Bioethics, healthcare policy, and related issues.
The Schiavo autopsy results all but certainly substantiated the interpretation of her clinical situation made by every competent and responsible professional involved in her case. But that is by no means a majority of the whole group of people who were, in one way or another, and with or without invitation, involved. For purposes of reference, and to put these meddling buffoons on record, let’s take a look at some of the players and their “professional” opinions, rendered before termination of Terri Schiavo’s feeding tube.
Dramatis Personae
Dr. William Frist (Senate Majority Leader, and surgeon)
Dr. William Cheshire (Director of Biotech Ethics of the [evangelical Christian] Center for Bioethics and Human Dignity, and consultant to Governor Jeb Bush in the Schiavo case)
Dr. Victor Gambone (court-appointed neurologist consulting in 2002 medical hearing)
Dr. William Hammesfahr (Schindler-appointed consultant at 2002 medical hearing)
Dr. Peter Bambakidis (Schiavo-appointed consultant at 2002 medical hearing)
Dr. William Maxfield (Schindler-appointed consultant at 2002 medical hearing)
Dr. Ronald Cranford (Schiavo-appointed consultant at 2002 medical hearing)
. . . and a cast of hundreds of jackass politicians of every stripe.
Court-Ordered Medical Screening - 2002 Judge’s Summary
Three of the five doctors testified that Terry Schiavo was in a persistent vegetative state, although Dr. Cranford felt it more appropriate to phrase it permanent vegetative state which meant that the condition was irreversible. Two of the doctors felt that she was not in a persistent vegetative state. These two sets of opinions had little in common. Those who felt she was not in a persistent vegetative state placed great emphasis upon her interaction with her mother during Dr. Maxfield’s examination and the tracking of a balloon. . . .
Dr. Hammesfahr testified that he felt that he was able to get Terry Schiavo to reproduce [actions] repeatedly to his commands
Dr. Hammesfahr was asking [Terri Schiavo] to squeeze [his fingers] . . . [and] testified that she squeezed his finger on command.
Dr. Bambakidis . . . concluded that all the data as a whole supports permanent vegetative state.
Dr. Maxfield testified she related to [taped music] and “tried to sing”.
Dr. Maxfield also felt that ‘02 CT Scan showed improvement in the quality of the remaining brain matter and that one reason Terry Schiavo was not in a persistent vegetative state was that she could swallow her own saliva and breathe on her own.
[B]y the court’s count, [Dr. Hammesfahr] gave 105 commands to Terry Schiavo and, at his direction, Mrs. Schindler gave an additional 6 commands. Again, by the court’s count, he asked her 61 questions and Mrs. Schindler, at his direction, asked her an additional 11 questions. The court saw few actions that could be considered reponsive to either those commands or those questions.
While Dr. Hammesfahr testified that she squeezed his finger on command, the video would not appear to support that and his reaction on the video likewise would not appear to support that testimony.
[T]his music [played by Dr. Maxfield] was played markedly louder than any other music or voice commands of the doctors. It was probably louder than the handclasp or dropped objects that always seemed to produce a startle reflex.
These views [of Dr. Maxfield regarding the CT scans and swallowing capacity] were not supported by any of the other doctors and Drs. Greer, Bambakidis and Cranford strongly disagreed with his ‘02 CT Scan opinion. Dr. Cranford further testified that saliva handling is from the brain stem, a reflex.
Mrs. Schiavo’s brain showed marked global anoxic-ischemic encephalopathy resulting in massive cerebral atrophy. Her brain weight was approximately half of the expected weight. Of particular importance was the hypoxic damage and neuronal loss in her occpital lobes, which indicates cortical blindness. Her remaining brain regions also show severe hypoxic injury and neuronal atrophy/loss.
Treatment Options Proposed at 2002 Medical Hearing Judge’s Summary
The treatment options essentially were the vasodilatation therapy offered by Dr. Hammesfahr and the hyperbaric therapy proposed by Dr. Maxfield.
Dr. Maxfield felt there was an 80% chance of improvement in Spect Scan results from hyperbaric therapy. He has seen such with similar patients. Also, he felt there was a significant probability Terry Schiavo would improve cognitive ability with hyperbaric treatment.
Dr. Hammesfahr feels his vasodilatation therapy will have a positive affect on Terry [sic] Schiavo.
Drs. Greer, Bambakidis and Cranford do not feel it will have such an affect [sic]. It is clear that this therapy is not recognized in the medical community.
While Dr. Hammesfahr blithely stated he should be able to get her to talk, he admitted he was not sure in what way he can improve her condition although he feels certain her can.
Dr. Maxfield spoke of a “chance” of recovery although he [also] stated there was a significant probability that hyperbaric therapy would improve her condition.
Judge’s Observations
What is significant, however, and what undemises [Dr. Hammesfahr’s] creditability is that he did not present to this court any evidence other than his generalized statements as to the efficacy of his therapy on brain damaged individuals like Terry Schiavo. He testified that he has treated about 50 patients in the same or worse condition than Terry Schiavo since 1994 but he offered no names, no case studies, no videos and no tests results to support his claim that he had success in all but one of them. If his therapy is as effective as he would lead this court to believe, it is inconceivable that he would not produce clinical results of these patients he has treated. And surely the medical literature would be replete with this new, now patented, procedure. Yet, he has only published one article and that was in 1995 involving some 63 patients, 60% of whom were suffering from whiplash. None of these patients were in a persistent vegetative state and all were conversant.
It is clear from the evidence that these therapies [hyperbaric oxygen and vasodilation] are experimental insofar as the medical community is concerned with regard to patients like Terry Schiavo which is borne out by the total absence of supporting case studies or medical literature.
Neither Dr. Hammesfahr nor Dr. Maxfield was able to credibly testify that the treatment options that they offered would significantly improve Terry Schiavo’s quality of life. . . . The other doctors, by contrast, all testified that there was no treatment available to improve her quality of life. They were also able to credibly testify that neither hyperbaric therapy nor vasodilatation therapy was an effective treatment for this sort of injury.
Autopsy Findings
Mrs. Schiavo’s brain showed marked global anoxic-ischemic encephalopathy resulting in massive cerebral atrophy. Her brain weight was approximately half of the expected weight.
The damage to [her brain] “was irrecoverable, and no amount of treatment or rehabilitation would have reversed” it, said pathologist Jon R. Thogmartin, who is the chief medical examiner for Florida’s sixth judicial district.
The brain examination was “consistent with a persistent vegetative state,” said Stephen J. Nelson, a neuropathologist who was a consultant to the medical examiner’s office.
Cheshire’s “Findings” - March 2005
[Terri Schiavo] does fixate her gaze on colorful objects or human faces for some 15 seconds at a time and occasionally follows with her eyes at least briefly as these objects move from side to side.
Rehabilitiation notes from 1991 indicated that she tracked [objects with her eyes] inconsistently . . . and demonstrated good eye contact to family members.
To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead or in some neurological sense no longer there.
Autopsy Report
Mrs. Schiavo’s brain showed marked global anoxic-ischemic encephalopathy resulting in massive cerebral atrophy. Her brain weight was approximately half of the expected weight. Of particular importance was the hypoxic damage and neuronal loss in her occpital lobes, which indicates cortical blindness. Her remaining brain regions also show severe hypoxic injury and neuronal atrophy/loss.
[Note: this only addresses some of Dr. Cheshire’s statements that are directly contradicted by anatomical findings at autopsy. For a fuller discussion of his bizarre and unprofessional “evaluation”, see here.]
Other Discussion Dr. Ronald Cranford on MSNBC with Joe Scarborough
CRANFORD: Wait a minute. You are not accurate on a lot of things here. You’re saying a lot of — she’s not starving to death. Do you understand that? She is dehydrating to death.
DANIELS: Well, why do you say that? Tell us how you came to that conclusion? . . .
CRANFORD: . . . And this will come out in the next three to five years about this condition and starvation.
DANIELS: Are you 100 percent correct in your opinion that Terri Schiavo is in a persistent vegetative state? Do you agree with that?
CRANFORD: I am 105 percent sure she is in a vegetative state. And the autopsy will show severe irreversible brain damage to the higher centers, yes. . . .
SCARBOROUGH: . . . AP had a report yesterday. They said seven doctors have looked at her. Four said she was in persistent vegetative state. You were one of them, hired by Michael Schiavo to do that. There were three others that looked at her that disagreed. . . .
CRANFORD: Joe, Judge — Judge [George W.] Greer disallowed, didn’t believe what [Dr. William] Maxfield [a doctor selected by Terri Schiavo’s parents] said. You got your numbers wrong. There were eight neurologists saw her. Seven of the eight said she was in a vegetative state. Only one said she wasn’t. . . .
SCARBOROUGH: . . . A radiologist told the court that the 2002 scan actually showed improvement over the 1996 scan. Is that inaccurate? . . .
CRANFORD: Absolutely. Maxfield said it was improved. And Judge Greer didn’t buy it because the others said it wasn’t improved. It was probably worse than it was before.
SCARBOROUGH: Is he a charlatan also?
CRANFORD: Yes. Maxfield is an HBO [hyperbaric oxygen], vasodilator — look it up, Joe. See what vasodilator does. See what hyperbaric oxygen, see in these cases, and you tell me they are not charlatans.
SCARBOROUGH: You know what? This is the disappointing thing. You try to have a conversation. You try to talk about what is going on. . . . And what I always find out is, there are certain doctors — I am not claiming that this doctor is a charlatan. I don’t know his body of work. I am not claiming that he is a hired gun. But too many doctors out there can be bought off by attorneys on either side. And then they come out, instead of telling you the facts, you get into debate like you are talking to an attorney. It is very, very disappointing.
Judge’s Observations
It is clear that this therapy [vasodilation] is not recognized in the medical community.
These views [of Dr. Maxfield regarding the CT scans and swallowing capacity] were not supported by any of the other doctors and Drs. Greer, Bambakidis and Cranford strongly disagreed with his ‘02 CT Scan opinion. Dr. Cranford further testified that saliva handling is from the brain stem, a reflex.
It is interesting to note the absence of any case studies [of HBO therapy in severe hypoxic injury] since this therapy is not new and this condition has long been in the medical arena.
The other doctors, by contrast, all testified that there was no treatment available to improve her quality of life. They were also able to credibly testify that neither hyperbaric therapy nor vasodilatation therapy was an effective treatment for this sort of injury.
Autopsy Report
Mrs. Schiavo’s brain showed marked global anoxic-ischemic encephalopathy resulting in massive cerebral atrophy. Her brain weight was approximately half of the expected weight. . . . Her remaining brain regions also show severe hypoxic injury and neuronal atrophy/loss. . . .
7. By what mechanism did Theresa] Schiavo die?
Postmortem findings including the state of the body and laboratory testing, show that she died of marked dehydration (a direct complication of the electrolyt disturbances brought about by the lack of hydration). The state of her fatty tissue and laboratory findings indicate that she did not starve to death.Coroner’s Statement
The damage to [her brain] “was irrecoverable, and no amount of treatment or rehabilitation would have reversed” it, said pathologist Jon R. Thogmartin, who is the chief medical examiner for Florida’s sixth judicial district.
The brain examination was “consistent with a persistent vegetative state,” said Stephen J. Nelson, a neuropathologist who was a consultant to the medical examiner’s office.
Reverend Robert Johansen in National Review Online 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.
In addition to the 15 neurologists’ affidavits Gibbs had in time to present in court, I have commitments from over 30 others who are willing to testify that Terri should have new and additional testing, and new examinations by unbiased neurologists.
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 . . . 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.
Dr. [Peter] Morin . . . 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.”
[Morin] added, “A CT scan is useful only in pretty severe cases, such as trauma . . . . But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.” Other neurologists have concurred with Dr. Morin’s opinion. Dr. Thomas Zabiega, who trained at the University of Chicago, said, “Any neurologist who is objective would say ‘Yes’” to the question, “Should Terri be given an MRI?”
But in spite of the lack of advanced testing, such as an MRI, attorney George Felos has claimed that Terri’s cerebral cortex has “liquefied,” and doctors for Michael Schiavo have claimed, on the basis of the CT scans, that parts of Terri’s cerebral cortex “have been replaced by fluid.” The problem with such contentions is that the available evidence can’t support them. Dr. Zabiega explained that “a CT scan can’t resolve the kind of detail needed” to make such a pronouncement: “A CT scan is like a blurry photograph.” Dr. William Bell, a professor of neurology at Wake Forest University Medical School, agrees: “A CT scan doesn’t give much detail. In order to see it on a CT, you have to have massive damage.” Is it possible that Terri has that sort of “massive” brain damage? According to Dr. Bell, that isn’t likely.
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.
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.”
At one point, Dr. Cranford struck Terri very hard on the forehead between her eyes. Terri recoiled and moaned, seemingly in pain. In his court testimony, Cranford dismissed the reaction and moan as a “reflex.” “I asked Dr. Bell if he thought a moan uttered after a painful blow could be a reflex. “It’s highly unlikely,” he replied. He qualified his answer by noting that he had not actually seen the video of the exam, but he believes that the description of Terri’s reaction is not consistent with a reflex. “A moan is not a reflex,” Bell said. “A wince or grimace is not a reflex.”
An MRI was never recommended because, in this case and other patients in a permanent vegetative state, the CT scans were more than adequate to demonstrate the extremely severe atrophy of the cerebral hemispheres, and an MRI would add nothing of significance to what we see on the CT scans. Plus the MRI is contraindicated because of the intrathalamic stimulators implanted in Terri’s brain. A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG’s were more than adequate to diagnose PVS to the highest degree of medical certainty, along with the credible testimony of the three neurologists at the longest evidentiary hearing in American law, whose opinions were strongly affirmed by the trial court judge and three appeal court judges. Please see Judge Greer’s opinions on the credibility of the experts testifying on behalf of the Schindler family.
Autopsy Report
At autopsy, the brain weighed 615 grams. A total of 645 milliliters of cerebrospinal fluid (weighing 678 grams) were recovered upon opening the skull and exposing the brain. The brain was small, with widened sulci [fissures] and thinned gyri [ridges]. . . . There was prominent diffuse ventriculomegaly (hydrocephalus ex vacuo [fluid pulled into the skull to replace lost tissue]. . . . The lateral ventricles [hollow spaces] were markedly dilated . . . .Much discussion took place in the media concerning why the decedent had not undergone an MRI scan of her brain, rather than only a brain CT scan while alive. Last month, the Director of the Center for Devices and Radiological Health at the U.S. Fod and Drug Administration (FDA) issued an advisory to healthcare professionals that serious injury or death can occur when patients with implanted neurological stimulatros - such as the decedent’s implanted thalamic stimulator - undergo MRI (magnetic resonance imaging) procedures.
Political Debate and Press Statements Jeb Bush Statement
The neurologist’s [Dr. William Cheshire - see above] review indicates that Terri may have been misdiagnosed, and it is more likely that she is in a state of minimal consciousness rather than in a persistent vegetative state. This new information raises serious concerns and warrants immediate action.
Press Statements
House Majority Leader Tom DeLay (R-Tex.) said, “It won’t take a miracle to help Terri Schiavo. It will only take the medical care and therapy that all patients deserve.”
[Senator Bill] Frist said . . . “the interest in this case by myself, and the many members of the Senate on both sides of the aisle, is to assure that Mrs. Schiavo has another chance at life.”
“Every hour is terribly important to Terri Schiavo,” DeLay said.
[Tom Delay:] “Terri Schiavo is not on a respirator; she can breathe on her own. Terri Schiavo is not brain-dead; she talks and she laughs, and she expresses happiness and discomfort. Terri Schiavo is not on life-support.”
Committee Chairman F. James Sensenbrenner Jr. (R-Wis.) accused the Florida courts of “enforcing a merciless directive.” He invoked the civil rights movement . . . .
Schiavo’s brother, Bobby Schindler, visited the Capitol . . . accompanied by an official of the National Right to Life Committee. He told reporters he was there “to help save my sister’s life.” . . . Schindler . . . produced a video disk that he said shows she is functional . . . .
[I]s Terri clearly in this diagnosis called persistent vegetative state? I was interested in it in part because it is a very difficult diagnosis to make and I’ve been in a situation such as this many, many times before as a transplant surgeon. . . .
Persistent vegetative state, which is what the court has ruled — I question it. I question it based on a review of the video footage which I spent an hour or so looking at last night in my office here in the Capitol. And that footage, to me, depicts something very different than persistent vegetative state.
House of Representatives Debate
SENSENBRENNER . . . As the House convenes this Palm Sunday, the Florida courts are enforcing a merciless directive to deprive Terri Schiavo of her right to life. Terri Schiavo, a person whose humanity is as undeniable as her emotional responses to her family’s tender care-giving, has committed no crime and has done nothing wrong.
WEXLER . . . die. She has been denied therapy, and she has been denied treatment. It has been stated that she does not show any electronic brain waves. She only had a CAT scan back in the early 90s. She has never had an MRI. She has PET scan, and she has been denied treatment even for infection.
SCHULTZ . . . Despite aggressive therapies, revealed no functional abilities, only reflexive rather than cognitive moments, random eye opening, communication system, and little change cognitively or functionally.”
FRANKS of Arizona . . . It is true that Terri Schiavo lives among us in the shadows of life. But not brain dead or comatose. She is awake and she is able to hear, she is able to see, she is often alert. She can feel pain, she interacts with her environment, she laughs, she [*H1709] cries. She expresses joy when her parents visit her and sorrow when they leave.
DAVIS . . . Leading the charge in this debate are several physicians who are Members of Congress. I think it is fair to say none of them have examined Terri Schiavo. I seriously doubt any of them had a chance to review the medical records. Instead, many of them, many Members of Congress, are forced to rely upon a videotape that is several years old that does not begin to tell the story.
FOXX . . . Terri Schiavo is not brain dead, she is not terminally ill or in the process of dying. She is brain damaged but if given the chance to be rehabilitated again, there is no telling what she can do.
SMITH of New Jersy . . . Let me also point out to my colleagues Dr. William Hammesfahr, an M.D., board certified neurologist from Clearwater, Florida has testified, and he has signed an affidavit as recently as March 6 of this year, and he has said Ms. Schiavo is not in a persistent vegetative state. He goes on to point out that she could benefit, and I will include this full statement in the Record, from medical interventions that are available right now as we meet, she could be getting therapies, that would make her situation all that much better.
Statement of Dr. William Hammesfahr - Reproduced in Congressional Record by Congressmember Smith 3. I have personally examined Terry Schiavo, reviewed her available medical records, and reviewed her CT can. When I last reviewed her CT scan I noted that Ms. Schiavo had significant brain tissue. She has a large amount of viable brain tissue in her cerebellum space and cerebral hemispheres, not just scar tissue or
spinal fluid.4. I have previously testified, and I am still of the opinion, that Ms. Schiavo is not in a persistent vegetative state.
5. Further, Ms. Schiavo had the ability to swallow. When I examined her approximately two years ago, she was not PVS of MCS, she was in an alert state, able to follow commands, able to respond to language, and able to swallow.
6. Her condition of hypoxic emcephalopathy is a type of stroke. It is a condition I routinely treat with therapy, sometimes 50 and 60 years, after the injury. She is only 15 years past the injury. We routinely see major improvements within the first six months of treating such patients. Terri Schiavo deserves to have the benefit of further treatment.
7. There have been new advances in medical evaluation and treatment for patients like Terri Schiavo even in just the past few years. For example, in November of 2003. Judge Susan Kirkland of the Florida Department of Health validated the treament I have been providing victims of stroke by identifying me, during her ruling, “the first physician to treat patients successfully to restore deficits caused by stroke.” With my therapy, there is improvement of blood flow to the brain.
8. There are other therapies that could benefit Terri Schiavo, such as Hyperbaric Oxygen Therapy, and nutritional therapy, that all have high success rates, and these should be tried on Terri.
9. As a patient, Terri Schiavo is not in that bad of a condition to begin with. We treat many patients who are a lot worse. There are a lot of therapies out there that will very likely improve her condition, and they all compliment each other, so if you do them all in a series, she could get a lot better.
10. Without a doubt, I observed Terri swallow. At a previous hearing for Terri, all five physicians who examined her agreed and testified that she can swallow. We know that because the body makes approximately 2 liters of saliva and post-nasal drainage a day and if she can swallow that, which she can because she swallows her saliva, then she can swallow food.
Statement of Dr. William Maxfield - Reproduced in Congressional Record by Congressmember Smith 2. I have extensive experience in treatment of stroke, multiple sclerosis, brain trauma, cerebral palsy, other cognitive diseases and congenital problems such as ataxia-telangectasia as well as many other diseases that are treated with Hyperbaric Oxygen Therapy (HBOT). My experience in imaging and hyperbaric medicine provide a unique background for my work in developing protocols to diagnose and treat conditions that may benefit from hyperbaric oxygen therapy, such as the current condition of Terri Schiavo.
4. In May of 2002, I previously evaluated Terri Schiavo. I reviewed supplied medical records, personally observed and evaluated Ms. Schiavo on two separate days at the request of attorney Pat Anderson, who was involved in the case at that time.
5. When I evaluated Ms. Schiavo I observed that she was able to swallow at that time. She swallowed her saliva. She didn’t drool her saliva like a patient would if they could not swallow.
6. Based on my observation that Ms. Schiavo can swallow, I believe that she deserves the opportunity to see if she could sustain her life by swallowing food and water. I recommend that she receive further swallowing testing, and the right to sustain her life by eating and drinking on her own.
7. During my personal observation of Ms. Schiavo, I saw her respond to music and to her family by grimacing, moving and smiling, and turning her head. She could not move her body very much at that time, because of stiff joints, but she turned her head toward her family and looked at them. She would follow balloons around the room to a great degree. These behaviors, in my opinion, are not consistent with a Persistent Vegetative State (PVS), but are those of Minimally Conscious State (MCS).
8. There have been medical advances in the evaluation and treatment of patients like Ms. Schiavo even in just the past several years and since the last time that I examined her. For example, these advances include further documentation of the neurological response to HBOT and now the developing field of Hypoxia Imagining. Having just a normal MRI or CAT Scan is not enough for a patient like Ms. Schiavo. I would recommend Ms. Schiavo have a SPECT brain scan before and after HBOT. There is a data demonstrating an improved SPECT brain scan after one or a few HBOT sessions can provide a significant correlation as to response from a full course of HBOT. We can then determine if there is improvement in the pattern of her brain, and predict if additional hyperbaric treatment would produce improvement. Ms. Schiavo deserves to receive the benefitof this advance in medical evaluation and treatment. I have worked with many patients who have shown marked cognitive improvement with HBOT. Documentation is available upon request.
9. When I observed Ms. Schiavo, I noted that she did not interact with me, but she did interact with her mother and father. She does not respond to other strangers. She does respond to people she knows and this is not something a person in a PVS state would be able to do. I base this opinion on my 30 years of practice in radiation therapy, and as medical director for a hospice program, where I have dealt with many patients who are in a PVS state.
10. In my opinion Terri Schiavo is [in a Minimally Conscious State], because if she was PVS, she would not respond to the stimuli around her, including the music. In my opinion, she is in a vegetative state. [sic]
11. Without out a doubt, Terri does respond and she does swallow her own saliva. If she can do that, then, in my opinion, she can swallow liquids.
FRANK of Massachussetts . . . The caption tonight ought to be “We are not doctors. We just play them on C-SPAN”
MORAN . . . I have never met, certainly not examined, Ms. Schiavo; but nor have any of the so-called medical experts in this body that have testified on the basis of edited videotapes ever examined her either. But every qualified doctor who has examined her has reached the same conclusion: she is in a perpetual vegetative state; she has no cerebral cortex.
GINGREY. Mr. Speaker, in response to the remarks a few minutes ago from the gentleman from Massachusetts, I want to say that I am not sure whether or not I am on C-SPAN, but I am absolutely sure that I am not playing doctor, for indeed I am one.
Mr. Speaker, I want to thank my colleagues for returning to Washington on Palm Sunday to take up this very important issue. . . . Mr. Speaker, since Terri Schiavo’s brain injury 15 years ago, she has been profoundly disabled. She is not, however, in a coma. She responds to the people around her; she smiles and she can feel. Terri is very much alive. . . . Terri responds to verbal, auditory, and visual stimuli, normally breathes on her own and can move her limbs on command. . . . [M]y basic courses in medical school taught me that dehydration is a horrific process. . . . The patient’s skin cracks, their nose bleeds, they vomit as the stomach lining dries out, and they have pangs of hunger and thirst. Starvation is a very painful death to which no one should be deliberately exposed. The tragedy of this situation is that with proper treatment, now denied, condition can improve.
ADERHOLT . . . The truth is Terri is not brain dead. She is awake. She is aware of her surroundings.
RYUN . . . Terri Schiavo does . . . is responsive to the sound, touch, and sight of those caring for her. She has parents and siblings who desperately want to take care of her. Yet the courts have even denied the ability of the relatives to offer food and water to her lips. In fact, Noble Prize Nominee Dr. William Hammesfahr recently issued a statement saying he has examined Terri and he believes her injury is the type of stroke that he treats every day with success. In fact, he said there are many approaches that would help Terri. I know because I have had the opportunity personally examine her and her medical record and her x-rays. [Note: Hammesfahr is a “Nobel Prize Nominee” only because Ryun himself wrote a letter to the Swedish Academy touting Hammesfahr’s quack vasodilators - a bogus procedure that the Academy does not recognize as a nomination.]
WEXLER . . . I practiced medicine for 15 years, internal medicine, before I came to the House of Representatives. I took care of a lot of these kinds of cases. . . . Number one, by my medical definition she was not in a vegetative state based on my review of the videos, my talking to the family, and my discussing the case with one of the neurologists who examined her.
BAIRD . . . For 23 years before working in this body, I served as a clinical neuropsychologist. I have been with many patients in persistent vegetative state. . . . I wish life were different. I really wish it were. I will tell Members the stories like the gentleman from Arizona (Mr. Franks) and others about sudden recoveries, where people almost miraculously or magically are better and return to their former state are apocryphal for the most part. . . . After years of coma, people do not return to who they were before. What happens is we have a brain stem that is miraculously robust at protecting breathing and heart rate, but it is our cortex that makes us who we are and that cortex dies when it is deprived of oxygen and we effectively die with it. And I am sorry about that. It is so tragic.
KINGSTON . . . .Here is what we do know. Terri is not a PVS, someone in a permanent vegetative state. Florida has a legal definition of this and it states that one has to be permanent or irreversibly unconscious, with no voluntary or cognitive behavior of any kind, and without ability to communicate. Terri is able to laugh, she is able to cry, and she, apparently, can hear. She responds to stimuli, such as voices, touch, and people.
NADLER . . . The doctors’ testimony. The doctors testified, doctors who examined her, not doctors standing up on the floor here who say, well, from the video tape we can infer. Doctors can be deprived of their license for making diagnoses from afar. But doctors who have actually examined this patient have testified her cerebral cortex is liquefied; that it is destroyed. Without a cerebral cortex there is no sensations, there is no consciousness, there is no feeling, there is no pain, there is no possibility of recovery.
That is what a persistent vegetative state is. There is no possibility of recovery, despite the wishes, despite the fervent hopes, despite the illusions of desperate relatives. We should not feed those illusions.SCHWARZ . . . I am a head and neck surgeon. Terri Schiavo . . . does have some cognition and some cortical activity.
MUSGRAVE . . . When we talk about a permanent vegetative state, I am offended by that. Terri and acknowledges the people that love her when they come to see her. She cries when they leave. How heartless are we to call somebody like Terri Schiavo a vegetable? What are we thinking?
McDERMOTT . . . And what troubles me, and I have heard my colleagues here, as a psychiatrist, I cannot make diagnoses of people that I have not examined. That is contrary to my profession, and I can be disciplined for doing that. The rest of you can be doctors. You can come out here and tell us anything you want. But a doctor cannot come out here and say anything really about somebody they have not examined.
SOUDER . . . Terri swallows, shows eye movement, and seems to respond.
WASSERMAN SCHULTZ . . . The independent guardian ad litem appointed to represent Terri Schiavo has said in his report that, despite the facts cited by my colleagues on the other side of the aisle who have said that Terri felt pain and laughs and cries, that that is factually inaccurate; that her cerebral cortex has been liquefied, and that is the area of the brain that responds to emotion and reason. So that is impossible what they have detailed here tonight. Additionally, they talk about six neurologists and eight physicians that have said that she is not in a persistent vegetative state. Also factually inaccurate. Those physicians to which they refer have only viewed Terri via videotape. The five court-appointed physicians that have examined Terri, two appointed on Michael Schiavo’s side, two on the Schindlers’ side, and one court-appointed physician, who have all examined her, the board certified neurologists who had scientifically-based academically-researched testimony, their testimony was deemed to be clear and convincing by the court that she was and is in a persistent vegetative state. The other physicians’ testimony was discounted as anecdotal only.
AKIN . . . Not only has a tube delivering food and water been removed, but her parents have been barred from even putting ice chips on her tongue. Yesterday, advocates were arrested for attempting to bring water to Terri.
Comments
I will not re-quote the relevant sections of the autopsy, the judicial findings, or the prior clinical findings. The relations of these statements to the facts of the case should be overwhelmingly obvious by now. The facts contradicting the idiotic statments made above can be found in the various preceding text sections as well as the full autopsy report. (The 2002 clinical “Mandate” hearing is also instructive.)
What is clear is the universal pattern of flatly false statements made in gross ignorance or even defiance of clinical facts observable at the time, and which were later disproven by autopsy, from supporters of intervention in this case. It is even more shocking to see, over and over, Republican Congressmembers who are doctors violate the most basic tenets of responsible behavior - and then be shown up as complete fools in doing so.
It is slightly heartening to see repeated admonitions of restraint and acknowledgement of the irresponsibility and factual inadequacy of long-distance diagnosis on the part of Democratic members, however unavailing. The unsupportability - the sheer, indifferent irresponsibility and gasping ignorance - of their opponents, however, is a stain not just on the Congress but on the intrusive and equally ignorant electorate those members pander to.
Throughout this case, the anti-autonomy side has persistently misunderstood and misrepresented the clinical facts. The magnitude of their falsities and misconceptions is only hinted at by the autopsy report. (And these quotes above deal only with physical findings addressed at autopsy. The gross misconceptions regarding “life support”, “terminal care”, and the role of patient’s wishes, not to mention the bizarre rumors and accusations that infected every corner of this case, are not even mentioned here.)
The courts saved patient autonomy in this case, and the confusion and aggressiveness of Congress’s intervention caused a backlash that may help galvanize the public into insisting on their own rights. The autopsy report clearly underscores the the need. But we should not forget what was done by grandstanding right-wingers catering to their “pro-life” base - and what was allowed to be done by weak liberals unable to stand up to them. Remember the words above. Remember the falsities, the stupidities, the confusion, and the ignorance.
