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March 25, 2005



A very succinct rundown of the medical facts of the case. How come they have such a hard time getting across this information in a 24/7 news cycle? You think they'd fill it up with something like -- oh, I don't know, news.

That's great about protesting against Randall Terry. He's real scum and you are very brave.



Ohh, when I did protested Terry we were (I thought) equal peons in the big drama: it was before OR, certainly before Kopp. I'd love to be given the samr opportunity again, though.....


There are two problems with the medical evidence you stated here. You quoted Dr. Cranford, who was arguably the doctor whose testimony carried the most weight in the 2002 trial determining that Terri was in a PVS with no hope of recovery, making two extremely errenous and misleading statements.

First of all, Terri's brain has not completely turned to liquid. Somewhere between 70 and 90 percent of her cerebral cortex is damaged, creating a condition called hydrocephalus ex vacuo where spinal fluid comes in to replace damaged tissue. But she does still have between 10 and 30 percent of her cerebral cortex, as well as the rest of her brain such as the stem.

Physical brain structure in itself can be one indication of the brain's possible ability to function, but people have been shown to be quite functional and even to have IQs of over 100 and relatively normal lives with 90 percent or more of their cerebral cortex damaged or even completely missing. I've quoted several of those studies on my blog.

For instance, J. Lorber did a study of patients with hydrocephalus and found that in the group with 10 percent or less of their cerebral cortex present (90 percent or more missing), only half were severely mentally handicapped. There are many case histories of people who were diagnosed to have completely non-fucntional brains based on the physical structure of the brain, but ended up having dramatically more function than ever thought to be possible.

Dr. J. Lorber, for instance, did a study of hydrocephalus patients and found that in the group with 90 percent or more of their cerebral cortex missing or severely damaged, only half were severely impaired. The other half had IQs of 100 or more and were quite functional despite having almost no brain.

There are many similar case histories--I've quoted a number of them on my blog if you're interested in following that up, along with showing some pictures of brain-damaged but highly functional CAT cans next to Terri's--not directly comparable, but much more accurate a comparison than to compare her brain with that of a normal woman much younger than Terri as Cranfield and Felos are doing.

Here's a link to that particular post my blog if you care to check it out (the one previous to it covers case histories of children with little to no brain and much higher levels of functioning than expected, and I talk about J. Lorber's study in an earlier post): http://www.xanga.com/item.aspx?user=purple_kangaroo_Angela&tab=weblogs&uid=235615226

As for Terri's EEG, the fact is that it was so poorly done and so much restless movement, eye movements, etc. filtered out that it APPEARED flat. However, a completely flat EEG is incompatible with any movement (reflexive or not), breathing, heartbeat, etc. A prolonged flat EEG is the criteria for prounouncing someone dead.

Even the doctors who believe she has no response other than reflexive don't believe she's brain dead--no doctor had ever claimed that she met the scientific definition of brain death. So obviously she couldn't have had a truly flat EEG.

If you read the trial testimony, you will see that the doctors discussed the fact that the EEG was messed up and needed to be redone, but it was not performed again at her bedside as recommended. So the EEG test itself was faulty and can't really be used to draw any conclusions as to Terri's true state.

The entire transcript of the 2002 trial is linked in my website (which is very much in progress) here: http://www.geocities.com/purple_kangaroo_angela/terrischiavotimeline.html

Here's Dr. Cranfield's own article on "Diagnosing the Persistent Vegetative State."


A couple of interesting quotes . . .

"But the cardinal features that distinguish the vegetative state from other syndromes of lesser brain damage, such as the minimally conscious state, are the absence of sustained visual pursuit (visual tracking) and visual fixation. The eyes do not follow objects or persons, nor do they fixate on these objects or persons. And, when patients do emerge from the vegetative state, almost invariably the first and most reliable sign of improvement is the ability to visually track objects or persons in a consistent, sustained, and reproducible fashion. The question is often asked, what exactly does “consistent, sustained, and reproducible fashion” mean in this context? None of the guidelines in the literature precisely defines these terms, but when the patients do develop sustained visual pursuit, it is usually readily apparent to anyone seeing the patient, families and health care professionals alike, and it is so consistent and reproducible that it is present almost 100 percent of the time during the periods of wakefulness."

This seems to me to be a different definition of PVS than that in Florida Law, doesn't it? Saying that a patient must show signs of intelligent response to their environment such as tracking "close to 100 percent" of the time seems very different to me than the Florida definition of a PVS as being a person who shows "NO voluntary action or cognitive behavior OF ANY KIND."

FL 765.101
(12) "Persistent vegetative state" means a permanent and irreversible condition of unconsciousness in which there is:

(a) The absence of voluntary action or cognitive behavior of any kind.

(b) An inability to communicate or interact purposefully with the environment.

More from Cranford's article . . .

"The diagnosis of the permanent vegetative state is primarily clinical, with repeated neurological examination necessary over a period of time to establish absence of cognitive functions and irreversibility. Laboratory studies may be useful and confirmatory in some cases. For example, EEGs will show severe background slowing. When monitored over a few years, CT scans and MRIs will show progressive cerebral cortical atrophy. While the degree of cerebral cortical atrophy does not necessarily correlate with the complete loss of cerebral cortical functions, it does, however, help to confirm that the underlying process, given the severity of destruction seen on these neuroimaging studies, is irreversible, thus establishing to a high degree of certainty that the condition is permanent. Clinical studies evaluating the usefulness of PET (positron emission tomography) have confirmed the absence of consciousness in these patients by conclusively demonstrating levels of oxygen and glucose metabolism in the cerebral cortex consistent with deep levels of coma, and other forms of deep unconsciousness."

Even he says that much more time than the one-time 45-minute examination he gave Terri and much more testing than the one CAT scan and the unuseable EEG done in 2002 are needed before diagnosing a patient with PVS. He did not follow his own standards.

His definition of PVS as someone who shows tracking (cognitive response) near 100 percent of the time disagrees with the definition in Florida law, which SHOULD have been the definition used in Judge Greer's court. But Judge Greer ruled based on Dr. Cranford's and the other doctors' testimony and definition rather than based on Florida law. This is proven by the fact that he said in several of his rulings things like the following direct quotes:

"Testimony at prior evidentiary hearings did establish that patients in a persistent vegetative state like Terri Schiavo could utter words from time to time." (from Greer's denial of the petition for a stay based on Terri's saying "I wa" and then bursting into tears when asked to say she wanted to live.)

"The court saw few actions that could be considered responsive." (Verdict in the 2002 trial)

"The court finds that based on the credible evidence, cognitive function would manifest itself in a constant response to stimuli," (Verdict in the 2002 trial)

He disregarded testimony from doctors based on the fact that (direct quote again): "It is clear therefrom that they do not believe that Terri is in a persistent vegetative state. Therefore, any conclusion that they have reached would be fatally flawed." (Greer's denial of the Petition for Immediate Therapy)

These are just a few of the facts which raise concerns for those of us who don't accept everything we hear in the media, or even the ruling of one biased judge (who had, for example, accepted a substantial campaign donation from Schiavo's lawyer Mr. Felos and several others in his law firm who were also involved with the case during the trial--just one of many examples bringing a potential conflict of interest into question) as absolute truth.

Also, did you know that in Judge Greer's ruling, he didn't order the removal of life support, the feeding tube, or artificial nutrition and hydration? He specifically ORDERED AND ADJUDGED "the removal of nutrition and hydration from the ward, Terri Schiavo" and later reinforced in his "denial of petition to provide food and water by natural means" that "permission to provide Terri Shciavo with food and water by natural means is denied."

By all accounts, this was enforced even to include denying Terri ice chips and wet mouth swabs, which are standard medical care and a necessary comfort measure routinely used for someone whose feeding tube has been removed.

It's interesting that Dr. Cranford and others consider spoon-feeding to be "artificial nutrition and hydration" that can be ethically witheld, as well as a feeding tube.

It seems reminiscent of the cases of Marjorie Nighbert and so many other patients, who were denied food and water based on their family's wishes or their own advance directives for "no extrordinary means of medical treatment" even though in some cases they were begging for it or in Ms. Nighbert's case, reportedly had to be restrained in her bed to prevent her pilfering from other patients' food trays.

The judge in her case ruled that, even though it was obvious she desired and was clearly asking for food and water, she was not mentally competent to make that decision after having had a stroke.

The issue isn't really about quality of life or even a person's level of functioning--it's about when assisted suicide or euthanasia can take place, and how.



Sorry about the redundancy there in that one paragraph . . . I thought I'd lost part of my post and retyped it. :)

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