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Miscellaneous thoughts and ramblings
Sunday, March 20, 2005
Starving for a Fair Diagnosis
Rev. Robert Johansen on Terri Schiavo on National Review Online

I've provided quite a few excerpts here. I urge you to read the entire article however. (nod to Galley Slaves)


Last week, Pinellas County Circuit Court judge George Greer issued a steady stream of rulings denying almost every motion the Schindlers raised. He denied some of them summarily, without hearing arguments or evidence. Among the motions Judge Greer denied was a request for new testing and examination of Terri by independent and qualified specialists. David Gibbs, attorney for the Schindlers, submitted 33 affidavits from doctors and other medical professionals contending that Terri’s condition should be reevaluated. About 15 of these affidavits are from board-certified neurologists. Some of these doctors also say that Terri could benefit from therapy. Judge Greer was unmoved.


I have spent the past ten days recruiting and interviewing neurologists who are willing to come forward and offer affidavits or declarations concerning new testing and examinations for Terri. In addition to the 15 neurologists’ affidavits Gibbs had in time to present in court, I have commitments from over 30 others who are willing to testify that Terri should have new and additional testing, and new examinations by unbiased neurologists. Almost 50 neurologists all say the same thing: Terri should be reevaluated, Terri should be reexamined, and there are grave doubts as to the accuracy of Terri’s diagnosis of PVS. All of these neurologists are board-certified; a number of them are fellows of the prestigious American Academy of Neurology; several are professors of neurology at major medical schools.


But before that, one needs to know a little about Cranford’s (the doctor whose testimony has served as the backbone for Michael Schiavo's case) background and perspective: Dr. Ronald Cranford is one of the most outspoken advocates of the “right to die” movement and of physician-assisted suicide in the U.S. today.

In published articles, including a 1997 op-ed in the Minneapolis–St. Paul Star Tribune, he has advocated the starvation of Alzheimer’s patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights.


So, did Dr. Cranford, or any of the doctors testifying for Michael Schiavo, spend months evaluating Terri? No. To be fair, none of the doctors appearing for the Schindlers spent months with Terri either. But it is hardly coincidental that the doctors who spent the most time with Terri came to the conclusion that she is not PVS. The doctors brought in by the Schindlers spent approximately 14 hours examining Terri over more than two weeks; their conclusion was that Terri is not PVS, and that she may benefit from therapy.

In marked contrast, Dr. Cranford examined Terri on one occasion, for approximately 45 minutes. Another doctor for Michael Schiavo, Dr. Peter Bambikidis of the Cleveland Clinic Foundation in Ohio, examined Terri for about half an hour. When Dr. Bell learned of the cursory nature of these exams, he said: “You can’t do this. To make a diagnosis of PVS based on one examination is fallacious.”


Given the difficulty of diagnosing PVS, the high rate of error, the obvious bias of the doctor whose judgment forms the basis of the judge’s ruling that Terri is PVS, and the growing outcry from the neurological community, how is it that Judge Greer’s ruling has been sustained? The answer is that in our legal system, once a judge has ruled on a matter of fact, it is very difficult to revisit such a ruling. The lawyers’ rule of thumb is that trial courts hear and rule on questions of fact, and appellate courts rule on questions of law; it’s unusual for an appellate court to overturn a lower court’s ruling because of an issue of fact.

We've had a lively discussion of the Terri Schiavo case here. I think the issues are these:

Specific to Terri Schiavo

--What is her true medical state?
--What were her actual wishes?
--How have ulterior motives played a role in Michael Schiavo's decision making regarding his wife's condition?

More generally

--Which types of care should be considered obligatory and which should be considered optional? (The difference between someone who can chew and swallow versus someone whose nourishment must come via a tube)

--Who should have legal authority to make decisions for a person, when her actual wishes aren't known, and how can we be reasonably sure that the person entrusted with making life and death decisions is acting on behalf of the patient and not in his own selfish interest?

--What is the morality of denying somebody food and water, when it is easily able to be provided? For purposes of discussion, I think we can remove the physical suffering debate here, as I don't think that the pain, or lack thereof really has a bearing on the morality/ethics/cruelty/humanity of the action.

So, generally, the fundamental question I keep returning to: Is it okay to starve someone to death based on secondhand information about her wishes from a person who may or may not be acting in her behalf? The answer I keep coming up with is no. More specifically, with respect to Terri Schiavo, after reading the article in the National Review linked to in this post, I'm even more adamant. We don't know her wishes. We don't know the sincerity of her husband's motives. And, it sounds like we can't even be sure of her medical condition.
For the sake of defragmenting the conversation about the Schiavo case, please make all further comments on this thread. Thank you.

Move along. Nothing to see here.
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