Do you ever read an argument written by someone you agree with, and find yourself saying, “please, please - get off my side!”

I’ve seen a few people commenting on Ashley’s case say “I’d rather be dead,” or saying that if they were in an accident that left them in a state similar to Ashley’s, they’d like to be allowed to die, or even that their living wills will call for them to be killed in that situation. And they’ve usually been people who, like me, are generally supportive of Ashley’s parents’ decision to give the “Ashley treatment” to Ashley.

There are several problems with this view, in my opinion.

First of all, it’s advocating murder, or at the least implying that someone else — Ashley — would be better dead. (Even if that’s not what folks mean, that’s what it implies.)

Ashley is not, from what her parents describe, miserable. She’s engaged with the environment around her, she enjoys watching TV and listening to music. She enjoys being with her family and being held. She’s a person, and saying that people like her shouldn’t live, or that if you were like her you wouldn’t want to live, is (imo) ablist. And it’s rude.

Second, it’s irrelevant. No one who’s capable of speaking or writing in a discussion about Ashley, is in Ashley’s position. The position of someone who was once capable of participating in internet discussions, but who then for whatever reason becomes cognitively disabled to an extent similar to Ashley, is still significantly different from Ashley’s position. Ashley is a person of her own; she doesn’t appear to regret being herself.

Since it’s not relevant, it’s best not to bring it up. And if someone asks “what if you were in an accident that left you in Ashley’s position” or something like that, it’s more logical to say “that’s not relevant” than to say “I’d want to be dead!”

Third, non-disabled people who say “I’d rather be dead” have mistaken assumptions of how people feel after they become disabled. Research has shown that people who lose the use of their limbs — even if they previously believed that they could never find life worth living as quadriplegic — are usually (after a period of adjustment) about as happy with their lives “after” as they were “before.” Being able to move unassisted is not, in practice, what makes life worth living.¹ There’s no reason to think that someone with a mental state similar to Ashley’s couldn’t experience contentment, happiness, and a life that is worth living.

Finally, some people are likely to respond to this post by reminding me that I was in favor of letting the courts and Michael Schiavo decide that Terri Schiavo would die. I think Terri’s case is completely unlike Ashley’s; Ashley is conscious, has a central cortex, and is capable of experiencing the world around her. Terri could not have any experiences at all; her cortex, the area of her brain that thought and felt and experienced, was completely destroyed. Terri was profoundly dead in a way that Ashley is profoundly alive.

More importantly, Terri was at one time in her life capable of making her own decisions — and she decided to make Michael Schiavo her legal next of kin and decision-maker were she ever incapacitated (and vice versa). That decision is the only one we know for sure Terri made, and it should have been respected; just as if she had left a living will that said that if comatose she’d want to be kept alive as long as possible, that decision should have been respected. So in these two respects, the Terri Schiavo case and Ashley’s case are completely different.

Updated to add: This post is a response to stuff I’ve read all over the blogosphere, not just to what I’ve read in comments on “Alas.”

1. This is what makes a movie like Clint Eastwood’s Million Dollar Baby so dangerous; it suggests that immediate suicide is the right response to becoming disabled. (back)

By now, most “Alas” readers know that Terri Schiavo’s autopsy has been released; you can read it here (pdf link). For an excellent summary of the report’s findings, I recommend this post at Abstract Appeal.

The most interesting finding, to me, is the finding that Schiavo was blind. How many tens of thousands of people saw the video of Schiavo appearing to follow a balloon with her eyes, and concluded that she must be conscious? How many times did “pro-”Schaivo folks who had viewed the video say, in response to an argument or a piece of evidence contradicting their opinion, “I know what I saw, and that woman is conscious”?

To some extent these people were fooled by tricky editing. But they were also fooled by the human tendency to anthromorphize - to assume that if something has a face, then we can read thoughts behind that face. That there are thoughts behind the face to read. That everything with a face is, in ways that matter, just like us. (You see this in the abortion debate a lot, as increasingly sophisticated ultrasound images of fetuses are seen by pro-lifers as proof positive, while pro-choicers like me find them beautiful and wonderful for eager expecting parents, but irrelevant to the freedom vs. forced childbirth debate.)

Sometimes - just sometimes - it makes more sense to trust in science than to trust in what our eyes tell us.

The finding that Schiavo was blind also raises the possibility that she was misdiagnosed with PVS; at least one study has found that people who are visually impaired are the most likely to be misdiagnosed with PVS. However, the extreme damage to her brain (confirmed by the autopsy), combined with all the other evidence from before Schiavo’s body died, makes it overwhelmingly clear that Schiavo was, in fact, incapable of any cognition at all. 50% of her brain was simply gone, and what remained was in bad shape. So despite the blindness, I’m as confident as I can be that the PVS diagnosis was correct.

There is no autopsy evidence of trauma associated with abuse. In fact, the autopsy report seems more certain of this finding than any other. This doesn’t absolutely prove that she wasn’t abused - nothing can prove a negative - but it’s notable since the main evidence cited by the Terri-was-abused camp up to this point has been claims that her bones were damaged, and that claim has now definitively been proved an error.

There is no autopsy evidence that Schiavo suffered from bulimia, although as The J Train points out, it’s not clear that bulimia fifteen years in the past would leave any evidence for an autopsy to discover.

There’s more - as I said, see Matt’s post at Abstract Appeal for a fuller summary.

I don’t foresee myself posting much more (or, perhaps, ever) regarding Terri Schiavo in the future; most of what’s going on in the media seems to be more of Terri’s families bashing each other, and I’m just not interested.

Here are a couple of links worth reading, though.

First, an article about the medical examiner in charge of Terri Schiavo’s autopsy report, Jon Thogmartin. From the article’s description, the guy is a somewhat egotistical Star Trek fan who prides himself in his independence from outside pressures, which is probably exactly the kind of person we want for this particular task. Although the article doesn’t say, I’d bet twenty dollars that Thogmartin has read most of Robert Heinlein’s novels.

Second of all, Matt at Abstract Appeal has made a “greatest hits” page of his best (or anyway, most popular) posts about the Terri Schiavo case. Matt has consistently done better legal and factual reporting on the Schiavo case than anyone else in the blogosphere or in the media.

As the previous Terri Schiavo thread threatens to reach 500 posts, I thought I’d start a new thread. Please use this thread to continue any discussions started on the three previous extra-huge Schiavo discussion threads.

To start us off, a few links:

The Gimp Parade has a collection of links to articles by disabled activists about the Schiavo case and its related issues. From Harriet McBryde Johnson’s Slate article:

There is a genuine dispute as to what Ms. Schiavo believed and expressed about life with severe disability before she herself became incapacitated; certainly, she never stated her preferences in an advance directive like a living will. If we assume that Ms. Schiavo is aware and conscious, it is possible that, like most people who live with severe disability for as long as she has, she has abandoned her preconceived fears of the life she is now living. We have no idea whether she wishes to be bound by things she might have said when she was living a very different life. If we assume she is unaware and unconscious, we can’t justify her death as her preference. She has no preference.

I think Johnson has a good point regarding changing preferences. However, if we accept that point, then why does it make a difference whether or not someone leaves a living will? If someone who is not yet disabled lacks the information needed to make an informed choice about life while disabled - and it seems to me that is probably true - then they don’t magically become more informed if they leave their wishes in the form of a living will, rather than in the form of talking to their spouses and loved ones.

See also this Washington Post article, which respectfully quotes disabled activists on both sides of the Schiavo issue (is that fair because it doesn’t pretend that all disabled activists agree, or unfair because it gives undue prominence to marginal dissenters from a genuine consensus?), and this critique of the disabled rights argument by Cathy Young. (Like Young, I just can’t get over my belief that there is a substantial difference between being disabled and having no cerebral cortex to speak of). Both links via Disability Law.

An “Alas” reader George F pointed out this article, “Before the Circus,” by a journalist who visited Terri Schiavo several years ago.

Back then, both sides were civil to one another. No one disputed that Terri was in a persistent vegetative state and had been for a decade. Or that an eating disorder probably had led to Terri’s cardiac arrest and collapse, not physical abuse by Michael as some now contend.

Nobody was a murderer, an abuser, an adulterer, a fanatic, a liar. They were just family, trying their best to do right by their daughter, wife, sister. […]

After all these years, what haunts me is something Terri’s brother once said: “If Terri knew what this had done to this family, she would go ballistic.”

And he told me that before things spun out of control.

And, finally, a Schiavo-inspired post from the blog Transterrestrial Musings, which is noodling about with the question of self and soul. If we replaced someone’s brain with a mechanical brain, but the person still “feels” like herself, then does she still have a soul?

To the degree that I understand the concept of the soul, I can’t believe that it is associated simply with a body, living or breathing. To the degree that I believe in souls, I think of it as a different word for “mind.”

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.

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.

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.

In my previous post, I said that others are now writing much better posts about Terri Schiavo than I can. Here’s four examples.

• Hilzoy at Obsidian Wings has written the unequalable if-you-read-only-one-post-about-Terri-Schiavo-this-should-be-it post. Hilzoy’s post (which is long) starts off by laying out the background, so if you’re already familiar with the case you may want to skim that section. The post also contains a discussion of the ethical issues involved which is both persuasive and impeccably well written.
• There’s also an idea spreading around the left blogosphere that there are cases - especially in Texas - where conscious patients are being unplugged by hospitals just because the patients are broke, and it’s all because of a law that George Bush signed, and aren’t those right-wingers hypocrites? I can understand the eagerness to take that position, especially since some leading onservatives have been repulsively eager to use Terri Schiavo to paint liberals as evil death-cultists. And there is some genuine hypocrisy there. (And here, as well.)

  Nonetheless, the real issues aren’t as simple as some of my lefty allies are painting them; given finite resources, it does make sense for hospitals to be able to refuse genuinely futile measures. Lean Left has an excellent discussion of the more complicated reality.

• A writer at the Democracy Cell Project is eloquently appalled at how Terri Schaivo’s death, which should be a private matter for her family, has been twisted into a platform for political grandstanding.
• Finally, go check out Majikthise for a list of many, many more recent (mostly lefty) posts about Terri Schiavo.

And now I promise: my next bunch of posts will NOT be about Terri Schiavo.

I don’t plan to post much more about Terri Schiavo. In late 2003, When I started blogging about Schiavo, it seemed that I was one of a bare handful of lefty bloggers who even knew the case existed. Now, however, lots of people are thinking about it; and many of them are doing a better job of it than I could.

For me, there are three central issues to consider in the Terri Schiavo case.

1) First, the constant claims that Terri may be conscious, Terri is trying to speak, Terri has spoken, Terri could get better with treatment, etc, demonstrates both a failure of the American media to educate the public about the basic scientific issues involved, and also demonstrates the fruits of the right-wing cultivation of anti-science sentiment (see also the “controversies” over global warming and evolution). Terri Schiavo lacks her cerebral cortex; without a cortex, she cannot speak, or feel, or suffer, or think, or experience anything at all. Every part of her capable of any desire or awareness died many years ago. There is no legitimate controversy over this question.

Since I posted a CT scan of what Terri’s brain looks like, dozens of blogs have reproduced it or linked to it. That image, or ones like it, should have been constantly on display in the mainstream media; and what it tells us about the claims that Terri is aware, could suffer, or could recover should be repeated in every news story. As far as I know, no mainstream news outlet has reproduced any images of Terri’s brain; instead, they’ve reduced the controversy over her diagnosis to “side A says, side B says” quotes without real analysis. As a result, too many people have been easy marks for the lies told about Terri.

2) Second, the controversy over Terri’s treatment is about the rule of law versus theocracy. The law says that Terri has a right to refuse treatment, and if she cannot, then either Terri’s chosen guardian or a court can determine what Terri would have wished. Right-wing Evangelical theology says that’s not acceptable, and Terri must be kept alive regardless. (I realize that not everyone who opposes removing Terri’s feeding tube is a right-wing Evangelical, but that doesn’t change the fact that virtually all the political muscle being flexed to keep Terri’s body alive is coming from the religious right).

When right-wing Evangelicals and the law are in conflict, what happens? I hope the law will end up carrying the day, but it’s not certain it will.

3) Finally, in both “Terri’s Law” in Florida and in the more resent actions in the national Congress, this is about maintaining the Constitutional separation of powers. The courts conduct trials and protect Constitutional rights; the legislature can change the laws (within constitutional limits) and thus affect future trials, but they shouldn’t be able to conduct a trial by legislation.

* * *

On a personal level - and I acknowledge that Terri may not have felt the same way - the more I think about this case, the more horrified I become imagining myself in Schiavo’s position.

Here’s what gets to me: After I’m dead, the main way I’ll continue existing is in the memories of my friends and relatives. It’s macabre to imagine that my loved ones, rather than remembering me as I was, could instead focus on a shell, animated by a brain stem and reflex motions but completely empty of self. Over the years, all the dominant memories of me - what I was like before the accident - would be gradually replaced by memories of my mindless body making random motions and sounds in a hospital bed.

And then I’d really be gone, gone even from the memories of my friends and relatives, removed from their brains in favor of an empty shell. It’s hard for me to imagine anything more gruesome.

(Here’s a free online source of Living Will documents, by the way.)

[I’m “promoting” this comment left by “Cerebrocrat” in the Terri Schiavo News thread. –Amp]

Cerebrocrat wrote:

But there’s something being lost in this discussion of brain imaging methods. The fact that an MRI would give a better structural picture of Terri Schiavo’s brain does not at all mean that the existing CAT scan isn’t good enough for present purposes. I see much serious armchair scan-reading in this thread that signals ignorance of the subject. Let me tell you: if you are sufficiently familiar with brains and brain images, you do not need an MRI to tell you how severely the brain in the pictured CAT scan is damaged, nor do you need to see more slices than the one depicted here. This single image shows a very severely damaged brain. The large “blue blobs” in the middle are ventricles, also present in healthy brains (you can see the two little dark crescent shapes in the brain on the right) that have expanded to such a large size because the overall brain volume is so low. Cranial space that would otherwize have been filled by gray matter is now filled with cerebrospinal fluid. And yes, that’s what the blue space is: cerebrospinal fluid that is filling up space left behind by necrotic brain tissue that has been scavenged and removed by the body. The white squiggly things are white matter - connective tracts that have the loose, uncoiled look about them that they do because, again, the grey matter that once compressed them is no longer there, so they “float” loosely in CSF. The gigantic ventricles, expanded white matter, and undifferentiated blue space in that scan all point to the same thing: massive loss of grey matter in the cerebral cortex. You don’t need an MRI to tell you that, it’s clearly visible in the CAT scan.

It is true that given the poor resolution of this image, it’s possible that some cortical tissue has been spared. But that doesn’t matter. Whatever wisps of cortex we might be missing in this image are not enough to sustain behaviors that could differentiate Terri Schiavo from any other vertebrate. All the neural equipment you need to do ocular following and emotional responses is subcortical. All the neural equipment you need to be a self-aware, reasoning, behaving human being is cortical. And since i gather this image was made some time ago, the present condition of the brain can only be worse.

There is no way any qualified brain doctor or scientist could look at this image and suggest that significant recovery of function is possible. The fact that we could have all this discussion on the subject is a triumph of politics over science. Tragic for Terri Schiavo, and really for us all.

(Please see the comments for Cerebrocrat’s description of his background).

Currently, it seems likely congress will pass a law allowing Terri Schiavo’s fate to be appealed to a Federal Court. Assuming the law passes, it seems likely that Ms. Schiavo’s feeding tube will be ordered re-inserted while the courts consider the matter. Watch Abstract Appeal for ongoing legal analysis.

• CBS News’ legal analysis Andrew Cohen is full of scorn for Congress’ action. His analysis, in Q&A form, is worth reading (via Eschaton). Here’s a small sample, but read the whole thing:

  QUESTION: Let’s start first then with Michael Schiavo’s expected arguments. Does he stand a chance of getting this law declared unconstitutional?

  ANSWER: Absolutely he has a chance. There are plenty of serious constitutional issues raised by this law. First, it applies only to one family and thus may create equal protection problems– after all, why shouldn’t other people who want to keep their loved ones on life support over the objections of others not also received tailor-made legislation? Second, as Harvard Law School Professor Laurence Tribe points out, it arguably deprives Terri Schiavo herself of the constitutional right to “halt the unwanted bodily invasion by a tube” and does so without any due process to her (and her husband and guardian). Third, it raises big separation of powers problems and also federalism concerns– the Supreme Court in particular hasn’t been receptive to federal intrusion into matters normally resolved by the states– matters like guardianship laws.

  QUESTION: So you are saying that it is not a slam dunk that this effort by Congress ultimately will succeed even in getting another round of substantive hearings on the merits of Terri Schiavo’s rights?

  ANSWER: That is exactly what I am saying. And I will go a little further. I’m also saying that there are probably some smart folks on Capitol Hill who are supporting this legislation knowing that ultimately the courts will strike it down. That way, being the politicians that they are, they will be able to blame the heartless judiciary for the result and still will be able to say to their constituents that they tried their best. It is the politics of cynicism at its very best (or very worst).

  QUESTION: Okay, settle down. Now take me through the scenario if the law initially is declared constitutional.

  He also quotes Laurence Tribe referring to what Congress is trying to do as “trial by legislation,” which seems very apt.

• To no one’s surprise, Michael Schiavo is angry at Congress, too. (Via Abstract Appeal). He has a lot of good quotes, but here’s one:
  

  “To make comments that Terri would want to live, how do they know?” Schiavo said of the members of Congress who want to keep his wife alive.

  “Have they ever met her?” Schiavo said. “What color are her eyes? What’s her middle name? What’s her favorite color? They don’t have any clue who Terri is. They should all be ashamed of themselves.”

• A good article in the Tampa Tribune criticizes the media’s misleading focus on out-of-context video snippets of Terri. Via Abstract Appeal.
• Knight Ridder has a sympathetic article about Jay Wolfson, the court-appointed guardian ad litem for Terri Schiavo, who spent hours with Terri and regretfully decided that Terri has no consciousness at all. (He has refused to take a public position either way on pulling Terri’s feeding tube).
  

  Wolfson was dismayed to learn Friday that Barbara Weller, an attorney for the Schindlers, claimed that Schiavo tried to speak. “Terri does not speak,” he said. “To claim otherwise reduces her to a fiction.”

  One thing Wolfson never doubted was that for all their intense, mutual antagonism, both Michael Schiavo and Terri’s parents love and adore her.

• You can also read Jay Wolfson’s report to Jeb Bush (pdf link).
• Rivka at Respectful of Otters has an excellent discussion of the medical issues involved in this case. There’s too much good stuff to quote, so go read the whole thing, but I was particularly struck by this quote, from one of the doctors hired by Terri’s parents:
  

  Interestingly, some of the commands, such as close your eyes, open your eyes, etc. she tended to do several minutes after I gave her the command to do so. She had a delay in her processing of the action. However, when praised for the action, she would then continue to do the action repetitively for up to approximately 5 minutes. As we had moved on to other areas of the exam, at times she was continuing to do the previous command, then at inappropriate times since the focus of the exam had changed.

  As Rivka points out, Dr. Hammesfahr’s standards are “ludicrously low”: Even if Terri is closing and opening her eyes completely at random, he would still interpret her has having conscious intent.

• Evil Genius (and Mrs. Genius) has also written a good post on the medical issues.
• And, for yet more on the medical issues, there’s this Newsday article quoting several unaffiliated doctors. (Via Mahablog).
• Bioethics.net extensively quotes Art Caplan regarding the ethical issues involved. Via P.Z. Myers, who also comments briefly on the CT scan.

So today Terri Schiavo is scheduled to have her feeding tube removed. Will it actually happen? I have no idea. (Update: Zuzu in the comments reports that Terri’s feeding tube has now been removed.) But even if her feeding tube is removed today, her body won’t die for a week or two, so this issue isn’t over.

Today, two Houses of Representatives - Florida’s and the country’s - passed laws intending to save Schiavo. Neither Senate went along, however. The newest delaying tactic is to subpoena Terri to testify before Congress (and forbidding anyone from removing her feeding tube in the meanwhile). Currently it appears that her feeding tube will be removed regardless. The subpoena seems to me almost a mockery - Terri can no more answer congress’ questions than she can fly counterclockwise around the Earth to turn time backwards. Several bloggers, who feel the same way I do, are pissed off by this latest development, and by the perceived cynicism - see Schussman.com, Stone Court, and Rude Pundit (who, I should warn you, lives up to her/his name).

But I realize that folks on the other side don’t look at it the same way. Some activists are going on a hunger strike to protest; I’m appalled, but I nonetheless admire their idealism and dedication. I hope they don’t harm themselves.

* * *

I hesitate to publish these next images. I’ve decided I’m going to, because the physical condition of Terri Schiavo’s brain is essential to any serious discussion of Terri Schiavo’s condition. By including these images, I don’t intend any disrespect to Terri Schaivo whatsoever.

On the left is a CT scan of Terri Schiavo’s brain (source). On the right, for comparison’s sake, is a CT scan of a healthy human brain. (You may also find it useful to look at these medical illustrations of the human brain, here and here.)

As I understand it - and goodness knows, I’m no doctor - the sparsely detailed dark areas in Terri’s CT scan (both the large dark area in the center and the smaller dark areas around the edges) are where Terri’s brain has been replaced with brain fluid. To quote myself: The conclusion the court came to is that, based on medical testimony and Terri’s CAT scan, her cerebral cortex has basically turned to liquid. The cerebral cortex is the seat of all our higher brain functions. Without a cerebral cortex, it is impossible for a human being to experience thought, emotions, consciousness, pain, pleasure, or anything at all; nor, barring a miracle, is it possible for a patient lacking a cerebral cortex to recover.

* * *

I’m not convinced that there is any legitimate doubt on this point. A National Review article (hat tip: Bob Hayes) quotes a few doctors arguing that CT scans are “useful only in pretty severe cases”; but what has happened to Terri Schiavo’s brain is, in fact, very severe.

When people argue that a CT scan could not possibly tell us anything about Terri Schiavo’s condition, logically they must believe one of the following two things:

1) CT scans cannot reliably detect when someone’s cortex has mostly turned to liquid.

Or:

2) That someone’s cortex has turned mostly to liquid does not tell us anything important about their condition.

I don’t think either of those propositions are defensible; therefore, I don’t think the proposition “a CT scan can’t tell us anything about Terri Schiavo’s condition” is defensible.

Finally, the National Review article implies that there’s some sort of death-cult conspiracy between the judge and the doctors to hide Terri’s true condition. I think that sort of conspiratorial thinking is ridiculous. But in any case, for it to be correct, it’s not only Michael Schiavo, the judge, and the two doctors hired by Michael who would have to be in on it; two court-appointed doctors and at least three more judges (pdf link) must be in on the conspiracy too. Not to mention all the other medical experts who have commented on the case and disagreed with the National Review’s conclusions (see the neurologists quoted in this article, for example). How far does the conspiracy go?

* * *

I thought this Abstract Appeal post - explaining why the question of “would Terri Schiavo have wanted to be kept alive?” wouldn’t normally come up during the malpractice lawsuit - was particularly well done. In general (and I know I’ve said this before), Abstract Appeal is the absolute-must-read blog for Terri Schiavo related news.

* * *

UPDATE: I’ve edited the post to remove an argument that I didn’t think I could stand behind; I’ve put the argument in the comments for posterity’s sake. I’ve also “promoted” an argument I made in the comments to the main post.

In a comment on “Alas” last month, TZ and I had this exchange:

Amp: “What I haven’t seen is an explanation of how a woman who, according to cat scans, lacks the physical capability to have thought or emotion or feeling or experience, can be said to be having any sort of life.”?

TZ: “You’re making a statement on a highly complex clinical issue about which even experts in this matter disagree.”

It has not been established that “experts” do disagree. At her own (extremely good) blog, TZ writes:

Seventeen medical experts have reportedly filed affidavits questioning whether Terri Schindler-Schiavo is in a persistent vegetative state and supporting the need for additional neurological, neuropsychological, and other testing of her abilities, particularly with new technologies.

The affidavits are available on the web at Terri’s family’s website. Here’s a quotation from one of them: “She obviously is not in a vegetative state.”

“17 experts” certainly sounds impressive. Yet, if you visit creationist websites, you can find many more than 17 “experts” claiming that Darwinistic evolution couldn’t have happened. That doesn’t mean that it’s true that experts disagree about Darwinistic evolution; it just means that sometimes unqualified people claim to be experts, or advocates misunderstand or misrepresent what experts say.

The quote TZ provides is from Dr. David Hopper. Dr. Hopper does not comment on Terri’s cat scans at all; this is rather like someone arguing gravity doesn’t exist but not commenting on the issue of how it is everything tends to stick to the ground. He doesn’t disagree with the most essential evidence in Terri’s case; he ignores the evidence altogether.

Although Hopper claims to have a doctorate “in neuroscience” on his website, in his under-oath affidavit his only claimed Ph.D. is in counseling psychology. According to the bibliography he provides, he’s never had any research published in specialized neuroscience journals. In fact, apart from some allegedly “in press” articles, he hasn’t published anything in over a decade - and the majority of his publications before that point appeared in Somnology, a journal edited by - what a coincidence! - Dr. David Hopper. (Somnology, by the way, is the study of sleep disorders.)

Dr. Hopper is the sort of faux-expert who makes a big deal of being listed in a bunch of “Who’s Who’s” directories - never mentioning that virtually anyone can be in “Who’s Who” if they write a check to the publisher. He collects certifications - however lame most of them are - like they were baseball cards (hilariously, he reproduces 20 or 30 mostly irrelevant wall-decoration certificates and degrees with his affidavit). For most of the past decade his main academic position has been high school science teacher. There’s nothing wrong with teaching in high school, but it’s not a position held by actual experts in brain science.

* * *

How about the others? None of them apart from Dr. Hopper are ridiculous. However, regarding the specific issue discussed in my and TZ’s exchange, most of them are not experts. There are more speech pathologists and psychologists than there are neurologists. And the most qualified experts in this group, seem to take care not to state an opinion. For example, Dr. Kennedy - arguably the best-qualified neurology expert of the 17 - says that he’s willing to examine Terri with the most modern MRI technology. And that’s all he says.

I’ve read all 17 affidavits. I’m not a doctor, of course. But I know a lot about argumentation and debate. One of the most basic tenets of debate is that you have to address the opposing arguments. These affidavits simply don’t do that; like Dr. Hopper, rather than addressing the most crucial evidence and arguments in this case, they pretend that they don’t exist.

There are two issues here: Terri’s cerebral cortex, and the famous videos of Terri appearing to smile and react to her parents.

1. The Cerebral Cortex Argument.

The conclusion the court came to is that, based on medical testimony and Terri’s CAT scan, her cerebral cortex has basically turned to liquid. The cerebral cortex is the seat of all our higher brain functions. Without a cerebral cortex, it is impossible for a human being to experience thought, emotions, consciousness, pain, pleasure, or anything at all; nor, barring a miracle, is it possible for a patient lacking a cerebral cortex to recover.

There are only two logical responses to that argument, that I can think of.

A) An expert could argue that someone can experience consciousness without a cerebral cortex.

B) An expert could argue that Terri’s CAT scan was faulty, or was not read correctly.

Not one of the 17 experts clearly made either of the above arguments. Nor did they make some other argument I didn’t think of. In fact, none of them mentioned the term “cerebral cortex” at all. None of them even referred directly to Terri’s CAT scan.

Many of the 17 pointed out that there are more subtle tests than a CAT scan or MRI (several recommended an fMRI). However, it does not require a subtle test to detect that someone’s cerebral cortex is mostly liquid; nor do any of the experts suggest that a CAT scan is incapable of distinguishing between liquid and solid. (On the contrary, Dr. Uszler - an expert on medical scanning technology - states that “CAT scans are good for examining anatomy”).

None of the experts argued that any mental life is possible sans cerebral cortex. None of them argued that Terri’s CAT scan was inaccurate or misunderstood. Contrary to TZ’s claim, if these 17 affidavits are a fair sampling, experts don’t disagree about these matters.

However, two of the 17 - Dr Weidman and Dr. Uszler - addressed the cerebral cortex argument obliquely.

Dr. Uszler says that he hasn’t examined Terri, and has no opinion one way or the other about her case. He does say that “CAT scans are good for examining anatomy, but they do not tell you about brain function.”

That’s doubtless true in many cases, but in Terri’s case the CAT scan shows that her cerebral cortex anatomy has liquefied. It would be bizarre to claim that a CAT scan can accurately show that brain anatomy is essentially absent, but cannot support a claim that absent anatomy isn’t functioning. Nothing in Dr. Uszler’s comments addreses the specifics of Terri’s case, or argues that someone who lacks a cerebral cortex could possibly recover higher brain functions; nor does he argue that the CAT scan already done of Terri has been misunderstood or is faulty.

Dr. Weidman also addresses the question of the CAT scan, pointing out that his mother had cognitive functioning even after CAT scans showed “a significant decline in gray matter.” However, there’s a big difference between a “decline in gray matter” and a near-total liquidization. Unless Dr. Weidman’s mother’s CAT scan shows a cerebral cortex as destroyed as Terri’s - and he doesn’t claim it did - then the comparison simply doesn’t address the question of how someone without a cerebral cortex could possibly recover higher brain functions.

2. Those Famous Video Clips of Terri

So if none of the 17 experts address the cerebral cortex issue, what do they talk about? None of these experts have examined Terri, and only one claims to have looked at her medical records. What they discuss is the famous videos of Terri apparently tracking a balloon’s movement with her eyes, smiling at her mother, and so forth.

The court ruling addressed those videos. Although the out-of-context video snips featured on the terrisfight.org website, and on TV newscasts, seem to show Terri reacting to things around her, the full, uncut video shows Terri smiling and moving her eyes at random. In one instance, her eyes appear to track a balloon; that short sequence has been shown over and over. What they don’t show is the many failed attempts made to get Terri to follow the balloon. With clever editing, even random motions and reflexes - such as smiling and eye movements - can seem conscious. The intelligence and cognition on display isn’t Terri’s, but the film editor’s.

This is a well-known argument, brought up by past expert witnesses and relied on by Judge Greer in his decision. Yet not one of the 17 experts address this argument at all. Not one of the 17 experts reports having viewed the uncut films of Terri (and I doubt any of them did); in fact, several of them specify that they viewed the short clips available on the internet or seen on TV.

These 17 affidavits do not respond, in any way at all, to the court’s reasoning regarding the videos of Terri. Again, rather than addressing essential arguments, they simply pretend they don’t exist.

* * *

Obviously, I am not a medical expert. But you don’t have to be a doctor to understand that you can’t refute an argument if you don’t address it. These 17 expert opinions do not address any of the arguments for why Terri experiences no cognition, feelings or thoughts at all; nor do they address the court’s reasoning regarding the videos. They do nothing but repeat long-discredited arguments; which is great if the goal is to be able to say “look, 17 doctors say blah blah blah,” but not useful if the goal is to meaningfully discuss Terri’s medical condition.

UPDATE: Majikthise has more criticism of the 17 affidavits.

This is of interest to folks who have been following the Terri Schiavo case: unless a court intervenes, Terri Schiavo’s feeding tube will be removed today. (So far - as of 10am Florida time - there has not been a court intervention - although there was a false report of a court intervention, so that’s created some confusion.)

Do I want Schiavo to die? No, but to me the question is nonsensical, because I’m convinced she died 15 years ago. Not everyone agrees with me, of course. The pro-life blogs are making a final (or not?) push to try and save Terri’s “life” by placing an ad in the St. Petersburg Times.

As always, Abstract Appeal is the blog with the best information on this case (especially for legal matters). The medical blog RangelMD also has an excellent series on the medical and ethical issues involved.

Also of interest is this Ragged Edge point-counterpoint feature (it’s actually a couple of years old), debating whether or not Schiavo’s cause should be a concern of the disabled rights community.

Kind of interesting article in the Inclusion Daily Express about how saving Terri Schiavo through pro-life activism, has led to the disability rights issues being overlooked. The article criticizes both pro-life and pro-choice groups.