Wednesday, March 16, 2005

Terri Schiavo - Never Properly Diagnosed

Hugh Hewitt was talking about this article by Rev. Robert Johansen tonight, regarding the Terri Schiavo case.

If you're one of those who doesn't find her upcoming death by intentional starvation no big deal, I urge you to read it. Once of the things I've found out about this case is how way off people's perceptions are about the real situation. Not their fault. Most MSM reports have never bothered to report much beyond calling her "vegetative," and citing only the barest facts of her husband's "guardianship.

A few points from the article linked above:

Many people believe that Terri Schiavo has had “the best of care,” and that everything has been tried by way of rehabilitation. This belief is false. In fact, Terri has had no attempts at therapy or rehabilitation since 1992, and very little had been done up to that point. Terri has not even had the physical therapy most doctors would regard as normative for someone in her condition. The result is that Terri suffers from severe muscle contractures, which have caused her body to become contorted. Physical therapy could remedy this, but husband Michael has refused to provide it.
Emphasis mine. You'll find that line becomes a recurring theme.

Terri has also suffered from what many professionals would regard as neglect. She had to have several teeth extracted last year because of severe decay. This decay was caused by a lack of basic dental hygiene, such as tooth-brushing. She also developed decubitus (skin) ulcers on her buttocks and thighs. These ulcers can be prevented by a simple regimen of regular turning: a basic nursing task that any certified nurse’s aide can perform. The presence of these easily preventable ulcers is a classic sign of neglect. Bob and Mary Schindler have repeatedly complained of Terri’s neglect, and have sought to remove Michael as guardian on that basis. Judge Greer was unmoved by those complaints as well.
Emphasis mine again. But can someone please explain how classic evidence of neglect does not factor in to his suitability to make "guardian" decisions about whether she lives or dies? I don't mean explain it legally. I want real moral reasoning that can justify ignoring this.

Now onto the even more shocking stuff that sends this case into moral abomination territory...

And, quite apart from the question of Terri’s therapy and care, it is entirely likely that Terri has never been properly diagnosed. Terri is usually described as being in a Persistent Vegetative State (PVS), and indeed Judge Greer ruled as a finding of fact that she is PVS; but this diagnosis and finding were arrived at in a way that has many neurologists expressing surprise and dismay.
I have read a lot of opinion on this matter siding with the husband on the basis of this "Persistent Vegetative State." If you're one of those, you need to read this:

Almost 50 neurologists all say the same thing: Terri should be reevaluated, Terri should be reexamined, and there are grave doubts as to the accuracy of Terri’s diagnosis of PVS. All of these neurologists are board-certified; a number of them are fellows of the prestigious American Academy of Neurology; several are professors of neurology at major medical schools.


Terri’s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging). MRI is widely used today, even for ailments as simple as knee injuries — but Terri has never had one. Michael has repeatedly refused to consent to one. The neurologists I have spoken to have reacted with shock upon learning this fact.
Got that? There are more accurate means of determining this vegetative state question available. They have been offered. The husband has repeatedly refused them.

How significant is this piece of information? Rev. Johansen interviewed a leader in the field of degenerative brain diseases about this topic:

In the course of my conversation with Dr. Morin, he made reference to the standard use of MRI and PET (Positron Emission Tomography) scans to diagnose the extent of brain injuries. He seemed to assume that these had been done for Terri. I stopped him and told him that these tests have never been done for her; that Michael had refused them.

There was a moment of dead silence.

“That’s criminal,” he said, and then asked, in a tone of utter incredulity: “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?” He drew a reasonable conclusion: “These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information.”

There's much more in the article putting all of this into context. I encourage everyone to read it all. But if you can't in summary the unanimous opinion of every neurologist and neurological researcher contacted by Rev. Johansen was that the tests done on Terri simply cannot diagnose a "Persistent Vegetative State" for someone in her condition. There are such tests available. They're routine in such cases. And Terri's husband Michael has persistently blocked them. Every. Single. Time.

There are all sorts of bizarre facts about this case that just leap off the page at you... facts that the judge in this case had available and simply chose to ignore. There's this:

So why hasn’t an MRI been done for Terri? That question has never been satisfactorily answered. George Felos has argued that an MRI can’t be done because of thalamic implants that were placed in Terri’s skull during the last attempt at therapy, dating back to 1992. But Felos’s contention ignores the fact that these implants could be removed. Indeed, the doctor who put them in instructed Michael to have them removed. Michael has never done so.

And this:

Dr. Morin, when told that Michael had refused an MRI, and that Judge Greer had confirmed the decision, said: “He refused a non-invasive test? People trying to do the right thing want the best and most complete information available. We don't have that in Terri’s case.” Dr. Bell agreed with this assessment, saying, “It seems as though they’re fearful of any additional information.”

And this:

Dr. Cranford was the principal medical witness brought in by Schiavo and Felos to support their position that Terri was PVS. ...

But before that, one needs to know a little about Cranford’s background and perspective: Dr. Ronald Cranford is one of the most outspoken advocates of the “right to die” movement and of physician-assisted suicide in the U.S. today.

In published articles, including a 1997 op-ed in the Minneapolis–St. Paul Star Tribune, he has advocated the starvation of Alzheimer’s patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights. Perusing the case literature and articles surrounding the “right to die” and PVS, one will see Dr. Cranford’s name surface again and again. In almost every case, he is the one claiming PVS, and advocating the cessation of nutrition and hydration.

And more and more and more. I don't understand how anyone knowing the full facts of this situation can continue to support it.

Rev. Johansen summarizes the situation this way:

The whole history of Terri’s case over the past few years can be summed up as the efforts of the Schindlers, and those who value Terri’s life, to try to introduce additional information before the courts and other authorities. Some of this information consists of facts and arguments that were ignored or dismissed without adequate consideration; some has been the result of advances in the diagnosis and treatment of brain injuries over the last five years. On the side of Michael Schiavo, George Felos, and Judge Greer, their efforts have consisted almost entirely in trying to prevent any new information from being presented or considered.

There is no way any "guardian" who truly has the best interests of their ward in mind would behave the way Michael Schiavo has. There is no way any legal system devoted to protecting the rights of innocent people could continually rule the way Judge Greer has.


Captain Ed weighs in with his take on the article. Most telling are his comments at the end of his post:

Up to now, my inclination was to consider this an unfortunate case of dueling experts and bitter family feuding. Now I think this is something more. The people who want the feeding tube pulled all seem to have vested interests outside of Terri's well-being -- Cranford wants to push an agenda for euthanazing people who he finds inconvenient, and Michael Schiavo appears to have a long history of neglect, or at least disinterest in pursuing the proper testing for his wife's condition.

As I wrote earlier, when in doubt, we should err on the side of life rather than death. As Father Johansen points out, grave doubts exist about Terri's true condition. It seems almost perverse to insist on pulling out her feeding tube until the proper testing can be done, and if Schiavo won't allow it, the court should demand it. A few more weeks to determine the real diagnosis of Terri Schiavo won't hurt anyone, and might just save a life.


Anonymous Anonymous said...

How certain are you of your facts? Has Mrs. Schiavo received an MRI or not? The report that she has not has been running through the internet. Yet, it appears that she has indeed received a scan, and it showed very negative results. Of course, knowing this would not be acceptable information in some quarters.

10:33 PM  
Blogger Doug said...

A couple points anonymous.

First, they're not "my facts." They're from the article I linked. Check it out.

Second, Michael Schiavo's expert physician witness defended the lack of an MRI scan this past Friday, March 18: Schiavo - Dr. Cranford Offers a ReplyThis would seem to discredit your unsourced allegation that it "appears she has indeed received a scan."

You might be referring to the CT scan she did receive, as opposed to the MRI. If so, that is directly addressed even in the excerpt I posted above, and in much greater detail in the full article it comes from. Please take the time to read it.

12:08 AM  
Anonymous Anonymous said...

Then the "facts" are wrong. Terri had an MRI in 1990:

MRI Report Dr. Pinkston
Profound atrophy w/ very atrophic appearing cortex. Mild white matter disease, anoxic/hpoxic injury

6:46 AM  
Anonymous Anonymous said...

Oh, and before you accuse me of being unsourced -- the information comes from YOUR "side":

6:47 AM  
Blogger Doug said...

Thanks for the citation. But I'm not sure this constitutes a slam-dunk, since Michael Schiavo's court expert just defended the fact that she had not had an MRI last Friday.

It does deserve further inquiry. Which is one of the elements the courts and Michael Schiavo don't seem to want at this point. They want her dead right now.

Additionally, an MRI in 1990 - even if it happened - hardly justifies ignoring the availability of one in 2005 before starving someone to death on the basis that you're sure you know all you need on the basis of 15 year old tests.

Before most people have surgery, they ask for a second opinion. Before someone is executed they deserve the same at the very least.

8:31 AM  

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