I ate my wafer...

3/26/2005

Terri Schiavo, once again.

Both Jake and Talcott have posted some interesting, and particularly reasonable stuff on the topic recently. In Jake’s case, he points out that the judges involved interpreted the law(s) correctly, and don’t deserve the utter and complete trashing that they’re getting in conservative circles. (I’ve been trying, very poorly to make that point for weeks now.) In my opinion, the big lesson from the whole mess is that, in the future, state legislators would do well to very, very carefully word such statutes.


Talcott raises a number of interesting items, and is definitely worth reading. I am a little disturbed that he said that I’m making strong arguments that Terri is PVS. I’m not a neurologist, and her medical records are quite rightfully sealed, so we *may* have one leaked scan film out a stack of hundreds. (It is worth remembering that most of the doctors commenting on the case haven't seen any medical records either, and there are patient confidentiality concerns that should restrain the ones that have from too much public comment. ) I’d like to think that instead, I’m making strong arguments that from what we do have available; we cannot assume that Greer, and especially the 2nd Circuit Court of Appeals made an incorrect determination. The main reason that I’ve argued medical issues at all is because of the tapes, and in responses to issues others have brought up.

Short, and mostly tangential thoughts:

1. There is a split in the conservative blogosphere as to how to interpret the presidential approval rating drop. This is amusing to me, but I have no real opinion yet on the topic. Anyone care to speculate on how the drop relates to the distaste most americans have for the congressional intervention?

2. I’m tired of seeing Dr. William Hammesfahr on TV, and his words parroted without thought. (A good example is the eeg issue that I already brought up, if you can get useful information from an eeg of a patient during a seizure, his claim that Terri was too restless despite the fact that he wasn’t present requires some critical thought). Oh, and lets stop calling him a Nobel Nominee(I've been curious about that for weeks, and just this morning got around to firing up google on the topic.)

3. Why is it that people are so convinced that the courts have erred that they’re doing civil disobedience to bring Terri bread, and threatening to kill Greer, etc, while the other side is content to let Terri live if the courts rule that way? Six months ago, I don’t remember hearing about a bounty for euthanizing Terri, and noone has been arrested with a syringe of whatever sneaking into her room.

4. I think part of the answer to Talcott's concern about how to establish consciousness from a biological standpoint has to be based in eeg or similar measurements, not just in a percentage of brain area(s) left + clinical exam. Although I have the utmost respect of the privacy of medical records, and do not wish this case to become a precedent for trying end of life cases publicly in the press and polls, I wish I had more information on the eeg’s in this case.

5. Jeb Bush and others seem to think that part of the problem with this case is that the trials and appeals were always in front of judges, never a jury. I have reservations about mandating jury trials in this situation. In criminal cases, it is recognized that there are matters so emotional or technical that a defendant would prefer a bench trial. (Not to mention that given the current rules of evidence that some material is too emotional or prejudicial to go in front of a jury.) How the heck do we decide if the incapacitated person would want a jury or bench trial?


8 Comments:

  • Hrm. I took you to be arguing that Terri's PVS with this sort of business: "one has to either argue that the CAT scans are faulty, or that consciousness can occur without a cerebral cortex to make a argument for any actual thought or mental activity AT ALL." etc., but I guess I was reading in to things.

    So, if I'm reading you right, you're saying "We don't have good information--the courts that made the decision did. So we're not in a position to make a credible evaluation in opposition to what the court made." I would certainly think there are some situations in which we are able to think that courts made a bad decision, namely, situations where we have first hand knowledge crucial facts which contradict the courts decision (e.g. you watched a robbery and then the court didn't convict). In that case you seem justified in saying the court made the "wrong" decision. Though, I agree with you we shouldn't place much stock in tapes, and it's fine to point out all sorts of ways in which the biological reality of the situation is not properly reflected in 5 minute clips.

    Re: (3). Why is it hard to understand how this is civil disobedience and why it is justified? This is particularly relevant for some of us now. Is your complaint that they weren't doing it 6 months ago? Or that they're doing it at all now? Or that they're acting so wildly without a proper epistemic basis. Perhaps they subscribe to my Principle (L) and they act on that basis--CTs and EEGs be damned.

    Re: (4). So EEGs are the cruicial factor now in determining consciousness...why hasn't this come up earlier?--I thought the decision depended upon Terri being PVS....btw--you should look at this critical discussion of the CT scan of Terri's brain. Curious your thoughts on that....

    Re: (5). I agree with you that I'm not sure jury trial's some kind of magic bullet here..., and Re: (4), I agree we don't need to make private medical records available to the public just cuz a lot of us would like to know more.

    Not only Hammesfahr (who despite the "nobel nominee" fiasco still seems at least a half-decent neurologist), but also Cheshire (who confirms that some cerebral cortex remains, and essentially endorses my principle (L) at the end of his point 6) seem to think she's conscious to some degree--so from where I'm sitting the state screwed up--conflicting reports from neurologists means err on the side of life...though I'm no lawyer...

    By Blogger David Talcott, at 9:10 PM  

  • re: 3
    It makes sense that there was no coalition trying to sneak into the hospital to euthanize her. The scare for those acting now is twofold: 1) they believe they are saving a life, equal in status to any of our lives, and 2) this is the touchstone case (so it is thought widely) on euthanasia

    re:5
    Good point. However, I worry for when others will deny me a jury. I know, I know, I sound like Chicken little, but. . .

    By Anonymous Jake Allen, at 9:41 PM  

  • Hmm, well it would be fair to say that I am/was arguing that she is PVS based on what I saw as a fair original hearing followed by a rigorous review process . That is, my position, a week ago was that looking at Greer's original order, if 5/6 (Which obviously includes one of the Schindler's picked witnesses, and Greer's neutral)of the expert witnesses' and the CT scans supported the order, I was comfortable with it. I do want to be completely clear that I don't think that I can argue conclusively for PVS or for that matter against it based on what's publically available.

    I agree that there are rare situations where it is acceptable to question a court's fact finding decision on a medical matter. Unfortunately, I don't see any obvious reason to suspect Greer of bias, and the expert witness panel seemed balanced. The best argument, that I know of for questioning the fact finding decision is the neurologist's report from last week. For me, it is slightly unsettling, but I'm not certain that if the courts, having more evidence and little outright suggestion of bias, aren't swayed that I should be. I'm increasingly concerned with the medical records issue, no matter what court reviews and signs off on Greer's original decision, without the records being completely open, the decision will be questioned publically. Anyone have a thought on that topic?

    #3 was merely an observation, I really don't have a point. I wasn't surprised or shocked that people feel that strongly. I do think that it is interesting that this particular case has been picked for such interest, and the media's role cannot be denied in that.

    #4 was more in general than about Terri. That is, I think that a general biological definition of consciousness would include eeg results. I do wonder why the current push is for MRI's, even though even a completely normal MRI doesn't eliminate a PVS diagnosis, when I think eegs would be more useful.

    I'm increasingly more and more suspicious of Hammesfahr so I'm personally unwilling to consider his testimony, and current endless blabbing as conflicting. My understanding is that during the original trial he that he had treated (with great improvement) many patients that were in similar or worse shape than terri, but under cross examination could offer nothing to support the statement. That, combined with his rather questionable claims on vasodilation has all but convinced me that at best, he's an attention hungry opportunist with no respect for patient privacy, and more likely that he's a false hope giving, lying jerk. Whether the remaining testimony, i.e Cheshire is enough to institute an automatice presumption in favor of life...I'm unsure. I don't *think* that it is at the moment. That is, we know that Cheshire sounds more than a bit biased towards not removing support, and even with that predisposition, the strongest thing he could say was: “Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior,"...yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her." I can see why the courts would be...underwhelmed by that.

    I honestly don't want to comment much on the CT scan yet. I think there are plenty of good analysis pieces on it out there (the one you linked isn't bad). I have been looking for references to the shunt, etc, to establish for certain that the film is from her, and would very much like links or more information.

    I happened to have very long discussion over Easter with my extended family on the topic, which was definitely interesting and useful (part of the reason that I'm especially suspicious of Hammesfahr is the medical commentary on his suspension and claims for vasodilation). Anyway, my dad has suggested that state laws should probably include a time cap on removing support, for the sake of argument, 5 years. That is, baring substantial worsening, it seems inertly wrong to keep someone on any form of life support, feeding tubes included for more than 5 years or so and then discontinue it. Besides the fact that it would have resolved this current issue, it did seem interesting and useful to me. Anyone have thoughts on the matter?

    By Blogger Bob, at 12:37 PM  

  • Do you think the autopsy will reveal anything legally significant?

    By Anonymous Jake Allen, at 10:02 PM  

  • I hope so. Personally, I think the fact that Michael is willing to do one, and his lawyers aren't balking is pretty fatal to the abuse theory. I suspect that the resualts will be sort of ambivalent overall.

    The proof is in the autopsy report...

    By Blogger Bob, at 10:58 AM  

  • Will they be investigating anything relevant to the abuse theory? Also, will we find out any more about just how intact, or not intact, her brain is? Guess I'm wondering the "scope" of the autopsy...

    By Blogger David Talcott, at 1:59 PM  

  • My understanding is that he is allowing an autopsy of the brain only, and not the whole body.

    By Anonymous Anonymous, at 11:14 AM  

  • My understanding is that it is a conventional autopsy PLUS a through dissection of the preserved brain (which will take some weeks).

    I've never heard the term autopsy used for merely removing a brain...and most news articles seem to say "full autopsy"...http://www.msnbc.msn.com/id/6210240/
    for example.

    By Blogger Bob, at 1:53 PM  

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