Pharyngula

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Saturday, March 19, 2005

Schiavo reconsidered

Majikthise has a great summary of the issues, and has also made one persuasive comment here. I still stand by my utilitarian argument, that Schiavo is effectively dead and it's pointless to fight over whether she should be simply extinguished and end the indignity, or whether her body ought to be kept twitching for the delight of jackals…but this other point, that I thought was particularly well-articulated on blog.bioethics.net, gives me second thoughts.

The time has come So, it is clear that the time has come to let Terri die. Not because everyone who is brain damaged should be allowed to die. Not because her quality of life is too poor for anyone to think it meaningful to go on. Not even because she costs a lot of money to continue to care for. Simply because her husband who loves her and has stuck by her for more than 15 years says she would not want to live the way she is living.

I'm more likely to be swayed by arguments about compassion for the living than about rights or respect for the dead. It's clear that her husband has made great sacrifices to carry out those wishes (not the least the way he is standing up to the outrageous vilification of the right), and he has the valid legal rights in this case.

If someday I were to be a mindless hulk, I would want my wife to be able to do what she felt was best. And damn any superstitious ninnies who get in the way of allowing her to find peace and closure and dignity because they think my idling quasi-corpse needed salvation.


Good stuff by Rivka, and interesting additional information over at Alas, a blog: a CT scan of Schiavo's brain.

image

I am not a medical doctor, but I do have that Ph.D. in neuroscience (I am eminently qualified to analyze the brains of fish and insects), and that is one ghastly mess. That's not much of a brain, it's a balloon bobbing about in there.


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Comments:
's avatar #19193: Ken Cope — 03/19  at  07:31 PM
The addition of PZ to the fossil record would create two new gaps.



#19197: — 03/19  at  09:45 PM
She was subpoenaed "to appear at the Hospice of the Florida Suncoast in Pinellas Park" not DC; the sole purpose of the subpoena was to prevent anyone from doing anything to her (ie pulling tube etc). See
http://www.foxnews.com/story/0,2933,150797,00.html
In addition to the testimony, the subpoenas require that Schiavo's feeding tube remain in place ...
Further, it reads: "This request is continuing in nature and applies to any newly deployed things required for the continued hydration and nutrition of Theresa Schiavo."

Since Terri Schiavo herself has been designated a congressional witness, Schiavo's family or other concerned parties can go to the U.S. attorney in Florida and ask for a temporary restraining order against anyone wishing to harm her, sources on Capitol Hill say.
----------------------------------------------------------
can you believe that Congress subpoenaed Terri Schiavo to testify before a Congressional committee? Did you know that she could be charged with contempt of congress if she doesn't show up, as commanded?



#19199: — 03/19  at  10:30 PM
I am floored by the hypocrisy and indifference of the politicians to their principles in this case. Republicans, long defenders of the Federal Government not interfering in state and local issues, are seeking to inject Congress no less into the private affairs of a family over the objection of the family member legally responsible for the question at hand, a responsibility that has been affirmed by not only the entire chain of Florida state courts but by the US Appellate and Supreme courts in their refusal to hear the case. For the Schiavos, and even the Schindlers, the affair must begin to seem like something out of Dante’s Inferno.

Congress’s move is alien not only to long-standing Republican tenets, but US social and legal tradition. The affair is doubly hypocritical in that here is the party that sees a need to defend the "sanctity of marriage" trampling the rights, as defined by existing law, of a married couple to resolve their own personal hell. Hypocrisy truly knows no shame.

In the meantime the nation burns, metaphorically, while our solons sing like the tragic chorus to a Dante-esque side-show, oblivious to their irrelevance. Frist, Delay and the others must count Nero as a common ancestor.



#19200: donna — 03/19  at  10:32 PM
I just want to shove a feeding tube down anyone in the opposition's throat and force them to be tied in a bed for about a month, with no stimulation whatsoever. Then maybe they will get the idea....

It's because of crap like this that my husband and I now have pre-signed legal documents giving each other the right to consent for all medical care if we cannot do it for ourselves.



's avatar #19202: Chris Clarke — 03/19  at  10:43 PM
I just want to shove a feeding tube down anyone in the opposition's throat and force them to be tied in a bed for about a month, with no stimulation whatsoever.

If you dress right, Santorum will pay you big bucks for that.

"I do not think we should antagonize the religious when it is not warranted, though I think we should be willing to do so whenever it is.”
-- Glen Davidson



#19203: — 03/19  at  10:56 PM
Out of extremely morbid curiosity, exactly WHAT should be done in this ( or any similar ) case instead of simply removing the feeding tube? 'Assisted Suicide' is still illegal outside a couple of the the Western states (Oregon and Washington, I believe). In any case, 'Assisted Suicide' is legal (IANAL) only with competent subjects, not comatose patients.



#19205: Hank Fox — 03/20  at  01:48 AM
Loren, I like your suggestion that the "keep her alive" faction pay the medical bills.

I've toyed with imaginary scenarios where people protesting outside family planning clinics are suddenly each handed a live baby, and told "You obviously care very deeply for children. Here, this one's now yours. Good luck."

But it would never work. Wouldn't be fare to the kids, to saddle them with parents who were KNOWN idiots.



#19215: — 03/20  at  05:44 AM
We Phans should reject PZ's will to process and distribute cubes among his disciplines. At the Museum of Natural Sciences of La Plata we had shelves of glass containers with human brains. According to the legend, founder Florentino Ameghino had established a tradition of teachers adding their brains to the Museum's collection.



#19220: — 03/20  at  06:53 AM
PZ, if you DID become a mindless hulk...

.. admit it, you'd have some fun on the way out. You'd head on down to the Discovery Institute, and get a little "MYERS SMASH PUNY HUMANS!" on them, right?

(Because I sure would. I even have purple pants.)



#19227: Orac — 03/20  at  10:42 AM
Hank,

Actually, as far as I know, the "keep her alive" faction has volunteered to pay the medical bills; so I think your suggestion is beside the point, just as others have called my suggestion that functional MRI is not a bad idea to be beside the point.

As an aside, however, although it's usually not an issue in withdrawing care in a hospitalized patient, where you'd have to give really enormous doses of morphine or other drugs to get into trouble, there is a very real fear among physicians of the DEA coming after them if they prescribe what the DEA considers to be too much pain medicine. This fear is not at all unjustified, either. See this item for an example.

All I can say is that I'm glad I'm not an oncologist these days. Surgeons generally treat acute pain for short periods of time, leaving little opportunity for us to get into trouble with the DEA. The oncologists have to deal with the chronic cancer pain over long periods of time...

--
Orac “A statement of fact cannot be insolent.”
http://oracknows.blogspot.com



#19228: — 03/20  at  11:14 AM
Sunday's [I]Philadelphia Inquirer[/I] (subscription required) has a lengthy article by Sandy Bauers profiling Michael and Terri Schiavo (the Schiavos and Schindlers are from the Philadelphia area originally) and their ordeal of the last 15 years. Bauers didn’t interview either Michael or his in-laws, the Schindlers, but she did interview a number of Schiavo friends of long standing. If the friends, in quotation and per the reporter’s judgement, are to be believed, then Michael Schiavo has gone farther on behalf of Terri Schiavo than any normal human could be expected to go. Although the article makes no comment on public actions of the right-to-life crowd, Tom Delay and Congress, or, for that matter, the Schindlers, the RTLer’s and Congress have no business sticking their oar into a quintessential family dilemma. I can’t fault the Schindlers for not wanting to let go—I have no idea what I’d do in their situation—but by going public with their anguish, they’ve been marginalized by zealots who are now using Terri Schiavo for their own ends. I expect that of the RTLer’s but I would have expected better of elected politicians, especially the president. What crass opportunists the lot is. Congress is apparently being flooded with emails and phone calls by the RTLers and the Christian right demanding Congress save Terri. Anyone with a different view should let their representative or senator know today that they see it differently.



#19230: — 03/20  at  12:13 PM
I could respect the Republicans for acting to intervene more if I believed they were actually motivated by a consistant concern for life and it all wasn't a nauseating attempt to pander to the rightwing base; The link below will introduce you to the Texas Futile Measures Act originally signed into law by W in 1999. It was amended in 2003 after the Republican party took total control of the Texas Legislature. Thers's concern for life and then there's concern for life when the patient cannot pay

http://www.markarkleiman.com/archives/_/2005/03/schiavo_hudson_and_nikolouzos.php



Trackback: Terri Schiavo: Our Take Tracked on: The Two Percent Company's Rants (67.18.141.194) at 2005 03 20 16:26:58
We haven't said anything about the whole Terri Schiavo debacle because, frankly, we hadn't looked into it enough to have an educated opinion. When we decided to do a little research, it became apparent that with even a cursory look, two...



#19250: — 03/20  at  05:07 PM
Terry's CT: There is no gray matter left. It's all atrophied. Fluid has enlarged the ventricals to make up for the deficit. (question: why the ventricular shunt?) This woman is never going to "wake up".



's avatar #19276: Ben — 03/20  at  11:26 PM
This is why I luuuurve the field of medical ethics: there is no right or wrong answer. The solution for every individual case lies not in physiology or blanket morality, but in the hands of the consent of the patient. We live in such a death-denying society (probably exacerbated by our survival instincts) that the concept of preferring death to life is abhorrent to so many people. There was a doctor who made the news over here a few weeks ago because he had the words "Do Not Resuscitate" tattooed onto his chest as a direction to paramedics in response to statistics governing successful CPR preventing brain damage following cardiac arrest. Obviously many people found this unbelievable for some reason.

This issue isn't about medicine. It's about the tyranny morality can often exert over individual liberty.

"The great trouble is that the preachers get the children from six to seven years of age and then it is almost impossible to do anything with them." --Thomas Edison.



#19278: — 03/20  at  11:30 PM
Oops, I meant to say there is no white matter left. I was correcting the "diagnosis" floating around the internet of "her cerebral cortex has turned to fluid". Her cerebrum is affected, not the cerebral cortex. Her cerebrum is atrophied because her white matter is atrophied. The cortex is intact. Nothing has turned to fluid. The ventricals are enlarged with cerebrospinal fluid to take up the space of the now missing white matter.



#19280: — 03/20  at  11:37 PM
Shunting may have relieved hydrocephalus. She has been "brain dead" for a time.



#19283: — 03/21  at  12:31 AM
eudoxis: it seems like a cerebral infarctus and consequent autolysis. She is dead and her organs should be donated. To me, it is immoral to spend money on dead people. I do not understand the Church's position.



#19296: — 03/21  at  08:00 AM
Re: cubes of PZ

Most unsightly. How about very thin cross-sections (slices), preserved between glass? Phans could then hang these on walls, incorporate them into stained-glass windows and the like...



Trackback: A despicable political act Tracked on: Expert Opinion (72.9.234.70) at 2005 03 21 15:27:12
Well, since everyone else with a keyboard is expressing themselves about the Terri Schiavo case... However... I'm not going to say anything about Ms. Schiavo's fate. Why? BECAUSE IT'S NONE OF MY BUSINESS!...



Trackback: Who's Paying For Terri Schiavo...? Tracked on: Have Coffee Will Write (72.9.234.70) at 2005 03 21 19:34:05
OK. I'm about to be a cold-hearted bastard. No where have I seen who's paying what has to be the several-thousand-dollars-a-day hospital bill for keeping the physical body of Terri Schiavo functioning. And I want to know.



#19400: CKL — 03/22  at  03:31 AM
Sorry for joining in late, especially because my comment is a bit off topic, but I just noticed this post.

I have a question for those of you who actually have experience reading CT scans. Is that a hard spot where Schiavo's right ventricle should be or am I simply misreading the scan? If it is a hard spot what do you suppose it is? From what I've read Schiavo's brain damage resulted from a cardiac arrest brought on by bulimia, how would that cause a mass to form in her head?



Trackback: Terri Schiavo Tracked on: El Blog Nulo de Gianko (66.98.224.26) at 2005 03 22 11:10:23
Para akellos ke viven en una cueva y no saben la historia de Terri Schiavo les doy un resumen: Terri Schiavo sufrió hace kince años un atake ke la dejó en coma cerebral. Su marido, ke la ha acompañado todo ese tiempo, argumenta ke ella no kería "vivir...



#19438: — 03/22  at  03:06 PM
Nowhere in any discussion I've seen or heard has it been established that Terri is brain dead. The problem is that there is no actual evidence of what her wishes are except for Michael's word. So what we have here is a man who fought for and won an award for over a million dollars to be used in Terri's therapy and rehabilitation, and then once he had it, he refused to provide the care. He went so far as to forbid it. He now lives with another woman with whom he has two children. So okay, maybe he's the hero that you've described him as here. But then, maybe he's not. The family seems to believe he's in some manner culpable for Terri's condition. Is he? Could he be a really slow acting Scott Peterson? I cannot believe that Terri's family are all insane, that they just can't let go. It's been 15 years. If she were brain dead, wouldn't they see that? If Mom just couldn't let go; if Dad just couldn't let go, might there not be even one sibling who would side with Michael? There is a sanctity of life argument here just as there's a right to die argument. What I'm hearing all too often is the "duty to die" argument disguised as right to die. Congress did not overstep here--they simply gave the family another chance to argue this case further in the courts.



#19481: — 03/22  at  08:35 PM
PBJ made a number of assertions based on assumptions and claims that cannot be substantiated. He/she opened…
"Nowhere in any discussion I've seen or heard has it been established that Terri is brain dead."
No one has said so because she is not. She’s just shy of it in that she retains the ability to breathe on her own. Were she to require a respirator, she would be considered brain dead.

PBJ then went on to claim that Mr. Schiavo refused to provide care for his wife. That is patently false. The million dollar award has paid for the many attempts at physical rehabilitation, her continuing care, and the legal fees, with the Florida courts’ approval. Those legal fees were mostly to defend Ms. Schiavo’s interest and welfare from outsider "pro-life" organizations which sought to interfere.

The rest of your post is far off base, impugning Mr. Schiavo’s integrity and implying egregious behavior with no basis other than wishful thinking. Before you opine further, you should read a couple of blogs that have extensive information about the case’s history. Specifically I recommend you read the chronology, history, and comments at Abstract Appeal a legal blog by a lawyer devoted to Florida law and the US 11th Circuit Court of Appeals. If you’re a real masochist, it provides links to the legal briefs in this case. The other blog you should read, by a scientifically literate philosopher, is Majjikthise.

The only item at issue before the courts, which they couldn’t resolve, was the extent of the damage to Ms. Schiavo’s brain. In the words of the Florida Second Court of Appeals…
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.
Neither outcome of that debate offers much promise for Ms. Schiavo’s future. She is an unresponsive, reflexive body at this point.

In concluding you somehow imply that Ms. Schiavo’s parents are behaving quite rationally. I question that. They do find it difficult to let their daughter go, and I can understand that, but under the conditions many people will see what they want to see, not what they actually see. Given the testimony and analysis of the various physicians who have been consulted, no disinterested parties have supported the contention that Ms. Schiavo is responsive. I suspect the Schindlers, who are not wealthy, have become unknowing captives of larger forces, and as much as they may believe so, they are no longer in control of their own behavior, having become tools for political and social opportunists.

And as for whether Congress overstepped, most lawyers and the lay public—Republican, Democratic and independent—disagree. And I suspect that the Federal Courts will disagree as well. Also most lawyer with whom I’ve spoken who are familiar with the case, agree that the Florida courts were exhaustive in their zeal to do right by Terri Schiavo. They left no stone unturned in examining her situation and gave her extraordinary access to due process in what is an extraordinary case.



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