Tuesday, March 22, 2005

Death, Liberty, and the Pursuit of ???

I heard an interesting interview as I was listening to the Hannity radio show in my car today. One of Terri Schiavo's nurses was talking about everything that Mr. Schiavo had done to make sure that Terri never recovered. For a while, she was getting therapy, even to the point that she could feed herself, but as soon as Mr. Schiavo won the malpractice suit he started taking steps to try to kill her off. I can't recount all the details here, but it included using intimidation and threats to prevent the hospital personnel from providing even the most basic care for her. He may have even tried to induce a coma by giving Terri insulin shots behind a locked door. Additionally, Terri was often responsive enough to laugh when the nurse said things that were funny and use basic words like "Mama," "help me," and "pain."

This is unlike anything that I had read or heard of up to this point in time. Every article that I had read (and there were several) pronounced Terri to be in a Permanent Vegetative State, in which she was able to sustain herself in terms of breathing and heartbeat and such, but was unable to respond to stimulus. Her husband claimed that she would not have wanted to live in such a state, and her parents claimed that she has a chance at recovery with therapy and that she wants to live.

So I started looking around and found some interesting information. This article, from the National Review, is about the only one I've found so far that takes a deeper look. So what's the big idea? My usual tendency is to believe the big news organizations over the small ones, but I've found their coverage lacking in a few incidents lately. Besides, this article appears to have been researched pretty thoroughly and--frankly--rings truer than the other story. Specifically, since I know a fair bit about medical imaging, including what you would be able to see with a CT scan versus a PET and MRI. Some of the more potent points:
  • Terri shows identifiable signs of neglect, which does not speak well for her quality of care. Specifically, because her husband has denied her even the most basic therapy.
  • Terri's diagnosis was apparently achieved based on a CT scan, a 45-minute visit by one doctor, and a 30-minute visit by another doctor. Proper diagnosis of a permanent vegetative state, especially in a life-and-death case, would involve an MRI and PET scan, plus weeks, if not months, of observation. (There was one court-appointed doctor, whose opinion is not mentioned)
  • Two of the five doctors enlisted to provide an assessment of Terri's condition found (after spending 14 hours with her over two weeks) that she is not in a permanent vegetative state, and that she may recover with therapy.
  • "A 1996 British Medical Journal study, conducted at England’s Royal Hospital for Neurodisability, concluded that there was a 43-percent error rate in the diagnosis of PVS. Inadequate time spent by specialists evaluating patients was listed as a contributing factor for the high incidence of errors."
  • George Felos (Mr. Schiavo's lawyer) has argued that an MRI can’t be done because of thalamic implants in Terri's skull. The doctor who put these implants in instructed Mr. Schiavo to have them removed.
  • Dr. Ronald Cranford, Mr. Schiavo's star witness, specializes in the field of clinical ethics, and has advocated the starvation of Alzheimer's patients in published articles like this one. (This sort of strikes home for me; my girlfriend's family currently cares for her great-grandmother, who suffers from Alzheimer's disease. She's difficult to care for, but I've spoken with her and she definitely wants to stick around for "as long as these nice folks will keep me." I can't imagine the wickedness of somebody wanting to starve her to death out of convenience.)
  • Dr. Cranford has also described PVS patients as indistinguishable from other forms of animal life.
  • Dr. Cranford diagnosed a man with PVS who could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request, and who could operate a both a standard and an electric wheelchair.
  • During Dr. Cranford's 45-minute assessment of Terri, he 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.” (Note that PVS is defined as "a condition of unresponsiveness to mental and physical stimuli and no sign of higher brain function, wherein the patient is kept alive through medical intervention.")
Read the whole article for more details. This Wikipedia article has other interesting information about both sides of the case.

Now, are the powers-that-be doing the right thing in attempting to write laws specifically to force courts to deal with this issue? Probably not. From what I do know about the way our legal system is set up, they are using their power in ways that they were not intended to do so. That's called abuse. On the other hand, I have seen judges doing arguably the same thing when they "write" law in the name of constitutionality. And I think it is certainly wrong for these higher courts, just because they are used to making policy decisions, to refuse to reexamine the factual findings of the case. It seems interesting to me that, when we're deciding the guilt of a criminal our courts require evidence beyond a reasonable doubt, yet we can sentence a handicapped woman to death by starvation when there remains significant doubt. Is that worse than sentencing her to continued life in a semi-responsive state of mind? I think so. It seems to me that if she's in a bad enough condition that she might welcome death, it is her husband that has put her into that condition, intentionally and deliberately. And the law needs to seriously investigate him on counts of neglect and--when the time comes--homicide. I am not in the position to judge him or his decisions, but there are certainly enough interesting points to merit an investigation.

It's far later than I intended to stay up tonight, and so I guess I'll end with a quick scripture:
2 Ne. 9: 8-10, 28-29, 40, 42-43

8 O the awisdom of God, his bmercy and cgrace! For behold, if the dflesh should rise no more our spirits must become subject to that angel who efell from before the presence of the Eternal God, and became the fdevil, to rise no more.

9 And our spirits must have become alike unto him, and we become devils, bangels to a cdevil, to be dshut out from the presence of our God, and to remain with the father of elies, in misery, like unto himself; yea, to that being who fbeguiled our first parents, who gtransformeth himself nigh unto an hangel of light, and istirreth up the children of men unto jsecret combinations of murder and all manner of secret works of darkness.

10 O how great the agoodness of our God, who prepareth a way for our bescape from the grasp of this awful monster; yea, that monster, cdeath and dhell, which I call the death of the body, and also the death of the spirit.

• • •
28 O that cunning aplan of the evil one! O the bvainness, and the frailties, and the cfoolishness of men! When they are dlearned they think they are ewise, and they fhearken not unto the gcounsel of God, for they set it aside, supposing they know of themselves, wherefore, their hwisdom is foolishness and it profiteth them not. And they shall perish.

29 But to be alearned is good if they bhearken unto the ccounsels of God.

• • •
40 O, my beloved brethren, give ear to my words. Remember the greatness of the Holy One of Israel. Do not say that I have spoken hard things against you; for if ye do, ye will arevile against the btruth; for I have spoken the words of your Maker. I know that the words of truth are chard against all duncleanness; but the erighteous fear them not, for they love the truth and are not shaken.

• • •
42 And whoso aknocketh, to him will he open; and the bwise, and the learned, and they that are rich, who are puffed up because of their clearning, and their dwisdom, and their riches—yea, they are they whom he despiseth; and save they shall cast these things away, and consider themselves efools before God, and come down in the depths of fhumility, he will not open unto them.

43 But the things of the wise and the aprudent shall be bhid from them forever—yea, that happiness which is prepared for the saints.

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