A few days ago, I wondered out loud if the results of Terri Schiavo’s autopsy might mean that Michael is owed an apology. The discussion in the comments was long and interesting. Be sure to check it out.
That discussion got me thinking about some issues surrounding the autopsy results, the post mortem diagnose, and the various medical examinations during Terri’s life.
The report says that her brain was severely atrophied. Does it corroborate the CT scan interpretation that she lacked any useful cortical tissue? (If the report reveals cortical function, however minimal, the official interpretation of her CT scans is wrong.)
How much cortical functionality is required for minimally human behavior? (Even if the report found functioning cortex, Terri might still have been vegetative.)
Regardless of whether she lacked cortical function at the time of death or not, could that fact be determined beyond reasonable doubt via scans (or other available means)? (Being right after the fact is meaningless if there was no reliable way to be certain beyond resonable doubt that Terri would be better off dead.)
Assuming that the “right” scan(s) could determine presense or lack of functional cortex, was the CT scan done in 2002 sufficiently convincing? (This ties into the previous question. Though one might theoretically be able to determine by reasonable doubt lack of cortical function, actual scans performed might not have sufficient resolution to allow that determination.)
Assuming that Michael Schiavo and other parties had sufficient evidence that Terri lacked meaningful neural activity beyond autonomic functions, was dehydration/starvion an appropriate way to end her life? (Why didn’t they just give her a lethal injection?)
The report determined her condition at time of death. Was her cerebral atrophy always that bad? Was the damage always irreverible? Could, as the family claims, aggressive therapy helped Terri?
Terri’s collapse was not caused by bulimia. Doesn’t that contradict the basis of Michael’s medical malpractice suit? Should he be asked to return the settlement he won?
There was no evidence of abuse. Even if (let’s say) Michael Schiavo is a jerk with questionable motives, is he not still owed an apology for being accused of abusing his wife?
Thoughts?
Update: I received some angry email from a woman named Gayle, who seems to think that I’m totally in the “Michael Schiavo has been vidicated” crowd. I’m just thinking out loud and hoping the discussion is interesting an experience I can learn from. Anyhow, since any email sent to me is bloggable unless stated otherwise, here are her comments and my responses.
“Michael Schiavo (‘MRS’) of denied rehabilitative therapy to his
‘spouse’ Terri. In fact, Terri was maintained in a state of a
relatively HIGH degree of sensory deprivation for over a decade.
Florida law REQUIRES rehabilitative therapy be given. Do refuse
it is illegal, and surely amounts to abuse.”“Everybody knows this. Why don’t you?”
1. If I recall correctly, Terri did indeed receive therapy early on, which produced no noticeable improvements. 2. While I think it odd and suspcious that he ordered that she never leave her room, I’d hardly call a hospice with frequent medical and family visitors sensory deprivation. If there’s something I missed, please enlighten me. I’d be glad to discuss it. 3. For how long is rehabilitation required? Are there any legal reasons for the cessation of therapy? 4. Everybody knows Florida law?!? OK…
“I believe that MRS also abused his wife by torturing her to death
by dehydration, and I presume you have a television, but somehow
you don’t know this, either.”
Was the body that died by dehydration still Terri Schiavo or had she long since ceased to be truly human? Was she still a person? I don’t know. That’s the kind of thing I want to discuss with people. Furthermore, I wonder if her personhood status was even knowable. Lastly, did the actions fo Michael Schiavo and the medical staff at her hospice constitute cruelty? Again, I don’t know. Let’s talk about it.
“The circumstances surrounding Terri’s collapse SCREAM that an
investigation should have been made, 15 years ago. Now, we
find out that ALLEGED bulimia was probably NOT a factor in her
collapse, and the observed electrolyte imbalance must have been
caused by something else. There was no investigation. Why?”
Do you think none of the litany of doctors to look at her ever wondered about or investigated the cause of her collapse?!? Obviously insufficient evidence was found to justify a criminal investigation of Michael.
“This last set of facts proves that MRS probably perjured
himself on many occasions, claiming that his wife was
bulimic, when the postmortem showed she was not. Friends and
acquaintances CLAIM SHE WAS NOT. And in fact, MRS pocketed
an unknown amount of money in excess of about $1.6 million
dollars, based on the lie that Terri Schindler had bulimia.”
That’s a good point and one worth discussing. In fact it’s so good I brought it up in this post this morning. Everybody knows this. Why don’t you?
“Even if Terri was bulimic, the other information including
the long delay between here collapse and the 911 call, SCREAM
that an investigation should have been made.”
Why are we only hearing about this now? In all the furor a few months ago I never once heard about this issue. Something smells fishy…
“I think your proposed apology to MRS is at best premature.”
Mayhaps. Bear in mind that I merely suggested it as a possibility. I didn’t say I thought it to be immediately necessary.
“One more important fact:”
“Bulimics don’t purge more than a few minutes (say 30 to 60,
I don’t know the exact number) after eating.”“It is almost impossible to imagine that Terri could have
been purging an evening meal, at 4AM.”“Why don’t you check it out?”
Ummm…did I suggest otherwise? As I recall, I accepted the medical examiner’s assertion that her collapse was not caused by bullemia without question. Some of your questions and comments suggest you haven’t really read what I’ve written. Why don’t you check it out?
“Now, we find out that ALLEGED bulimia was probably NOT a factor in her collapse, and the observed electrolyte imbalance must have been caused by something else.“
Not that I’m quibbling with established facts here (because I’m not sure of them myself), but that sentence, regardless of the facts, contains a logical flaw:
If bulimia was probably not a factor, then it does not follow to say that “the observed electrolyte imbalance must have been caused by something else” [emphasis added]. Rather, if bulimia was probably not a factor, it follows that the electrolyte imbalance was probably caused by something else.
Also, this sentence suffers from problems, too:
“This last set of facts proves that MRS probably perjured himself on many occasions, claiming that his wife was bulimic, when the postmortem showed she was not.“
First, you don’t “prove” a “probably.”
Second, the postmortem showing that Terri Schiavo was not bulimic does not automatically mean that Michael Schiavo perjured himself. It is possible that he genuinely believed she was bulimic. An autopsy (or any medical procedure, for that matter) is a scientific experiment, which may prove a hypothesis wrong. That does not mean, however, that the person holding the hypothesis was deceitful in doing so.
“As I recall, I accepted the medical examiner’s assertion that her collapse was not caused by bullemia without question.”
The autopsy did not provide any conclusive evidence for why Terri collapsed, Funky. Again, per the article I sent you, the real issue at hand with Terri is due process and patients’ rights.
Bringing up the issue of personhood at the end of life is quite relevant, but you are erring in using Terri as your test case, not only is the case quite inflammatory, but the data are rather poor, to put it delicately. Thus, folks are going to get riled up without good evidence to put things to rest one way or another. I’d strongly recommend starting some general posts, perhaps using some relevant sections of the Catechism as a starting point, and then working through what the issues mean ourselves. You can keep this furball of attack and counterattack with the Christian blogdom (you’ve already revised this post at least twice to accomodate attacks against you), and I’m already beginning to lose track of the original point!
“No Left Turns,” the blog of the Ashbrook Center at Ashland University (a center for conservative politics) has had an interesting exchange on it, in which the autopsy results have been quite a subject of discussion. Unfortunately, around comment #38 it disintegrated into a bunch of partisan name-calling. Still, though, it’s the most discussion I’ve seen of the autopsy results.
You can read it here:
http://noleftturns.ashbrook.org/comment.asp?blogID=6875#comments
The retort I’ve heard brought up most often is that the dehydration could have caused some of her brain’s shrinkage, as well as the blindness. I have no idea if that’s even possible, but it’s what I’ve heard… I’d like to hear someone with a little more medical knowledge (Jerry, perhaps?) weigh in on that.
Brain scans can detect a brain that’s probably capable of consciousness. But the only way to detect real consciousness is for another conscious being to see it in action and then say, “Hey, that thing is like me!”
Terri Schiavo’s parents were (allegedly) looking at her and saying, “Hey, she’s like us!”
Michael Schiavo was (allegedly) looking at her and saying, “Nope, don’t see it.”
I’ve seen those famous videos, and I didn’t see any consciousness, either.
Personally, I think what throws most people for a loop on this one is that she still looked like a person, that she had eyes and a nose and a mouth and ears and arms and legs and all those things, that there was still life-like motion (i.e., she wasn’t just a really nice statue or inanimate object), so people were a little creeped out at the thought that this body could still be considered dead, or at least brain-dead, or a “vegetable.”
But studies have shown people get creeped out when CG animated characters, which clearly are not alive and have no consciousness (i.e., they are like nice statues or inanimate objects), look like living humans, too.
I really think this whole thing boils down to natural, unconscious species recognition wiring in the brain, and whether people are willing to go with their “gut” (“She sure looks alive to me!”) or with rationality (“She hasn’t communicated or done anything meaningful for fifteen years; how is that living?”)
Good suggestion, Jerry!
I don’t think it is much of reach to say that euthanasia activists will attempt to do exactly what you’ve suggested (actively end life). In the end, there is not an ethical difference between this and what was done to Terri passively.
Regarding the “right” scan, no medical device is capable of determining consciousness, despite the claims of some.
P.S. Never mind. I apologize for not reading all the comments on your previous post before I posted that.
The whole autopsy thing brings up another point which has a tremendous amount of relevance to the preservation of life in the country. Autopsy are now performed in a very small percentage of deaths.
It may be thought that all the improvements in scanning technologies have rendered them irrelevant, however in a very large number of cases (somewhere between 30 and 50 percent, I don’t remember the exact number) the autopsy shows that the cause of death was not what the doctor treating the patient thought.
And that number is the same as it was fifty years ago. We’re making a lot of mistakes that aren’t getting caught.
The medical profesion can’t be perfect, it’s always going to lose patients (that it saves so many is amazing). But we shouldn’t let people die in our care without at least trying to learn from what we did wrong so that we can help the next person better.
Whether Terri had enough cortical material prior to death and if the means to determine that were available, it wouldn’t have made any difference. Randall Terry (have you ever heard him tell the story of the abuse he received at the hands of a Pittsburgh paramedic? Care to guess why I remember him telling that story?) has said that the data from the autopsy didn’t matter.
From what I read of the autopsy (the whole thing) Terri’s damage was so severe that it didn’t contradict the interpretation of the CT scan. There were individual neurons left in some areas, or areas where the damage to the neurons remaining was so pervasive as to make any thought impossible. When they say that there was nothing to contradict the PVS, that’s what they mean.
The damage dated back to the original insult, based on the type of damage observed. Had the brain continued to deteriorate, it would have shown up differently.
The MRI would have theoretically been out because the neural stimulator wire might have cooked what was left of the brain.
The doctors told the family from the first month that there was no hope. Everyone ignored the doctors for years. After (I think) 7 years, Michael gave up hope.
As for his time discrepancy: Most people I have ever met as a paramedic cannot give the time they called 911 accurately to within a couple hours. The exception would be a public safety employee or medical professional, and at the time Michael was neither.
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I worked for a couple of years at a state school for the mentally retarded (what it was called then). There were many non-responsive patients who received direct care that included feeding tubes and physical therapy. I’m sure they had no living will. They definitely had no money – no future – only the present. I can’t imagine at the time someone taking a look at them and deciding that these people probably preferred death and therefore food and water would be withheld so that they could die by starvation and dehydration.
How times have changed in twenty years.
By the way, it is not legal to do this to puppies. It is considered inhumane.
oh, yes…Michael has been vindicated.
woo hoo – high five.
Stay healthy. Don’t become disabled and unable to speak for yourself. Someone will speak for you. You do prefer to die, right?