Saturday, March 19, 2005

More thoughts on the Schiavo case
Matt over at Cognitive Dissonance wonders why the Schiavo case breaks down along left-right lines and argues that liberals are being inconsistent when they argue for the removal of her feeding tube:

Others have argued with me that the doctors have declared that Terri is in a persistent vegetative state and that is good enough for them. Well, as is typical, the doctors paid for by the family say Terri isn’t in PVS and the doctors paid for by the husband say she is. I watched the videos and see the interaction between Terri, her parents and the doctors and for me that’s enough. How many times have doctors declared people will never walk again, or comatose patients will never regain consciousness only to hear reports of people making miraculous recovery?

This also begs the question, who has the right to speak or make decisions for Terri, her parents and family or the husband? It unfortunately comes down to property rights. Marriage law has evolved over the years but it starts from a position where the wife is property of the husband. To this day a married woman cannot get certain procedures done to her own body without the consent of the husband. So far many of the judgments in this case have been based on the notion that the husband and no one else has the default right to speak for and make decisions for his wife (his property). There are no written or recorded statements by Terri on her wishes of what to do if she ended up in a persistent vegetative state (again this diagnosis is itself in question). After the Scott Peterson case I tend to give more credence to the blood relatives of Terri rather than the husband.

It seems odd to me that liberals would be taking a position which backs the property rights of husbands over wives and attacks government involvement in the lives of citizens. I offer no explanation or answer to the primary question of why this issue polarizes many on the right and left.This is turning to another issue, like gun control, which separates me from most leftists and liberals and I suspect, if the husband has his way, will further distance the Democrat party from the majority of Americans.

Since Matt's post is thoughtful, I thought it deserved a thoughtful reply. The first thing to note is that this isn't about property rights, it's about guardianship. Terri would have precisely the same right to guardianship over a brain-dead Michael as he has over her. So with all due respect to Matt, I think this issue is a red herring.

It seems pretty clear to me why this tracks generally as a right-left issue, and that's because the Schiavo case slides pretty neatly into the right-to-die debate which divides the political spectrum in this country. Many liberals believe that a human being has the right to choose their time and place of exit from this world without the interference of the state. People who feel this way generally favor assisted-suicide legislation that would allow doctors to help the terminally ill die with dignity. Most left-liberals don't feel that this is a contradiction with their general philosophy, since we tend to make a sharp distinction between autonomy and freedom from interference in our personal lives and the regulation of commerce and taxation in the public sphere.

Now, of course, Terri can’t “choose” to die in this case because she is in a Permanent Vegetative State (PVS). This alone makes her case significantly more ethically complex than your average right-to-die situation. Matt links to Terri’s Fight, which has some videos purporting to show Terri reacting to various stimuli. But looks can be deceiving. First, some have charged that the videos are edited to make it appear as though she is conscious when she really isn’t. The other problem is that patients in PVS are known to display signs of consciousness that are really only manifestations of what is called “wakeful unconsciousness.” Far from being evidence of awareness, the behavior in Terri’s videos is actually considered by the American Medical Association to be evidence of a PVS:

But the cardinal features that distinguish the vegetative state from other syndromes of lesser brain damage, such as the minimally conscious state, are the absence of sustained visual pursuit (visual tracking) and visual fixation. The eyes do not follow objects or persons, nor do they fixate on these objects or persons. And, when patients do emerge from the vegetative state, almost invariably the first and most reliable sign of improvement is the ability to visually track objects or persons in a consistent, sustained, and reproducible fashion. The question is often asked, what exactly does “consistent, sustained, and reproducible fashion” mean in this context? None of the guidelines in the literature precisely defines these terms, but when the patients do develop sustained visual pursuit, it is usually readily apparent to anyone seeing the patient, families and health care professionals alike, and it is so consistent
and reproducible that it is present almost 100 percent of the time during the periods of wakefulness.

People, there’s a reason those clips are 40 seconds long -- the behavior is not consistent and reproducible. And because that’s true, and because Terri has been in this condition for 15 years, she has absolutely no chance of ever recovering meaningful cognitive function. The relevant areas of her brain are not just asleep, they are dead, and they cannot be brought back to life with “rehabilitation.”

There’s another reason that this tracks as a right-left issue – the right is and has always been skeptical of the conclusions of the medical scientific community (and their attitudes are mirrored by the Foucaltian far left). Christian fundamentalists and others inclined to keep Terri alive tend to believe a handful of dissenters in the vast scientific community, just as they are inclined to doubt the conclusions of macro-evolution based on the ruminations of a roomful of creationists and “intelligent designers.” So the hostility to the medical community’s longstanding and well-researched conclusions about PVS is not an isolated instance of skepticism about this one woman’s wretched condition, it is a symptom of a much wider and more dangerous skepticism of the enlightenment.

The courts have spoken in this case, drawing on 30 years of precedent in right-to-die cases. For the GOP to step in at this late hour, on a transparently procedural platform, is indicative, as I stated earlier, of gross political grandstanding, and demonstrates a total and willful ignorance of the relevant medical and scientific consensus. The Schiavo case thus represents the struggle against the GOP state’s uncontrollable urge to insert itself between the individual and his or her physician, and to legislate, from a position of theologically informed arrogance, the most personal of our decisions.


At 8:01 AM, Blogger purple_kangaroo said...

Are you aware that the article you quoted is written by Dr. Cranford, the doctor who diagnosed Terri with "105% certainty", to use his own words, as being in a PVS based on a 45-minute exam? Here's the full text of his artcile on diagnosing PVS:

I have been looking, and I can't find a single source other than Dr. Cranford that claims visual pursuit lasting 5-10 seconds (Dr. Cranford's estimate, in his testimony at the 2002 trial, of how long Terri's tracking lasted) alongside focusing on an object for "a few seconds" (using Cranford's wording again) and closing the eyes in response to visual threat would be criteria that are at all compatible with PVS.

Every other article I've been able to find says that visual pursuit (most don't mention that it needs to be sustained and the ones who do define "sustained" as "lasting more than a fraction of a second"), visual fixation, looking toward sounds (another response Terri exhibited that Cranford said was a reflex), and blinking in response to visual threat--all responses Terri displayed consistently--would be considered an indication that a person does NOT have PVS.

Dr. Cranford is the only one who says that visual tracking has to last somewhere in the range of 3-5 minutes (!!!) to count as sustained, and must be repeated 100% of the time (or very close to that) in response to stimulus in order to be considered repeatable and valid.

Cranford's definition of PVS is completely incompatible with the definition given by the AAN and every other credible organization I can find, as well as the definition of PVS in Florida law.

Also, Dr. Cranford did not follow even his own standards in diagnosing PVS, as I explored in this post:

You can find all the testimony in the 2002 trial, as well as many other documents, on the site I am building here:


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