Pharyngula

PZ Myers. 2005 Mar 19. Schiavo reconsidered. <http://pharyngula.org/index/weblog/schiavo_reconsidered/>. Accessed 2008 Dec 01.

Posted on M00o93H7pQ09L8X1t49cHY01Z5j4TT91fGfr on 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.

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.

Posted by PZ Myers on 03/19 at 09:39 AM
Politics • 6 Trackbacks • Other weblogs • Permalink

Obviously, everyone needs a living will. My problem with only pulling the feeding tube is this: How long will she starve until she dies. Is that barbaric? Or is that as kind as we should be?
#: Posted by on 03/19 at 10:00 AM
I'm a doctor. I support patient autonomy and the patient's right to withdraw support. However, I have grave concerns about this specific case. For one thing, Shiavo will die not of starvation (which can take 30-60 days, depending upon the lean body mass of the patient), but rather of dehydration, which usually takes somewhere between a week and 10 days, give or take. It is most unpleasant (very intense feelings of thirst and hunger will develop relatively quickly, for one thing). If she does have any ability to feel pain or suffering or that very intense hunger and thirst, she will suffer for at least several days before her kidneys shut down and she lapses into a coma. That is one reason I have always had a hard time with removing feeding tubes as a means of withdrawing support. It's different with withdrawing ventilator support, because the end is usually not protracted and, with a bit of sedation, the feeling of suffocating can be minimized quite effectively.

I agree that a living will is imperative for pretty much everyone, even 20-something year olds, who view their deaths as something that is very far off. Although, embarrassingly, I have to admit that I don't have one yet. Maybe it's time to get off my duff and do it...
#: Posted by Orac on 03/19 at 10:41 AM
I think the reason they remove the feeding tube and allow a terminal/braindead person to starve is just that it is the least objectionable way to go about it. There's some back-thought of "letting nature takes its course" or "allowing god's will to take over" – thereby putting SOME of the blame for the person's death on an impersonal external force rather than the people who actually participate in it.

Although many people seem perfectly comfortable with killing convicts on death row, or blowing innocent bystanders to bits in "war," we're squeamish about accepting responsibility for the deaths of hospitalized patients.

(So much so that terminal cancer patients, so I've read, have long had a tough time getting adequate medication for pain. Doctors unconsciously want to err on the side of “I didn’t have anything to do with that guy’s death – it was the cancer, not the morphine.”)

It’s all understandable, when you think about it. I don’t feel really great about this Sciavo situation either. But ...

We’re left with this question: Who does your life belong to? I can think of a couple of arguments that conclude “If your life doesn’t belong to YOU, you’re basically a slave to the people who DO claim it.”

My feeling in the Sciavo case is mainly that it’s none of my business, and I’m kinda disgusted that it’s become such a circus.

Yet I continue to have moderately strong feelings about the right of the husband to have his way in this, based in part on this “slavery” argument. The intervention of congress and churches, etc., to me falls clearly in the category of turning Terry Sciavo into a POSSESSION – these external entities assume they have every right to intervene in the determination of her life and death, as if she, a total stranger, somehow belonged to them – and not her husband or family.

Aside from Sciavo’s specific life or death, the precedent set if Congress and these other strangers have their way in this case will be that none of us belong to ourselves. The slippery-slope extension of that is that nothing we own belongs to us either – not our possessions, not our families, not our intellectual property, not our minds. We become slaves, possessions, of somebody else.

Resisting a trend in that direction is well worth pursuing. I’m sorry for the way the woman’s parents will be affected by this, but I’m glad the husband is fighting this fight.

His tenacity in the face of all this strikes me as uncommonly courageous, even heroic.
#: Posted by Hank Fox on 03/19 at 10:50 AM
Speaking of formalized idiocy .. 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? It might be the effects of the early hour when I first heard this news on the radio, but I think that "Contempt of Congress" is most appropriate in this situation.
#: Posted by GrrlScientist on 03/19 at 10:52 AM
PZ, at the Pharyngula Phan Club meeting last night, you'll be happy to know that when the vote came up on the question of "What if PZ becomes a mindless hulk?", the greatest number of votes went to "Honor his wishes and pull the plug." However, "Have him bronzed" came in a close second, and there was even one vote for "Take souvenirs."
#: Posted by Hank Fox on 03/19 at 10:56 AM
Is the penalty for contempt of Congress a prison term or only a fine? If it's a fine then it'll be downright evil to charge her husband, whereas if it's a prison term it'll be comic rather than hurtful stupidity.
#: Posted by on 03/19 at 11:07 AM
A question I would like to ask all of those who want to keep Schiavo alive is when do you pull the plug? If it's murder now, isn't it murder a decade (or four) from now?
#: Posted by Michael Feldgarden on 03/19 at 11:11 AM
Great! Send me the list of fan club members and their addresses, and I'll write into my living will that my remains should be fed into a giant Ronco Veg-A-Matic, and each member should be mailed a quivering, gooey, lumpy cube of PZ.
#: Posted by PZ Myers on 03/19 at 11:15 AM
Hank, I think you could do a better job of representing the wishes of the "pull the plug now" faction.
#: Posted by Chris Clarke on 03/19 at 11:15 AM
Chris, the "pull the plug (on PZ) now" people are not members of the Pharyngula Phan Club.

That's the Pharyngula Phoes. They're evil.

(We in the PPC have sprayed "Pharyngula Phoes Suck!!!" on their clubhouse numerous times.)
#: Posted by Hank Fox on 03/19 at 11:25 AM
Orac, thanks for that. We -- my sibs and I -- faced that same dilemma when our mother had her second stroke. She was left unable to speak or communicate any other way, but, as happens with strokes, there was at first a period when some recovery might have been possible, and there's no way (as far as I know) to determine that except to try as much therapy as possible and see what the results are. Because she couldn't swallow, we allowed a gastrostomy tube to be placed to feed her.

Then we were looking at a long hard period when she was in nursing homes, a fate she'd explicitly feared. None of us was able to a/ stay home and not work for a living and b/ provide the skilled nursing care she needed. So there she was and there we all were, for six years. Six years, and every one of us thought about Mom every day and hurt for what she must be feeling, if anything. We honestly couldn't tell -- and a couple of us have had some experience with stroke patients, and a teaspoon or two of expertise in "reading" them. Her docs said they thought she had no cognition. We hoped that was true.

But we also knew that starvation/dehydration isn't painless -- I've watched it myself, in conscious, non-brain-damaged people -- and none of us was willing to risk life in prison for putting a pillow over her face, or finding the drugs to end it all faster. So the ordeal dragged on until she got pneumonia and died. What was interesting, in a rather barbed way, is that in the three months before her death, she rallied a little: started dragging herself around the halls in her wheelchair, using the handrails; seemed to recognize some of her kids and grandkids, reacted strongly when one of my out-of-town sisters visited. I was getting vacation time and funds together to visit too, from across the continent, when she died.

We all have turned the problem over again and again: did we do the right thing? Were we right about how pulling the feeding tube would have hurt? Were we right about how much cognition she had left? How badly did we hurt her, seemingly with no other choices?

I can't imagine how much more painful it would have been to have the legal and media circus at our elbows, baying for some damned quack or cleric or legal body to take over. And I do know that, if faced with evidence as strong as Terri Schiavo's brain scans, we'd have let her go immediately. I do believe that pain is the last thing that goes away.
#: Posted by Ron Sullivan on 03/19 at 11:42 AM
Abstract Appeal has some great information on the case. Apparently, many of us have misunderstood that Michael made the decision to pull his wife's feeding tube. In fact, he waved his right to do so (as guardian) and invoked Florida law to allow a court to hold a trial to discern Mrs. Schiavo's wishes. Two trials were eventually held, in which Michael stood for Terri's wish to pull life support, and the Schindlers (her parents) stood opposite. In both cases, the court was able to find "clear and convincing" evidence--the highest standard in civil law cases--that Terri would have wanted her G-tube discontinued. Apropos of this, the case of the man who offered Michael $1 million to give up his guardianship is absurd, as even if the Schindlers had guardianship, it's the court's decision, as mediated by two trials that applies here.

I'm only a medical student, so I'll defer to Orac; although my understanding of the case is that most or all of Terri's cerebral cortex has withered and atrophied, and that she is incapable of experiencing pain--or anything else for that matter.

But I will concur with Hank Fox--this is a case that is frankly none of the public's (and especially not Congress's) business, but has blown up because A) the Schindlers, a lost cause in the courts, took their case to the real in modern America, and B) many officeholders with stakes in the illusion of their unquestionable kindness to life are hoping to ride this horse to reelection.

That Congress wishes to hold hearings on the state of health-care for people like Mrs. Shiavo is surreal. I was given to think that the law regarding individual wishes and heroic measures has been maturing over the past ten to twenty years. There is no defect in her treatment besides the alleged malpractice that led to her cardiac arrest in the first place. This is about how palatable decisions to end treatment are to the public, and I'm afraid any legislation arising from this is just going to rob thousands of people of their dignity in their last days.

But most galling of all--and naive, rhetorical question alert--how does Congress go about thinking they can interfere with something in all probability Terri would have wanted?
#: Posted by Tyson Burghardt on 03/19 at 12:15 PM
The court ruled that Schiavo wouldn't want a feeding tube. If she wouldn't have consented to the tube, it follows that she would have been resigned to the consequences of not having it.

Besides, why should we think that Terri Schiavo is capable of suffering the subjective effects of dehydration? Her higher brain centers have been destroyed. She has no detectable mental life.

Are there drugs that could reduce her brain function any further without killing her? Can PVS patients be put into drug-induced comas. If yes, then I would argue that all such measures should be taken, as much for the sake of concerned onlookers as for the patient herself. If there is no way to reduce her brain function any further without killing her, that suggests to me that she isn't sufficiently aware to suffer.

I would support a law permitting voluntary euthanasia by advance directive, but I wouldn't support true euthanasia in Schiavo's case because there is no reason to believe that she desired this outcome before she succumbed.

Ron, thanks for discussing your experiences so frankly. I'm glad your mother is at peace. She was lucky to have such a concerned family.
#: Posted by Lindsay Beyerstein on 03/19 at 12:40 PM
The problem, of course, is that, as much as partisans on both sides of the issue like to pontificate and make sweeping statements one way or the other, we don't truly know whether Schiavo is capable of feeling the very unpleasant effects of dehydration that will now occur over the next several days, at least not with the data available.

As for the CT scan, yes that's bad. It's very bad. There's undeniably marked hydrocephalus and severe atrophy of the cerebral cortex. But showing just the CT scan is a red herring. There are quite a few demented senior citizens in nursing homes with CT scans that look as bad or almost as bad (I've seen them on occasion when nursing homes shipped their patients to the hospital for one reason or another), not to mention a few patients who are status post anoxic brain injuries, and we aren't proposing pulling the plug on them, are we?

Or are we?

Personally, I think Respectful of Otters and Alas, a blog are just a bit too quick to dismiss the use of functional MRI or other functional neurologic imaging studies as being pointless in this case. At the very least, such studies might answer the question of the extent to which Schiavo is capable of feeling, as Lindsay put it, the "subjective effects" of noxious or painful stimuli, which is an important question to answer before any sort of withdrawal of care that would cause suffering in a person with higher mental function. If noxious stimuli caused no changes in activity in the higher cortex on functional MRI, that would be pretty conclusive evidence that there are no higher mental functions, at least with respect to the subjective suffering caused by noxious stimuli. I honestly can't understand what the objection is to doing such studies is.
#: Posted by Orac on 03/19 at 01:17 PM
PZ,

Won't you have a clause in your living will that you be used as squid kibble?
#: Posted by on 03/19 at 01:30 PM
Personally, I think Respectful of Otters and Alas, a blog are just a bit too quick to dismiss the use of functional MRI or other functional neurologic imaging studies as being pointless in this case

A good point in general, which the legal finding of Sciavo's wishes renders moot in this case.

Won't you have a clause in your living will that you be used as squid kibble?

And then we use the squid ink to print the Pharyngula Phestschrift! And the painted ponies go up and down.
#: Posted by Chris Clarke on 03/19 at 01:38 PM
Orac, is your primary objection to removing the tube that Schiavo might suffer? Taken by itself, this is not a convincing objection.

The courts found clear and convincing evidence that Schiavo wouldn't have wanted a feeding tube. Now that this decision has been made, the tube must be taken out. Those who dispute Terri's wishes or the fitness of Michael Schiavo to serve as her legal guardian have already had their days in court. Now that the facts have been heard and the legal avenues exhausted, it would be immoral and illegal for doctors to continue to feed Schiavo by tube.

A functional MRI would be beside the point. I have serious doubts that an fMRI could reveal anything meaningful about Schiavo's state of mind. Suppose that her vestigial brain registered metabolic activity upon noxious stimuli. We would be begging the question if we concluded that this metabolic activity was evidence of consciousness. Nobody doubts that her brain stem works. The relevant evidence is behavioral--does she respond mindfully to stimuli? Does she show signs of being aware of her own internal or external milieu? Her family claims that she does, but neither the doctors who have actually examined her, nor the judge who evaluated their findings give any credence to these claims.

The "potential sentience" argument cuts both ways. How are we to know that she isn't suffering in her current state?

We know because she doesn't behave as if she's suffering. Michael Schiavo wouldn't be allowed to argue that every moment is a living hell for Terri, despite neurophysiological and behavioral evidence to the contrary. So why should we give credence to the similarly unsupported opposing view?

Let's suppose for the sake of argument that Schiavo has some minimal level of consciousness. Even so, the issue is whether she would want to live as she is now. Her parents are arguing that she would want to live because there are viable treatments that might increase her level of consciousness. This is absurd. There is no way to restore the brain tissue that has been lost and no way to stop the ongoing atrophy of her remaining brain tissue. This case has become an ongoing infomercial for "alties" touting hyperbaric therapy, herbal medicine, homeopathy, off-label Namenda and other unproven treatments. Terri didn't consent to the standard treatments, let alone to unsupervised experimentation on her body.

If there are any doubts about potential suffering, palliative care is the answer, not nonconsensual feeding.
#: Posted by Lindsay Beyerstein on 03/19 at 02:13 PM
Regarding the brain image, could someone who knows more about these things tell me how that scan differs from that of a person with hydrocephalus ?
#: Posted by Moebius Stripper on 03/19 at 03:28 PM
The far right sees this as a fundamental 'right to life', no doubt motivated by religious beliefs, even though the meaning of 'life' has become quite flexible. The Supreme Court held in Rogers v. Tennessee that the "year and a day" common law murder rule (you murder if you proximately cause your victim's death within 366 days) is essentially useless where life can be sustained indefinitely by machinery. And obviously many states have enacted right to die suits. Where there is no evidence of choice, the spouse usually decides intent.

So then, there is an irony here: by seeking to undermine a state-granted right of a husband to decide his spouse's intent in such a situation, Congress is infringing on a right they're planning on arguing is fundamental enough to merit its own Amendment. Sanctity my ass.
#: Posted by scott pilutik on 03/19 at 03:52 PM
Moebius,

there are lots of answers to that question, and people more qualified than me to give them. But I'll just give you the one that I see as most important: plasticity.

Hydrocephalus is treated, or not, when a person is young, and young brains have a pretty remarkable ability to adapt to abnormalities. If you grow up with an abnormal brain (or suffer a brain trauma while young), there's lots of room for the brain to make accomodations. Just as a way out on the fringe example, there are kids who are born missing an entire hemisphere of their brain, and they do a lot better than you'd ever think.

However, if you suffer the kind of loss of brain tissue evidenced in the CAT scan above as an adult, you're very much out of luck. That's just way beyond the pale.
#: Posted by on 03/19 at 04:25 PM
Addendum:

also note, that while both brains share the extremely oversized ventricles, the hydrocephalic brain is still pretty dense with tissue everywhere else (as would be expected since it's essentially just being "squished" by the excess CSF). Schiavo's, on the other hand, has numerous gaps even where there is still surrounding tissue of some sort.
#: Posted by on 03/19 at 04:47 PM
What, no one remembers our earlier promise to (repeatedly) clone Dr. Myers into a Super-race of evil Marxist-Communist-Darwinist-Terrorist-Atheistic baby-killing biologists?
#: Posted by on 03/19 at 05:51 PM
I have two solutions:

1. That the keep-Terri-alive lobby be given her medical bills to pay.

2. That some leading theologians be convinced to rule that Terri's soul has departed her body, and that what's left is the moral equivalent of donated organs.

I'm sure that that lobby will enjoy paying her medical bills, since they care so much about keeping her alive.

And I think that there is a good theological argument to be offered for the proposition that Terri's body is now soulless. According to the separable-soul theory, the soul is a sort-of symbiont of the body, and it departs from the body when it becomes an unsuitable host, usually by dying. So with her brain largely gone, a good case can be made that her soul has deserted her body as an unsuitable host.
#: Posted by on 03/19 at 05:54 PM
Hank, I don't doubt that there are doctors who will undermedicate terminally ill patients rather than be seen to have hastened them along. That said, I personally know strongly 'pro-life' Roman Catholic doctors who do not hesitate to load up moribund patients on a raft of (relative) comfort, completely unconcerned that they might thereby be (in effect) euthanising them. The doctrine of 'double effect' strikes me as profoundly silly, but if it helps such doctors do the right thing in deeply unfortunate circumstances, I am not going to argue with them.

On a (slightly) less serious note, though the wishes of the patient should normally be paramount, I do not wish to see PZ portioned out pro rata as so many spoonsful of jam. Surely we should do whatever it takes to ensure he becomes part of the fossil record.
#: Posted by Mrs Tilton on 03/19 at 07:04 PM
The addition of PZ to the fossil record would create two new gaps.
#: Posted by Ken Cope on 03/19 at 07:31 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?
#: Posted by on 03/19 at 09:45 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.
#: Posted by on 03/19 at 10:30 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.
#: Posted by donna on 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.

If you dress right, Santorum will pay you big bucks for that.
#: Posted by Chris Clarke on 03/19 at 10:43 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.
#: Posted by on 03/19 at 10:56 PM
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.
#: Posted by Hank Fox on 03/20 at 01:48 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.
#: Posted by on 03/20 at 05:44 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.)
#: Posted by on 03/20 at 06:53 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...
#: Posted by Orac on 03/20 at 10:42 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.
#: Posted by on 03/20 at 11:14 AM
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
#: Posted by on 03/20 at 12:13 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".
#: Posted by on 03/20 at 05:07 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.
#: Posted by Ben on 03/20 at 11:26 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.
#: Posted by on 03/20 at 11:30 PM
Shunting may have relieved hydrocephalus. She has been "brain dead" for a time.
#: Posted by on 03/20 at 11:37 PM
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.
#: Posted by on 03/21 at 12:31 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...
#: Posted by on 03/21 at 08:00 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?
#: Posted by CKL on 03/22 at 03:31 AM
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.
#: Posted by on 03/22 at 03:06 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.
#: Posted by on 03/22 at 08:35 PM
Last night on talk radio, I listened to a nurse who had cared for Terri Schiavo who has made a sworn statement that Michael Schiavo kept asking, "When is the bitch going to die?" Does that sound like a loving husband to you? He is the ONLY person who stands to gain by Terri's death - by receiving money from her life insurance. He also told this nurse about all the ways he was going to spend the insurance money, if only Terri would go ahead and die. He has already broken his marriage vows to love Terri in sickness and in health by fathering two children with another woman. Why would he not divorce Terri and let her parents, who love her, assume responsibility for her care? Why would he refuse $1 million from a California businessman to turn Terri's care over to her parents? Because if Terri dies, Michael gets the insurance money, free and clear. But if he takes the $1 million and turns Terri's care over to her parents, who would see to it that she gets therapy, there is a slight chance Terri might recover enough to tell the world what really happened to her. The interviewed nurse told about how Michael would lock himself up with Terri and later the nurse would find bruises in Terri's armpits and groin and under her breasts. The nurse said she suspected Terri had received injections in these locations, and that it might have been insulin. Doesn't this strike anyone as the least bit suspicious? This nurse said she went to the police and they asked her if she actually witnessed Michael Schiavo injecting his wife with anything, and the nurse had to answer "no." Thirty-three (33)doctors have said there is a possibility that Terry could be rehabilitated to a degree. Did you know that she was actually walking and learning to feed herself at one point, but Michael Schiavo discontinued her therapy? He did not want her to get better. Let's face it folks, the law is assisting a man in getting rid of his helpless wife, and it seems he is going to get away with this crime and get some money out of it to boot. I find it very pathetic that our courts will not intercede and protect the rights and the life of a helpless woman who cannot speak for herself. Too many people are calling this woman a vegetable. I have watched her on video, and she does not appear to be a vegetable to me. You all better pray you never wind up in Terri's condition, because this could happen to you, too.
#: Posted by on 03/23 at 08:14 AM
This slandering nurse is a fraud.

Your claims are ridiculous and false.

I think that one thing that thoroughly discredits the Schindler's case is the way people are swallowing these outright lies so readily.
#: Posted by PZ Myers on 03/23 at 08:52 AM
I'm finding a fair amount of hope in the fact that a significant majority of Americans seem to be thinking more critically about this than the lunatic talk-radio parroting above would seem to imply. I think Delay done went and stumbled onto a wedge issue to peel regular folks away from the Talibaptists.

In other words, I find it useful to watch who's swallowing the lies. It's a diagnostic. People like Radford above are probably beyond help, but there seems still to be hope for most of us.
#: Posted by Chris Clarke on 03/23 at 09:02 AM
Kathleen Radford, you are seriously misinformed.

Everything you heard on the radio and repeated in your posting was false, with most of it a flat out lie, pushed by those whose beliefs are more important than the facts. Your repeating them compounds the lies. Let me give you a little guidance:

To wit the nurse you heard on the radio was Carla Sauer Iyer, who in 2003, seven years after she had cared for Terri Schiavo, submitted an affidavit to the court loaded with inflammatory accusations against Michael Schiavo. Judge George W. Greer, the Florida circuit judge (incidentally he’s a Republican Baptist who had to resign from his long time family church because of harassment by his fellow parishioners) who has presided over the Schiavo case, dismissed Iyer's allegations as "incredible" and noted in a September 17, 2003, order that not even Terri Schiavo's parents sought her testimony in the case. He further noted that "…neither in the testimony nor in the medical records is there support for these affidavits as they purport to detail activities and responses of Terri Schiavo."

In his decision Judge Greer wrote
The remaining affidavits [including one from anther nurse, Heidi Law] deal exclusively with events which allegedly occurred in the 1995-1997 time frame. The court feels constrained to discuss them. They are incredible to say the least. Ms. Iyer details what amounts to a 15-month cover-up which would include the staff of Palm Garden of Lago Convalescent Center, the Guardian of the Person, the Guardian ad Litem, the medical professionals, the police and, believe it or not, Mr. and Mrs. Schindler. Her affidavit clearly states that she would "call them (Mr. and Mrs. Schindler) anyway because I thought they should know about their daughter." The affidavit of Ms. Law speaks of Terri responding on a constant basis. Neither in the testimony nor in the medical records is there support for these affidavits as they purport to detail activities and responses of Terri Schiavo. It is impossible to believe that Mr. and Mrs. Schindler would not have subpoenaed Ms. Iyer for the January 2000 evidentiary hearing had she contacted them as her affidavit alleges.
Judge Greer’s determination of Iyer’s veracity is almost certainly accurate.

Furthermore, you should read a detailed chronology of the case and the voluminous court decisions and briefs on the case. For that go to Abstract Appeal. You will find that far more informative than a political radio show that specializes in misinformation and propaganda.

And, if you’d like to know who the real villains in this public tragedy are ,visit the web site of The American Journal of Bioethics where you can find a run down of the multimillion dollar campaign by right wing ideologues to break Michael Schiavo, a lone individual trying to do right by his wife.

And for a briefer but informed discussion of the facts concerning Terri Schiavo go to Majikthise.

Or go to Respectful of Others a website run by a clinical psychologist for an analysis of assorted medical opinions offered by the Schindlers in their court filings. Especially read his entry Friday, March 18th Terry Schiavo, Part I: The Medical Post."

Ms. Radford, read all those references and you may come to a decidedly different conclusion, provided you’re open minded and not an ideologue like the political forces who are trying to score political points at the expense of all concerned. It would also behoove you to be skeptical when listening to right wing pundits on the air and do a little digging before opining on a situation about which you know precious little.
#: Posted by on 03/23 at 10:01 AM

Orac, have medical practices changed when dealing with patients who are brain dead or nearly so, or who are unconscious and suffering from severe injury or disease, and who are unquestionably going to die without recovering any significant function? I am aware of cases from 25 to 30 years ago in which patients like this were "allowed" to die in hospital by modifying their fluid intake in some fashion. I thought it was common practice at the time (common in the sense of not unusual for the type of case rather than in the sense of frequent).
#: Posted by on 03/23 at 10:40 AM

Chris, re: "I think Delay done went and stumbled onto a wedge issue to peel regular folks away from the Talibaptists."

I agree. I think the issue is opening some eyes.
#: Posted by Hank Fox on 03/23 at 12:01 PM

A panel of federal appeals court judges has rejected the appeal to reconnect the feeding tube. All that remains is an unlikely request for the Supreme Court to hear the case.

Now we get to see how the Bushistas spin the outcome.

Some off-the-cuff predictions:

"We've got to get rid of these dangerously-independent, liberal activist judges."

"It's all the Democrats fault, for blocking Bush's judicial appointees."

"Evil liberals and heartless money-grubbing Democrats want to kill helpless people, whereas good solid Christians like Republican candidates for Congress want to save and cherish life."

"If we could just get the Ten Commandments back into schools and courthouses, and stop the liberal atheist agenda from destroying the freedom-loving Christian heart of this great nation, we'd never have to go through this heart-rending process again, because we'd all have a godly moral compass that would tell us what to do every time."

If they're willing to be really vicious about it:

On the day Terri Schiavo dies, a visibly-saddened Bush and conservative members of Congress will fan out to appear on all the TV talk shows, and speak of the senseless tragedy of her death and the sadness of the nation at her passing. They will manage to spin this into both the anti-abortion debate and the continuing sales pitch for gutting Social Security.

Finally, if they're willing to pull out all the stops and just leave us breathless with their sheer manipulative audacity:

Bush, who has not managed to appear at a single one of the 1500-plus funerals for servicemen and -women killed in Iraq, will go to Terri Schiavo's funeral. And then, in full view of the cameras and microphones, he will cry.
#: Posted by Hank Fox on 03/23 at 01:38 PM

One of the unheralded ironies of this entire case is that the Florida trial judge, George Greer, is a Republican, a life-long Southern Baptist, and alledgedly a conservative. Sadly because the man has tried to do right he's been harangued, harassed, and threatened by his fellow parishioners to the point that he's resigned from the Baptist church to which he's belonged for decades. If those Baptists are Christian, who presents the greatest threat to this democracy, such Christians or the Taliban? One guess which I'd pick.
#: Posted by on 03/23 at 04:19 PM

Death from dehydration is, as you can imagine, unpleasant and painful. This is my only concern in Ms. Schiavo's case, as I am an RN who believes in death with dignity and the right to refuse medical intervention. My thoughts on this case are twofold: first, I think that given the degree of atrophy in her brain, it's unlikely that she has any self-awareness or is cognizant of pain. Second, in the event that she does indeed feel pain, remember she is in a Hospice House. Hospices' main concern is comfort care and the emphasis on a peaceful death. They use narcotic medications such as morphine much more freely than with healthy individuals. I refuse to believe that Hospice would ever allow her to suffer.
#: Posted by on 03/23 at 09:01 PM

Isn't it interesting that the Right to Lifers are the ones who fought against a quick injection for people in these circumstances and WANTED, once the plug/tube was removed to let nature take it's course? Now, they're screaming about the inhumanity of it, but this is what THEY WANTED!
#: Posted by on 03/24 at 08:56 AM

If any of these dimwits succeeded in hydrating TS, she'd drown. Worse, there has been litigation over the administration of communion multiple times, to which MS has objected. Can't you see the death certificate, "Asphyxiated by communion wafer." Many deaths among Alzheimer sufferers occur from the aspiration of food or liquid, leading to pneumonia; it's suspected Reagan went that way.
#: Posted by Ken Cope on 03/24 at 09:23 AM

gingerplum -

Thank you, thank you, for bringing up the vital role that Hospice can play in providing death with dignity. It is a very important point, further demonstrating that those who are in support of "pulling the tube" are not insensitive to the issues of human suffering.

Not many doctors (let alone TS's parents) can fully comprehend TS's quality of life over the past couple of years. But given all the evidence, it seems clear that allowing this mindless body to finally fade away is the humane, ethical, and moral thing to do.

Knowing that your child is going to finally be at rest, at peace, without pain...

...What else could a parent want for his/her child?

That is, unless there are grander issues at hand...

...and I think we all know what they might be (ahem, Republican Agenda, ahem).
#: Posted by on 03/24 at 09:54 AM

I hope the Florida Board of Nursing is paying attention... IF the nurse(s) and CNA(s) really were 'sneaking' food & fluids to their patient against medical and/or nursing orders and the careplan and if they failed to report their concerns to the board there are several investigations/prosecutions due.
Also, how can a patient be lethargic and hysterical at the same time?
#: Posted by on 03/27 at 12:14 AM

Annmarie Britan's comment's are dead-on correct. I've thought exactly the same thing. What the hell would any competent nurse be doing by offering Jell-O and thin liquids (water, etc) to a patient with a G-tube on Aspiration Precautions? If this doesn't discredit Ms. Iyer once and for all as a nutcase and a disgrace to her profession, I don't know what will.
#: Posted by on 03/30 at 09:41 AM