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Tuesday, February 22, 2005

One More Day

Terri has a stay until tomorrow at 5 PM. There will be a hearing at 2:45 to decide on whether there will be another stay. The Schindler family is asking that new neurological testing be conducted to confirm her state:
While the family of Terri Schiavo is grateful for the stay issued today by Judge George Greer of Pinellas County Florida’s Sixth Judicial Circuit, they continue to be hopeful that the court will allow the numerous, outstanding legal issues in Terri’s case to be resolved before any action to end their daughter’s life is taken.

Recent advances in neurological testing may be better suited to determining Terri Schiavo’s true cognizant state and the Schindlers would like them to be made available so that no doubt about their daughter’s condition remains.

The family believes that Michael Schiavo will welcome this new opportunity to resolve unanswered questions about Terri’s neurological state before any further action to remove her food and fluids is carried out.
The Amicus brief filed earlier (October, 2003) in the case explains some of the legal issues:
The termination of Ms. Schiavo’s life violates her substantive due process rights under the Fourteenth Amendment in two ways. First, Florida courts did not consider whether clear and convincing evidence existed that Ms. Schiavo, had she reviewed the new medical information adduced at the last hearing, would still have wanted to terminate life support. Instead, the trial court reviewed the evidence and determined, purely to its own satisfaction, that Ms. Schiavo’s condition was sufficiently grave that her death was warranted. That is the very “best interests” standard the U.S. Supreme Court has rejected in such cases. The trial court’s failure to consider what Ms. Schiavo’s own decision would be in light of the new medical information – much of which gave her a strong chance of recovery – violates her substantive due process rights under the Fourteenth Amendment.

Second, the trial court imposed a new, extralegal standard for determining whether Ms. Schiavo was in a “persistent vegetative state” – a necessary precondition for authorizing her guardian to terminate her life support. Contrary to established medical practice, the trial court required that persons with severe disabilities demonstrate not just voluntary action “of any kind,” as PVS has been defined, but rather “consistent” and “reproducible” actions or responses to establish their own cognition. This arbitrary and capricious standard brings a new and ominous level of subjectivity into the process of determining “persistent vegetative state.” The trial court’s new standard would lead to inconsistent and overly broad determinations of what is or is not a “permanent vegetative state” and potentially subject thousands of people with severe cognitive disabilities to third-party enforcement of their “right” to die.
Barbara Weller, an attorney, describes what she saw during the Schindlers Christmas, 2004. Weller belongs to the Gibbs law firm, I believe:
Terri’s parents, sister, and niece went immediately to greet Terri when we entered the room and stood in turn directly beside her head, stroking her face, kissing her and talking quietly with her. When she heard their voices, and particularly her mother's voice, Terri instantly turned her head towards them and smiled. Terri established eye contact with her family, particularly with her mother, who spent the most time with her during our visit. It was obvious that she recognized the voices in the room with the exception of one. Although her mother was talking to her at the time, she obviously had heard a new voice and exhibited a curious demeanor. Attorney Gibbs was having a conversation near the door with Terri’s sister. His voice is very deep and resonant and Terri obviously picked it up. Her eyes widened as if to say, “What’s that new sound I hear?” She scanned the room with her eyes, even turning her head in his direction, until she found Attorney Gibbs and the location of the new voice and her eyes rested momentarily in his direction. She then returned to interacting with her mother.
There is plenty more. Terri is not unaware as you or I would judge the state. A recent study showed that persistent vegetative syndrome is greatly overdiagnosed, but Terri really doesn't fit into even that syndrome. The "Key Messages" cited in the BMJ report are:
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

Any motor activity, no matter how slight, that can be used for communication by the profoundly disabled patient should be identified at an early stage and repeated at regular intervals

Identification of awareness in the presence of profound and complex neurological disabilities requires the skills of a multidisciplinary team expe- rienced in long term management of disability due to brain damage
Read the attorney's whole statement, and you'll see why I don't think she has been correctly diagnosed. There is purposeful motor activity and eye-tracking in Terri's case. You can look at the videos on the website to see for yourself. Terri has not been given the type of rehabilitative care that the patients in the BMJ study received.

The family says that their earlier offer to take over Terri's care remains on the table (website under headlines for Jan 28th, 2005):
Following a court hearing today before Judge George Greer in the Pinellas County FL Probate, Robert and Mary Schindler, parents of Terri Schiavo, made public a settlement offer that was proposed by their attorneys to attorneys for Michael Schiavo on October 26, 2004.

Although Mr. Schiavo's attorneys have verbally rejected their proposal, the Schindlers will continue to keep their offer on the table and remain hopeful that they will one day be allowed to bring their daughter home.
The family is Catholic and the Catholic Media Coalition has asked for prayers on her behalf. It would be best for all concerned, I think, if that earlier settlement offer were to be accepted by Michael with the legal protections offered to him. The Schindler family is attempting to create an atmosphere that will allow this to happen. Do as your conscience and your beliefs suggest.


Comments:
Thank you for posting about this. You get more traffic than I and are much calmer and level headed than I can be about this.

I cannot do what my conscience and beliefs tell me to do....as my belief is this man is the one that deserves death, not Terri, and my conscience screams at me that his destruction would be a noble cause.

I am angry beyond words....can you tell?
 
I understand your anger but I can't share in it. My mind is too consumed with knowledge of the pain and desperation her parents must be feeling.

Neither one of us knows all the facts in this case. Destruction is never a greater or nobler cause than saving a life. Wouldn't the greatest miracle in this case be for Greer, Michael and the Schindlers to be able to step away from their ingrained roles in this tragic play and agree on life?

Remember that we will be condemned as we condemn others. We create the rules and conditions by which we must ultimately live. All the anger, all the hard words, all the distress in this case can only have combined to build psychic cages for these people. The Schindlers appear to have escaped theirs, the judge may have, and now it remains for Michael to get out. It would be best if he saw a route to freedom.
 
How can anybody, against the death penalty, remain silent on this?

Is there no limit to hypocrisy?

TO those who remain silent, consider this: Depending upon your beliefs, you will b ejudged by God or by your fellow man, for your actions.

May God/Your fellow man have mercy on your soul, if you allow, through benign neglect, this horror to manifest itself.
 
On the website, I think under headlines, there is a discussion by a lawyer about how she would have more due process rights if she had been condemned to death.
 
I'm not whacking you, Marty, but if
can feel pain now she can feel the pain of dying from thirst and hunger.

BTW, she doesn't have the feeding tube in all the time. My mother had a surgical implant for infusion of medication, and she told me it didn't hurt although it felt a bit odd. Terri probably is in some pain from bedsores.

I know there must be some people to whom this is some great cause for the cause's sake and who aren't thinking of the people involved, but there are certainly some on the other side of the question who are treating the matter in that way also.

The truth is that we can't know what Terri is experiencing, but we do know that she does seem to recognize people and seems to have awareness of what is going on around her, seems to react with pleasure to her mother, and probably would suffer greatly in dying. It is also certain that her mother would suffer horribly at being unable to prevent Terri from dying in this way.

What your question presumes is that Terri is not really in a persistent vegetative state. And if she isn't, then this does not qualify under the Supreme Court's definition, and is also illegal under Florida statute as I understand it. One reason why it is illegal is that there is a huge incentive (largely coming from large insurance corporations and hospitals) to let such people die rather than be stuck with the bill for their care. I will see if I can find the Supreme Court decision that ruled on when nutrition can be withdrawn.

Now, I personally strongly believe in the right to refuse treatment (if one can), and the right to have artificial life support removed. I strongly support having the legal ability to record your wishes in advance of such an eventuality and to have the courts carry them out. There are dangers to this right, and those dangers are not subtle. FOR OUR OWN CONVENIENCE, we may be killing people who are cognitively aware but unable to protest. History shows that crossing that line is dangerous to everyone. I also believe it is ethically and morally wrong.

My support of right-to-die statutes is not a position I have taken without thought, because I have much greater liklihood than you of needing those laws. I have already been pretty much a drooler and recovered somewhat. I would prefer not to end up in that state again and I have and will continue to follow a strategy aimed at ensuring that I don't end up as an institutionalized drooler. I have already decided to starve myself to death rather than go into a hospital when I'm severely ill, although I can't face the dehydration death. That really hurts.

But - take it from a temporary non-drooler - even when I couldn't talk I did have some consciousness and awareness left. I was never totally not there, although I was for quite some time too stupid even to tie my shoelaces, dress myself or boil water. Even after I usually managed to get out of the bedroom in the morning by walking instead of crawling, and even after I had recovered enough to be able to write pretty complex computer programs, I wasn't a full person - I was like a computer rebooted in safe mode, with only the most essential computer programs running.

I would date becoming a full human being again as beginning about four years ago (I think, connected memory was just about the last thing I got back, I really haven't mastered it fully yet), when I leaped out of bed one night at about 11:30 and staggered out to check whether my driver's license had expired. I saw my birth date, realized how old I was and was shocked, because I realized I was in my 40's. Then I realized how old my mother must be, and I was devastated. It was not that I had not abstractly known those facts before, it was that I had lacked the capability to know what those facts MEANT. Ever since I have been dealing with the consequences of being able to know such things.

Marty, the human brain and consciousness is a mystery. No doctor can define it. Even when I was a drooler I was aware of the importance and rights of other human beings, although certainly not on as broad a spectrum as I am now. I worried about what I was and the impact I was having on others. I wanted desperately to hurt no one.

The reason I am posting about this is that I understand the fear that some people feel at the prospect of being helpless, but I also understand the other danger. Even the drooler within me knows that a person with limited consciousness and low intelligence still has rights as a human being, and that if we shut our eyes to Terri's real state, we are committing a crime of indifference. Even as a drooler I would not have been willing to commit such a crime.

Terri's feeding tube will be removed, if it is, on the basis of a lie, not the truth. She will die as a result of an official denial of what consciousness she has, not as a result of our support of her right to make the decision to control her life or under what circumstances she chose death. I don't and I can't support the idea that a person may ever be consigned to death based on a lie supported by society's indifference. This is one reason I don't support capital punishment except in rare circumstances.

Let me sum my position up this way. On the basis of the videos, statements of doctors and nurses, and other person's statements, I cannot believe that Terri is totally unaware. She is not in a coma or a persistent vegetative state. She has some degree of emotional connection and awareness with her mother (more, btw, than on my bad days I can probably evince even now), and has some degree of understanding of her surroundings. To knowingly choose a death by dehydration under such circumstances would take more guts than most human beings have. Terri did not take the legal steps available to her to establish her wishes before she ended up in this state. Therefore she can't have considered the matter very deeply. What a court is purporting to determine is that she made the decision to consciously suffer this death, and that the court's decision is what her decision would be could she express it.

I don't believe it. I don't believe anyone willing to consider the facts of the matter can believe this. I dissent. I say that I do not think what is happening here is honest, legal, or morally proper. If it happens, I don't want to have any trace of responsibility for this action.

I exercise my right of free speech to say both that human beings should have the right to refuse medical treatment that artificially sustains life but that the only person who can make such a decision is the person herself. I'm not mad at you, but don't presume that people who see this matter as violating Terri's innate human rights are doing so shallowly or to salve their own consciences.
 
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