RE: cruzan v schiavo what a difference a decade makes

I suggest a simple experiment. Allow Michael Schiavo to enter the room alone where his wife is and record with a camera her facial and other physical reactions. Allow Terri's mother to enter the room and collect the same data. I am sure we can decide Terri's fate based on the data collected by the cameras.

Moorad

________________________________

From: asa-owner@lists.calvin.edu on behalf of jack syme
Sent: Wed 3/23/2005 8:03 PM
To: asa@calvin.edu
Subject: Re: cruzan v schiavo what a difference a decade makes

"Perhaps, Jack, as a neurologist, you could offer your opinion on this?
 Obviously I'm not an expert here, and may be being manipulated by the
article. I can sort out the obvious misleading stuff ( how beautiful,
the stuff about the inner light in her face), but when that filter is
applied, what stands out to me is still a real person with emotions
etc."

I will respond first to your direct question, and then go into some
background information for those interested.

I will tell you up front my bias here is to not put much value on the things
I hear in the media and accounts like this. As far as I am concerned the
best evidence for her condition, that I have access to, is the hearing that
addressed exactly this issue. In that hearing there were 5 experts. 2
appointed by the family, 2 appointed by the husband, and 1 appointed by the
court. The 2 witnesses appointed by the husband and the 1 appointed by the
court, all agreed that she was in a PVS. This is in addition to the staff
of doctors that are caring for her. The 2 witnesses appointed by the family
that did not think she was in a PVS were thought by Judge Greer to be less
reliable, for uncertain reasons, than the other three. And his conclusion
was that she was indeed in a PVS. And this in my opinion is the best
evidence that everyone not directly involved in this case has.

From professional experience I can tell you that many families have a lot of
difficulty accepting that their loved one is in such a terrible condition as
this, which is understandable. And family members often see reflexive limb
movements, facial expressions, and eye movements as purposeful, when with
careful repeated observation there is no evidence of purposeful activity.
Statements such as the comment about her recognizing an unfamiliar voice in
the room, is obviously subjective, and is an example of what I am talking
about.

Now if you are interested I will try to explain some terminology that keeps
getting thrown about in discussions of this case, which might clear this
issue up some.

First some brain anatomy. For our purposes there are two divisions of the
brain, the neocortex, and the subcortex. The subcortex includes the
brainstem, thalamus, and connections. The neocortex is the upper portion of
the brain, and is the part of the brain responsible for thought, memory,
emotions, language, visual interaction, planning.

Now to explain the terms.

Coma: A coma is a condition of unconsciousness. And there are many causes
of coma, anoxic brain injury, stroke, trauma, drugs, medications,
infections, metabolic abnormalities. But comas are temporary, the patient
can recover, or die, or if the injury is severe enough be determined to be
brain dead, or in a persistent vegetative state.

Brain Death: This could also be called whole brain death. The meaning isnt
meant to imply that every single neuron in the brain has permanantly ceased
to function, it is to indicate that there has been irreversible loss of both
cortical and subcortical function. Because of the loss of subcortical
function the patient cannot breath on their own and needs to be on a
ventilator, and similarly there is no brain control of any body functions
including regulating the heart beat, blood pressure, etc. And even with
full support the ciruculatory system eventually collapses usually in a
matter of days. Brain death is equivalent with death in all 50 states, and
many countries.

Persistent vegetative state: It turns out that the cortical neurons,
probably because of differences in the population of certain membrane
channels that are responsible for neuronal plasticity, are more sensitive to
injury, especially anoxic injury, than subcortical neurons. So if the time
the brain was deprived of oxygen was long enough to kill the cortical
neurons, but not long enough to kill the subcortical neurons, the result is
a persistent vegetative state. In this case the subcortical functions
remain, sleep wake cycles, roving eye movements, blood pressure and pulse
regulation, spontaneous respiration, perhaps even some tracking movements.
But the cortical functions are lost with the death of cortical neurons, the
ability to speak, understand, remember, think, plan, comprehend ones self,
recognize loved ones, any of those functions that you associate with a
person, and with thinking. So a person in a PVS opens their eyes, has
reflex grimacing and smiling, wakes up, goes to sleep, breaths without a
machine. But cannot swallow, use their limbs, or interact with the
environment in any consistent or meaningful way. Some have proposed the
term neocortical death for this condition. The philosophical idea being
that the person has died. I am not advocating that idea however.

PVS, like brain death, is a modern aflliction. It is not a natural
condition, but one that results because of medical technology. And they are
perpetuated by technology. This is why I think that we have a obligation to
God, and to patients, to use these technologies responsibly. I think that
withdrawing a feeding tube from a person that is in a vegetative state can
be a reasonable, just, and responsible use of our medical technology. And
mostly I think that this decision is a private one, between the doctors and
the surrogate decision makers; and the courts, the media, the churches, the
protestors, have no business interfering with such a decision.
Received on Wed, 23 Mar 2005 21:09:02 -0500