Wednesday, March 23, 2005

Well, this about closes the Schiavo case for me...

Predendum -

Original post starts -

I know that there are people who don't like the WaPo, but this seems to me to put the FACTS together quite nicely...

Medical, Ethical Questions Largely Decided, Experts Say

By Shankar Vedantam and Rick Weiss
Washington Po
Tuesday, March 22, 2005; Page A06

For all the political controversy over whether Terri Schiavo is in a persistent vegetative state and should be allowed to die, neurologists and ethicists said yesterday that the case presents few scientific and legal ambiguities.

Congress, President Bush and others have sought to place the case in the context of a broader ethical and political struggle to define when life ends -- with resonances for the lingering question of when it begins. But many experts said this is the wrong test case for a nation struggling with those profound questions.

Michael Schiavo has maintained that his wife, Terri, had said she would not want to receive treatment if she were ever in a situation like the one she is in. The brain-damaged woman will never regain the conscious awareness she lost 15 years ago, medical experts said, and decades of case law have already dealt with the legal issues raised by people in her condition.

Patients who do not return to normal within weeks of losing conscious awareness have a very poor prognosis, studies have shown. Electrical measurements have revealed no activity in the regions of Schiavo's brain needed for such consciousness, and repeated clinical examinations have left no doubt about her future.

"She is permanently unconscious and will never again have consciousness," said Robert M. Veatch, a professor of medical ethics at the Kennedy Institute of Ethics at Georgetown University, adding that she cannot feel sensations of hunger or thirst. "She can't starve or be thirsty. Anyone who uses those words doesn't understand the condition she is in."

Schiavo's husband has said she expressed a desire not to receive treatment if she were ever in such a situation -- a claim that was repeatedly upheld in court.

Schiavo's parents, however, have argued that their daughter's condition is not as bad as doctors suggest. Schiavo sleeps and wakes, blinks, and sometimes seems to smile. Her parents and other critics of the decision to remove her feeding tube insist that she responds to the presence of friends and relatives.

Medical experts said those behaviors are the cruelest aspect of a terrible condition: Grimaces and other facial expressions give families of tens of thousands of such patients hope, but they are evidence only that Schiavo's brain stem is working, keeping alive reflexes and routine bodily functions. They do not suggest that the higher areas of brain functioning needed for her to regain conscious awareness will return, experts said.

"It's uncanny but misleading," said William Winslade, who has studied how to distinguish patients in a persistent vegetative state from those suffering from other conditions at the University of Texas Medical Branch in Galveston. "Family members . . . will interpret random eye movements as something is happening. That has to be the case with Terri Schiavo. A truckload of physicians have concluded she is in a persistent vegetative state."

Videos, such as those of Schiavo examined by Senate Majority Leader Bill Frist (R-Tenn.), a heart transplant surgeon and sponsor of legislation requiring her case to be heard in federal courts, can be particularly misleading, said a neurologist who helped develop national guidelines for determining when someone is in a persistent vegetative state.

Ronald Cranford, like other doctors who have examined Schiavo, found that she cannot respond to commands and lacks visual tracking, essential signs of consciousness. Cranford, a neurologist and medical ethicist at Hennepin County Medical Center in Minneapolis, has testified on behalf of Schiavo's husband.

"Tomorrow I will do a transplant surgery if [Frist] starts doing neurology," he said. "I have as much competence in transplant surgery as he is competent to do a neurological diagnosis on a videotape. He has no clue."

Schiavo's wish not to be kept alive should be respected regardless of whether others agree with her decision, several ethicists said.

"This case isn't about definitions of death, it's about personal autonomy," said R. Alta Charo, associate dean of law at the University of Wisconsin at Madison. "She expressed her wishes, and now people are standing in the way of her having those wishes carried out."

The struggle over Schiavo's state of consciousness echoes the long-standing controversy over defining death. Such debates have been as contentious -- if less public -- as debates over when life begins. They have changed substantially over time with the advent of new technologies and advances in scientific understanding about how the brain works.

The idea that a stopped heart determined death gave way in the late 1960s to the idea of "irreversible coma" or brain death.

Such definitions, however, have struggled to impose a bright line on what appears to be a biological gradient between life and death. A persistent vegetative state is confusing because only part of the brain is alive, even as higher centers are dead. The diagnosis can be controversial because it relies on clinical judgment and experience -- not an objective test or marker -- but experts said those ambiguities disappear when people have been unresponsive for very long periods.

Advances in imaging technology have recently raised a new round of issues, however. Some high-tech scans, for instance, show variations in blood flow in the brains of patients who are totally unresponsive, but the significance of those findings is unclear.

"Our brains are mysterious entities because you have chemical activity, electrical activity, organic activity all going on simultaneously," Winslade said. "Just because there is blood flow doesn't mean there is cognitive ability."

Because the brain performs so many functions, Veatch and others said, the ongoing challenge facing scientists and ethicists is to determine which of those functions add up to a life.

Mystic Knight, obviously you know more than any of these "experts" at least some of whom have had the opportunity to examine Mrs Schiavo in person.

I take it that your informed opinion is based upon similar informed examinations made by yourself?


Dave Justus said...

In fairness to Mystic Knight, there are numerous experts and conflicting testimony on both sides of this case.

The media has done a great job of repeating sound bites and publishing each side's spin but a pretty terrible job of investigating and reporting what the facts are.

I find those who say that Terri cannot and will not recover convincing for a variety of reasons, not the least because that is also what her court cases have found.

There are though a lot of people who disagree with me, and some of them are experts.

The probligo said...

Dave, I happen to agree with your points, even to the extent of being fair to MK.

The other side of the coin is that I find it very difficult to listen to people who have these "righteous solutions" to problems and issues such as Terri Schiavo.

That difficulty stems ENTIRELY from the fact that not one (in this instance) of these people, in any of the fora where Schiavo has been discussed, has EVER proposed what should happen if the Schindlers were to succeed in their action.

I doubt that MK will ever address the questions I put, in the same way as no one else ever has in other fora.

Why is this? It is because of the two alternatives...

If they are wrong, if the miracle does NOT happen it would mean having to admit that they are WRONG!!! That is a situation that can not be allowed; the God is on their side, they will always be RIGHT! There will always be the MIRACLE, you require patience to wait for it...

So, their faith, their belief, their justification is that the miracle will happen. Therefore they do not have to worry about what might happen after the Court rules in their favour.

That, in my opinion, is blind faith being taken to the extent of stupidity and irrationality.

Dave Justus said...

I don't think whether a miracle happens or not is relevant.

If Terri Schiavo had a living will that said she would want to be kept alive in this situation I certainly wouldn't advocate killing her.

If her family couldn't pay for such treatment that would create some issues, but I don't think that is the case here.

I certainly wouldn't advocate mandatory killing of people in her situation. All I am willing to advocate is a right to choose how one lives.

Tommy Meisel said...

I find it very interesting that many of the Republican senators and representatives, having leapt into action with overnight legislation to force the Shiavo case into federal court, then finding that a great majority of Americans were opposed to their intervention, suddenly became silent on the subject.
I find it also interesting that in this case the traditional states rights Republicans and the traditional federal dominance Democrats have suddenly reversed roles. It is like having the sun rise in the west.
I also find it disgusting that my elected representatives are so shallow and so opportunistic, and so willing to switch positions at the drop of a hat.
Not being a medical neurologist, I cannot say what my opinion is of Terri's chances for rehabilitation, but knowing that all but one of the myriad neurologists who have examined her have concluded that she has no cognitive abilities, and that court after court has ruled in the husband's favor, I conclude that they probably know more about this than I do and they are right.
What is really disturbing about all this is that it has been going on for 15 years. I know that the wheels of justice grind slow but exceedingly fine, but methinks we must have reach a microscopic powder stage 14 years ago.