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.

[TheAngryClam]

Note the statements from her family in it- particularly the part about the liquid diet.

[HiTech RedNeck]

Well the weasel-word is "documented." This means someone wrote it up in a journal. The vast majority of family doctors would be too busy to bother.

[Dog Gone]

There is no sin in being disabled. IMO she has the right to live as much as you guys walking around with high IQs do and I feel that society has a responsibility to help others who can't , from babies to the elderly. Is that so wrong?

It's not wrong at all. What's wrong is that there is no clear indication from Terri as to what she would want. Her wishes should be respected, but we don't have much indication. Her husband does not seem to be a reliable and impartial source of information.

[PleaseNoMore]

To anyone who believes that starvation/dehydration is "peaceful" I say that it isn't. My own father died due to dehydration. He had a tumor that closed off his esophogus
and he would attempt to take in fluids and they would come out of his nose. He would cry because he couldn't drink. He would literally beg God to allow a drop to go down. He was so thirsty. In the end his death was horrible. Had he been strong enough for a feeding tube he would have had one. If only to lessen his discomfort in the end. Before you advocate this method of death for anyone, try going a couple of days without a drop of water or an ounce of food. Then see what you have to say. I assure you that you will be grateful for the ability to be able to pick up a glass or a spoon.

[TheAngryClam]

Because it makes no factual statements about the Schindlers, and it state the truth about Terri Schiavo (as found by the trial court).

[FITZ]

But look at the way "persistent" could be used or misused. If someone recovers then they would say they were not in a "persistent" state after all --- it proved to be only "temporary" Persistent would mean they never come out --- so it could only be used on those who after years --- until they died a natural death, never came out.

[TaxRelief]

EUTHANASIA AS A SUBSTITUTE FOR HEALTH CARE RATIONING?

By Burke J. Balch, J.D., Director

NRLC Department of Medical Ethics

 

Considerable commentary has followed in the wake of the determination by Attorney General John Ashcroft that federally controlled drugs may not be used to assist suicide. Not yet in effect while under challenge in the courts, the determination would have its greatest impact in Oregon, the only state whose law currently authorizes physician-assisted suicide.

In an otherwise urbane, "on the one hand, on the other hand"-style article by George Mason University Law School Professor Nelson Lund criticizing Ashcroft,1 one chilling paragraph stands out:

"[E]ven a skeptic like me has to admit the very real possibility that Oregon's approach is not the worst imaginable," Lund wrote in the February edition of Commentary magazine. "If ... the political and economic pressures for health-care rationing become significantly more intense, we may see a much more widespread denial of medical care to very feeble patients, including the withholding of food and water."

Having set the reader up, Lund then adds, "If the alternative to a miserable death by dehydration turns out to be physician-assisted suicide or euthanasia, Oregon's approach may begin to look a lot less bad than it does today."

Lund's justification of assisted suicide is all the more jarring in the context of the rest of his article, which raises many important warning flags about assisting suicide. For instance, he deplores the fact that, "Whether it happens directly through law and regulation, or informally, very sick patients who are elderly or whose prospects for recovery are thought to be small are going to be prime targets for 'hastened death.' ... Once physician-assisted suicide is legalized, there will be strong temptations to pressure such patients to accelerate the inevitable ... especially effective with those who are clinically depressed."

Lund's scary prediction of pressure for assisted suicide as an " alternative" to starving and dehydrating people to death or as a " cost containment" measure is already well on its way to realization.

The most recent official annual report on Oregon's unique-in-the-nation law that has legalized physician-assisted suicide there found that 63% of those who killed themselves said they were motivated at least in part by fear of being a "burden."

In December 1997, Faye Girsh, executive director of the pro-euthanasia Hemlock Society USA, issued a statement endorsing killing individuals - - such as people with Alzheimer's disease and children with disabilities - - who are legally incapable of making the decision themselves.

"A judicial determination should be made," Girsh said, "when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child." (Confronted with vigorous protests by disability rights activists, Girsh later tried to pull back, issuing a " clarification statement" calling this position simply "one suggestion about the question of ending suffering" not officially endorsed by the Hemlock Society.)

In December 1998, the founder of the Hemlock Society, Derek Humphry, wrote positively of the use of assisted suicide as "one measure of cost containment." "[T]he elderly," Humphry's book (ironically, entitled Freedom to Die) said, are "putting a strain on the health care system that will only increase and cannot be sustained."

Speaking of people with disabilities, he wrote, "People with chronic conditions account for a disproportionately large share of health care use, both services and supplies." In light of all this, he asked, "Is there a duty to die--a responsibility within the family unit - - that should remain voluntary but expected nevertheless?"

In the justly famous "Iron Curtain" speech in which Winston Churchill helped awaken the West to the danger of Soviet communist expansionism at the beginning of the Cold War, the former British Prime Minister referred to his unsuccessful efforts in the 1930s to warn a Britain enamored of appeasement of the rising danger of Hitler's Nazi regime. "Last time I saw it all coming and cried aloud to my own fellow-countrymen and to the world, but no one paid any attention. Up till the year 1933 or even 1935, Germany might have been saved from the awful fate which has overtaken her and we might all have been spared the miseries Hitler let loose upon mankind. There never was a war in all history easier to prevent than the one which has just desolated such great areas of the globe."

We have been warned of the consequences of legalizing euthanasia. We have been warned by the mouths of its foremost proponents; we have now been warned by the mouth of one of its reluctant facilitators. If we fail to act now to stop it before it spreads, then - - if in time to come we see our grandmothers, parents, and children, when "very feeble," taken away to be killed - - let us blame no one more than ourselves.

NOTE:

1. What Lund conceives to be the main point in his article is that Ashcroft's ruling is not in keeping with "federalism" because it renders more difficult something a state has chosen, as a matter of its own state law, to permit. In fact, of course, the issue is whether the federal government will endorse and facilitate assisting suicide by authorizing the use of federally controlled drugs to kill patients.

[secretagent]

The scans either show the damage or they don't. Calling Cranford names doesn't argue the facts.

The Schindlers' doctors can deny the scans show what Cranford claims. I haven't read anything from them adressing the scans, the damage they show according Cranford, and the implications for rehab, with the possible exception of Maxfield:

While Schiavo's doctors and the court-appointed doctor see no improvement in the cat scans of Terri's brain from 1996 to 2002, William Maxfield, a Tampa radiologist petitioned by the Schindlers, testified Terri has shown improvements in brain tissue and would benefit from hyperbaric oxygen therapy, a treatment that increases blood flow and oxygen to the brain.

http://www.worldnetdaily.com/news/printer-friendly.asp?ARTICLE_ID=29505

Perhaps Maxfield has seen the brain scans, or perhaps he just infers "improvements in brain tissue". And "brain tissue" doesn't match the specificity of Cranford's description.

I'd sure like to interrogate them side by side, point and counterpoint. Neither side has challenged the other to a debate.

[george wythe]

Has anyone any inside info as to how much of it is gone in Terri?

During the evidentiary hearing ordered by the court of appeals, 5 experts addressed this issue.

The two experts hired by the Schindlers argued that Terry "has a small amount of isolated living tissue in her cerebral cortex." The other three experts, two hired by Schiavo and one hired by the court, claimed that there is no living tissue in Terry's brain cortex.

Although the physicians are not in complete agreement concerning the extent of Mrs. Schiavo's brain damage, they all agree that the brain scans show extensive permanent damage to her brain. The only debate between the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex. The evidentiary hearing held on remand actually focused on an issue that was not the issue we anticipated would be the primary issue on remand. The parents contended that Mrs. Schiavo was not in a persistent or permanent vegetative state. Both Dr. Maxfield and Dr. Hammesfahr opined that she was not in such a state. They based their opinions primarily upon their assessment of Mrs. Schiavo's actions or responses to a few brief stimuli, primarily involving physical and verbal contact with her mother. The three other physicians all testified that Mrs. Schiavo was in a permanent or persistent vegetative state. The guardianship court was most impressed with the testimony of Dr. Bambakidis, who concluded that Mrs. Schiavo remained in a permanent vegetative state.

All these experts had complete access to Terry's medical records, and they also had the opportunity to examine Terry personally. All these examinations were video-taped and entered into evidence.

Through the assistance of Mrs. Schiavo's treating physician, Dr. Victor Gambone, the physicians obtained current medical information about Theresa Schiavo including high-quality brain scans. Each physician reviewed her medical records and personally conducted a neurological examination of Mrs. Schiavo. Lengthy video tapes of some of the medical examinations were created and introduced into evidence. Thus, the quality of the evidence presented to the guardianship court was very high, and each side had ample opportunity to present detailed medical evidence, all of which was subjected to thorough cross-examination. It is likely that no guardianship court has ever received as much high-quality medical evidence in such a proceeding

[mylife]

I dont summize that I am an expert in this case, but Legally the Hubby is the gaurdian. Perhaps he has malicious plans at heart, but I am sceptical. Many refer to the money as proof. That money wouldnt last 13yrs I assure you, let alone a life time. I dont believe all this "He wants to be a millionaire upon her death" stuff.
If Terry's Parents wish to be her "longsuffering" guardians I wish them Godspeed.

[HiTech RedNeck]

Had he been strong enough for a feeding tube he would have had one.

That's very very tragic. If it were myself in that spot I would sooner risk dying getting the feeding tube put in, than try to go without.

[I still care]

The best response to this article is this affidavit, filed by Terri's nurse. Note it refutes much of what this article states as "fact".

And while I have the greatest respect for doctors - I have met some extremely knowledgeable ones - on a day to day basis, it seems to me the nurse would be a better judge of her responsiveness than a 15 consult. (Come on, we've all had one of those!)

AFFIDAVIT _________


STATE OF FLORIDA ) COUNTY OF PINELLAS )

BEFORE ME the undersigned authority personally appeared CARLA SAUER IYER, R.N., who being first duly sworn, deposes and says:

1. My name is Carla Sauer Iyer. I am over the age of eighteen and make this statement of my own personal knowledge.

2. I am a registered nurse in the State of Florida, having been licensed continuously in Florida from 1997 to the present. Prior to that I was a Licensed Practical Nurse for about four years.

3. I was employed at Palm Garden of Largo Convalescent Center in Largo, Florida from April 1995 to July 1996, while Terri Schiavo was a patient there.

4. It was clear to me at Palm Gardens that all decisions regarding Terri Schiavo were made by Michael Schiavo, with no allowance made for any discussion, debate or normal professional judgment. My initial training there consisted solely of the instruction "Do what Michael Schiavo tells you or you will be terminated." This struck me as extremely odd.

-1- 5. I was very disturbed by the decision making protocol, as no allowance whatsoever was made for professional responsibility. The atmosphere throughout the facility was dominated by Mr. Schiavo's intimidation. Everyone there, with the exception of several people who seemed to be close to Michael, was intimidated by him. Michael Schiavo always had an overbearing attitude, yelling numerous times such things as "This is my order and you're going to follow it." He is very large and uses menacing body language, such as standing too close to you, getting right in your face and practically shouting.

6. To the best of my recollection, rehabilitation had been ordered for Terri, but I never saw any being done or had any reason at all to believe that there was ever any rehab of Terri done at Palm Gardens while I was there. I became concerned because Michael wanted nothing done for Terri at all, no antibiotics, no tests, no range of motion therapy, no stimulation, no nothing. Michael said again and again that Terri should NOT get any rehab, that there should be no range of motion whatsoever, or anything else. I and a CNA named Roxy would give Terri range of motion anyway. One time I put a wash cloth in Terri's hand to keep her fingers from curling together, -2- and Michael saw it and made me take it out, saying that was therapy.

7. Terri's medical condition was systematically distorted and misrepresented by Michael. When I worked with her, she was alert and oriented. Terri spoke on a regular basis while in my presence, saying such things as "mommy," and "help me." "Help me" was, in fact, one of her most frequent utterances. I heard her say it hundreds of times. Terri would try to say the word "pain" when she was in discomfort, but it came out more like "pay." She didn't say the "n" sound very well. During her menses she would indicate her discomfort by saying "pay" and moving her arms toward her lower abdominal area. Other ways that she would indicate that she was in pain included pursing her lips, grimacing, thrashing in bed, curling her toes or moving her legs around. She would let you know when she had a bowel movement by flipping up the covers and pulling on her diaper and scooted in bed on her bottom.

8. When I came into her room and said "Hi, Terri", she would always recognize my voice and her name, and would turn her head all the way toward me, saying "Haaaiiiii" sort of, as she did. I recognized this as a "hi", which is very close to what it sounded like, the whole sound -3- being only a second or two long. When I told her humrous stories about my life or something I read in the paper, Terri would chuckle, sometimes more a giggle or laugh. She would move her whole body, upper and lower. Her legs would sometimes be off the bed, and need to be repositioned. I made numerous entries into the nursing notes in her chart, stating verbatim what she said and her various behaviors, but by my next on-duty shift, the notes would be deleted from her chart. Every time I made a positive entry about any responsiveness of Terri's, someone would remove it after my shift ended. Michael always demanded to see her chart as soon as he arrived, and would take it in her room with him. I documented Terri's rehab potential well, writing whole pages about Terri's responsiveness, but they would always be deleted by the next time I saw her chart. The reason I wrote so much was that everybody else seemed to be afraid to make positive entries for fear of their jobs, but I felt very strongly that a nurses job was to accurately record everything we see and hear that bears on a patients condition and their family. I upheld the Nurses Practice Act, and if it cost me my job, I was willing to accept that.

9. Throughout my time at Palm Gardens, Michael Schiavo was focused -4- on Terri's death. Michael would say "When is she going to die?," "Has she died yet?" and "When is that bitch gonna die?" These statements were common knowledge at Palm Gardens, as he would make them casually in passing, without regard even for who he was talking to, as long as it was a staff member. Other statements which I recall him making include "Can't anything be done to accelerate her death - won't she ever die?" When she wouldn't die, Michael would be furious. Michael was also adamant that the family should not be given information. He made numerous statements such as "Make sure the parents aren't contacted." I recorded Michael's statements word for word in Terri's chart, but these entries were also deleted after the end of my shift. Standing orders were that the family wasn't to be contacted, in fact, there was a large sign in the front of her chart that said under no circumstances was her family to be called, call Michael immediately, but I would call them, anyway, because I thought they should know about their daughter.

10. Any time Terri would be sick, like with a UTI or fluid buildup in her lungs, colds, or pneumonia, Michael would be visibly excited, thrilled even, hoping that she would die.

He would say something like, -5- "Hallelujah! You've made my day!" He would call me, as I was the nurse supervisor on the floor, and ask for every little detail about her temperature, blood pressure, etc., and would call back frequently asking if she was dead yet. He would blurt out "I'm going to be rich!" and would talk about all the things he would buy when Terri died, which included a new car, a new boat, and going to Europe, among other things.

11. When Michael visited Terri, he always came alone and always had the door closed and locked while he was with Terri. He would typically be there about twenty minutes or so. When he left Terri would be trembling, crying hysterically, and would be very pale and have cold sweats.

It looked to me like Terri was having a hypoglycemic reaction, so I'd check her blood sugar. The glucometer reading would be so low it was below the range where it would register an actual number reading. I would put dextrose in Terri's mouth to counteract it. This happened about five times on my shift, as I recall. Normally Terri's blood sugar levels were very stable due to the uniformity of her diet through tube feeding. It is medically possible that Michael injected Terri with Regular insulin, which is very fast acting, but I don't have -6- any way of knowing for sure.

12. The longer I was employed at Palm Gardens the more concerned I became about patient care, both relating to Terri Schiavo, for the reasons I've said, and other patients, too. There was an LPN named

Carolyn Adams, known as "Andy" Adams who was a particular concern. An unusual number of patients seemed to die on her shift, but she was completely unconcerned, making statements such as "They are old - let them die." I couldn't believe her attitude or the fact that it didn't seem to attract any attention.

She made many comments about Terri being a waste of money, that she should die. She said it was costing Michael a lot of money to keep her alive, and that he complained about it constantly (I heard him complain about it all the time, too.) Both Michael and Adams said that she would be worth more to him if she were dead. I ultimately called the police relative to this situation, and was terminated the next day. Other reasons were cited, but I was convinced it was because of my "rocking the boat."

13. Ms. Adams was one of the people who did not seem to be intimidated by Michael. In fact, they seemed to be very close, and Adams would do whatever Michael told her. Michael sometimes called Adams at -7- night and spoke at length. I was not able to hear the content of these phone calls, but I knew it was him talking to her because she would tell me afterward and relay orders from him.

14. I have contacted the Schindler family because I just couldn't stand by and let Terri die without the truth being known.

[FITZ]

It doesn't say which liquid diet. If it was something like "slimfast", there is almost now way she would starve or get a potassium imbalance if she followed that ---- yet should could get a little too thin if she stayed on it too long. Which liquid diet? What was the actual potassium value at the time of her collapse?

[HiTech RedNeck]

That money wouldnt last 13yrs I assure you, let alone a life time.

If he hadn't sued most of it away trying to kill Terri... and the parents would have surely been glad to kick in what they could, if she was allowed to live.

[Calpernia]

How can you say it makes no statements about the Schindlers? This whole paragraph opening with this, "According to most neurological experts, Terri Schiavo is definitely PVS" are statements about Terri.

"According to most neurological experts, Terri Schiavo is definitely PVS"

I would let it slide if it said some. I can personally pull 20 psychiatric and neurological experts that DISAGREE.

[DaGman]

I'll be darned... someone posted some sanity on this issue. Do reason, logic and clinical descriptions mean anything anymore? Or is telling a family how they can conduct their private business the issue? I see no way whatsoever this "law" will be held constitutional if only because the judicial system's relevance as an institution has been seriously challenged. Will this country continue to have 3 branches or the mob rule of two?

[TaxRelief]

She "hasn't come out of it" in more than 3 months, because she has never "been in it", not to mention the fact that she has *never* received treatment to help her state.

[george wythe]

Sorry I forgot to post a link to the source:

Second District Court of Appeals in Florida.

[MarMema]

perhaps you could post some (any?) scientific/ medical evidence to support your position.

I hope the posts I have made here for you were helpful. In the meantime, a word of advice, if I may. Don't worship too often at the temple of the gods of science and medicine.

When I was born, these same gods told my mother that breastfeeding was harmful and strongly discouraged it. At the same time many physicians were doing advertisements for cigarette companies.

[HiTech RedNeck]

Calling Cranford names doesn't argue the facts.

It highlights his bent. He was a pioneer in such deaths.