The controversy was not about what Terri wanted, as that is what the Court determined. It was about conservatives turning the entire ordeal into a Right-to-Life argument that mirrored the abortion issue.

The conservatives and right side of the spectrum that supported the parents will still claim it was a life, whether in a PVS or not.

Thank you for making sure this was noted here Ed. I was wondering if anyone would.

Of course, there's still plenty of things about this case that are disturbing, from the fact that her family and her husband couldn't agree on what Terri's wishes would have been vis-a-vis her feeding tube (you all have living wills now, right?), to the fact that she wasn't terminally ill (the autopsy confirmed she could have lived for at least another decade).

But I think it's safe to say that ITA's authors have always agreed that the Florida courts' actions were consistent with Florida law (even if we didn't like the outcome and/or thought the law should be changed), and that the intervention of politicians--particularly at the national level--was regrettable even if well-intentioned.

Oh, one other thing that I find interesting. The autopsy states that the vision centers of her brain were dead. Yet even those who concluded Terri was in PVS did not deny that she seemed to follow people and objects with her eyes--they just said that was a reflex reaction. Can that sort of reflex reaction occur even in a blind person? Can the eyes track an object even when the brain is not processing any images?

I'm not implying anything here. Just asking.

Yes.

Eric, that's what a lot of us were saying the whole time. That's why you can't diagnose whether or not a person is in that state using just a video.

"Can that sort of reflex reaction occur even in a blind person? Can the eyes track an object even when the brain is not processing any images?"

Oddly, perhaps, the answer is yes. In fact, there's a fascinating condition called "blindsight" in which patients are blind--that is, they are not conscious of any visual stimuli--but if you show them an object in a particular part of their visual field and ask them to point to it, they'll be able to with a surprisingly high degree of accuracy. They even avoid walking into chairs and such when they navigate a room. (Incidentally, there's another condition in which patients display the exact opposite symptoms: they are actually blind, but claim that they're not. If you ask them how many fingers you're holding up, they'll confidently give you a random, completely wrong number.)

Incidentally, it's inaccurate to state, as some news stories and blogs have, that Schiavo was missing "her visual areas" and was simply "blind". Technically, she was "cortically blind", meaning that she could have retained the ability to track objects with her eyes, since it seems that she possessed somewhat intact subcortical structures such the thalamus.

I think it's inaccurate to take ITA's silence of nearly several hours on this issue as an implication that none of us cared to post the results. You see, a great many of us spend much of the day away from the computer, which is a large reason why we're not a breaking news site.

For more neuroscience background relevant to Schiavo's condition, see here: http://tinyurl.com/7bb8v

There are still questions as to how she got into that condition, as the autopsy ruled out her having a heart attack as well as bulimia being the causes. Therefore, there are definitely more questions than there are answers. The truth is, they really don't know what happened to Schiavo, or what was going on in her body.

Thanks for the link to the actual report. I'd pay more attention to the last paragraph. This medical examiner is not done with this matter. I am surprised that there have not been a few books out on the case-expect them, especially since the examination makes mockery of much of the media reporting. Read the last paragraph.

Oh, give it up, Leon. The last paragraph states that the exact cause of Schiavo's death has yet to be fully determined. The document is very clear, however, on the more important issue--the extent of cortical damage that Schiavo had already suffered. Almost no cerebral cortex, no occipital lobe whatsoever. Oh, and the report also states that there were valid medical reasons to not give her an MRI.

The reason that there was no need for an MRI was the fact that CT scans are almost as good and she had at least two of those which showed pretty much the same thing. Most of her brain was GONE.

What Terri's "supporters" were hoping is that those parts of the brain might have grown back, a medical impossiblilty...or that CT scans LIE.

It's creationism, the idea that you can't trust ANY science.

ericl wrote:

It's creationism, the idea that you can't trust ANY science.

I would modify that slightly - it's really the idea that you can't trust any science that conflicts with you want or believe strongly to be true.

I saw her brother and sister on Hannity & Combs last night. They maintain that she could still get better, abdicate an investigation into her husband's activites when she collapsed (almost accusing he did something illegal), and indicated the autopsy was not correct which made it sound they believe a conspiracy is afoot.

This will never be resolved.

This will never be resolved.

It's already been resolved. The fact that one group of people won't accept it for purely emotional reasons has nothing to do with whether it's been resolved, any more than the existence of flat earthers leaves the shape of the earth in doubt or unresolved.

No, the corner's report did not conclusively determine the cause of her collapse. It ruled out possibilities. Thus, it will never be resolved.

No, the corner's report did not conclusively determine the cause of her collapse. It ruled out possibilities. Thus, it will never be resolved.

But that really isn't the main focus of the autopsy in this case. It would be very difficult for an autopsy to determine the cause of the trauma that took place 15 years ago. They can do the best they can, but that question was never going to be resolved by an autopsy in the first place. What was resolved, conclusively, is the prognosis and diagnosis that there was no way she was going to get any better due to the condition of her brain. And that was the only thing anyone believed it would resolve in the first place.

As someone often repulsed by the reactionary Christian movement, I agreed with the courts and was disturbed by the efforts of the United States Congress to intervene in the matter. However, I was always uneasy with Michael Schiavo's uncompromising determination to remove the feeding tube no matter the legal and emotional cost to all parties involved. In a persistant vegetative state, Mrs. Shiavo was not suffering. Why all the fuss? Why not just sign guardianship over to the parents and move on with life, as Mr. Shiavo seemed already to have done long ago when he found a new wife? Such questions, I suppose, are not mine to ponder. In making himself a public figure, his motives are subject to scrutiny. I don't believe, as some do, that Mr. Shiavo was malicious, or that he somehow caused his wife's unfortunate condition, or that he had a monetary interest in Mrs. Shiavo's death, or that he was motivated by anything other than the deepest conviction that this is what his wife would have wanted. But what if he was wrong? Especially with the diagnosis of PVS. Once someone has been diagnosed with PVS, any movements or seeming reactions to environmental stimuli are presumed reflexive. However, in a recent Cornell study using PET scans, it was found that a large proportion (I don't recall the specific fraction of the sample) of patients diagnosed as PVS were actually in a minimally conscious state. One would think that thoughtful, pro-science people would be open to the possibility that Mrs. Shiavo might have been in this minimally conscious state. I realize, of course, that a brain as significantly reduced in mass by atrophy as Mrs. Shiavo's was never to recover and probably would not have turned out to be minimally conscious. Most minimally conscious people have suffered brain damage from trauma rather than from oxygen deprivation, which is far more devastating. However, it was sad to see what years of trench warfare have done to both sides of the old argument between children of the Enlightenment and children of Christ, and the concomitant crushing blows that this rancor has done to those who who dare to consider themselves both. With battle lines drawn, people on my side rightly defended the legal process and the courts but showed no unease with Mr. Schiavo's crusading unwillingness to negotiate or subject his wife to the latest science. I won't even mention my disgust with the religious right and some Republican politicians who brazenly took up the cause for political advantage with the pro-life movement. Not that Democrats who voted with the majority to pass Terry's law are any better.

Joan Didion has an excellent piece on the Schiavo case in the New York Review of Books. It is more balanced than most in the broad public will be able to stomach, but I suspect readers of ITA will be interested.

http://www.nybooks.com/articles/18050

By the way, it is broadly agreed among the physicians that did examine Mrs. Schiavo that the cause of her brain damage was a lack of oxygen (anoxia) resulting from a heart attack brought on by a potassium deficiency. That potassium deficiency is the topic of some debate, but most people agree that Terri suffered from bulimia, and vomiting is known to cause K+ deficiency. There was no way an autopsy this long after the fact was going to have much to say about the cause of the brain damage, and religious reactionaries' attempts to keep the debate going because of this lack of information is pointless.

Chuck wrote:

However, I was always uneasy with Michael Schiavo's uncompromising determination to remove the feeding tube no matter the legal and emotional cost to all parties involved. In a persistant vegetative state, Mrs. Shiavo was not suffering. Why all the fuss? Why not just sign guardianship over to the parents and move on with life, as Mr. Shiavo seemed already to have done long ago when he found a new wife? Such questions, I suppose, are not mine to ponder. In making himself a public figure, his motives are subject to scrutiny.

Well I think his position was perfectly reasonable given the circumstances. Let me explain why. Put yourself in his situation. He's spent 5 years consumed with doing anything he can to help his wife recover. He's been by her side virtually day and night during that time, he's taken her around the country for experimental treatments and watched over her through years of attempts to rehabilitate her and make her better. None of it works. The doctors have been telling him for years that the chances of improvement are nil and the catscans show that half of her brain is simply gone, liquified completely. He finally comes to terms with this reality and with the fact that Terri had told him and several others that she would not want to be kept alive indefinitely if there is no hope of recovery. So he files a motion to do what she would have wanted done...

Her parents immediately begin a public campaign to destroy him. They falsely accuse him of abuse, charges that all of the doctors who examined her at the time of the trauma (and now the coroner) denied completely, and charges that the court dismissed with prejudice. They accuse him of being in it for the money, which he had no control over and offered to divest himself of any future claim to anyway. They publicly accuse him of not allowing Terri to have any rehab therapy, which was a total lie - he had just spent 5 years exhaustively doing almost nothing BUT that. They've started accusing him of adultery for dating another woman after they themselves had encouraged him to do so. On top of that, the parents testified under oath that they didn't care what Terri's wishes were, that they would keep her alive no matter what. The attorney even went into increasingly gruesome scenarios in questioning them about this, asking what if they had to amputate all of her limbs, and so forth. They testified that no matter what, even if they absolutely knew that Terri would not want to be kept alive under such circumstances, they would refuse to let her die. And they lined up donors to try and bribe Michael to divorce her, to the tune of at least a million dollars.

Now, given those facts, do you still wonder why he didn't just sign over custody to the parents? Also bear in mind that the court's decision was not based on who had custody and their wishes. The court determined that Terri's expressed wishes were not to be kept alive with no hope of recovery and that the medical evidence clearly showed no such hope. The court was acting as Terri's guardian, so Michael could not just sign it over to the parents. Under Florida law, once the court determines what the patient's wishes were, no one else's wishes matter - either Michael OR the parents.

The fact is that it was the parents who brought all of the lies and false accusations to this case and made it public. I don't blame Michael a bit for not "negotiating" or "compromising" with them after that point. When I first began to research the case, I had enormous sympathy for the parents. But after seeing the long list of deceitful claims they made in the media - and not just lies but destructive lies - that sympathy disappeared. I understand their desire not to lose their daughter, who they no doubt loved very much. But that does not excuse their reprehensible behavior in the case.

Eric,

"and that the intervention of politicians--particularly at the national level--was regrettable even if well-intentioned."

So, does blatant political posturing or hijacking an event to enhance one's political stature come under the description, "well-intentioned"?

However, in a recent Cornell study using PET scans, it was found that a large proportion (I don't recall the specific fraction of the sample) of patients diagnosed as PVS were actually in a minimally conscious state. One would think that thoughtful, pro-science people would be open to the possibility that Mrs. Shiavo might have been in this minimally conscious state. It's about 30%, but my understanding is that there's an important difference between those patients and Schiavo: those patients still had intact gross neuroanatomy that Schiavo had patently lacked on her last scans. It's one thing to do a scan and look at potentially intact tissue, and wonder, hm, is this all dead, or is any still functioning? It's another, however, to do a scan and see nothing but fluid in the relevant regions.

So, does blatant political posturing or hijacking an event to enhance one's political stature come under the description, "well-intentioned"?

Speculations about ulterior motives are ultimately pointless. Do you think Nancy Pelosi, Ted Kennedy, et al are sincerely concerned about Gitmo, or might that be political posturing? The answer is likely to depend on your pre-existing political point of view.

ericl at June 16, 2005 09:13 AM |

...or that CT scans LIE....

I understand your point, but the idea that CT scans lie is idiotic (and I know that you're not suggesting that they do). I'll merely point out that CT scans provide images, which are interpreted by technicians and doctors. As do PET scans. As do ultrasound scans (and I've undergone some of them). The interpretations of the scans may be "problemmatic" but the scans themselves do not lie. The scans provide images.

It isn't worth much time going into the Terri Schiavo issue. I am of the opinion that the falling out between Michael and the Schindlers (Terri's side of the family) was over money. Recall that Michael was awarded US$300k for loss of consortium in the malpractice settlement and the Schindlers got nothing. I'm not an expert in that field, but I am not aware of a legal theory on which the Schindlers might have claimed a right to damages--and I am a lawyer, btw--but Michael had a valid legal claim for loss of consortium.

Am I cynical about the situation? You bet I am. It was recently reported that the Schindlers are hawking their "list" (pun intended) of people who have expressed support for them to various organizations for various amounts of--get this--money. It was and probably still is an issue over money. And that is truly sad.

Confirms diagnosis? Which diagnosis? PVS?

If you are claiming that the autopsy confirms the PVS diagnosis, that is simply not true. The autopsy states things like:

"PVS is a clinical diagnoses arrived at through physical examination of living patients. Postmortem correlations to PVS with reported pathologic findings have been reported in the literature, but the findings vary with the etiology of the adverse neurological event."

and contains Stephen Nelson's letter to Jon Thogmartin which says,

"Neuropathologic examiniation alone of the decedent's brain - or any brain, for that matter - cannot prove or disprove a diagnosis of persistent vegetative state or minimally conscious state."

There are still questions as to how she got into that condition, as the autopsy ruled out her having a heart attack

Heart attack is unhelpful layman's usage. There was zero evidence for a myocardial infarction, but the report does not rule out hypokalemic arrhythmia as the cause for the anoxia, suspected from the first when she presented in the hospital.

it is broadly agreed among the physicians that did examine Mrs. Schiavo that the cause of her brain damage was a lack of oxygen (anoxia) resulting from a heart attack brought on by a potassium deficiency.

This is flat out wrong. There was no evidence she had a myocardial infarction, rather arrhythmia.

Jivin J wrote:

Confirms diagnosis? Which diagnosis? PVS?

I should more properly have said prognosis rather than diagnosis. The prognosis was that there was no hope of improvement regardless of what action was taken. The autopsy did indeed confirm that prognosis.

Your points are well taken, Ed. By and large I agree. I was arguing more from the heart than the head - and that inner battle within all of us is largely at the core of the whole debate. I merely wish more people on both sides would try to see that.

In the agora, of course, the head should always prevail.

I was curious as to what the conservative side of the blogosphere would have to say about the report and so did some research via Google news. And the, shall we say less thoughtful, conservative blogs still rant on about the case, very carefully selecting quotes from the autopsy report. Quite frankly I find them sickening in their completely blind refusals to admit that they might have been wrong. How they expected someone whose brain had atrophied to half of the mass it should have had to recover any significant function shows the extent to which they have abandoned rational thought.

One source of ethical guidence says, "..food and water should be provided for all patients who suffer pvs unless it fails to sustain life or causes suffering...In general, the provision of nutrition and hydration to the patient is proportionate and morally obligatory. Removal of food and water is permissible only when they no longer attain the ends for which they are provided." I note also that Mark Furman, author and criminal investigator, has spent a number of weeks going over the totality of the records and will shortly deliver a book to the public.

I note also that Mark Furman, author and criminal investigator, has spent a number of weeks going over the totality of the records and will shortly deliver a book to the public.

Uh, yeah, Replace "author and criminal investigator" with "disgraced former cop with a penchant for racial epithets" and you're a lot closer to the truth. We've already had someone go over the entire record, including every medical report, every court transcript, and spend nearly 90 hours with Terri herself, and deliver his report to the public. His name was Jay Wolfson and he was the Guardian Ad Litem appointed pursuant to the Florida legislature's intervention. And unlike Mark Fuhrman, he was actually qualified, with a PhD in public health and a law degree, to evaluate that evidence. But please let us know as soon as Kato Kaelin publishes something about it.

Ed: Can I quote your response about Michael's motives in my blog?

Oh yes, it's not settled till we hear from Kato Kaelin! To get a balanced picture, we need more idiots to balance out all those highfalutin' experts. Oh wait, we've heard from enough "IDiots" already. Never mind...

Ed, et al. - Your argument is a straw man - it was never the position of the Schindlers and their supporters that the only basis for not killing Terri was that she might improve. So any "confirmation" that there was no hope of improvement does absolutley nothing to undermine their position.

Jim Rockford wrote:

Ed, et al. - Your argument is a straw man - it was never the position of the Schindlers and their supporters that the only basis for not killing Terri was that she might improve. So any "confirmation" that there was no hope of improvement does absolutley nothing to undermine their position.

I'm not sure how that makes it a straw man. At worst, it means I haven't defeated every possible argument they made, but I didn't claim to so that's irrelevant. A major part of the legal argument was whether or not she could recover. They made a huge deal out of their false claim that Michael had not allowed rehab and they trotted out the incredibly dishonest Dr. Hammesfahr to claim that she could improve. The autopsy shut down those arguments entirely. From a legal standpoint, the only other argument that matters is over whether Terri had made her wishes known or not. The court ruled that she had and that ruling was upheld by multiple appeals courts. Those are the only two legally relevant arguments in the case, so to claim that conclusively disproving one of them does "absolutely nothing" to undermine their case is, well, quite silly.

Ed, you have defeated no argument. Piling rant upon rant equals rant. I note your scorn about a criminal investigator and author of many talents being dismissed with all the bravado of a three year old. Will you say the same of Jeb Bush? You sure have a lot of confidence in Florida courts-a confidence not shared by very many folks in this world or any of its judicial systems.

Hey, I hear Rosa Lopez is working on an article on the subject for Harper's.