When Morality Lies in a Persistent Vegetative State

Very disturbing news in this roundup of the Terri Schiavo case:

And, quite apart from the question of Terri’s therapy and care, it is entirely likely that Terri has never been properly diagnosed. Terri is usually described as being in a Persistent Vegetative State (PVS), and indeed Judge Greer ruled as a finding of fact that she is PVS; but this diagnosis and finding were arrived at in a way that has many neurologists expressing surprise and dismay.

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.

So how can Judge Greer ignore the opinions of so many qualified neurologists, some of whom are leaders in the field? The answer is that Michael Schiavo, his attorney George Felos, and Judge Greer already have the diagnosis they want.

Terri’s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging). MRI is widely used today, even for ailments as simple as knee injuries — but Terri has never had one. Michael has repeatedly refused to consent to one. The neurologists I have spoken to have reacted with shock upon learning this fact. One such neurologist is Dr. Peter Morin. He is a researcher specializing in degenerative brain diseases, and has both an M.D. and a Ph.D. in biochemistry from Boston University.

In the course of my conversation with Dr. Morin, he made reference to the standard use of MRI and PET (Positron Emission Tomography) scans to diagnose the extent of brain injuries. He seemed to assume that these had been done for Terri. I stopped him and told him that these tests have never been done for her; that Michael had refused them.

There was a moment of dead silence.

“That’s criminal,” he said, and then asked, in a tone of utter incredulity: “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?” He drew a reasonable conclusion: “These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information.”

Dr. Morin explained that he would feel obligated to obtain the information in these tests before making a diagnosis with life and death consequences. I told him that CT (Computer-Aided Tomography) scans had been done, and were partly the basis for the finding of PVS. The doctor retorted, “Spare no expense, eh?” I asked him to explain the comment; he said that a CT scan is a much less expensive test than an MRI, but it “only gives you a tenth of the information an MRI does.” He added, “A CT scan is useful only in pretty severe cases, such as trauma, and also during the few days after an anoxic (lack of oxygen) brain injury. It’s useful in an emergency-room setting. But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.”

I'm quite familiar with MRI, CT, and PET scans, having worked for several years for a company which built this equipment.

The reason PET and MRI scans are preferred for brain injuries by clinicians is that they enable the trained eye to clearly see what's happening with the brain. CT scans using contrast material, particularly those done on a LightSpeed-style multislice scanner, may approach MRI-level quality, but most CT scans won't really be helpful. The fact that Michael Schiavo won't let his wife have a simple procedure which involves no more discomfort than that caused by injecting the contrast material is pretty disturbing.

The Florida judge who has decided that Terri must starve to death is a disgrace. All her parents have asked to do is be allowed to care for her. Why has the judge imposed a death sentence on her, one marked by cruel and unusual suffering?