Wednesday, March 23, 2005

Terri Schiavo: Euthanasia and Government Interference

I have a good friend in the blog world at Blonde Sagacity. Most of the time we agree on many things. This is one issue that we do not agree on. She has posted subsequent comments on allowing Terri to die as was her wish and the inappropriateness of government interference in this process.

She has been getting hate mail, but not from me. And, as my friend is an ultra-conservative who voted for Bush, this is not a "left/right" issue as she points out and it is clear this is the case as the different "left/right" folks have weighed in on the subject and it the support or lack thereof does not separate on this divide.

But, since it continues to be an issue and since Terri Schiavo had her feeding tube removed last friday and is in the process of dying today, I thought I would weigh in more than making comments at Ala's blog.

Ala's last post indicates from Miami Medical University:

Scans have shown extensive damage to Schiavo's cerebral cortex, a part of the brain essential to higher-level functions such as cognition and consciousness. An electroencephalogram, which examined patterns of her brain's electrical activity, documented virtually no normal response.


The scan image can be seen at Miami Medical University

That would seem pretty definitive as a case for "brain dead" although they do go on to say:

The part of the brain responsible for these responses - smiling, crying, chewing, moaning - is still working. But the part of the brain responsible for thinking is not," said Dr. Ghada Ahmed of the Rehabilitation Institute of Chicago. "source


So, she is persistant vegetative state, but some part of her brain still controls the basic functions. At this point, some may wonder what the argument is about. If you only read this information, you would assume that this was it, they were arguing over a vegetative woman who would never get better or be able to improve her situation.

However, as I read all the other information available, I stumbled across this med blog at Code Blue via My Vast Right Wing Conspiracy which makes these comments:

First, I contest the theory that Terri's brain actively continues to degenerate as implied by the above statement. How could they gage serial brain degeneration without serial follow-up? And by what mechanism would her brain CONTINUE to atrophy? Second, Terri's cerebral cortex has not been replaced by fluid. That is inaccurate. The cortex is thinned and the sulci are enlarged. There is a difference.

Third, and most importantly, given the amount of atrophy on this image I disagree with the court's inadequately considered conclusion.


Then they got me thinking about something I also know:

I HAVE SEEN MANY WALKING, TALKING, FAIRLY COHERENT PEOPLE WITH WORSE CEREBRAL/CORTICAL ATROPHY. THEREFORE, THIS IS IN NO WAY PRIMA FACIE EVIDENCE THAT TERRI SCHIAVO'S MENTAL ABILITIES OR/OR CAPABILITIES ARE COMPLETELY ERADICATED. I CANNOT BELIEVE SUCH TESTIMONY HAS BEEN GIVEN ON THE BASIS OF THIS SCAN.


Then they ask the burning question:

Now...why was Terri being shunted in 1996?


Make sure you go over and read the answer, it may surprise you what you really don't know about medical conditions.

Continuing on to things that got me thinking:

IF Terri had hydrocephalus in 1996, she may still have hydrocephalus now; some patients with hydrocephalus respond to shunting with increased mental functioning!


Why was Terri's shunt taken out or no longer in use if she is showing continued hydrocephalus? The reason I picked up on this is because I have to personal interactions with patients suffering from hydrocehpelus.

First, my youngest nephew has hydrocephalus and his shunt drains into his stomach. His shunt became infected and they had to take it out. Shortly after that while waiting for the infection to clear up and a new shunt to be put in place, the hydrocephalus became worse and caused him to have seizures. These seizures caused him to have strictures in his left arm and leg, just like Terri Schiavo. He has had to have serious physical therapy to overcome these problems. It also affected other motor skills like his speech, swallowing, general coordination and balancing. Once the shunt was put back in place, his condition improved immensely. The strictures did not go away completely, but he was able to learn to walk and use his hands and his speech and swallowing was greatly improved.

So, what Code Blue is indicating could be correct. While there maybe atrophy, complete loss of cognitive functioning, not just physical responses, may still be had.

My second incident actually involves my great uncle who has been diagnosed with Parkinsons for sometime. He was exhibiting serious loss of motor skills, cognitive deterioration, speech impairment, loss of balance, he shook all the time. These are all things that typically point to Parkinson's disease. Just last month he had a change in physicians at the nursing home he was staying in and the doctor took a PET scan and CAT scan. Guess what? Hydrocephalus. They immediately shunted him relieving the pressure from his brain and he immediately showed a huge leap forward in cognitive reasoning and motor skills. Unfortunately, he is 76 so his condition is still a concern, but, the point is, there may be other issues at play for Terri Schiavo and I am wondering, along with Code Blue, how this is being passed off as "jello for a brain" or a "bag of water" in her head?

This information along with the emotional and physical responses that Terri's able to give does leave me with many questions about why somebody who was not dying before Friday is suddenly a candidate for Euthanasia.

And, that is what this is about.

Normally, I would be all over the government for making any such law that interferes in the patient's right to determine their own healthcare. And make no mistake about it, if this law is passed, it will be sited from here to eternity in every case where a family member, spouse or other representative contests the withdrawal of treatment on a patient. This could be big time law suits in the medical field for malpractice or dereliction of duty. I don't like it one bit as we have gone to great links to allow patients and their family to be the decision makers on whether to take care to the extreme extent on a dying or brain dead patient who still has heart, lung and other internal organs functioning, but for all intents and purposes have no brain activity.

I still stand by that law that allows patients and their families to make those decisions.

Some might wonder then why I don't support it for the case of Terri Schiavo. Mainly because there was no living will. Living will's were not all the rage in 1990 to be sure, but there is also little collaborating information or witnesses from what I've seen that indicated "she would not want to live like that". Secondly, if you have seen pictures of Terri Schiavo then you will have noted that, at the base of her throat, she has an indention that is indicative of a healed over tracheostomy or hole placed in her airway to help her breath.

At some point, Terri Schiavo was intubated. It may have been at the very beginning when she was first brought to the hospital for care after her "incident". Usually though, you are only intubated for two reasons:

1) Your airway is blocked
2) You are not breathing on your own and they want to put you on a ventilator that will mechanicall breath for you.

If Terri Schiavo was intubated, at what time did this occur? During the first incident and subsequent emergency room visit? Was her airway blocked or was she not breathing on her own?

If her air way was blocked, from what was it blocked? If this was a stroke brought on by bulemia, there would be no blockage. The intubation would have been for mechanical breathing for Terri since she couldn't do it herself. However, if, according to the bone scan, she had skull fractures and extensive injury to the brain area and cortex, she may have been bleeding profusely into her mouth and nose and required intubation to by pass the blockage caused by the bleeding.

Why is this important?

First, if there was such a thing as a directive which she told her husband she would not want to live under certain conditions, the time to have made those decisions would have been shortly after her admittance to the hospital or within a few days or weeks even. At which time, the vent could have been removed and Terri would have died of asphyxiation over fifteen years ago, quietly without anyone questioning what was going on. Her family probably would have even accepted it.

Why did it take Michael Schiavo ten years and a "right to die" lawyer to make that decision?

Secondaly, if it was because of "blockage" due to blood or other trauma, how severe and how did this trauma occur? She fell and hit her head? The damage shown by the bone scan and the subsequent bleed out either into the brain or out of orifices like nose and mouth requireing intubation would have to be some severe damage. None of which is likely to be caused by simply dropping where you stand and hitting your head on the floor. There is not enough force/trauma involved in such an event to cause that type of action.

The other reason I question this, aside from why it took Michael Schiavo to remember she wouldn't have wanted to live like this, is that the decisions to put her in a non-rehabilitation mode and reduce care to sustenance come AFTER large medical malpractice suits were awarded and AFTER Michael Schiavo started his new life with a new person.

I don't begrudge him that except to say that he should have divorced Terri Schiavo and went on with his life, but it seems there was a lot of money involved. Whether the problem was that he wanted it for himself, didn't want to account for where it all went to or thought that her parents were after the money, it doesn't really matter. The point is, Michael Schiavo should not have been, after all this and all this time, however, "legally" bound he may still be to Terri Schiavo, her recognized guardian.

Another issue here is that she was not dying before Friday when they removed her tube. Since she was not dying, whatever her condition, taking her feeding tube from her and causing her to die is euthanasia. I have a serious problem with euthanasia because it implies killing the weakest and most vulnerable amongst us in order to avoid spending money on their care, to relieve the physical and mental pressure of care from a caregiver or simply ridding ourselves of ubermenshen or "undesirables".

That is something that I am against whether that is a societal norm or government imposed.

It is quite another issue if a patient writes down, video tapes or otherwise clearly indicates what treatments they want or do not want to have under what conditions.

One of the commenters at Ala's on a previous post on the subject made the comment:

WOULD YOU WANT TO LIVE LIKE THIS?


My answer is that I want to live as much as possible. I don't know what it would be like to live trapped in your mind unable to communicate with people yet knowing things were going on around me. And, if I was in the actual condition that they say Terri Schaivo is in, I probably wouldn't know or care. So the point of the issue is not whether anyone would want to live like that so much as what position it leaves the family in. Most people who make decisions about "not living like this" are not talking about terminally ill patients who will eventually die, but patients like Terri whose long term care could be financially, emotionally and physically draining on the family or their other loved ones. That is why people make decisions about "not living" like Terri Schiavo. Not because they are dying or brain dead, but because of concerns outside of their medical care.

This is where I start having problems with these decisions and where I start seeing it as "euthanasia" instead of "right to decide on care".

That's also why Michael Schiavo has a "right to die" attorney who would defend Jack Kevorkian in a heartbeat. These folks actually believe that people like Christopher Reed or even less, someone who was simply wheelchair bound with MS, certainly a progressive disease that will one day prove fatal to the patient, but doesn't imply immediately terminally ill, should have the right to decide to terminate themselves (ie, suicide) rather than be a burden or deal with their worsening condition.

Frankly, to the person that asked whether anyone would want to live like that, like Christopher Reed or Terri Schiavo, my answer is unequivocally "YES!" I would want to live however and as long as I could because that is what I am here for. I am here to live and not to die. Dying is the end state.

We don't know what Terri would want and if she were capable of telling the doctor to remove her feeding tube, I would stand by her decision 100%. But she's not and the person that is making those decisions for her, with the assistance of the court, is not an appropriate guardian. He hasn't been for years.

The courts continue to rule in his favor because they are afraid of setting a precedent where the immediate line of recognized care givers/authorized representative is breached and there could be hundreds if not thousands of law suits or doctors who simply will do nothing or do everything to care for the patient in order to avoid this quagmire. I understand that completely, but I do not understand how Michael Schiavo's extra curricular life does not preclude him from that line of decision making.

I understand that there is differing opinions on Terri's condition. Whichever you believe in regards to her brain condition, the most important point was that she was not "dying" before Friday, March 18 and she was not "dead" fifteen years ago as Michael Schiavo implies so much as suffered brain damage.

I don't like the government interference in family/patient decision making since it will open up a whole new can of worms, but I would rather err on the side of caution for this one woman and put the question in jeopardy for all the future ones than to have one woman die because we fear action against this new wave of Euthanasia in this country will bleed over into normal patient/physician decision making process.

Last, I will say as I have said in many posts on this subject. If you don't already, get a living will and spell it out. Then, if you are like the commenter at Ala's who said, "Would you want to live like that?" you can make sure that you don't and that it is in writing, signed by you and notarized so no one can change that decision.

PS...I'm pretty sick of hearing opinion journalist and other so called experts say that dying by starvation and thirst is painless because the patient will lapse into coma before the real deterioration and shut down of the internal organs begins. I'd like to recommend that anyone repeating this fallacy try to go without food and water for a day much less five as has been the case for Terri Schiavo and then tell me how you felt about it. Make it two or three days at least.

PSS...there is no proof that she had bulemia or that it was the cause of her stroke. It was never diagnosed nor placed on an official medical document anywhere. Those are conjectures and rumors.

10 comments:

Donal said...

Kat the jury in the medical malpractice suit found that bulemia was the cause of her heart attack and the doctors were liable for not catching that. Also I think there is some confusion over a shunt being in place- my understanding is that an experimental treatment involving devices implanted in her brain was tried. In fact that is why they cannot do an MRI because the devices would have to be removed.

Kat said...

Now I can finally comment here. Just to be clear, the malpractice suit was not because the doctor misdiagnosed bulemia. The malpractice suit #1 was because they mis read or did not order a lab to check for low potassium which allegedly led to her stroke. The doctor's did not do it because she was too young and they were looking for other causes of her collapse. Because of this low potassium, there has been rumor and conjecture that it was caused by bulemia. At know time did the suit find that the doctor misdiagnosed bulemia.

By the way, you can have low potassium from not eating for a day. It doesn't have to be from bulemia. You can have low potassium from going running or walking in the sun for long hours. You can have low potassiumm for staying in the sauna too long. You can have low potassium by simply not eating enough food with potassium in it. You can naturally not produce enough potassium.

So again, there is no diagnosis of bulemia on any official documentation.

You are correct in saying that she was receiving experimental shock treatment. However, her medical records that have been released clearly indicate a shunt being put in place in 1993 to relieve pressure from hydrocephalus. The problem is that sometime after 1996 all such therapies and treatments have been stopped. Basically in the hopes that she would die from "natural" untreated causes.

Donal said...

Ok I didnt see that her medical records said that, I just saw speculation. True low potasium can be caused by many different factors it is true however that there are no facts behind the rumors that she ended up the way she is by a delibrate act of her husband.

Kat said...

You are right. AT this time, there is no proof. actually, proof would have had to come at the time of the incident. In which case, that is the whole problem with the bone scan that was never reviewed properly. The fractures in the skull were much more than falling from standing in the kitchen.

However, that is the purpose of the DCFS investigation and I would have liked that to go forward. Then all allegations are off the table.

Frankly, I realize that these are difficult decisions. I had to make them myself, but at least my relative was actually dying and not just brain damaged on a feeding tube. I am also thankful I had long discussions with them before hand and a written document to guide me.

I suppose in a very reall sense, what bugs me the most is that she is, for all intents and purposes alive. She sleeps, opens her eyes, all the things that you expect of some sort of sentient being. It is not like a coma patient lying there never opening their eyes or moving having a ventilator breath for them.

Secondly, and I keep saying it, what bothers me is that it took years and years for this guy to finally say Terri would have wanted to die in this condition. If that were so, why didn't he have the plug pulled a long time ago?

Those questions bother me.

I understand the processes that the legal folks have gone through. The processes are complete, however, I still don't understand how a court could render this guy her guardian because he legally stayed married to her, but physically and emotionally he was already someplace else.

It seems wrong, even if the legal steps are right. I don't know how else to explain it.

And,maybe I'm working from emotion here. I completely believe that people should have the right to make decisions about the care of themselves or thier loved ones including discontinuing medical services, which is what tube feedings are.

It is only in this one case that I find it problematic because the legal steps do not seem to match with the moral ones and I don't mean religiously. I mean philosophically and down in my gut that there is something wrong here.

Tell me I'm crazy.

Anonymous said...

It is BulIMIA. Learn to spell. Your argument is emotional, not logic based, and I am sure someone with a Ph.D. in Neurolog knows just a wee bit more than you do about the subject. She is not THERE anymore. Her body is. Her parents are selfish and your damn country lets this dominate the news while people suffer and die in Iraq over your stupid war, but hence, no news about that this month. How fucking convenient. BULIMIA. And yes she had an ED history.

Kat said...

Anony mouse

First, I note you say "your damn country". I take it you're not from around here?

Secondly, ARe you a neurologist? It's a PhD in neurologY while we're on about spelling.

Where do you get this information about a history of eating disorder? Something you heard or read in the opinion articles? Rumor and conjecture as I point out to Donal. There is no official diagnosis on any medical chart (at least, none currently available to the public).

Third, how do we go from Terri Schiavo to the Iraq war? Those are two different subjects. Why is it people like you are always trying to lump everything together?

I say peanut butter and jelly, you say Iraq war.

Come back and post when I comment about the Iraq war or should I say the Iraq mop up operations.

Tom said...

"Anonymous" is a gd coward and troll. Bastard.

Althought I have of course followed this, I gotten into the the medical or legal details of this case because it just isn't me.

Peggy Noonan and Tom Sowell essentially said the same thing in different columns the other day; what is it about this group who seem to want Terri dead?

My take exactly.

However you come down on the case (and I say keep her alive), common decency says you should understand why people want to keep her alive. What I cannot understand are those who - like your troll - are so absolutely hateful. And this hateful group includes prominent Democrats like Reid and Carville.

I hear lots of contradicting things about Terri and frankly don't know what to make of it all. But what really scares me is the desire of some people to discard those who have become inconvenient. Brave New World, here we come?

Naw, you're not crazy, Kat, just a good hearted person trying to work through an awefully difficult issue. A

Norma said...

I think I've met Anony Mouse--or his clone/twin--on Usenet. Brit. Anti-Bush. Anti-Christian. Loves the F word. And a nut about spelling. But he does have a child. Wonder what he'd do if he were in the Schindlers' shoes?

Kat said...

I wonder what I would do if I was in the Schindlers shoes? I mean, if it was my child?

I wonder if I would be convinced they were still there and needed me or if I would be convinced that it was time to let them go?

This just makes you sick at heart because you can't imagine not being the person to make that decision when you birthed and raised that person.

Heraldblog said...

Why didn't the plaintiffs in the malpractice suit raise the issue of spousal abuse? And why did 7 out of 8 court appointed neurologists in 2002 diagnose PVS, and even raise the likelihood Terri had gotten worse, not better, over the years?

Finally, Michael Schiavo did not make the decision to discontinue life-prolonging measures for his wife. By 1998, - eight years after Terri's heart attack - Michael and Terri's parents disagreed over the proper course for her.

Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate can petition a court to act as the ward's surrogate and determine what the ward would decide to do.

Hope all this helps.

Heraldblog