schiavo case...

[escarzamd]

There's a message here....

There's a message here....

This is a topic very close to my heart professionally.

"Persistent vegetative state" is not something that has changed by defenition over the years. This is not Hollywood. All of her functions are reflexive at this point. Blinking, breathing, digestive function, response to pain and sound, urination, defecation.......all run by the brainstem and spinal cord. This is the core of our Central Nervous System, and as such are more resilient in the face of oxygen deprevation due to redundant circulation. Everything we uses intuitively and scientifically to define "consciousness" ceased to exist with the overwhelming loss of usefull cerebral tissue. In reality, she has the same capacity as a 7 week old fetus.

The core of this discussion becomes philosophical at this point. Terry Schiavo ceased to exist as an individual 15 years ago. Her body, if fed, can subsist in this state as long as anyone else's. Decide for yourselves where you define "life." I have my own thoughts about where the buck should stop with regards to end-of-life issues. Can patient's families really be trusted to make rational decisions? Shouds lawyers really be allowed to decide what constitutes a "life," much less what should be considered standard of medical care? Can doctors be trusted to always act in a patient's best interest in the face of legal, moral, or family influence? Which article/section of the Constitution says "All citizens have the right to be alive indefinitely, whether that citizen wants to be or not"? Tough questions all. Questions sure to get you some raised voices in a crowded room. Questions sure to get you 5 answers from 5 people.

The lesson to take is to make sure you put your personal decisions on paper. Make it legal for your own benefit, and more importantly, for the benefit of your loved ones. Its those that lose you that will ultimately pay if you are the one with tube. Have a day

 

[gardenweasel]

my main problems are ...


1...the husband`s motives...as someone stated previously,apparently they were on the outs when this happened...

would anyone want an ex-wife or husband making a decision like this?...even though they were still legally married..

the guy doesn`t have the woman`s best interests at heart...not like the mother and father do..i read that he refused to let her be taken outside for fresh air and some sensory stimulation...wtf is that all about?...

anybody want this guy making decisions for someone YOU love?...

he`s got the money....another family.....he`s happy..

the liberal media is giving this guy a pass...it disgusts me...

2).........if she is truly brain dead,and she MUST die...euthanize her.....give her a humane death...don`t make her die of dehydration....a horrible death...a long,lingering death...

and what about those that actually DO care for her?...imagine their suffering...

our legal system is so archaic....a convicted murderer has more appeal rights than this woman`s family does...

our legal system is bereft of common sense...every fricking issue becomes a political football...hard to believe that a society overrun by lawyers and judges can`t figure out a way to put a suffering human being out of their misery....a dog or a cat?...yeah,we can do that....

dying with dignity?.....lol......that means starving someone to death....or denying water to someone that can`t defend themself or speak up for themself?.....that`s what the most advanced civilization on earth has to offer?...


if it were me,i`d want to be euthanized....not die of thirst...or starve to death slowly...

the problem?....the religious fanatics....and the lawyers....

makes me ill just thinking about what they are doing to that woman...

could you blame a family member if they put a pillow over that poor woman`s face?....i wouldn`t...

 

[fletcher]

ESC you have helped me out many times, once again you tought me something I did not know, what and why all body functions besides brain were working, so ,is her brain on a cat scan black like my moms? due to all the blood and dead? so she can't come back just like my mom could not? Then why can't they do what I had to choose with the morphine. If that is the case I can understand that and go for the comfort care and let her go easy fast and peaceful. but i can't and won't ever agree with tube being pulled and her going like that, they way i said I choose then yes if she has no chance of ever coming back, it was hard but i did it and was the right thing for my dad it sucked for me but I also knew there was no chance ever so i made the call my sister said ok I trust you and so did other brothers when they got there.

so if that is the case i would agree for comfort care no problem but the pulling of tube i just can't. I am only 43 and i have all my papers in order you never know.I hade them made after the drunk hit me head on almost 3 years ago and messed my leg up for life, before then thought he I am young can do it later well was done with in the next few weeks after i got to leave hospital and go to my dads. If i can't live real life I am covered and won't have to make a choice for me like I had to make for my mom and family, if it was a choice where they did not do comfort care with the morphine till she just went to sleep and on to a better place I don't know what they hell i would of done, would not of been able to do it with out the way I was able to do what was right for my whole family.

Thanks for letting me learn more but still diagree with pulling tube would agree with the morphine comfort care and let her go to god in peace. I am ok with that with what you explained to me thanks.

I also trust you and a few others on here who have helped me and my family in anything you call if i ever need a 2nd opinionin life things, hope i never have to many more times but you 3 know who you are and all have been very helpful to me and my family in explaining things , you always have my trust.

 

[djv]

Congress is a joke.

 

[dr. freeze]

she is NOT brain dead

she did NOT cease to live as an indvidual

you do NOT know that she is unable to perceive and you do NOT know what exactly the remaining brain functioning really is

Even with EEG's, and any scan you want to do, you do not know what exactly her subcortical function level is, nor do we know all that subcortical function is capable of...we are still learning these things....

So please do not get on your high horse and tell us "professionally" about what you know because if you are truly informed on the subject, you will admit that there is a lot we do not know about a case such as this

and if you are truly informed on the subject, you will realize that diagnostic criteria and different diagnoses themselves are being rewritten all the time

why exactly are lawyers and "religious fanatics" the problem?

do you consider it "fanatical" to want to protect life and respect its sanctity?

we have lawyers for a reason, and yes this is one of the time we need them

 

[kosar]

she is NOT brain dead

she did NOT cease to live as an indvidual

you do NOT know that she is unable to perceive and you do NOT know what exactly the remaining brain functioning really is

Even with EEG's, and any scan you want to do, you do not know what exactly her subcortical function level is, nor do we know all that subcortical function is capable of...we are still learning these things....

So please do not get on your high horse and tell us "professionally" about what you know because if you are truly informed on the subject, you will admit that there is a lot we do not know about a case such as this

and if you are truly informed on the subject, you will realize that diagnostic criteria and different diagnoses themselves are being rewritten all the time

why exactly are lawyers and "religious fanatics" the problem?

do you consider it "fanatical" to want to protect life and respect its sanctity?

we have lawyers for a reason, and yes this is one of the time we need them

Freeze,

You lead off your post by stating two absolutes, as you see it, and then rail on the guy about how nobody knows anything absolutely. Maybe you should get off of *your* high horse.

You see everything through biblical colored glasses, so of course you will take issue with GW's comment, but he has a point. After all, our religious fanatic president felt this was so important that he signed the bill at 1:11am this morning.

As far as 'protecting life and it's sanctity'? If you were only so concerned about our troops and the tens of thousands of Iraqi civilians as you are about a lady that hasn't spoken or eaten on her own for 15 years.

Anyway, the circus continues at 3pm eastern in a Tampa courtroom.

 

[SixFive]

Again, this is a good time to make sure your living wills and health care surrogates are in place and that your wishes are CRYSTAL CLEAR.

My opinion is this. The husband says that his wife would have never wanted to live like this. D'oh, who would? This is different situation than a gorked out, brain dead (coma) pt. on a ventilator. Even if she's in a PVS, she has her eyes open, she seems to track with her eyes, and she's certainly not in a coma. Even if recovery is hopeless, I don't think it's correct to just pull her tube feeding. Painful either way for the family, and motives aside, I really feel for them all. I can just imagine my wife in that situation and how devestated I might be. Tough!

 

[djv]

It's tough no doubt. Congress should stay the hell out of it. There late night grand stand with the Prez chipping in was nuts.
What is it 6 different docs have looked at this woman. She has had over 22 scans 22. Chit most of us would be lucky to get two.
It's been thru the courts and even the SUPREME court. Why this has been left to drag out 15 years. That is the biggest sin of all. If I'm that federal judge today. I have one question. Has she changed or improved since the Supreme courts ruling. If answer is no. Well then bring peace to her.
Six Five your dead right get your paper work in order.

 

[dr. freeze]

Freeze,

You lead off your post by stating two absolutes, as you see it, and then rail on the guy about how nobody knows anything absolutely. Maybe you should get off of *your* high horse.

You see everything through biblical colored glasses, so of course you will take issue with GW's comment, but he has a point. After all, our religious fanatic president felt this was so important that he signed the bill at 1:11am this morning.

As far as 'protecting life and it's sanctity'? If you were only so concerned about our troops and the tens of thousands of Iraqi civilians as you are about a lady that hasn't spoken or eaten on her own for 15 years.

Anyway, the circus continues at 3pm eastern in a Tampa courtroom.

Here is an absolute:

If the brain is dead, she cannot breathe.
simple enough? the subcortical area controls and regulates all sorts of functions which would not be working if she was braindead...we also do not know a whole lot about neuronal plasticity and also have know way of knowing how such a thing might be manifested in this lady

Here is another one:
An individual is an individual until one dies. The burden of proof is square on the shoulders of anyone who wants to make a case AGAINST this statement precisely because we DO NOT KNOW enough to discredit it.

Why you wacko peaceniks think that going to war is inconsistent with people who respect the sanctity of life is absolutely nauseating.

Bush was signing the bill at 1AM for 2 reasons.
1. Political
2. He believes that he is there to uphold the Constitution which protects individual rights

 

[escarzamd]

freeze.....

I knew someone would raise their voice.

I did did not say she was brain dead. I didn't offer what my own opinion is on this case. Case by case, one can fall on both sides of this issue. My own father had been ill for years due to a dense stroke. He lived happily (most of the time) for 18 years after he was forced to retire b/c his right side was useless and his ability to speak was significantly impaired. He finally had the heart attack that was not if, but when, and we had to have the family discussion when his big as a house heart didn't quit, but his already damaged brain suffered far too much more damage. Had he been 50 instead of 76, his heart might go on 20 years...but to myself and my family, the decision was clear and very difficult swallow. He was gone. We turned off support and his heart kept going for 36 hours until lack of nutrition and dehydration did its final work. I would have preferred to take his doctor aside and ask, and when that wouldn't work, tell him to give him a sedative, a pain killer, and burst of potassium so that it may be quick and "painless" (for us, not for him.....pain response was there, but if your brain doesn't tell you its pain, is it really pain?), but I didn't.

I have the benefit "professionally" to not have to take a side (I don't b/c I can't). I give the facts, and then they get interpretted by the listener. My own opinion never gets put into play. Interpretation of the facts is influenced in large part by ideology, as we are all aware, and it would not be fair to offer my opinion even if asked. It would violate the one thing I truly hate, which is impose one's own views on another. I'll stand on the fence here, but believe me when I say that if it involves my own, I will act decisively towards end of life if I see no alternative to recovering even some of the capabilities that allow the life we all currently enjoy.

I just see it every day...... Elderly people who were the victims of irreversible brain insults who get carted to dialysis 3x/wk when they haven't spoken, or fed themselves, or cleaned themselves for years....... Infants who will spend their lives as wards of the state in skilled nursing facilities b/c a mother to be decided that she still had to smoke cigs, drink, smoke crack, or whatever they did to deprive that developing brain the oxygen required for survival.........Car accident victims who traumatized their head so forcefully, the brain swelled and stayed swollen too long to save enough tissue to regain any previous functional, or expressive ability.......

Its the cases like this that bring the issue to the forefront.....a tragic accident. This case is a circus, period. Its about partisan politics now, and that is just sad. The husband might be trying to get paid, or re-marry, or whatever. The family might be seeing her respond and I guess thats enough......... just remember it happens on some level every day to all ages, and we only talk about it when its an outrageous example......Peace.

BTW.....we know her sub-cortical function is intact....its the cortical function that allows you to live like you do.

 

[dr. freeze]

big difference in this situation:

1. Your dad was on life support/this lady is not
2. You and your family clearly has no secondary intentions other than what was best for your dad/this situation is much different with a commonlaw marriage and big financial settlement at stake

Because of the 2nd situation, we have a big problem.

The first situation adds to the complexity as if #2 were not a problem, #1 likely would not be a problem.

 

[escarzamd]

fletcher....I can't say her scan would look like your mother's did. If I'm guessing right, your mom had a bleed and that swelling put too much pressure on the other ares, causing blood flow to stop or slow enough to kill that part of her brain. That takes some time (24-72 hrs) after the injury to show on a scan. This woman's scan likely has some area that shows damage, just not to that extent. The problem was, all this womans blood flow stopped for a time. This causes injury in an even distribution. CT isn't built for that. We can't study that to get a black/white answer. Like handicapping, there is some degree of probability that we have to put into play based on hard science coupled w/ experience. Sure, a miracle can come about and a person snaps out of coma b/c we did enough blood flow going soon enough to allow the partially damaged parts of the brain a chance to recover. Brains are delicate. The tissue can survive, but be in a temporary state of shock that takes time to wear off, like your catching hand after a game......swollen but not painful until the swelling goes down a bit. It just isn't an occurence that is seen enough to warrant consideration that this patient has "a chance." What we do know is that after 6-12 months, we cannot measurably improve lost functions, 6-12 being a gross overestimation.

Dont know if that helps.....its a different situation than your mother's I should think. Peace.

 

[kosar]

Here's a good article on Michael and his ways and possible motives other than financial.


Michael Schiavo: Loving Husband Or Monster?
By Bonnie Chernin Rogoff (02/21/05)

As national pro-life groups and prominent leaders converged in vigils outside Woodside Hospice in Pinellas Park, Florida, Terri Schiavo is inside the building in her bed, still hooked up to the feeding tube that has been center-focus of this so-called ?right-to-die? case for the past several years. Ms. Schiavo is profoundly disabled and cannot communicate with words at this time.

But she knows. She feels. There?s expression in those eyes. Just one look at her in a video with her mother and everyone except the Scarecrow on his way to Oz knows it, too.

Recently, another presumed ?brain-dead? woman made news in Kansas. In a coma after becoming the victim of a drunk driver, Sarah Scantlin snapped out of a twenty year silence and began to speak. Memories are now coming back to her. By legal definition, Miss Scantlin?s life is valid. Yesterday, it was not. Was she ever in a persistent vegetative state, or PVS? She?d respond to questions by blinking once for no, twice for yes, but since she couldn?t speak no one was ever sure she understood the questions.

That?s the problem. No one is ever sure. The only ones who claim to know what?s best for the profoundly disabled are those who seek to benefit the most by having them legally murdered.

On Monday, February 21, new hearings will commence before Judge Greer with regard to the Schiavo case. The Empire Journal reports that David Gibbs III, attorney representing Terri?s parents Robert and Mary Schindler, will argue that new medical tests be ordered for Terri based upon a new brain imaging study published in the journal ?Neurology.? These tests could determine whether Terri Schiavo is, in fact, in a PVS. Since Judge Greer believes she is, ruled to have her killed and has thus far refused the admission of any medical evidence that would save Terri?s life, I?d be shocked to see him budge.

Greer has been acting in the dual role of judge and guardian ad litem. He previously denied a petition by Terri?s parents that their daughter be given a swallowing test, and has denied them the right to visit Terri. He continues to promote the interests of Michael Schiavo by refusing Terri the right to independent counsel, a right which even serial killers like Ted Bundy received.

Whenever people discuss euthanasia, you?ll always find those who will defend the odious practice. However, no one defends domestic violence. That leads to the 6 ft. 6 inch, 250 pound problem: Michael Schiavo. The evidence compiled against him suggests a history and pattern of domestic abuse against Terri and other women that is strong and significant. An immediate criminal investigation is warranted.

The main evidence comes from a bone scan taken on March 5, 1991. As Terri?s guardian, Michael Schiavo denied her family access to Terri?s records, the results of which were not made available until November, 2002. This scan indicated numerous broken bones in various stages of healing, including compressions fractures, a broken back, pelvis, ankle, bone bruises and ossifications.

Board certified radiologist Dr. Walker read the scan in 1991 and interpreted the results as abnormal, which he attributed to either an accident or earlier trauma. Based on the remodeling process of her bones, Dr. Walker stated in his deposition that a) the injuries indicated by the scan occurred on or around the time that Terri Schiavo collapsed; b) the abnormalities on the bone scan were not typical of someone suffering cardiac arrest and collapsing to the floor, and c) the fractures indicated by the bone scan are not typical of patients bedridden only thirteen months. As recorded in Dr. Walker?s November 21, 2003 deposition, Terri might have been the victim of foul play via a blow to her body, being thrown into a sharp furniture corner, or assaulted with a blunt object.

On October 24, 2003, renowned forensic pathologist Dr. Michael Baden was interviewed by Greta van Susteren on Fox News. He disclosed that with low potassium and no elevated enzymes, it would be extremely rare for a young woman to collapse as Terri did from a heart attack. When asked what the bone injuries suggest to him, Dr. Baden replied, ?Some kind of trauma. The trauma can be from a fall, or the trauma can be from some kind of beating that she obtained from somebody somewhere. It?s something that should have been investigated in 1991 when these findings were found.?

Other medical testimonies are in agreement. One medical expert testified that a diagnosis of a heart attack was never made. Another testified that Terri?s rigid neck indicates she may have been the victim of strangulation. Psychiatrist and expert witness Carole E. Lieberman, M.D., M.P.H. offered preliminary thoughts and provided a chilling profile of Michael Schiavo as an abusive husband.

Prior to Terri?s collapse, there were serious financial problems in her marriage and her husband Michael tried to control her behavior. He was fired from six jobs in two years, some of which he held only two weeks. They often lived on her income, which Michael often spent on himself. He monitored her odometer and isolated her from her family and friends. On the day of her collapse, Michael and Terri had a bad fight after he accused her of spending too much money at the hairdresser.

Dr. Lieberman concludes: ?He (Michael) should most definitely be investigated as the perpetrator of the ?incident? that caused Terri?s collapse and her current condition.?

Michael Schiavo insists that Terri stated early in their marriage that she never would want to be kept on life support. Even if that were true, Terri is not on life support; she breathes on her own. Since Terri has no written will, everything Michael Schiavo says is hearsay. He violated numerous Florida statutes and the Americans for Disabilities Act by failing to perform his duties as his wife?s guardian, most notably by denying his disabled wife basic medical care as part of a malpractice settlement award he received.

However, of all Michael?s offensive actions against his wife, what I deem most suspicious was his decision to have Terri cremated immediately upon her demise. In all the documentation on this case, there is not a single account of Terri Schiavo having ever expressed a desire to be cremated. Michael?s excuse is to say that she wouldn?t want a standard burial because she ?doesn?t like bugs.? I?m not buying. The likely reason is that Michael has something to hide ? like the cause of her numerous bone injuries, perhaps? ? and he doesn?t want an autopsy to uncover any incriminating evidence.

So, what really happened on February 25, 1990? We know that Terri fell in her home and sustained serious injuries. We know that Michael Schiavo, who was trained in CPR, oddly did not administer CPR to his wife. We know for the past fifteen years his only mission has been to deny any rehabilitation for Terri.

Dr. Carole Lieberman observed, ?If Terri were to be allowed to die, as Michael has been desperately struggling to achieve for years, it could help him escape detection. This would be a grave miscarriage of justice.?

That?s exactly the way Michael Schiavo and the Florida judicial system want it.

 

[Bombs]

Terry Schiavo is not brain dead. If she was brain dead, she would be on a ventilator, and care would have been withdrawn a long time ago. We do not keep brain dead people alive.

Yes there are cases of patients recovering from what was believed to be a persistent vegitative state. Obviously, its exceedingly rare.

The bottom line in this case is that end of life issues are to be made ACCORDING TO THE PATIENTS WISHES. When the patient cannot talk for his/herself, others are to make decisions according to what they think the patient would have wanted.

This ex-husband making decisions is a total joke. He switched his mind on this multiple times in the early 90s. He has absolutely no idea what she would have wanted.

This is NOT A QUESTION OF RIGHT TO LIFE OR ALL THAT BULLSHIT like these moron politicians are making it out to be. This kind of dilemma occurs every day at hospitals and what usually happens is a family consensus is reached and they go from there. In this case, there is no family consensus, and the husband is basically trying to push through his wishes. He cannot prove, and his actions prove he does not know, what Terry Schiavo's wishes were. It's really unclear if he should be functioning as next of kin since there were obviously problems in their relationship and he has clear secondary motives at play. Thus, the only sane thing to do is to err on the side of feeding her.

People have misconstrued this issue and most in the media do not understand it. They have tried to make it into some sort of euthanasia case, which IT IS NOT.

 

[escarzamd]

freeze.....

I know my personal example is different. She has a young, strong heart that could support her for up to month while this goes down. My father had a weakened heart from years of vascular disease, but if it was a 50 yr old heart...he could have lingered for days. He was not on a ventilator, or pressors or anything to supplement his respiratory or cardiac function. His heart quit when we allowed no supplemental nutrition in his drips. Bare minimum fluid, no sugar, room air......36 hrs. We starved him b/c we couldn't do it in a way he would have asked had he had the foresight.

I don't care about the politics. No decision that important should be trusted to the government, IMO. I define life on a personal level. The law can keep me from allowing a loved one the dignity of a merciful death. The government can do what it wants. They can write legal briefs, yak about it in Congress and in the papers, stand in front of my house and yell, I don't care.....what they cannot and will not ever influence is how I define it personaly, and if put it the position where I have to decide for someone I care about whether they have a life, I'll do what I think is right.

Bombs.....you're right about brass tacks, but would we be going back and forth about it if that wasn't the issue that we want to talk about? Without the hot-button topic, this case boils down to People's Court. The ex-husband should have no say. If they're not divorced, then doesn't the law say power of attorney falls to the spouse, even if he's a dick? I thought it was part of the legal contract that marriage has become. I don't know. I know starving her is cruel. Peace.

 

[AR182]

kosar,

since i haven't really been paying attention to this case (hate the subject matter), i was just asking somebody what happened to terry to make her into that state.my friend didn't know either.

but after reading that article & hearing today that the husband is refusing to allow her parents from visiting terry, i'm surprised that nobody is investigating this creep.

the article also helps to explain why the husband turned down $1 million if he would step aside.

 

[kosar]

The bottom line in this case is that end of life issues are to be made ACCORDING TO THE PATIENTS WISHES. When the patient cannot talk for his/herself, others are to make decisions according to what they think the patient would have wanted.

Well, yeah, and that's obviously the whole problem here. That way isn't working, but wtf is the solution? One guy is (possibly) pretending that he knows and the parents don't believe it and are pursuing the opposite.

This ex-husband making decisions is a total joke. He switched his mind on this multiple times in the early 90s. He has absolutely no idea what she would have wanted.

Very true. At the malpractice suit he said he was pursuing a large settlement to provide lifetime care for Terri. Only after the money was paid did he decide that Terri actually told him of her wish to not be kept alive.

 

[escarzamd]

kosar....

She was apparently dieting and had a her heart go into a rhythm that couldn't pump any blood b/c her potassium was too low. Same thing happens when potassium is too high. Complicated physiology, but the body is a big battery and the balance of electric-like signals is maintained by acid-base and electronic reactions. Sodium carries the electric signal down a nerve, but to get into the nerve to propogate (send) the signal, it has to trade spots with potassium in the cell its going into (in this case a nerve cell). Potassium comes out to make room and is traded back in for hydrogen at another place to keep balance. Any extra potassium (and there is alot) not needed in the blood is pissed out. Over a period of days, if you don't take in potassium in your diet, enough is taken from your cells (where the vast majority of body potassium is...99+%) and wasted at the expense of acid-base balance to affect the ability to exchange for sodium and send a nerve signal. It can cause paralysis of the arms and legs too, in some cases, but in this case it screwed up her wires that signal the heart and ask it to work as a unit.

The heart quit pumping for an unknown amount of time b/c the signal to pump wasn't sent. Happens in heart attacks, but this wasn't due to that type of process where a vessel gets blood flow blocked. Long winded, but hope it helps.

ps I say apparently b/c it can and does happen, not b/c I think M. Schiavo is a community pillar.

 

[kosar]

escarzamd,

That was AR who was asking about that, but I appreciate the explanation. I know there has been a lot of debate over the last decade regarding whether this was actually a heart attack or not. Not so much from the 'did Michael kill her' angle, but more from the technical/diagnostic standpoint.

It seems like most doctors agree(d) that a woman of her age and her health would not have reacted like that to a potassium shortage, no matter how severe. But there were also some who agree with you that it's possible, but not particularly likely. Thanks again.

 

[kosar]

kosar,

since i haven't really been paying attention to this case (hate the subject matter), i was just asking somebody what happened to terry to make her into that state.my friend didn't know either.

but after reading that article & hearing today that the husband is refusing to allow her parents from visiting terry, i'm surprised that nobody is investigating this creep.

the article also helps to explain why the husband turned down $1 million if he would step aside.

Yeah, back in the early/ mid-90's or so everybody was all over Michael, but as mentioned somewhere above it's hard to find much about his character these days.