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.

[FITZ]

Courts may... and some courts.

Right ---- but you can see how vague and questionable the diagnosis of someone else's awareness really is. At any rate, Terri is not terminal --- she requires no extraordinary care, her family observes something ---- wishful thinking --- or maybe not. It's very possible that if Terri has awareness she does not wish to respond in any way to Michael or to his girlfriend --- so they see her as a vegetable --- but to her family maybe she does choose to respond. You aren't there, I'm not there.

[The Iguana]

It's time that her long-suffering parents and the grandstanding politicians let her go in peace.

I guess it's time to starve her to death.

[mylife]

Have there ever been any CAT Scans, EEG's or the like done that prove or disprove brain responce to stimuli? Surely after 13 yrs some one has looked into this.

[secretagent]

The cortex is the outer layer of the brain. Has anyone any inside info as to how much of it is gone in Terri? The medical records are sealed tighter than a drum and we only know what new-age spaced-out talk-to-other-souls Felos says.

Cranford has seen them, along with 5 other doctors at an evidentiary hearing. I don't know if Dr. Hammesfahr, the Schindler's witness, attended the hearing:

With his permission, here is an e-mailed summary of Terri Schiavo's condition from Ron Cranford, a neurologist who has personally examined her:

Terri Schiavo is in a classic permanent vegetative state. I have personally examined her and testified at a 6 day evidentiary hearing in Tampa in October, 2002, where six doctors testified on her neurologic condition, chances of recovery, and any possibility of her responding to treatment. The trial court judge concluded Terri was in a persistent (permanent) vegetative state, there was no possibility of recovery, and no chance of her responding to any treatment, including vasodilator therapy and hyperbaric oxygenation. Terri's most recent CT scans (extensively reviewed during the evidentiary hearing) show massive atrophy of the cerebral hemispheres, and the cerebellar hemispheres and brain stem, findings typical for a patient with severe and irreversible brain damage secondary to hypoxic-ischemic encephalopathy after 13 years in this condition.

http://www.healthlawblog.blogspot.com/

I don't recall the Schindlers stating that their doctors souldn't access the CAT scans at the evidentiary hearing, or disputing the details of those scans.

[HiTech RedNeck]

If I needed it I wouldn't mind being drugged into lala land. But don't ever tell me to dry up....

[texaslil]

You are soooooo right. From what I've seen, she appears to be in no pain, but her poor parents are. If she's in no pain and not aware of any even if she is, what's the harm in giving her parents who love her the comfort of their precious daughter. The harm as I see it is the cost to medicare since MS has already blown all the money. This should make all old people tremble.

[secretagent]

See my #104.

[Cicero]

I read the article you pointed to, but it doesn't prove anything. The reporter argues that she must have had an eating disorder because her calcium level was low. She offers NO EVIDENCE AT ALL that she actually was anorexic or bulemic. Maybe she was, maybe she wasn't, but this article is based on sheer speculation. It rambles on anecdotally without giving a single piece of evidence in support of her theory.

[FITZ]

Not real solid concrete evidence from that link:

Terri Schiavo apparently had an eating disorder. Even some of her family members have said they think so.

[mylife]

Thanks...I showed up while i was posting

[HiTech RedNeck]

Dr. Cranford? Dry-up Death Cranford?

[F.J. Mitchell]

I didn't know this was one of those stir up a mob and lynch Rush threads. I must have clicked on the wrong article.

[FITZ]

I read somewhere that this 5'3" woman had gotten down to 120 pounds ---- that doesn't really strike me as a starvation level.

[Calpernia]

Now someone help out a legal impaired mind here. Why is the article NOT subject to liability and damages to the Schindlers; but yet our activism is?

See: http://www.freerepublic.com/focus/f-backroom/1007384/posts?page=667#667

To: Calpernia

The post I was making gets to both liability and damages - people spreading wild statements on the internet as fact without checking them out or having firsthand knowlege, followed by phone calls, emails and faxes (many of which were based on or even contained portions of those wild tales) to the governor and legislators of Florida, who used that information to act in a manner contrary to the legal rights and interests of Michael Schiavo. That doesn't even mention the effect of the bad info bandied about regarding Felos, Greer, experts, conspiracies, UFOs and the Devil's Triangle.

667 posted on 10/24/2003 5:24 PM EDT by Chancellor Palpatine

[MarMema]

Dehydration and provision of fluids in palliative care. What is the evidence?

"OBJECTIVE: To provide a clinical review of issues surrounding reduced fluid intake in palliative care patients and a practical approach to care for these patients."

"CONCLUSION: Without sound evidence upon which to base clinical decisions, patients, families, and clinicians are left to balance potential benefits and burdens against the goals of care."

[FITZ]

I've heard that some doctors consider Terri to be in a "minimally conscious" state.

That's what it seems she is in from statements her family has made. I'm quite certain the parents who brought her into the world would have no interest in watching her suffer greatly --- there is no reason to believe she is suffering greatly except maybe when Michael tries to starve her to death. It's very possible if she is minimally conscious that she responds to certain people more than to others. There is no reason to think the family is making things up ----- they might be wishful thinking --- none of us would know for sure but why not allow them the benefit of the doubt?

[HiTech RedNeck]

Supposedly the good gummint guys went and looked up the information themselves.

[Two_Sheds]

Still no answer.

How about we ask it again:

"But if she has no cognition as alleged, how can she suffer?

[MarMema]

A review of the literature gives conflicting reports of the physical discomfort that may be attributed to dehydration in dying patients.

"In the absence of definitive research in this area, the balance of the burdens and benefits of such treatment remains subjective."

[Calpernia]

>>>"There has never been a documented case of someone recovering after having been in a persistent vegetative state for more than 3 months.

This statement alone by Cranford is libel.