined state, declined from the gains seen in the 1993 videos.
A declined state which made it easier for Michael to claim Terri was in a coma or PVS.
Which raises another issue: the alleged statement by Terri that she wouldn't want to be kept alive artificially was supposedly made during a time when food and water were not considered artificial means of life support, so the Felos work to have Florida declare such as artificial is even more damming tot he death cabal that had Terri executed on greer's 'clear and convincing' testimony allowed in his court without allowing anything contrary to such into the court record.
Florida is still to dangerous a place to even drive through on the way to somewhere else.
At the time Terri made her supposed remarks, the term "machines" was used the most often. People at that time were most likely to say they didn't want to be "on machines" or "hooked up to machines."
This is one of the many reasons, I don't believe Terri ever uttered the statement about not wanting to be on "tubes" that she was purported to have made.
The gates of hell shall not prevail. Keep hope and remember that all happens as allowed by God. You are already able to discern that many so called Catholics both lay and clergy hold and teach views which are in direct contradiction to the Church's moral teaching. It is unfortunate that the MSM gives more voice to these " catholics" than those who are faithful Catholics.
For a good dose of orthodoxy I strongly suggest
www.ewtn.com and the websites for Crisis Magazine, Envoy Magazine, Biblical Evidence for Catholicism and Christianity Today. The last is Protestant but its core ethics and morals do not conflict with Catholic teaching and it always includes great articles in their weblog.
Pray for all the Church, especially our priests and bishops. The Church is always being purged but lately this purging is much more public and painful for many. Remember too that there are no new heresies and that the Holy Spirit is our protection against these heresies. The Truth of Jesus and the Church will remain long after the likes of the priest of St. Gertrudes are dry dust.
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