Just go and listen, you won’t regret it.

Via Body & Soul.

New York Times story.

Terri Schiavo, the severely brain damaged Florida woman who became the subject of an intense legal and political battle that drew responses from the White House to Congress to the Vatican, died today, 13 days after her feeding tube was removed on the order of a state court judge.

Let’s hope Terri’s family (both sides of it), and the many people who have been passionately drawn into her story, find some peace.

First of all, let me point out that Kevin at Lean Left has exactly the right take on this. The medical issues are secondary, not central, to this case.

The legal issue in the Schiavo case has always been what Terri Schiavo wants, and the court’s rulings on withdrawal of her feeding tube have always been reflective of Terri Schiavo’s wishes, not her husband’s and not based on some sort of evaluation of whether her “life is worth living” or not. The Court has heard evidence from many people and has concluded that Terri’s wishes were known convincingly and that they were to the effect that she would not want to live in the condition she currently is in. […] The court’s various orders to terminate treatment have always been predicated on this wish of Terri Schiavo’s, not on the personal request of Michael Schiavo or on his, the court’s, or any other person’s evaluation of her “quality of life” or belief that her “life is not worth living.” The only person who, legally and morally, can make that determination is Terri Schiavo, and it is her previously-expressed determination in that respect that the court has acted on.

(Kevin, by the way, has been doing absolutely top-notch blogging on the legal and ethical issues of the Terri Schiavo controversy. If you don’t read Lean Left, you really should.)

* * *

Nonetheless, I have a few links and comments to make regarding the debates over Terri’s diagnosis.

The National Review published an article which strongly implied that no responsible doctor could diagnose a Persistent Vegetative State (PVS) without an MRI and a PET scan.

Is that true? It seems to me that one way of answering that would be to look at what peer-reviewed medical journals say about diagnosing PVS.

For example, the British Medical Journal (1999) published an article entitled “The permanent vegetative state: practical guidance on diagnosis and management” which discusses diagnosis in great detail, yet never claims that MRIs, PETs, or any advanced imaging are necessary.

And the Royal College of Physicians published an article in Clinical Medicine (2003), “The vegetative state: guidance on diagnosis and management” pdf link). According to this article, either a CT or a MRI “often helps to clarify the cause of these clinical syndromes,” but did not say they were necessary for making a diagnosis. (Of course, Terri Schiavo has had both CTs and an MRI). As for more advanced scans, such as PETs, they specifically said “their use is not required for diagnosis of the VS.”

Note that both these articles come from Britain, where virtually no one had heard of Terri Schiavo before last month; it is therefore unlikely that these writers are in any biased by the current controversy. And although all of them are experts on diagnosing PVS - much more so than anyone the National Review quotes (none of whom, as far as I know, have published peer-reviewed articles on PVS diagnosis) - what they write clearly contradicts the NR’s claims.

More importantly, the constant claim that further testing is required to be able to diagnose Terri Schiavo is simply unsupported by the objective medical literature.

(I’ve written more about the NR article here. I have to thank “Alas” reader “Bob,” who pointed out the Clinical Medicine article.)

* * *

RangelMD, a doctor-blog, has a discussion of Terri’s condition. Referring to the image from Terri’s CT scan which has appeared on the web, Dr. Rangel writes:

To the medically trained person this scan appears grossly abnormal and sickening. The blue areas are remaining brain tissue but most of the scan shows black areas which are essentially fluid (cerebrospinal fluid). The normal body reaction to irreversibly damaged tissue is to replace it with fluid and this is clearly what has happened after Mrs. Schiavo suffered severe anoxic damage to her cerebral cortex . Most of what remains of her brain is essentially a fluid filled sac surrounded by a thin shell of brain tissue rather then the solid structure we normally associate with a brain. […]

While a CAT scan cannot detect brain function, further evaluation such as the use of a PET scan (Positron emission tomography) is not indicated. Advocates of further testing appear unaware of the paradox of calling for the evaluation of something (Mrs. Schiavo’s cerebral cortex) that is clearly not present on the CAT scan. A PET scan will not suddenly reveal a functional cerebral cortex in Mrs. Schiavo’s cranium as if it had been hiding behind her cerebellum all this time. Calling for a PET scan makes as much sense as calling for an X-ray of a leg that had been amputated. An MRI scan (magnetic resonance imaging) is not indicated either since the CAT scan is more than adequately sensitive enough to detect the presence or absence of a cerebral cortex.

Note that like the peer-reviewed articles, Dr. Rangel’s analysis undermines the premise of the National Review article, and of all those who have been saying that further testing is needed. The truth is, there is more than enough evidence; those who have not been convinced yet, will never be convinced by further testing. Terri Schiavo’s wishes have been ignored for well over a decade; to ignore them for even longer so that unneeded tests can be performed is not justified.

The Zoomquilt. If at all possible, I recommend using the flash version, not the html version. It may take a while to load if you have a slow connection.

A recent article in the New York Times bagged on current Broadway vocalists for being too “American Idol” and not distinctive and individualistic enough.

HE three women come from different times, different lands and different wardrobe departments. But since they are all denizens of that quaint provincial theme park called Broadway, the green-skinned witch (hometown: Oz), the pink-cheeked tomboy (hometown: 19th-century Concord, Mass.) and the ethnic rainbow of a waif (hometown: Paris, but now adrift in 21st-century Brooklyn) turn out to share the same voice.

Close your eyes and listen as their larynxes stretch and vibrate with the pain of being an underdog and the joy of being really loud. Bet you can’t tell them apart. For that matter, bet you can’t distinguish the heroines of the current Broadway musicals “Wicked,” “Little Women” and “Brooklyn” from the average female finalist on “American Idol.”

Ann Alhouse, who love AI and hates Broadway, thinks there’s nothing new here:

But crowd-pleasing has been part of shows and concerts for a long time. Why do they give Oscars for hammy emoting — crying and dying — and not for subtlety? Why do people at rock concerts cheer for show-offy guitar solos? Brantley’s article is titled “How Broadway Lost Its Voice to ‘American Idol’” — and I just don’t believe in the cause and effect. The human taste for big, loud, and spectacular goes back a long way.

I agree and disagree. The style of vocals favored on Broadway has definitely changed; in the forties and fifties, a generic Broadway song owed less of its stylings to pop - the vocal show-off numbers were smoother, slower, less full of needless soars and dips, all of it filed off to form a smooth, almost featureless vocal surface. It’s very impressive, and to my ear almost oppressively boring; I prefer the modern Broadway vocalist, crescendoing ever onward.

The Times critic, Ben Brantley, complains that nowadays there’s less individual flair. I’m not sure that’s true. Yes, Just what the generic style consists of has changed; but the fact that there is a generic style has not. It’s simply not possible for everyone to be Kristin Chenoweth; by definition, the majority of performers don’t have as much individual flair as the stand-outs. (Hey, I didn’t know Chenoweth did a recording of Candide - along with Patti Lupone. Damn. I’ve got to get that DVD.) Brantley is nostalgic for the days of Ethel Merman; well, she was fantastic, but you could hardly call her a typical example of what vocalists used to be like.

Matt at A List of Things Thrown Five Minutes Ago, who like me loves Broadway but unlike me knows something about it, defends “Defying Gravity” from Wicked, one of the songs Brantley criticizes:

The third song he singles out to bash is the Act One finale of Wicked, “Defying Gravity.” First, it must be noted that in a lot of ways, “Defying Gravity” is a traditional Act I Finale. While the song is primarily sung by one of the show’s two leading ladies, a substantial part of it is a duet, and it closes with punctuation from the entire ensemble. Second, unlike “Astonishing,” “Defying Gravity” fits into the plot, both musically and character-wise. The lyrics relate to and advance the plot, and the music makes sense–the character singing the song has reached a breaking point in her life–a departure–and the music reinforces that–soaring into a belt at the end of the first Elphaba verse–as does the staging. Wicked does have songs that might rightly be proclaimed as nothing more than “Look At Me!” songs (most notably “Popular”), but this isn’t one of them.

Kip is listening to the same song, but he doesn’t succumb uncritically to the soaring vocals:

“Defying Gravity“? is a king-hell slice of Disney cheese, a competently played first-act closer that bulldozes its way through what ought to be the most delicately charged moment between Elphaba and Glinda, leaping past questionable rhymes and awkward scansion straight to those triumphantly lung-punching diva belts your bones will thrum to all through intermission, and the less said about the climax, the better. And it doesn’t matter; it doesn’t matter. I can see the auctorial intent blundering up to me like a sloppy puppy dog, like a kid behind the wheel for the very first time, and it doesn’t matter one bit: my buttons still get pushed. Just about all of them. Hard. “And if you care to find me,”? Idina Menzel whoops over the accelerating horns and synths and drums, “look to the western skies!”? and it’s all I can do not to hit replay over and over and over again like some endorphin-besotted rat.

I know just how Kip feels. During that “and if you care to fine me, look to the western skies!” bit I have to close my eyes and I almost shiver. The thing is, this sort of thing is only good if it works on you; if it doesn’t hit you somewhere in the solar plexus, it’s plain embarrassing.

Kip shows just how little there is to “Defying Gravity” (which I love) by mentioning it the same post as another song with a close-your-eyes-and-thrill-to-it moment, Stephen Sondheim’s god-like “Now/Soon/Later,” from A Little Night Music, just as shiver-inducing but about a hundred times more intelligent, character-based and real. I’m playing Wicked on heavy (heavy!) rotation right now, but there was a time when I played Kiss of the Spider Woman just as often, and now I play it less than once a year. Sondheim isn’t as easy, but it’ll last a lot longer.

From WorldNetDaily:

One of the definitions of someone who is PVS is that they cannot swallow. A “liquified cortex” would prevent someone from being able to swallow the saliva that they produce. Doctors will testify that the average human can produce up to two liters of saliva a day.

You know how it is at homes for disabled children and adults. Many of them regularly have large amounts of saliva dripping all down the front of their shirts. […] But with Terri … it’s not. It’s missing. It’s just not there.

Her chin, lips, corners of her mouth, neck and face are never slimy. How is this possible?

From “Persistant Vegitative State” (pdf link), a paper by Dr Andrew Fergusson, Head of Policy, Centre for Bioethics and Public Policy, UK:

Clinical features [of PVS]:

• Spontaneous respiration and heartbeat
• No life support machinery
• Body functions normally
• Sleep/wake cycles
• Swallowing, but not safely or sufficiently (hence tube feeding)
• No intellectual activity
• No rational responses
• No sentience
• No cognitive function

Reflex swallowing of saliva comes from the brainstem, not the cortex. Link via Dawn Patrol, who was, alas, fooled by the WorldNetDaily’s false claim.

UPDATE (April 5th): This thread is now closed. For further responses and comments, please use this thread, instead.

Since the post about Terri Schiavo’s CT scan now has over 400 comments, which is a bit of a huge file, I’ve decided to close comments on that thread. People who want to respond to a comment in that thread, or who want to make a comment on the Schiavo case in general, may do so in this new thread.

Please don’t post here to suggest that Michael Schiavo, or Judge Greer, are evil people who are conspiring to murder Terri. Please refrain from comments suggesting that the Schindlers are evil people, as well.

To get things started, I’ll quote in full the most recent (as of this moment) two posts from the thread I’m closing, both of which I thought were excellent.

Susan wrote:

Thank you, Barbara, for your clear formulation.

It seems to me that the people who want that feeding tube re-connected take one of two positions, and sometimes both:

1. They think Terri has a duty to live that transcends what she would have wanted, as you say, or in the alternative, a duty to follow the speaker’s position on this instead of her own, and/or
2. They think the court was wrong about what she wanted, for a variety of reasons, either that Judge Greer is a vulture or that Michael Schiavo has evil eyes or whatever.

Both positions can be defended, but I’d like to see a defense up-front.

As for thinking the court was wrong, I donno. I disagree with a lot of court decisions (especially when I lose!), but that’s the way we do things here, and for obvious reasons we don’t re-litigate things just because the loser is unhappy with the outcome. All the appellate courts are convinced that Judge Greer did a responsible job. I’d invite skeptics to read the Second District’s first opinion on this matter. What’s the theory here? That all the state and federal judges who’ve reviewed this are vultures? This wades us deep into conspiracy theory, deeper than I personally wish to go.

If you think Terri has a duty to live regardless of what she thinks, or that your opinion is to be preferred to hers, I’d be interested in hearing why.

A minute or so later, Sally posted the following. Since it was posted so quickly, I think it may have been intended to be a response to an ealier post of Susan’s, but it’s nonetheless an apt reply to Susan’s point about the courts.

Sally wrote:

I think the difference, Susan, is that I have less faith than you do in the courts’ ability to determine Terri Schiavo’s wishes. The court is relying on eyewitness testimony about conversations that happened many years ago. People’s memories are notoriously selective, not because they’re consciously distorting anything, but because we remember things by slotting them into certain narratives, and we tend to select out the memories that don’t fit into those narratives. Michael Schiavo and his brother and sister-in-law believe that Terri would want to die, and it seems likely that they’d select out any memories that would contradict that narrative.

I realize that all we have to go on here is hearsay, but it makes me nervous. It would make me nervous in any court case: I’m really wary of convictions based only on eyewitness testimony, too.

And secondly, the courts don’t float above society: they’re subject to the same prejudices as everyone else. And one of those prejudices is a widespread belief that some lives are not worth living, that some people are just empty husks who are a burden on society, that medical care is a zero-sum game, and if we keep those people alive, we’re taking treatment away from someone more deserving. When judges weigh evidence, they have those prejudices in the back of their minds. I don’t have a lot of faith in the courts as neutral actors here. And given that they are biased, in the ways that everyone is biased, I tend to think we should err on the side of not killing people.

• Damn, but Amanda is brilliant. Check out her discussion of the politics of the anti-single-motherhood hysteria: “Divorce and electing not to marry are the feminist equivalent of unionizing and going on strike.”
• And while you’re at it, check out Trish’s debunking (for the nth time) of the claim that social science shows that “fatherlessness” means the sky is falling.
• Many more women than men lost their lives in the Tsunami. Now, with some towns having a male-female ratio of 3-1 or more, women are being valued much more highly and treated better than ever, right? Of course not.
  

  Sri Lankan women have reportedly been sexually assaulted in camp toilets and domestic violence is on the rise, the report found. Indian widows are now placed on the lowest rung of society where they can never remarry and must depend on their in-laws to survive. Indonesian women, according to Oxfam and women activists, are being sexually harassed in camps, forced or rushed into marrying much older men and victimized by abusive Indonesian soldiers who reportedly have strip searched them.

  Via Samhita at Feministing.

• Whiskey Bar discusses why he blogs; what’s the point, when it’s so clear that trying to tell the truth is simply irrelevant to politics? I relate to a lot of what he says; too often blogging feels like trying to turn back a storm by yelling at it. Via Pacific Views.
• Speaking of futile efforts, RadGeek recently attempted to explain to a father’s rights activist that it’s wrong to lie about what feminists say. He was met, of course, with total incomprehension - like trying to explain the appeal of Picasso’s blue period to a shellfish.
• Paid family leave, low infant mortality, decent child care; Egalia thinks that these things are what a real culture of life would include. What a nut!
• Rape-excusing Sleazebags in the army: “After considering all the facts and weighing all the interests at stake, the Acting Secretary found that no administrative action is warranted against those officers identified in those reports as bearing some responsibility for Academy’s sexual assault problems.” Shakespeare’s Sister has the story, via Third Wave Agenda.
• Pacific Views quotes from this fascinating (although very partisan) Harper’s Magazine essay arguing in favor of Physician-Assisted Suicide. Here’s a tiny sample:
  

  You will notice, for example, how the fear of playing God operates exclusively on one side of the medical playground. Thus to help a patient end his or her life “prematurely”? is playing God, while extending it in ways and under conditions that no God lacking horns and a cloven hoof could ever have intended is the mandate of “our Judeo-Christian heritage”? and the Hippocratic oath.

• Homophobes in Ohio are so determined to make sure that no gay person has civil rights, they’re yanking civil rights away from unmarried women too. I’ve commented on this before, but back then it was just a legal theory. Now a judge has made it reality: “Domestic violence charges cannot be filed against unmarried people because of Ohio’s new constitutional amendment banning gay marriage, a judge ruled Wednesday.” Media Girl has the story.

  UPDATE: It appears that there have been two contrary Ohio court decisions, so presumably it’ll be up to the Ohio Supreme Court to decide if unmarried couples can be treated like married couples for the purpose of domestic violence law. Stay tuned…

• Lorenzo at Unimpressed discusses how appeals to “rationality” “reasonability” and “objectivity” are often used to mask a total lack of, well, rationality, reason, and objectivity.

From the editorial in the current issue of Scientific American:

In retrospect, this magazine’s coverage of so-called evolution has been hideously one-sided. For decades, we published articles in every issue that endorsed the ideas of Charles Darwin and his cronies. True, the theory of common descent through natural selection has been called the unifying concept for all of biology and one of the greatest scientific ideas of all time, but that was no excuse to be fanatics about it.

Where were the answering articles presenting the powerful case for scientific creationism? Why were we so unwilling to suggest that dinosaurs lived 6,000 years ago or that a cataclysmic flood carved the Grand Canyon? Blame the scientists. They dazzled us with their fancy fossils, their radiocarbon dating and their tens of thousands of peer-reviewed journal articles. As editors, we had no business being persuaded by mountains of evidence.

Read the whole thing. (Via Pacific Views).

I’ll be attending the Alternative Press Expo (APE) in San Francisco this year - it’s located at “The Concourse at Exhibition Square, 620 7th Street, San Francisco.” If any “Alas” readers live within public-transport distance of that location, and would be willing to let me crash on a sofa from the evening of Thursday April 7th through Monday morning - or even just part of that - please leave a comment or send me an email. I’d be very grateful, and I’d be out of your hair and at the comic-con virtually the entire weekend.

One warning: my snoring could make Satan himself cry to God for mercy. Unless you have a door that you can shut between where I’d be sleeping and your own bedroom, it’s probably a bad idea to invite me.

From Amanda at Pandagon:

Anyway, the thing about this stupid “culture of life” phrase is not just the hypocrisy. I have also noticed that two values that BushCo likes to fling around are “life” and “freedom”, but I have also noticed that the two are opposite values in their rhetoric. You can have freedom or life, but not both. They are pretty consistent in this viewpoint, and if they evoke freedom, you can be sure they are covering up for someone’s death, and if they evoke “life”, you can be sure they are trying to take away your freedoms.

It’s rare that I find myself in agreement with anything on The Corner; this, however, seems spot-on to me.

Michael Schiavo, as best I can judge, is Everyman. He has not behaved with high nobility; but then, very few of us do, certainly not for 15 years at a stretch. He seems to have done his best for a decent while, then given up in despair and turned back to his life, to the degree the situation and his conscience would let him. It’s possible I’ve missed something, but I haven’t seen any point in Michael Schiavo’s trajectory this 15 years past where I couldn’t all too easily see myself doing pretty much what he did. For all I can see, this is Ordinary Joe doing his imperfect and occasionally erroneous best with an appalling situation.

I think I have now read all the slanders against him, including the really lurid ones. All I can say about that is: If all the people who hate Michael Schiavo have, after all these years, not been able to persuade the authorities to charge him with anything, then the presumption of innocence seems to me a pretty good position to take.

I feel a lot of sympathy for Terri Schiavo’s parents; I don’t think anything rivals the pain of a child dying prematurely. And I think some very unethical people are using their pain to take advantage of them.

I’m running short of sympathy for the pro-lifers who have taken up this cause. There are some pro-lifers, such as my friend Robert Hayes, who haven’t sunk to character attacks. But too many pro-lifers seem determined to demonize Michael Schiavo, and anyone who disagrees with them, beyond any reason.

I realize this occurs on both sides of the Schiavo issue, but it’s far more extreme among the pro-lifers. Florida police have had to make two arrests; one of a man who tried to pay $250,000 to have Michael Schiavo murdered, one of a man who was arrested robbing a gun shop so he could “take some action and rescue Terri Schiavo.”

Meanwhile, the Florida Department of Children & Families’ abuse hot line is being flooded, day after day, by calls from pro-life Terri Schiavo protesters. “‘Inadvertently these callers may be putting other neglected, abused and vulnerable citizens at risk,’ said DCF spokeswoman Zoraya Suarez on Friday.” (”Other”?) I’m not sure whether this is a spontaneous action by thousands of individuals, in which case it’s just thoughtless, or an organized protest, in which case it’s despicable.

I know I said that I wouldn’t be posting about Terri Schiavo again. Well, I was wrong. I’ve seen so many references to Rev. Robert Johansen’s National Review article about Terri Schiavo - and the article itself is so irresponsible, full of distortions, outright lies and character assassination - that I can’t resist commenting on it.

At the start of the article, Rev. Johansen claims that Terri has been badly cared for. The proof? She’s had decubitus ulcers (or, as most of us call them, “bedsores”), which Rev. Johansen claims are “a classic sign of neglect.” But in fact bedsores are difficult to prevent absolutely; even a patient receiving excellent care can occasionally develop a bedsore (Christopher Reeve died from a bedsore-related infection). In just a single year, 13% of nursing home patients develop bedsores, and it’s been 15 years for Terri.

If anything, Terri’s relative lack of bedsores prove that she’s been well-cared for. From the neutral guardian ad litem’s report (pdf file):

[Terri’s parents] made allegations that [Michael] was not caring for Theresa, and that his behavior was disruptive to Theresa’s treatment and condition. Proceedings concluded that there was no basis for the removal of Michael as Guardian Further, it was determined that he had been very aggressive and attentive in his care of Theresa. His demanding concern for her well being and meticulous care by the nursing home earned him the characterization by the administrator as “a nursing home administrator’s nightmare”?. It is notable that through more than thirteen years after Theresa’s collapse, she has never had a bedsore.

Rev. Johansen also suggests that the fact that Terri needed dental care (she’s had a few teeth pulled) proves she’s badly cared for. But Terri was a bulimic (although Rev. Johansen doesn’t mention this) ; bulimics can have have tooth rot problems for years to come, due to having destroyed teeth enamel. Even ordinary adults can have tooth problems; given Terri’s history, that she’s had teeth pulled isn’t evidence of anything.

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).

That Terri has never had an MRI is Johansen’s major complaint. Johansen goes on to quote a number of hand-picked neurologists who say that they’d never diagnose without an MRI, and wrings his hands a lot over the moral horribleness of ever making a diagnosis without an MRI.

The problem? Johansen appears to have bungled his research. Two separate sources - one from a doctor who has examined Terri, and one from a right-wing website strongly opposed to letting Terri die - confirm that an MRI was performed on July 24, 1990. According to the right-wing website’s timeline, the MRI showed “Profound atrophy w/ very atrophic appearing cortex. Mild white matter disease, anoxic/hpoxic injury.” Nothing in that makes a diagnosis of “permanent vegitative state” surprising.

It’s true that no more MRIs have been conducted since 1990. One reason for this is that Terri had experimental implants put in her brain in 1990, which make it impossible to perform another MRI. Rev. Johansen implies in his National Review article that there’s no good reason not to remove the implants, but this is questionable. As an internet writer argued on Metafilter:

Taking out a thalamic implant involves going deep into the brain (the thalamus is basically located right in the middle) to take the implant out. Going to the thalamus means going through brain tissue on the way to the thalamus…which usually involves destroying some tissue on the way to the thalamus. It’s likely that tissue would be destroyed in this surgery…and if the whole point is to keep whatever is left of her brain intact, this seems like a mistake.

Obviously, I’m not claiming some writer on the internet is a medical authority (neither is Rev. Johansen). But what this writer says is both logical and consistant with what I’ve read elsewhere. More importantly, there is no such thing as risk-free brain surgery; and few responsible doctors would recommend brain surgery that was not necessary. And this surgery simply isn’t necessary.

As Dr. Cranford wrote, explaining why no MRI or PET scan was recommeded after 1990:

An MRI was never recommended because, in this case and other patients in a permanent vegetative state, the CT scans were more than adequate to demonstrate the extremely severe atrophy of the cerebral hemispheres, and an MRI would add nothing of significance to what we see on the CT scans. Plus the MRI is contraindicated because of the intrathalamic stimulators implanted in Terri’s brain. A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG’s were more than adequate to diagnose PVS to the highest degree of medical certainty.

At this point, based on an MRI, years of CT scans, multiple EEGs, and their own neurological examinations of Terri, eight different board-certified neurologists (Dr. James Barnhill, Dr. Garcia Desousa, Dr. Thomas Harrison, Dr. Jeffrey Karp, Dr. Vincent Gambone, Dr. Melvin Greer, Dr. Ronald Cranford, and Dr. Peter Bambakidis) have concluded that Terri is in a Permanent Vegitative State.

Although other neurologists - usually based on nothing more than seeing out-of-context video clips of Terri - have questioned this diagnosis, or suggested that further examination might be useful, these doctors have never done a neurological examination of Terri; and they have not looked at her MRI, her CT scans, her EEGs or her medical records. Of those who have made public affidavits, none address Terri Schiavo’s medical issues in any serious manner (Rivka, who has a doctorate in clinical psychology and has completed a year-long practicum in clinical neuropsychology, has a detailed critique of the affidavits).

Considering only the opinions of board-certified neurologists who have examined all of Terri’s medical records and who have given Terri a neurological examination, eight have determined that she is in a persistant or permanent vegitative state (PVS). Only one - Dr. William Hammesfahr - has said otherwise. However, Dr. Hammesfahr appears to be something of a con man. For example, he frequently claims to be a nominee for the “Nobel Peace Prize in Medicine,” a claim that’s simply not true. He has repeatedly claimed that he has cured patients with conditions similar to Terri Schiavo’s - but he was unable to name a single such patient when put under oath. In 2003, the Florida Board of Medicine found that he had charged a patient for providing medical services he hadn’t actually provided, and fined him over $50,000 (mostly in adminstrative costs). Although he says he can perform cures other neurologists would find miraculous, he has never published evidence of his amazing results in a peer-reviewed journal. (His theories have, however, earned Dr. Hammesfahr his own entry on quackwatch.org). Nor has he ever explained how it is that a MRI, multiple CAT scans, and multiple EEGs of Terri’s brain can all be so mistaken.

This is not the record of a doctor whose opinion should be taken above the opinion of eight of his peers. And aside from Dr. Hammesfahr, every doctor who has personally given Terri a neurological examination has found that she’s in a PVS.

Of course, Rev. Johansen might respond that in his article, he showed that Dr. Cranford, a highly-respected neurolgist who testified that Terri is in a PVS, has a record just as checkered. There are two essential differences. First of all, Dr. Cranford is just one of eight neurologists who have examined Terri and diagnosed her PVS, whereas Dr. Hammesfahr’s opinion stands alone. More importantly, what I’ve said about Dr. Hammesfahr is actually true, while what what Rev. Johansen said about Dr. Cranford is not.

First of all, Rev. Johansen points out that Dr. Cranford has been involved in many legal cases involving the question of withholding medical treatment (including feeding) from PVS and other severely incapacitated patients. That’s meaningless; Dr. Cranford is a prominant expert, so of course he’s been a witness multiple times. Rev. Johansen also points out that lawyers don’t call doctors as witnesses if the doctor’s diagnosis doesn’t suit their case, but that doesn’t say anything one way or the other about a testifying doctor’s credibility. (My father has frequently been hired as an expert medical witness in lawsuits involving hearing loss; he examines the patients and makes his diagnosis, and then the lawyers decide to call him to the stand or not. Nothing about this process means that expert witnesses are being dishonest; this is simply how our legal system works).

Rev. Johansen’s misinformed attempts at character assassination aside, is Dr. Cranford’s diagnosis unreliable? Rev. Johansen says it is:

In cases where other doctors don’t see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford’s assessment.

If true, this would be a very serious charge, and a legitimate blow against Dr. Cranford’s credibility. But it doesn’t appear to be true. According to Dr. Cranford:

The record is very clear that I did not testify that Robert Wendland was in a PVS, and the same applies for the case of Michael Martin in Michigan. Both these patients were clearly not PVS (see Broder AJ, Cranford RE. Mary, Mary, Quite Contrary, How Was I to Know? - Michael Martin, Absolute Prescience, and the Right to Die in Michigan. University of Detroit Mercy Law Review, 1995; 72:787-832. and Nelson LJ, Cranford RE. Michael Martin and Robert Wendland: Beyond the Vegetative State. Journal of Contemporary Health Law and Policy, 1999;15:427-453). In all the major right to die cases on a national level in which I have testified or been heavily involved with (including Brophy, Rosebush, Torres, Cruzan, Busalacchi, Ellison, Butcher, Martin, Wendland, and now Schiavo), my neurological diagnosis and the final opinions of the courts were identical (except for some legitimate differences of opinion on the degree of cognitive functions in Wendland). So my record stands for itself.

I’ve found and read a copy of Dr. Cranford’s 1999 article about Robert Wendland. Reading the article, it is perfectly clear that Dr. Cranford considered Mr. Wendland to be in a minimally conscious state, and not in a PVS. Consider this quote from Dr. Cranford’s article:

In other words, being kept alive in the minimally conscious state may be far worse for the individual than being maintained in the vegetative state. Judge McNatt was painfully aware of this aspect of his ruling: “It still can be debated whether [Mr. Wendland’s] life is being preserved or he is being sentenced to life [by my order].” In Mr. Wendland’s case, the “life sentence” is to an indefinite term in a prison of solitary confinement, unable to reach out to other persons, unable to express himself, unable to even move, possibly deeply frustrated by being stranded in a diminished life he never wanted, yet able to suffer to an extent ultimately known only by him. With the minimal degree of awareness that gives him the capacity for pain and suffering–the precise extent or nature of which is unknown to others–the minimally conscious patient potentially poses a much stronger case for allowing death than the vegetative patient does due to the principle of mercy.

Dr. Cranford is an expert, well aware of the difference between a “minimally conscious” patient and a patient in a PVS. Nor would Dr. Cranford ever describe a PVS patient as “frustrated” or “able to suffer.” Contrary to Rev. Johansen’s claim, it’s clear that Dr. Cranford described Mr. Wendland as being in a minimally conscious state, not PVS.

In addition, I’ve read both California Supreme Court decisions relating to Mr. Wendland’s case; neither one supports Rev. Johansen’s implication that there was controversy over if Mr. Wendland was in a PVS. Neither one of them supports Rev. Johansen’s implication that Dr. Cranford’s diagnosis was disagreed with by the Court.

In short, Dr. Cranford’s claim is consistant with the available evidence, whereas Rev. Johansen’s is not. Unless Rev. Johansen can produce real evidence to back up his claims about Dr. Cranford, it appears that Rev. Johansen’s most serious accusation is either incredibly irresponsible reporting or a flat-out lie.

Rev. Johansen also cites a medical review article:

Because of these difficulties, the American Academy of Neurology has made it clear that it can take months for a physician to establish with confidence the diagnosis of PVS. A 1996 British Medical Journal study, conducted at England’s Royal Hospital for Neurodisability, concluded that there was a 43-percent error rate in the diagnosis of PVS. Inadequate time spent by specialists evaluating patients was listed as a contributing factor for the high incidence of errors.

The main factor - listed in “key points” at the top of the article - that led to misdiagnosis was a severe loss of eyesight: “Many patients who are misdiagnosed as being in the vegetative state are blind or have severe visual handicap; thus lack of eye blink to threat or absence of visual tracking are not reliable signs for diagnosing the vegetative state.” There is, as far as I can tell, no evidence at all that Terri Schivo is blind or near-blind.

Nor is there any evidence that any of the patients discussed in the British Medical Journal article have CT scans or EEGs that look anything like Terri’s; none of the cases discussed in the article are described as including a misreading of scans or EEGs. Nor were any of the misdiagnosed patients examined and diagnosed by eight different neurologists, and in turn examined by at least two Courts. In short, Ms. Schiavo’s case is not at all comparable to the cases discussed in the BMJ article.

It’s notable, however, that the article - an extremely expert discussion of diagnosing PVS - no where supports Rev. Johansen’s claim that PVS cannot be diagnosed without a MRI and a PET scan. Apparently, it doesn’t bother Rev. Johansen that his hand-picked “experts” are out of harmony with the British Medical Journal article Johansen himself cited.

* * *

Reading though this article, I’m stunned by the amazing indifference to truth Rev. Johansen displays. Maybe he’s convinced himself that it’s moral to bend the truth (or to lie) in service of a higher cause; maybe he’s simply so dedicated to his cause that he’s convinced himself of things which simply aren’t true. But even if his motives were good, all he’s done is to further lower the debate into lies, half-truths, and character assassination. Nice job, National Review.

Some links via Respectful of Otters. Also, check out this op-ed piece by a “lifelong Republican” doctor outraged at some of the fake medicine that some conservatives have practiced recently.

UPDATE: And also check out Riffle’s thorough post on Dr. Hammesfahr. Apparently, the good doctor has created his own “journal,” in which he publishes articles by himself.

Interesting point from The St. Petersburg Times:

Three right-to-die cases have stirred the most controversy over the last 30 years: Karen Ann Quinlan, Nancy Cruzan and Terri Schiavo.

Is it a coincidence that all three are women who were under the age of 30 when they slipped into vegetative states?

One bioethicist doesn’t think it is.

Though the families of many vegetative patients - male and female - have faced life-or-death decisions over the years, the plights of injured young women are more likely to engage the public and attract right-to-life advocates, says Steven Miles, a professor for the Center for Bioethics at the University of Minnesota.

“People say, “She needs to be rescued, she needs to be cared for,”‘ Miles said in an interview with the St. Petersburg Times.

Miles said life-support measures on men are seen as an “assault” but with women, the technology becomes “a form of nurturing and care giving.”

Men also are more commonly viewed as clear-thinking adults who made wise statements about their end-of-life wishes. With women, however, any previous statements they made about end-of-life wishes are more commonly blown off as “emotional utterances” that don’t have weight, Miles said.

Via Ms. Jared.

I’m a bit late with this one, but if Maureen Connolly of the Coalition for Anti-Sexist Harvard is reading this, I just want you to know that you’re my hero. If you’ve got to appear on a hopelessly biased fake-news show like Hannity & Colmes, then I admire someone who is willing to be obnoxious to Sean.

From “Hannity & Colmes,” March 2 2005, about the Larry Summers bru-hah-hah.

SEAN HANNITY: Is it sexism or a point of valid debate? Joining us now, Harvard students on both sides of the issue, Josh Mendelsohn from the group Students for Larry and Maureen Connolly for the Coalition for an Anti- Sexist Harvard.

Maureen, are there differences between men and women? Do you see differences in men and women? Not just physical, their other differences?

MAUREEN CONNOLLY, COALITION FOR ANTI-SEXIST HARVARD: Differences between men and women? Of course, I see differences. Do you see differences between men and women?

HANNITY: What are some of the differences?

CONNOLLY: Oh, Sean, I think you can answer that question for yourself. You don’t need me to explain that to you.

HANNITY: You know, this is how it works here, Maureen. I ask the questions. You answer them. What are some of the differences you see between men and women?

CONNOLLY: Well, for example, I have long hair. You have short hair. That type of thing, don’t you think?

HANNITY: That’s not exactly the type of difference I was talking about. For example…

CONNOLLY: What differences are you talking about?

HANNITY: … do you think, and this is just an intellectual exercise, do you think women by nature are more nurturing to children than men are or is that a stereotype?

CONNOLLY: Oh, see, there’s your first mistake. The nature-nurture debate is far outdated, Sean. You’re making a big mistake. And that type of…

(CROSSTALK)

HANNITY: Do you think that or not? I’m asking a question, and is it yes or no? It’s a simple question.

CONNOLLY: That absolutism is entirely outdated. So why don’t you check up on your psychology and maybe we can go back and talk about the nuances of that debate?

From one of Katha Pollitt’s threads on Washington Monthly:

Ms. Pollitt, would you be so good as to suggest some of your favorite female bloggers? It’d certainly be a nice start in gathering the momentum you speak of.

Many thanks,
Scott

Scott, some blogs I like are feministing.com, echidne of the snakes, mediagirl, mousewords, Bitch Ph.d, trish wilson. I also dip into Alas, A Blog, which is (I think) a group blog captained by a man.

If I was cooler, I probably wouldn’t have admitted that reading this made my day. :-)

(Oh, and Katha: It’s pretty much just me, although I sometimes have guest posters. My former co-blogger, Bean, has her own blog now.)

I’ve mentioned in passing on this blog that I think prostitution should be decriminalized, but that being a John - that is, hiring a prostitute - should be criminal. I thought it might be nice to share with “Alas” readers one of the articles I’ve read which has helped convince me that this is a policy worth pursuing.

Here are some key quotes from “The Swedish Law That Prohibits the Purchase of Sexual Services,” by Gunilla Ekberg (of Sweden’s Ministry of Industry, Employment, and Communications), an article printed in the academic journal Violence Against Women (Vol. 10 No. 10, October 2004). I’ve liberally cut and pasted and changed the order of quotes to make this post; if you’ve got some time, I recommend reading the entire article (.pdf file).

For many countries, the options available for solutions to the problem of prostitution and trafficking in human beings for sexual purposes have been very limited. Some countries, such as Canada and the United States, have opted to criminalize the victims of prostitution…the women and children…as well as the buyers, through solicitation laws. These laws have generally been put in place for reasons of public order and are not based on gender equality or with concern for the well-being of the victims. The effects of such legislation have been that these laws are applied mainly to the victims.Victims have been arrested, fined or imprisoned, and have rarely been given access to services that could assist them to leave prostitution. The buyers usually escape punishment.

Many countries are looking for better and more effective solutions to the problem of prostitution than punishing the victims or, at the other extreme, legalizing prostitution activities, which, in reality, is capitulation to the prostitution industry. The Law in Sweden is an effective alternative to state-legitimated systems of prostitution. […]

On January 1, 1999, the Swedish Law that Prohibits the Purchase of Sexual Services (the Law) entered into force. This Law recognizes that it is the man who buys women (or men) for sexual purposes who should be criminalized, and not the woman. The Law is gender neutral and is, as mentioned previously, a fundamental part of the comprehensive Swedish strategy to combat prostitution and trafficking in human beings. […]

The ultimate goal of the Law is to protect the women in prostitution by, among other measures, addressing the root cause of prostitution and trafficking: the men who assume the right to purchase female human beings and sexually exploit them. From the Swedish experience, we know that when the buyers risk punishment, the number of men who buy prostituted women decreases, and the local prostitution markets become less lucrative. Traffickers will then choose other and more profitable destinations. The Law That Prohibits the Purchase of Sexual Services is a law that recognizes the harmful effects of prostitution on the women and girls who are the victims. This law is a fundamental step in abolishing prostitution and trafficking in women and girls. If more countries would address the demand for prostituted women, by criminalizing not only the pimps and the traffickers but also the buyers, then the expansion of the global prostitution industry would be seriously threatened. […]

It is important to note that this legislation only targets buyers of persons in prostitution. The persons who are in prostitution, the victims of male violence, are not subject to any kind of criminal or other legal repercussions. The government pledged money and assistance to women who are victims of male violence, including prostituted women. Thus, the state, to a certain extent, is responsible for assisting women to leave violent situations, including prostitution, and for providing women with access to shelters, counseling, education, and job training. […]

The Law is currently worded as follows:

A person who obtains casual sexual relations in exchange for payment shall be sentenced… for the purchase of sexual services to a fine or imprisonment for at most six months.[…]

The offense comprises all forms of sexual services, whether they are purchased on the street, in brothels, in so-called massage parlors, fromescort services, or in other similar circumstances. To put the length of imprisonment in context, the longest sentence that can be imposed on anyone for any individual criminal offense in Sweden is 10 years. […]

WHO ARE THE SWEDISH MEN WHO BUY PROSTITUTED WOMEN?

Every eighth man older than 18 years in Sweden, or approximately 13% of men ages 18 years and older, have, at least once, bought a person for prostitution purposes within Sweden or in other countries (MÃ¥nsson, 2001; National Institute of Public Health, 2000). These men represent all ages and all income classes. The majority are, or have been, married or cohabiting, and they often have children. Men who have or have had many sexual partners are the most common buyers of prostituted persons, effectively dispelling the myth that the buyer is a lonely, sexually unattractive man with no other option for his sexual outlet than to buy prostituted women. […]

The effective enforcement of the Law is ultimately determined by the attitude of the leadership within the local police forces, as well as that of the individual police officer. In Sweden as in other countries, the police force is a male, homosocial, and conservative working environment…a police force that is being asked to enforce a law that seriously threatens traditional male values. Therefore, initially, representatives of the police were critical of the law, suggesting that it would be difficult to enforce (”Polisen Kritiserar nya Sexköpslagen,”? 2000). For example, in some cases in which men have been apprehended for purchasing sexual services, the police officers involved have agreed to send the letter of notification of a crime committed to an address of the offender’s choice, rather than to his home address, presumably to protect the offender from scrutiny by his spouse or other family members.

To increase the police officers’ competence and knowledge about prostitution and trafficking in human beings, the National Criminal Police in collaboration with the Division for Gender Equality, as well as several local and regional police forces, have established education programs for its personnel on this subject. This has had noticeable and immediate effects. The initial criticism of the law as being difficult to enforce has ceased. One year after the program began in 2003, there was a 300% increase in arrests, believed to be the result of the investigating officers’ better understanding of the reasons behind the legislation, their deeper comprehension of the conditions that make women vulnerable to becoming victims of prostitution and trafficking, and the development of better investigation methods. […]

EFFECTS OF THE LAW ON TRAFFICKING IN WOMEN

The National Rapporteur for Trafficking in Women at the National Criminal Investigation Department (NCID), Kajsa Wahlberg, is responsible for the collection of data related to investigations and convictions for trafficking crimes in Sweden and for reporting annually to the Swedish government about the trafficking in women in Sweden. In her reports published in 2003 and 2004, she noted that there are clear indications that the Law has had direct and positive effects in limiting the trafficking in women for prostitution to Sweden.

The NCID estimates that between 400 and 600 women are trafficked into Sweden every year, mainly fromthe Eastern European countries such as Estonia and Lithuania, as well as from Russia. This number has remained fairly constant during the past several years (National Criminal Investigation Department [NCID], 2004). This figure should be compared to the numbers of women who are victims of trafficking for sexual purposes in neighboring Scandinavian countries […] where the purchase of sexual services is not prohibited. In Denmark, 5,500 to 7,800 women are prostituted every year. It is estimated that 50% or more of these women are victims of trafficking in human beings. […]

The NCID has received signals from Europol and national police forces in other European countries that Sweden no longer is an attractive market for traffickers. Traffickers and pimps are businessmen who calculate profits, marketing factors, and risks of getting caught when they decide in which countries they will sell women into prostitution. In conversations recorded during crime investigations, pimps/procurers and traffickers have expressed frustration about setting up shop in Sweden and attracting customers who are willing to buy their women in prostitution. According to these intercepted telephone conversations, and fromadditional testimonies given bywomenwhoare victims of trafficking, the pimps and traffickers experience the following difficulties:

• Prostituted women must be escorted to the buyers, therefore giving less time to fewer buyers, and gaining less revenue for pimps than if women had been in street prostitution.
• Swedish men who want to buy women for prostitution purposes express serious fear of being arrested and prosecuted under the Law and hence demand absolute discretion from the pimps/traffickers.
• To minimize the possibility of exposure/detection, the pimps/traffickers are forced to operate apartment brothels in more than one location and to change locations regularly. Thus the mode of operation is expensive and requires that the pimp have local contacts. The necessity of several premises is confirmed in almost all preliminary investigations that have been carried out in 2002.

[…]NORMATIVE EFFECTS OF THE LAW

As with all laws, the Law has a normative function. It is a concrete and tangible expression of the belief that in Sweden women and children are not for sale. It effectively dispels men’s self assumed right to buy women and children for prostitution purposes and questions the idea that men should be able to express their sexuality in any form and at any time.

When I last brought this up, Mythago wrote in a comment:

Amp favors a system that pretends to recognize the dignity of prostitutes, but in reality”“and under the guise of merely controlling their johns”“really keeps prostitution illegal. Amp, do you really believe that preventing prostitutes from earning a living will mollify pimps or help the prostitutes any?

I think that, in an imperfect and sexist society, prostitution will inevitably, in a significant number of cases, mean that the prostitute is hurt and abused by men - both the johns and the pimps. (Note I say “by men” purposely; whether you’re talking about male or female prostitutes, the vast majority of pimps and johns are male). The unequal power relationships involved guarantee it.

(In theory, prostitution could work differently, and better, in a more equal and decent society; but we ain’t even close to being there yet, so that’s kind of a moot point when discussing policy preferences.)

It’s actually a lot like having a minimum wage. Outlawing low-wage work does, beyond a doubt, hurt some potential low-wage workers; it would be easier for some people to find work if they could legally offer to work for a dollar an hour, for example. However, not having a minimum wage would hurt even more low-wage workers to a greater degree, because they’d be exploited to a greater degree than they currently are. (Note: Please don’t allow the comments discussion of this post to be divirted into a discussion of the minimum wage. If anyone feels an enourmous need to discuss the minimum wage, email me and I’ll do a separate post about it sometime soon.) To quote Michael Albert:

We set a minimum wage which precludes people paying or accepting less, even should they wish to. Violators can be fully cognizant adults. Low pay can be in their immediate interest. It doesn’t matter. The conditions of the economy and society coerce people, by the obliteration of alternative options, into accepting grossly dehumanizing, demeaning, and exploitative work. We say you can do the same work on your own, but we prevent an employer from paying you to endure the outlawed conditions. Similar logic justifies laws against demanding sexual favors for employee advance, or ignoring workplace safety regardless of the preferences of those involved. When the balance of power between constituencies is grossly unequal, we believe the state should proscribe certain behaviors. This is established.

I agree, as Mythago says, that it would be an unfair blow to some prostitutes that prostitution is not totally legal. But I think that complete legalization would be an even worse blow to more prostitutes (and non-prostitutes too), compared to the Swedish Law. (I also think that even total legalization, although I don’t favor it, would be better than the status quo here in the USA).

(It’s also worth noting that the Swedish law included increased efforts, and increased funding, for providing prostitutes with resources and training to leave prostitution. )

So about blogging: I try not to spend all day reading blogs, which I could easily do, but the political ones I follow are mostly by women. Before the election, I read male political blogs obsessively, and still get a lot of useful information from them. But … how can I say this in a nice way? … I find that (present company and all my friends excepted! I am making gross and unfair generalizations here) the voices don’t wear well: the range … of tones, of topics, of approaches to topics … is too narrow, and the mutual admiration society too exclusive: some blogrolls read like those interlocking directorates of railroad companies in the 19th century! There’s too much boasting and crowing, too much scorekeeping, too much self-anointment as instant expert and public executioner. If I look at the blogroll and see only male blogs, I assume, perhaps unfairly, that the blogger is promoting a narrow view of politics and boosting his male network and his own career. What a fine point Boygenius made over on nogirlsallowed.com! Thanks for the plug, NumberOneSon!

To me, women political bloggers are so fresh and smart and full of fascinating underplayed news items, not linking to them really is a kind of misogyny. And since linking is so important in raising one’s own visibility, Garance may well be right when she suggests that male liberal bloggers shoot themselves in the foot by overlooking women political bloggers, who are disproportionately liberal. (This would parallel the Democrats’ inability really to go after women’s votes by talking about issues women care about … like equal pay, childcare, affordable housing, domestic violence, the whole range of women’s health. I mean, weren’t you shocked that John Edwards looked as clueless as Dick Cheney when Gwen Ifill brought up the high rates of HIV among black women during the vice presidential debate? It’s not some big medical secret … but it’s black people, and it’s women, and it wasn’t on the talking points. But I digress.)

Even if you don’t normally read Political Animal, it’ll be worth paying attention to it as long as Katha (now that she’s blogging, I feel I can call her by her first name) is guest-blogging there. It’s also sad and depressing to read some of the comments; the “we shouldn’t even be talking about these petty chick issues, now when we have important issues to be worried about” argument comes up over and over again. This has always been the argument used by sexist leftists; if feminists had listened to them, then we’d still be waiting for suffrage today.

Regarding Edwards’ utter lack of clue when asked about HIV among black women, I’m not sure if I was shocked, but I was certainly appalled.

I’ve seen and vastly enjoyed several movies recently: Ong-Bak, Sideways, Harold & Kumar Go to White Castle, and Hotel Rwanda. This post contains brief reviews of all four films: