Thursday, April 21, 2005

Terri Schiavo

Terri Schiavo died on March 31st, 2005. Up till the moment of her death and beyond the controversy has been fiery and pointed from both sides. I got into it when I forum I belonged to began discussing it. I did some background research and this is what I've come up with.

Points for Keeping Terri Schiavo Alive refuted:

She was making progress in her therapy before it was cut off in 1993.

At the time when Michael sued for malpractice it could very well be that he thought (and the doctors thought) that there might be a chance of recovery for Terri. It wasn't so much that she was making progress, but that there was hope that she would make progress (literally at the time, it was too soon to tell). At the time of the malpractice trial all therapies had not yet been exhausted.

Michael received the settlement in January of 1993 and Terri didn't get put in a nursing home until March of 1994, she was treated aggressively for almost 3 years. Keep in mind Michael also was by that time a respiratory therapist and male nurse who could be considered an expert on rehabilitative therapies. Also keep in mind he didn't file with the courts to remove the feeding tube until May of 1998.

It was an evolving situation, so the fact that the therapy was discontinued around when the judgment was receive was a coincidence brought on by the slowness of the legal system. It wouldn't be the first time a judgment was won but the party it was supposed to benefit either didn't need it anymore or had passed on.

The actual award was to be applied primarily to her treatment and then secondarily to her maintenance. Another thing to consider, these experimental therapies were not cheap. Michael could have continued on longer, but the 750,000$ would have been exhausted in no time at all and no money would've been left for her continuing care. So when you say that for 12 years she was refused treatment, it could be very well that they couldn't afford it without jeopardizing her living annuity. Doctors are no doubt happy to accept money for experimental treatments that probably won’t work (like Dr. Hammesfahr and Dr. Maxfield for example). Michael Schiavo had consulted with enough experts by that time and had been told the same thing; there was nothing more they could do for Terri.

If progress was being shown in Terri's medical records and these therapies were making progress then that alone would've been grounds for keeping her alive and appointing guardianship to the parents. This was not the case, as most experts agreed with Michael, including the court appointed physician. I cannot stress enough that this court case was the most thoroughly and exhaustively examined case in recent history.

She was refused all treatment options for 12 years.

Again, “refused” (and “withheld”) is a hostile word employed by those that wish to demonize Michael Schiavo. He had run out of treatment options, this is what the qualified expert’s at the time were telling him; there was nothing more to be done. Incidentally the “experts” that believed Terri was not in a PVS and could be treated didn’t turn up until the case went to court in 1998. Where were these experts before?

The only witnesses to her making the statement that she did not wish to be artificially kept alive were Schiavo, and two of Schiavo relatives.

Granted that looks somewhat suspect, but equally suspect are the family and friends on Terri’s side of the camp saying that she made comments (in relation to a similar case) that being taken off life support was morally wrong. You can’t paste Schiavo without pasting the Schindler’s.

Michael just wanted to kill her off to inherit the money.

Michael Schiavo had no ulterior motive in getting the courts to decide to discontinue life support. Money wasn't a motive (there wasn't more than 50,000$ left in Terri's trust), Michael had even drafted a contract that would sign over any remaining money to charity if the parents would abstain from legal action. The parent's refused.

Interestingly, the guardian ad litem that was appointed to make the determination as to whether the feeding tube could be removed in 1998, Mr. Richard Pearse, he had concluded that the parents of Terri were in a conflict of interest as well for wanting Michael to divorce Terri so they could have legal guardianship over her (and thus have inheritance rights if she died).

Even more interestingly, the relationship between Michael Schiavo and the Schindler’s didn’t sour until after the malpractice award was paid and the Schindler’s wanted Schiavo to split his “loss of consortium” award with them (300,000$ that was Michael’s free and clear this being separate of Terri’s 750,000$ trust which Michael could not touch). Michael refused and the fight was on.

Michael wanted to kill her off to cover up abuse.

The alleged abuse, there exist no documentation of the physical injuries that would indicate that she suffered anything more than what would normally be suffered from bulimia, a fall, then CPR.

The problem with this allegation mostly lies in the fact that the Schindler’s decided to make this accusation in an emergency motion in Nov. 2002. The bone scan that they introduced was taken in 1991. Many medical professionals had a chance to look at Terri and draw that conclusion both before her cardiac infarction and after it. It was reasonable to the courts to accept that most of the damage to her structure was caused by bulimia, the fall, and subsequent CPR. Quite frankly, if she didn’t have a heart attack and the oxygen deprivation was from strangulation, then where were the bruises on her neck? These would’ve been quite prominent and documented by the hospital staff.

Terri Schiavo could swallow saliva on her own, so she could have learned to handle oral intake of food.

Saliva handling is handled as a reflex by the brainstem (necessarily so or we would aspirate saliva into our lungs as we slept, saliva production is also greatly reduced upon sleeping to the reflex doesn’t have to deal with a large amount of it, this is contrary to the situation we deal with in a food/drink scenario). Voluntary swallowing is needed for drinking and solids. The entire process of swallowing food is about 1/3 voluntary and 2/3 involuntary (peristalsis of the food down the esophagus is involuntary), but it is the voluntary portion that is required to get the bollus moving.

Richard Pearse, the Guardian Ad Litem, recommended that Terri remain on life support and was dismissed for it because Michael didn’t get the answer he wanted.

Michael, because of a recommendation by said guardian ad litem, could not make the decision because of a conflict of interest, but this same guardian ad litem also stated that the Schindler’s were in conflict as well as they wanted guardianship and encouraged Michael to divorce Terri and move on with his life. So what he did was personally petition the court to decide if indeed Terri Schiavo would want to be sustained artificially. The courts were designated to be a neutral surrogate. If the courts came back in the Schindler’s favour then the courts would have decided that Terri did indeed wish to live sustained artificially.

Richard Pearse’s reasoning that because a person has been on life support for X number of years is in it self a reason to continue it is flawed. It disregards the circumstances surrounding the reason for putting someone on life support in the first place. Most of the time one is place on life support with the hopes that with the aid, one will get better. That she has been on life support for 8 years is hardly a reason to keep her on it.

Richard Pearse was dismissed from his role as Guardian Ad Litem for reasons of bias and inaccuracy. He did not include in his report Michael’s formal repudiation of his rights to the financial estate of Terri upon her death, thus undermining the main reason why he made a recommendation to deny Michael the right to remove the feeding tube. Rightly so, his recommendation in light of those facts was taken with a grain of salt. Michael’s only authority (or choice) in the matter was to give up his ability to make a choice. Michael and the Schindler’s were having their ability to make a choice taken away from them. That is what happens when you let a court arbitrate a decision. It would’ve been legally binding independent of Michael’s wants and desires. If Michael had a reversal of opinion, it would’ve made the courts decision no less binding.

Richard Pearse’s view has since changed on the subject.

The doctors for Schindler’s Camp said that Terri was not in a PVS and could be treated successfully.

The judge had trouble with Dr. Hammesfahr and Dr. Maxfield’s credibility was that both doctors presented their cases full of anecdotal evidence and although Hammesfahr testified that he had treated scores of patients worse off than Terri he offered no names, no studies, no empirical results.

Dr. Maxfield wasn’t even a neurologist. He offered no studies that hyperbaric oxygenation would even affect this kind of brain damage. Considering that the procedure has been around for years, there should have been something.

Instead both Schindler experts discussed extensively the merits of stem cell therapies, although neither is an expert in such research. This is why the judge found both of their opinions to be lacking in credibility.

More on this here:

Michael Schiavo is an adulterous cheating husband.

It is true that Michael Schiavo took up with another woman and had children with her while still married to Terri. Probably not the most stellar of conduct, however it is not like he could have normal relations with Terri nor could Terri bear his children. In short it wasn’t a normal relationship so his actions should not be viewed in the same light, as they would be if Terri were an aware human being. Michael very much indeed wanted to get on with his life, but he also wanted to fulfill his wife’s dying wish. It would’ve been the easy way out to abandon her to her parents (indeed her parents encouraged him to do just that), but he stuck it out till the end.

She was never given a PET or an MRI to determine the extent of her brain damage.

A high quality CAT scan and X-Rays are just as useful in diagnosing the brain condition. It was decided that these could substitute for an MRI as the added benefit from an MRI would not outweigh the unnecessary risk of invasive brain surgery necessary to remove the implants.

An Excerpt from Robert Cranford’s e-mail:

“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.”

Sarah Mele, speech pathologist, swears a nine-page affidavit that with therapy Terri could speak.

Honestly, is Sarah Mele a neurosurgeon? Did she not take into account that Terri’s cerebral cortex was clearly missing and replaced by cerebra-spinal fluid? Any neurosurgeon worth his/her salt will tell you that cognitive coherent speech without a CC is impossible.

What about Kate Adamson, she was diagnosed as PVS and made a full recovery.

Kate Adamson had a double stroke in her brainstem. Her cerebral cortex was intact (thus her ability to think). Terri’s cerebral cortex was missing. These are two different and incompatible situations.

What about the misdiagnosis Dr. Robert Cranford made about Robert Wendland and others?

Individual doctors make mistakes, but in an interview with Ragged Edge Magazine, Cranford referred to Wendland as “minimally conscious”.

Wendland never had his tube removed; he died of pneumonia after the antibiotics weren’t working.

As evidenced by communication from Cranford himself, he never diagnosed Wendland as a PVS. Indeed he never misdiagnosed any patient.

An excerpt from an e-mail detailing his actual position:

“As for the National Review Online article, I stand by my record. The record is very clear that I did not testify that Robert Wendland was in a PVS, and the same applies for the case of Michael Martin in Michigan. Both these patients were clearly not PVS”

Did Judge Greer defy the law in making his decisions in the case?

It is any US citizens’ right to refuse medical treatment or care that will unnecessarily prolong their life to their discomfort. The above statute is to protect those incapacitated from being deprived of food and water against their will. The whole point of appointing the court to act as a surrogate was to determine to the best of anyone’s ability what Terri’s wishes were. The courts decided after extensive, adversarial approach to analyzing the evidence. Essentially Florida Statute 765.102(3) trumps 744.3215 (Rights of Persons Determined to be Incapacitated that requires that incapacitated people cannot be deprived of food and water against their will).

§ 765.102(3), Florida Statutes states:

The Legislature recognizes that for some the administration of life-prolonging medical procedures may result in only a precarious and burdensome existence. In order to ensure that the rights and intentions of a person may be respected even after he or she is no longer able to participate actively in decisions concerning himself or herself, and to encourage communication among such patient, his or her family, and his or her physician, the Legislature declares that the laws of this state recognize the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures, or to designate another to make the treatment decision for him or her in the event that such person should become incapacitated and unable to personally direct his or her medical care.

Definition of a "life-prolonging procedure":

§ 765.101(10), Florida Statutes

"Life-prolonging procedure" means any medical procedure, treatment, or intervention, including artificially provided sustenance and hydration, which sustains, restores, or supplants a spontaneous vital function. The term does not include the administration of medication or performance of medical procedure, when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain."

Judge Greer’s decisions were repeatedly reviewed and upheld by the second district, with one exception, the Second District court of appeals believed that he erred in denying a motion for a new trial based on new medical evidence. The Schindler appeals never made it to the Florida Supreme Court as they supported every decision made by the Second District and therefore Judge Greer. If Judge Greer were in violation of any statute, state or federal, the higher courts would have censured him. No law applies if it runs contrary to the patient’s wishes. That is what the first trial was about, to ascertain Terri’s wishes.

In Conclusion:

I believe that the media has skewed much of what Michael Schiavo has done in a negative light, evidenced by the fact that it is much easier to find right to live material on the web than it is to find right to die material, and much easier to find material that paints an awful (and unfair) picture of Michael, Judge Greer and the doctors and lawyers that represent him. In addition I do not think a grand miscarriage of justice has taken place only people’s perception of that justice (which is heavily coloured by religious beliefs).

The courts themselves have said that Terri could not have had a more supportive husband than she had in Michael. It would’ve have been the easiest thing in the world to walk away from Terri. No one would’ve blamed him, least of all the Schindler’s. The only reason he would’ve fought so hard was he was fighting for something he believed Terri would’ve wanted.

If anyone has some specific questions (or accusations), feel free to ask in the comments or e-mail me as I’m pretty well versed in the workings of the case. I couldn’t present the entirety of my research here (because it is pretty long and involved).

Some additional links (used in my research):

General info about the case

Legal references for the case and chronology

A commentary from the other side

The Richard Pearse report (PDF)

The Wolfson Report (PDF)

Wolfson’s Comments


Lute Calder said...

The relative interest into this case comes largely in part from the huge "ethical question" it presented to humanity. The larger question that often should be asked is why all of a sudden is it this is the centre of attention for a nation? Where were they leading up to the actual events?

To put it bluntly and what our good friend Vasper has pointed out is it only grabbed our attention when the media machine took over, and out of nowhere every bureaucrat with a cause came out of the woodwork. No one took the time to review allot of the documentation or actual facts, people just like crying murder!!!

Now here's where this gets interesting....I took a firm stance when this began that I have no opinion....I stand true to that fact as the whole issue (despite the opinions of bleeding hearts) took it's toll on both sides! I could take the road of "god's will" or "this is the harsh reality of life" but instead I've chosen to play the third party role...try and forget it happened because sad but true it will happen again and no matter what it's not something that is going to have any clear answer.

andrew mason said...

Wow Stu! I don't really have a comment on this persay only that for some reason I did an essay on assited suicide some years back and found it to be perhaps something that people outside of the immediate family(of course the law does keep the family in check)should not have any strong opnions (unless they went through a similar) experince because none of us could understand what the difficuly of such a decision. Of course this is perhaps why I could not pay attention becuase of the absolutley nauseating discourse surrounding this issue in the States. Nevertheless your research and comments on this are excellent and I think shown my intial opnion to be wrong and beleive me it is refreshing to read/hear something about this in which someones opnions are rational and well-thought out. Learnt alot about this issue. Also what your friend Lute said is somewhat true in that it will happen again and it seems ridiculus that so many people feel the need to get involved, which I do not think shows any concern except for their own personal agendas. Neverthelesss, Stu, I must reinterate your comments do not fall into that catergory.

neil bliss said...

just when i thought this subject was over and done with, mr reliable stewart easton decides to beat a dead horse...(or a dead vegetable, as the case may be)

i hate to agree with you stew...sometimes i wish i could disagree but our ideas on life seem to click as it were....

on a side note cant really blame terri shaivos parents for wanting to keep her "alive"...just imagine if you had to decide to pull the plug on your child...selfish? yea...I truly believe they knew nothing could be done to "fix" their daughter but they held on to the glimmer of hope because she was still alive physically.

on a side note though...the media did turn this into a circus event...(after all, the public sure likes controversy, and it was a refreshing change to the whole Iraq thing after all.)

what CNN showed the public was the same 3 images of terry apparently reacting to her family members calling her name...(you remember, her smiling and looking when her mother called her name.)
what they didn't...(and could'nt, due to time constraints....was show the endless hours of her slobbering and staring blankly as a result of her condition.)

further more, what really pissed me off was the conservative republican the Bushes, trying to force their "superior moral views" on something that was none of thier business to begin with.

It should be up to the individual whether or not they want to live like that ( i know i wouldn't) .....

it was already proven that her brain turned into mostly water...the only way to rehabilitate her would be to give her a brain transplant...(but then she still wouldnt be the same person now would she?

well thats all i have to say for now...and stew, please write something more up to date....if this whole thing was still going on i would have pulled out her damn feeding tube to end it once and for all....

good job on researching though...and nice web log....

PS...did i mention frazier friggin guild called us tonight while we were playing poker? kind of spooky.

your pal...neil