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Briefly, the autopsy findings included extremely severe brain damage, incompatible with any desirable state of existence, and despite modern advances in management, incapable of rehabilitation or recovery. Emeritus Senior Attending Rush University Medical Center Chicago, Illinois D. Schiavo’s brain damage had resulted in a persistent vegetative state, which was in turn “proof” that the decision to withhold food and hydration had been justified.That she was also cortically blind illustrates the complexities that caring doctors encounter in helping families whose interpretations of brainstem activity are so often based on understandable hope rather than reality. As the pathologists who performed the autopsy stated clearly, the diagnosis of a persistent vegetative state is clinical, i.e., based on observation of a living patient, and so cannot be determined by autopsy.He observed that medicine and the law were “united in common quest, the quest for the rule of order, the rule of health and disease, to which for individuals as a society we give the name of law.” Ethical discernment must begin with the clinical facts, lest misinformation augment the heartache of families touched by severe brain injury.
In the light of the autopsy findings, i.e., of a commonly observed bone pathology associated with prolonged immobility and bone loss—and all of this noted one and a half decades ago—we find it particularly egregious that Didion, if not asserting belief or disbelief in the accusations, repeated allegations of physical abuse against Schiavo’s husband. In a CNN interview on the day the autopsy results were made public, the chairman of neurosurgery at Emory, Daniel L. D., addressed this point: I think what the autopsy demonstrated …was that there was marked atrophy or shrinkage of the brain.
Clearly Didion’s essay was an expression of a sincerely held view on life, but in the light of the facts, would she now care to modify her advice to doctors and families; or, like the unfortunate young woman’s parents, does she feel she has a sufficient command of complicated neurological conditions to refuse to accept the two pathologists’ findings? And that really serves, I think, as a surrogate for determining the amount of brain damage. Schiavo’s condition as presented in the autopsy findings as “incompatible with any desirable state of existence.” This is not a judgment I would attempt to make, which is by no means to say that I “refuse to accept” the autopsy findings. They neither originated in a courtroom nor ventured to designate “desirable states of existence,” as did so much else in this case.
In that case…a brain-imaging test—once it has been standardized—could help determine whether brain damage has extinguished awareness.”Dr. Schiavo was “sufficiently evaluated by neurologists for the Florida Supreme Court to rule that there was clear and convincing evidence that she was in a persistent or permanent vegetative state,” a judgment “substantiated by the assessment of the independent guardian ad litem, Jay Wolfson, appointed by Governor Jeb Bush.” Jay Wolfson is not a neurologist, but a professor of law and public health at the University of South Florida. Professor of Neurological Sciences Rush University Medical Center Chicago, Illinois My intention was neither to “advance a thesis” nor to give “advice to doctors and families.” I wanted instead to examine the way in which the inflammatory climate surrounding this case had led to a general hardening of convictions based on thin or no evidence.
As for the complaint that questioning “legal authority and received medical wisdom” undermines “the two learned professions upon which society depends,” and so brings about a “weakened civil society,” I would suggest only that the sturdiness of those professions rests not on any presumed infallibility but on their willingness to consider and address the very questions that Dr. To the Editors: Now that the autopsy report on this unfortunate young woman has become generally available, we wonder whether Joan Didion would care to revise the thesis she advanced in her recent article [“The Case of Theresa Schiavo,” NYR, June 9]. Such hardened convictions extend now even to the reaction to the autopsy findings, which were widely received as “proof” that Mrs.
Schiavo was not the object of heightened clinical scrutiny.
She was the object instead of heightened legal scrutiny.Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital–Weill Cornell Medical Center. Fins was not involved in the study but collaborates with its authors on other projects. Fins’s repeated assertion that I referred to him “out of context.” I am also puzzled by his statement that he was talking about “the risk of misdiagnosis in patients who, unlike Ms.A better understanding of brain patterns in minimally conscious patients should also help cut down on misdiagnosis by doctors, Dr. He said one study had found that as many as 30 percent of patients identified as being unaware, in a permanently vegetative state, were not. Schiavo, were not the object of heightened clinical scrutiny.” Mrs.In the window between the persistent and permanent vegetative states, patients can progress to the minimally conscious state (MCS).In those settings, the power of the initial—authoritative academic—diagnosis may be difficult to overcome in the face of episodic and inconsistent evidence of self, environment, or others which is characteristic of MCS.Though his family believed that he was aware, their requests for more complete neurological assessment were dismissed. Schiavo was misdiagnosed does a disservice to some minimally conscious patients who, in contrast to the permanently vegetative, may harbor the potential for additional recovery. Fins in the following two passages: “This study [by a team of neuroscientists in New York, New Jersey, and Washington, D.It seems likely that he migrated from the persistent vegetative state into the minimally conscious state before it became permanent. More nefariously, these conflations may engender false optimism for families who have loved ones who will remain permanently unconscious while fostering a therapeutic nihilism for the minimally conscious who might be helped. C.] gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they’ve been there all along, even though we’ve been treating them as if they’re not,” said Dr. The slippery-slope argument — the opposition to state overreach generally — is a secondary point.I was reminded of this by the passing of the anniversary of the death of Terri Schiavo. Terri) Schiavo suffered a cardiac arrest at home, during which her brain was starved of oxygen and endured permanent damage. And on March 31, 2005, after 13 days without food or water, Terri Schiavo died.This was substantiated by the assessment of the independent guardian ad litem, Jay Wolfson, appointed by Governor Jeb Bush. Didion would ascribe to the rule of law and the role of the courts in adjudicating divisive issues. Didion does a disservice to the standing of the courts—and the impartial process of clinical diagnosis—by omitting these impartial judgments from her piece.Although it is the role of the social critic to question legal authority and received medical wisdom, such skepticism comes with the cost of undermining the two learned professions upon which society depends.