Thursday, March 31, 2005

RIP Terri Schiavo: The Sad Truth of Denial

The news of Terri Schiavo's death was not unexpected, but I nonetheless personally reacted to it with a hint of sadness. My feeling that she's in a better place, is seemingly similar to most people's reactions. However, there is a distinct difference between the two sides -- one which favors allowing Ms. Schiavo's wishes to be respected and honored -- and the other, which favors keeping her "alive" despite her wishes. Further, despite the fact that most thinking people concur with and respect her wishes and believe she would indeed want to be allowed to die, under the circumstances which have defined the last 14 years of her life, the volume and the urgency and the extremism which can be attributed to those who deemed her destiny theirs to control is quite interesting.

As I've touched on herein on several occasions, it amazes me that there are those so fervently against this nation's policy toward abortion that they are willing to kill doctors who perform abortions. This mentality -- of "doing right" no matter what the cost, or what common sense would dictate -- extended to the Terri Schiavo situation. Despite several doctors confirming Ms. Schiavo's cerebral cortex was gone -- virtually wiped out by the heart failure which occurred 14 years ago -- and that she had no hope for recovery, there remained -- and remains -- a minority of people who suspect conspiracy. Conspiracy by the doctors who apparently conspired to kill their daughter; conspiracy by the variety of judges who have heard various arguments connected to this situation to support Judge Greer, who ordered Ms. Schiavo's feeding tube removed on March 18th; and conspiracy by the media to bury all the truths that have been otherwise ignored in favor of a mass scale to assist Michael Schiavo in killing his wife.

In the minds of people supporting or concurring with the above-rendered "facts," these represent part or all of the truth surrounding Ms. Schiavo's "struggle to stay alive."

These are very interesting theories, they're very creative, and they are certainly thorough. Unfortunately, of course, they're all bullshit. But that hasn't stopped an entire segment of the Christian Right from extruding it like manure all over the place, infecting whomever is stupid enough to believe it.

At some point yesterday, my girlfriend and I were discussing the news of Douglas Smith, Jr., the former Boy Scout official who was indicted for sharing and possessing child pornography, when I mentioned to her that he had plead guilty to the lone charge set forth against him. "When was the last time you heard of someone pleading guilty to something like that?" she replied. And it occurred to me that I didn't remember the last time a high-profile case was cut short due to a guilty plea. Denial, it seems, whether it is OJ Simpson or a petty theft, is the word of the day.

Within that context, I was perusing the results of a search engine this morning and came across another blog which has addressed the Terri Schiavo situation, http://www.blogsforterri.com/. I clicked over to the "facts" page here and was impressed with both the creativity and the conviction the author conveyed. As I worked my way through it, however, I was amazed at how inaccurate the uncredited writer is. The below is a partial list of "facts" from the aforelinked page; my comments are in italics.



***

A few facts about Terri

For those of you who have not been keeping up with Terri's plight, here are some facts about Terri that you should know: · Terri Schiavo is not a “vegetable,” she is not “brain dead,” and she is not in a persistent vegetative state. She recognizes and responds to others and makes attempts to verbally communicate. Videos and the truth about her condition is available at www.BlogsforTerri.com and www.terrisfight.org.

Unfortunately, this is not "fact," it's fiction. Ms. Schiavo is in a persistent vegetative state, according to the court-appointed doctor who examined her together with her records. Her records include a variety of MRI's of her brain which shows her cerebral cortex is no longer present; it doesn't receive blood, and it has been replaced by spinal fluid. The cerebral cortex is the part of the brain which permits thought, reason and communication. It also enables the brain to interpret pain, pleasure and other sensory input received from cells all over the body. Since Ms. Schiavo's cerebral cortex is non-existent, she was, prior to her death, unable to experience any of these things. Doctors described her particular condition as a persistent vegetative state, because not only was she unable to experience these things, communicate in any meaningful way, or experience life as a human being, but because brain tissue does not regenerate, she had no hope of improvement.

· Terri is not on life support but does receive food and water through a removable tube, which experts testify would not even be necessary if she were given therapy. This assisted feeding is a natural means of preserving life and not a medical act of life support or heroic measures.

Partial fact, partial fiction. She was not on life support other than sustenance via a feeding tube; however, there was one "expert" who testified that therapy might have been sufficient in replacing the tube. That doctor, Dr. William Cheshire, suggested that Ms. Schiavo was not in a persistent vegetative state and that she could improve with therapy.

Dr. Cheshire, however, as I wrote in a prior entry, is the director of biotech ethics at the Center for Bioethics and Human Dignity, a group founded in 1994 to recognize the contribution of 'biblical values' to the bioethical debate. Judge George Greer discounted Dr. Cheshire's testimony in part due to his heavily-biased credentials and in part because all medical science demonstrated that, without a cerebral cortex, therapy and time would not improve Ms. Schiavo's condition. Further, there was discrepancy based on her failure to complete a "swallow" test -- which test determines if the incapacitated patient can ingest liquids and/or solid food. If said patient cannot do either, a feeding tube is necessary.

Incidentally, Ms. Schiavo never successfully completed a swallow test.

· Twelve medical experts and nurses who cared for her confirmed these facts. Video available through BlogsforTerri.com shows Terri responding and interacting with others. Health care workers have testified under oath that she expresses herself using words, such as “mommy” and “help me”. This evidence was not allowed in court by Judge Greer.

More fiction. Twelve "medical experts" did not verify any of the above. If they had, they would have been listed in any number of court cases during which Michael Schiavo and Ms. Schiavo's parents, Bob and Mary Schindler, clashed.

The video listed above doesn't show her "saying" anything; it shows her making sounds that can be interpreted in any number of ways. For example, one of the sounds she made was "uh" -- some people can interpret that as her indicating pain; others could interpret that as her jokingly referring to someone in her hospital room as ugly; and others, adhering to the fact that Ms. Schiavo, without a cerebral cortex, would be unable to form words, attributed this and other sounds as her body simply reacting physioglogically and without any predetermined or premeditated thought.

Further, the one videotape that Judge Greer viewed was edited, and that showed Ms. Schiavo reacting to her father waving a Mickey Mouse balloon and showed Ms. Schiavo smiling at her mother as she rubbed her shoulders; after Judge Greer requested and viewed the unedited tapes, however, he confirmed that Ms. Schiavo was unable to follow stimuli; she would smile, as she did in the edited tape at her mother, for no apparent reason and without anyone present in the room. She had the same blank look on her face whether her father was waving a balloon, her mother was rubbing her shoulders, or a nurse was changing her bedpan. In short, any and all reactions were actually physiological actions devoid of thought or cognitive reason.

· Terri is a person with disabilities who thinks and expresses her moods and desires. She is loved by her family and responds to their visits with smiles and laughter.

Fiction, except (presumably) the part about her family's love. By the time Ms. Schiavo's feeding tube was ordered to be removed by Judge Greer on March 18th, she had no cerebral cortex. She was, unfortunately, therefore, incapable of expressing moods, desires, love or responses. She was able to "laugh" but in essence there was no cognitive thought behind said laughter. In effect, by March 18th, she had less cognitive brain function than most pet dogs.

· Terri Schiavo may be the victim of ongoing negligence and injustice. She has been denied therapy and rehabilitation by her guardian since 1991. Florida’s guardianship laws REQUIRE that these necessary services be given to her.

Another vote for fiction. She was not only given proper care, her supervision was mandated to Michael, her husband, by a court of law, and five different courts (and at least a dozen judges) supervised her treatment as recommended not by a doctor hired by Michael but appointed by the court. Florida's guardianship laws require that necessary services be provided to people who require them. Each court reviewed Michael's care and supervision of Ms. Schiavo and none found any instance of wrongdoing whatsoever.

According to the Second District's initial opinion in connection with Ms. Schiavo's situation, this was part of their decision:
Theresa has been blessed with loving parents and a loving husband. Many patients in this condition would have been abandoned by friends and family within the first year. Michael has continued to care for her and to visit her all these years. He has never divorced her. He has become a professional respiratory therapist and works in a nearby hospital. As a guardian, he has always attempted to provide optimum treatment for his wife. He has been a diligent watch guard of Theresa's care, never hesitating to annoy the nursing staff in order to assure that she receives the proper treatment.
· In 1992, Terri’s husband Michael won $1.7 million in negligence lawsuit under the pretext of funding her rehabilitation and care. He testified, “I believe in the vows that I took with my wife. Through sickness, in health, for richer or poorer. I married my wife because I love her and I want to spend the rest of my life with her. I'm going to do that.” Since that time, Terri has received no rehabilitation, all beneficial forms of stimulation (e.g. music) have been prohibited and basic health care, such as treatment for a life threatening urinary tract infection, has been purposefully withheld at Michael’s direction.

More fiction. Firstly, Michael offered to share or relinquish that money to her family provided they acknowledged her interest in not being kept alive indefinitely. They refused. Secondly, she received rehabilitation, stimulation, and both basic and sophisticated health care throughout the last 14 years. Finally, to suggest that 30 or more separate court decisions have been offered without continuing medical testing is so ludicrous that it doesn't merit response.

· Even though Terri’s husband has started a family of his own with another woman and their two children, he refuses to end his marriage to Terri or relinquish her care to her immediate family.

This is true in that a) Michael Schiavo has has two children with another woman; and b) he refused to end his marriage to Ms. Schiavo. However, he was appointed her legal guardian by the State of Florida, and the Schindlers begged him to relinquish this position after he petitioned the court to see whether Ms. Schiavo's feeding tube should be disconnected. He didn't petition the court to have the tube removed, but merely to investigate whether, based on Ms. Schiavo's wishes, it should be removed, and he waited, incidentally, to even consider the subject until after the Second Court issued the following decision:



Over the span of this last decade, Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Theresa will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs.
· Terri’s “collapse” has become controversial after a previously unavailable bone scan surfaced in 2002 which revealed multiple fractures consistent with a traumatic event. To date, no investigation has been conducted to determine the source of Terri’s injuries, but a radiologist gave a sworn statement that the date of those injuries would fall within the period of her mysterious collapse.

Truth. According to www.abstractappeal.com, a bone scan was taken in 1991 and that the doctor who read it saw on it evidence of past trauma at various places on Terri's body. Some consider that evidence of a severe beating by her husband, others consider it evidence consistent with bulimia, a fall, and CPR by paramedics. Whether trauma really happened, or what kind, or when, are all unclear.The bone scan was not raised in the original trial regarding Terri's wishes. The issue was raised by the Schindlers in a November 2002 emergency motion. Judge Greer rejected the matter as being irrelevant to the issue of Terri's wishes.

· Remarkably, The Florida Courts have sided with Michael, accepting the testimony of two “expert witnesses”, one of whom is a known advocate of “mercy killing”, over that of twelve independent medical professionals (6 of them neurologists).

Fiction. The testimony provided by the Schindler family was based in large part on the examination-by-proxy performed by Dr. William Cheshire, (the director of biotech ethics at the Center for Bioethics and Human Dignity, a group founded in 1994 to recognize the contribution of 'biblical values' to the bioethical debate). The Court-appointed physician simply was asked to determine whether Ms. Schiavo’s condition was permanent and what the then-current status of her brain injuries were. Once it was established that her cerebral cortex was irreparably damaged by the court-appointed physician (verified by MRI tests), there was no need to revisit the issue provided by any number of medical personnel hired by the Schindler family.

· Without intervention by the Florida Governor and Legislature, Judge George Greer is set to give Michael the legal empowerment to withhold food and water from his wife for the purpose of starving her to death.

Fiction. Judge Greer never ceded to Michael that power. Michael sought a hearing to determine whether Ms. Schiavo’s feeding tube should be removed. He did not request her feeding tube be removed. Greer himself deemed Ms. Schiavo’s medical situation to be hopeless; he similarly agreed that her wish was to be allowed to die if she indeed became permanently incapacitated. Finally, it was Judge Greer who gave the order to have her feeding tube removed.

· Terri Schiavo deserves to have medical tests and therapy. She does not deserve to be starved and dehydrated to death.

Fiction in part. Certainly, Ms. Schiavo, like any human being, deserved proper medical attention. The fiction is the suggestion that she did not receive it.

Over the course of the past 14 years, Ms. Schiavo was examined by over 20 different doctors and had a cavalcade of tests. No human being deserves to be starved and dehydrated to death. However, in the place of the administration of a drug that would almost instantly allow Ms. Schiavo’s body to die, the only other option, legally and politically, was the removal of Ms. Schiavo’s feeding tube.

It should be made clear that a human being without a functioning cerebral cortex cannot process pain, sensation or stimuli. To wit, Ms. Schiavo was unable to feel a pin-prick on her skin, a hand on her shoulder or a tap on her knee. And despite her body’s ability to react physiologically to stimuli (eg a tap on the knee to test for reflexes), her mind was not able to feel the stimulus or control the movement of her knee. In fact, her mind was not able to sense the presence of the doctor examining her, the instrument used to test her reflexes, or the light in the room.

In layman's terms, her body was “alive” but her mind was not.

· Advancements in the understanding of brain activity and misdiagnosis and the recent recovery of a patient after 20 years in a persistent vegetative state, further calls into question any decision that would end the life of Terri Schiavo. Terri deserves to be cared for and loved by her family. She laughs and cries, she has a need for human companionship, she feels emotional and physical pain, she loves music, and she hates her dad's mustache when he kisses her (she makes a face). Her body isn't perfect, but her heart is. Why does Michael Schiavo, Judge George Greer, and George Felos want her dead?

Fiction. Lots and Lots of it.

The advancements in the study of the brain have certainly made progress since Ms. Schiavo’s heart failure, but what this progress has done was confirm, over the past 14 years, that her cerebral cortex had been irreparably damaged and its condition worsened over this period of time. And medical science has not yet found a way to regenerate brain tissue. Had that technology been discovered and successfully implemented, Ms. Schiavo might be alive today.

Unfortunately, the state of medical science was not able to “fix” or replace her cerebral cortex and until medical science finds a way to do this, someone without a functioning cerebral cortex will exist in a vegetative state.

As for laughing and crying, Ms. Schiavo uttered sounds which resembled laughter, but she did so involuntarily. She could not “cry;” one or both of her eyes, on occasion, would become watery, but it was her body’s way of expelling dust or other pollutants from the eye. Most humans, in their lifetime, will get a grain of sand, dust or even an errant eyelash on their eyeball; even if they are extremely happy at that moment, one of their eyes will water (or tear) in order to assist in removing the pollutant. It’s an involuntary, physiological response to environment, not a conscious, emotional reaction to a life event.

As for her need for human companionship, the review of unedited video showed she was unable to even acknowledge the presence of one or more people in her room at the hospice. Her “reactions” to same were identical, in fact, to instances where there were no people in her room at all.

Because her cerebral cortex is gone and non-functioning, the supposition that she could feel physical and emotional pain is patently false. It’s physiologically impossible for someone without a cerebral cortex to feel or sense anything.

As far as her hating her father’s mustache, prior to her heart failure, that is certainly a possibility. However, once she lost the ability to reason cognitively, it’s likely that her father’s mustache simply “tickled” her facial muscles and said muscles “reacted” by contorting. It would be the same reaction if someone ran their fingers repeatedly on the sole of another (ticklish) human’s foot. The person being tickled has no control over their reaction to the stimulus; but it doesn’t imply a conscious, cognitive reaction to the stimulus; rather, it’s purely physiological.

Finally, none of the people – Judge Greer, Michael Schiavo, nor George Felos – wanted Ms. Schiavo dead. Neither did the Second District Court, nor the Appellate Court, nor the US Supreme Court, nor Jeb Bush, nor the hospice, nor the members of the Florida Senate, nor the members of the Florida House, nor the members of the US Congress, nor the President himself, want Ms. Schiavo to die. However, all of these entities concurred that Ms. Schiavo’s wish to not be kept alive artificially, despite the beliefs and/or the ignorance of a group of people, were irrelevant.




***

While Ms. Schiavo’s death this morning was greeted with sadness and disappointment, many among us agree that it was her desire to not be kept alive artificially should she become incapacitated without hope for improvement. And many more among us feel similarly with regard to our own lives.

While Bob & Mary Schindler are allowed their own beliefs, as is every US citizen, it is unfortunate that they disregarded their daughter’s own wishes, distorted the facts, stole what little dignity she had left, and made a spectacle of the end of her life.

It amazes me that, of the extremely vocal minority who opposed her being allowed to die with dignity, so many thereof are armed with falsehoods, fiction and belief in the place of truths. The lone essential fact that Ms. Schiavo had no cognitive brain function, as a result of the irreparable damage to her cerebral cortex, made it impossible for her to function as a human being on a meaningful mental level, precluded her improvement no matter what therapy known to medical science was implemented, and made irrelevant any and all opinions about her life that were not hers.

Finally, I originally intended to cease addressing Ms. Schiavo herein once she passed away; and I will honor that, in order not only to be bound by my own decision but out of respect to her dignity. However, I anticipate that tomorrow, and the days thereafter, will be filled with more fiction in connection with this matter; if the author(s) of the listed material feel comfort in blatantly misrepresenting and/or corrupting the truth, I am sure that they are not alone. However, I would encourage any and all people interested in this topic to visit http://www.abstractappeal.com/ for unbiased, succinct review of the facts surrounding Ms. Schiavo’s life and death.

Further, I would hope that, in the face of clearly differing opinions, the reader will make his or her own decisions about the veracity of facts, opinions and concepts put forth here and every- and anywhere he or she travels. Blatantly obeying faith, half-truth and misrepresentation is why this “controversy” became so out-of-hand. In the words of Rush lyricist Neil Peart, in the song “Hemispheres,” I subscribe to the following, and I encourage all to do the same.

We can walk our road together
If our goals are all the same
We can run alone and free
If we pursue a different aim

Let the truth of love be lighted
Let the love of truth shine clear
Sensibility
Armed with sense and liberty
With the heart and mind united in a single
Perfect
Sphere

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