Official Terri Schiavo Thread

[AnandTech Moderator]

All posts about this topic should be posted in this thread. All current and future threads about this topic will be locked.

This is due to the multiple threads regarding this topic that are flooding P&N, most of which are redundant.

 

[dmcowen674]

Originally posted by: AnandTech Moderator
All posts about this topic should be posted in this thread. All current and future threads about this topic will be locked.

This is to be because of the multiple threads regarding this topic that are flooding P&N, most of which are redundant.

It did become a mess but it is a messy subject that will be a lasting mark in history.

 

[BaliBabyDoc]

Nevermind . . . the Schiavo threads are indeed a mess that required intervention.

 

[BaliBabyDoc]

Artificial nutrition and hydration are forms of life support. The Supreme Court has ruled it's identical to respiratory, cardiac, or renal support.

Let me give a quick synopsis of why Schiavo is not suffering:
We have two basic states that matter; wakefulness and consciousness. You must be awake to be conscious with the notable exception of dream states where varying levels of wakefulness and consciousness exist. Drugs (anesthetics, sedatives, hallucinogens, etc) can also manipulate wake and conscious states.

Schiavo is not in a coma. In a coma, a person lacks wakefulness and consciousness. These people require respiratory support b/c the respiratory center is located in the brainstem . . . same location as neural pathways that regulate wakefulness. They require nutritional/hydration support b/c the ability to feed requires coordinated activity between cranial nerves and the cerebral cortex . . . the cortex is required for consciousness. This means a person in a coma isn't hungry, isn't thirsty, and doesn't feel pain b/c all of those functions REQUIRE processing by the cerebral cortex. A healthy dose of ketamine (dissociative anesthetic) doesn't do anything for pain but you no longer care and won't remember. In essence, a drug induced form of altered consciousness.

Schiavo is in a persistent vegetative state. In PVS, a person has wakefulness (sleep/wake cycles) but lacks consciousness. Accordingly, she sleeps, wakes up, blinks, may even moan but she is not conscious. She lacks the desire and ability to eat b/c she doesn't know she's hungry. The same is true for thirst. In fact, most if not all neuroscientists would say "she" doesn't know "she" exists.

If Schiavo was existing in a minimally conscious state (MCS); ie some tiny shred of evidence she has some degree of consciousness . . . doctors would manage support withdrawal by providing palliative care (ice chips from dry mouth/lips, analgesics for pain, sedatives for sleep). Pain is NEVER a necessary component of death. Further, the organ failure (renal followed by cardiac) that will cause her death doesn't cause pain. Regardless of what Rush believes, OxyContin was never designed to get people high . . . it's an excellent means of controlling pain. A healthy dose of a barbituate (phenobarbital - seizure medication), not only induces sleep but it can suppress respiration enough to hasten death . . . a good physician knows how to cook up a quality palliative care plan.

Another issue is locked-in syndrome. By definition, these people are functionally, if not fully, conscious. They just lack voluntary motor control with the notable exception of eye movements. There's no way a competent neurologist would miss LIS if that's the appropriate diagnosis for Schiavo. The prognosis would still be poor but it would be immoral to end her life by nutritional/hydration support.

I've been very disappointed by the alleged medical professionals that have misrepresented Schiavo's condition, prognosis, and process of her death. I have no expectation that laypersons like DeLay, the Schindlers, the two Bushes, Lou Sheldon) would understand what's going on. But even a mediocre physician should be in the ballpark.

EDIT: Apparently Schiavo's doctors are taking the easy way out. They are giving her morphine. Opiates are very good analgesics and decent sedatives but they do not suppress respiratory drive . . . which means it's very difficult to kill someone with appropriate doses. I'm personally opposed to using opiates instead of barbituates for end of life care but several busy body politicians/AGs and families have been known to prosecute/sue doctors that help people achieve a "peaceful" death.

 

[sapiens74]

Originally posted by: BaliBabyDoc
Artificial nutrition and hydration are forms of life support. The Supreme Court has ruled it's identical to respiratory, cardiac, or renal support.

Let me give a quick synopsis of why Schiavo is not suffering:
We have two basic states that matter; wakefulness and consciousness. You must be awake to be conscious with the notable exception of dream states where varying levels of wakefulness and consciousness exist. Drugs (anesthetics, sedatives, hallucinogens, etc) can also manipulate wake and conscious states.

Schiavo is not in a coma. In a coma, a person lacks wakefulness and consciousness. These people require respiratory support b/c the respiratory center is located in the brainstem . . . same location as neural pathways that regulate wakefulness. They require nutritional/hydration support b/c the ability to feed requires coordinated activity between cranial nerves and the cerebral cortex . . . the cortex is required for consciousness. This means a person in a coma isn't hungry, isn't thirsty, and doesn't feel pain b/c all of those functions REQUIRE processing by the cerebral cortex. A healthy dose of ketamine (dissociative anesthetic) doesn't do anything for pain but you no longer care and won't remember. In essence, a drug induced form of altered consciousness.

Schiavo is in a persistent vegetative state. In PVS, a person has wakefulness (sleep/wake cycles) but lacks consciousness. Accordingly, she sleeps, wakes up, blinks, may even moan but she is not conscious. She lacks the desire and ability to eat b/c she doesn't know she's hungry. The same is true for thirst. In fact, most if not all neuroscientists would say "she" doesn't know "she" exists.

If Schiavo was existing in a minimally conscious state (MCS); ie some tiny shred of evidence she has some degree of consciousness . . . doctors would manage support withdrawal by providing palliative care (ice chips from dry mouth/lips, analgesics for pain, sedatives for sleep). Pain is NEVER a necessary component of death. Further, the organ failure (renal followed by cardiac) that will cause her death doesn't cause pain. Regardless of what Rush believes, OxyContin was never designed to get people high . . . it's an excellent means of controlling pain. A healthy dose of a barbituate (phenobarbital - seizure medication), not only induces sleep but it can suppress respiration enough to hasten death . . . a good physician knows how to cook up a quality palliative care plan.

Another issue is locked-in syndrome. By definition, these people are functionally, if not fully, conscious. They just lack voluntary motor control with the notable exception of eye movements. There's no way a competent neurologist would miss LIS if that's the appropriate diagnosis for Schiavo. The prognosis would still be poor but it would be immoral to end her life by nutritional/hydration support.

I've been very disappointed by the alleged medical professionals that have misrepresented Schiavo's condition, prognosis, and process of her death. I have no expectation that laypersons like DeLay, the Schindlers, the two Bushes, Lou Sheldon) would understand what's going on. But even a mediocre physician should be in the ballpark.

EDIT: Apparently Schiavo's doctors are taking the easy way out. They are giving her morphine. Opiates are very good analgesics and decent sedatives but they do not suppress respiratory drive . . . which means it's very difficult to kill someone with appropriate doses. I'm personally opposed to using opiates instead of barbituates for end of life care but several busy body politicians/AGs and families have been known to prosecute/sue doctors that help people achieve a "peaceful" death.

Why give pain killers when she can't feel pain?

 

[Ozoned]

The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

 

[mithrandir2001]

If this is the "official" thread, then use the correct spelling: Terri Schiavo.

I could never get myself worked up in this political drama. The nightly local news almost always produces a story about some senseless murder or act of violence, people killed for a few bucks or because they were in the wrong place at the wrong time. Terri has been figuratively dead for 15 years now but some have embraced her as The Cause. It's silly, really. It's not about HER, this whole drama is just another culture war battle. The Evangelicals have become hysterical because they thought that this was their time to shine, this being the 4th or 5th year of conservative Republican control of the Congress and the Executive Branch. And they've been handed a "loss".

They say the gay rights movement hurt itself by charging forward too quickly on gay marriage last year. Subsequently, the Religious Right hurt themselves in the Schiavo drama by thinking that they are above Man's law. I hope America has seen the danger of religious fantastism and why Church and State must remain separate.

 

[mithrandir2001]

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

So what's the alternative? Religious "evidence" such as the laughable claim that the Earth is only 10,000 years old?

 

[3chordcharlie]

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

Ancient Greeks proved that the world was round.

 

[Ozoned]

Originally posted by: mithrandir2001

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

So what's the alternative? Religious "evidence" such as the laughable claim that the Earth is only 10,000 years old?

No.
A conservative approach is in order, if there is any gray area between the boundaries of the issue. I personally am ok with the husband and family resolving the issue within the scope of what the current legal system, affords to them. However, I also believe that people that try to justify their support in one direction or another by saying that they know definitively what is going on in the mind of Terry Schiavo are being less than Intellectually honest...

 

[phillyTIM]

Thank God that Terri's parents have finally done the right thing, and asked all the supporters to go home and spend Easter with their families. And they know that they aren't gonna go witch-hunting any longer to attempt to find a Court that will slant a decision to their favor.

May God be with Terri and she finally be left to die in peace, as she has always wished. And may God comfort her family through these trying times, for their valiant efforts.

 

[BaliBabyDoc]

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

Uh, actually that wasn't science . . . it was ignorance and arrogance. The flat earthers believe that was true b/c no matter how far they traveled, they always saw a flat horizon. Such circumstantial evidence is often misconstrued as proof by weak intellects. Simple observations like looking at various "sides" of celestial bodies would make it abundantly clear that "flat" Earth doesn't make sense . . . unless of course the Earth is some how "special."

Religion more egregiously contaminated the "good" science about celestial movements. It's likely that Greeks, Chinese, and possibly other antiquity cultures surmised the Earth was round (sperical). The "belief" that the Earth is special . . . God's chosen vessel for his progeny . . . drove religious fanatics to criminalize good science. Copernicus started the ball rolling but it was Galileo that truly beotch-slapped the Church.

Physicians and other scientists . . . good ones . . . are REQUIRED to acknowledge we don't really know anything as an absolute certainty. We have high degrees of likelihood. The probabilites can be overwelming in our favor, yet a good scientist will always acknowledge the possibility of absent data or a flaw in interpretation that weakens our conclusions.

It's highly unlikely that Terri Schiavo exists in a state other than PVS. There's no doubt what her husband wants and there's no doubt what the courts have concluded. But medical science doesn't have Supreme Courts. We are always beholden to the limits of our technology and our expertise. If I was caring for Terri Schiavo, I would have recommended barbituates if the spouse wanted a peaceful death that might be hastened. If I was afraid of activist politicians/judges, I would recommend opiates. Even if I thoroughly believed she was PVS, I would still recommend use of opiate analgesics.

Now if you gave me a 9 Tesla fMRI machine and I could scan every millimeter of her cortex. I might consider saving a couple of dollars in opiates. But I doubt it.

 

[totalcommand]

Originally posted by: Ozoned

Originally posted by: mithrandir2001

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

So what's the alternative? Religious "evidence" such as the laughable claim that the Earth is only 10,000 years old?

No.
A conservative approach is in order, if there is any gray area between the boundaries of the issue. I personally am ok with the husband and family resolving the issue within the scope of what the current legal system, affords to them. However, I also believe that people that try to justify their support in one direction or another by saying that they know definitively what is going on in the mind of Terry Schiavo are being less than Intellectually honest...

There is no grey area. Her cerebral cortex is gone, replaced by spinal fluid.

 

[Ozoned]

Originally posted by: totalcommand

Originally posted by: Ozoned

Originally posted by: mithrandir2001

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

So what's the alternative? Religious "evidence" such as the laughable claim that the Earth is only 10,000 years old?

No.
A conservative approach is in order, if there is any gray area between the boundaries of the issue. I personally am ok with the husband and family resolving the issue within the scope of what the current legal system, affords to them. However, I also believe that people that try to justify their support in one direction or another by saying that they know definitively what is going on in the mind of Terry Schiavo are being less than Intellectually honest...

There is no grey area. Her cerebral cortex is gone, replaced by spinal fluid.

The day before the day that the first person recieved a dose of anti-biotics, there was no cure for bacterial infection, other than the immune system.

 

[Gaard]

She's been like this for 15 years. But maybe that isn't quite long enough. I say give it a little more time. Just like the Iraq War...oh wait.

She's been like this for 15 years. But that might not be enough time to draw any definitive conclusions. If there is any gray area, we should take some time to look into it. You know, just like we did with Iraq...oh wait.

 

[totalcommand]

Originally posted by: Ozoned

Originally posted by: totalcommand

Originally posted by: Ozoned

Originally posted by: mithrandir2001

Originally posted by: Ozoned
The best scientific evidence once indicated that the world was flat and the sun revolved around the earth.

So what's the alternative? Religious "evidence" such as the laughable claim that the Earth is only 10,000 years old?

No.
A conservative approach is in order, if there is any gray area between the boundaries of the issue. I personally am ok with the husband and family resolving the issue within the scope of what the current legal system, affords to them. However, I also believe that people that try to justify their support in one direction or another by saying that they know definitively what is going on in the mind of Terry Schiavo are being less than Intellectually honest...

There is no grey area. Her cerebral cortex is gone, replaced by spinal fluid.

The day before the day that the first person recieved a dose of anti-biotics, there was no cure for bacterial infection, other than the immune system.

and? so?

 

Originally posted by: BaliBabyDoc
Artificial nutrition and hydration are forms of life support. The Supreme Court has ruled it's identical to respiratory, cardiac, or renal support.

Let me give a quick synopsis of why Schiavo is not suffering:
We have two basic states that matter; wakefulness and consciousness. You must be awake to be conscious with the notable exception of dream states where varying levels of wakefulness and consciousness exist. Drugs (anesthetics, sedatives, hallucinogens, etc) can also manipulate wake and conscious states.

Schiavo is not in a coma. In a coma, a person lacks wakefulness and consciousness. These people require respiratory support b/c the respiratory center is located in the brainstem . . . same location as neural pathways that regulate wakefulness. They require nutritional/hydration support b/c the ability to feed requires coordinated activity between cranial nerves and the cerebral cortex . . . the cortex is required for consciousness. This means a person in a coma isn't hungry, isn't thirsty, and doesn't feel pain b/c all of those functions REQUIRE processing by the cerebral cortex. A healthy dose of ketamine (dissociative anesthetic) doesn't do anything for pain but you no longer care and won't remember. In essence, a drug induced form of altered consciousness.

Schiavo is in a persistent vegetative state. In PVS, a person has wakefulness (sleep/wake cycles) but lacks consciousness. Accordingly, she sleeps, wakes up, blinks, may even moan but she is not conscious. She lacks the desire and ability to eat b/c she doesn't know she's hungry. The same is true for thirst. In fact, most if not all neuroscientists would say "she" doesn't know "she" exists.

If Schiavo was existing in a minimally conscious state (MCS); ie some tiny shred of evidence she has some degree of consciousness . . . doctors would manage support withdrawal by providing palliative care (ice chips from dry mouth/lips, analgesics for pain, sedatives for sleep). Pain is NEVER a necessary component of death. Further, the organ failure (renal followed by cardiac) that will cause her death doesn't cause pain. Regardless of what Rush believes, OxyContin was never designed to get people high . . . it's an excellent means of controlling pain. A healthy dose of a barbituate (phenobarbital - seizure medication), not only induces sleep but it can suppress respiration enough to hasten death . . . a good physician knows how to cook up a quality palliative care plan.

Another issue is locked-in syndrome. By definition, these people are functionally, if not fully, conscious. They just lack voluntary motor control with the notable exception of eye movements. There's no way a competent neurologist would miss LIS if that's the appropriate diagnosis for Schiavo. The prognosis would still be poor but it would be immoral to end her life by nutritional/hydration support.

I've been very disappointed by the alleged medical professionals that have misrepresented Schiavo's condition, prognosis, and process of her death. I have no expectation that laypersons like DeLay, the Schindlers, the two Bushes, Lou Sheldon) would understand what's going on. But even a mediocre physician should be in the ballpark.

EDIT: Apparently Schiavo's doctors are taking the easy way out. They are giving her morphine. Opiates are very good analgesics and decent sedatives but they do not suppress respiratory drive . . . which means it's very difficult to kill someone with appropriate doses. I'm personally opposed to using opiates instead of barbituates for end of life care but several busy body politicians/AGs and families have been known to prosecute/sue doctors that help people achieve a "peaceful" death.

I would really like to know what qualifies you to say that she cannot feel pain. I don't feel that it is necessary that I repost my response in another thread, So in summary, I suggest that you read her medical record/observations: Terri's Record. Please read the whole observation, not just half of it.

As I said in the other thread, I recognize that the site linked is a biased site. However, I am not linking it for the personal opinion of the author. The purpose of the link is to provide access to the record according to the doctors, RNs, LPNs, LVNs and CNAs. Again, I have no idea how the author obtained this information. It is sensible to ask how I would know that those records are legitimate. The reason is that the statements made there are consistent with the account of the GAL and the court records. All sources are cited. Hence, I have no reason to doubt it. The subjective portions are implied as such with the sources listed.

As I said earlier, it seems rather scary to me that people, especially laypersons, could affirm the position of neurological studies. There's so much to be learned in this field with contradictory or inconclusive studies. Epilepsy has existed for eternity, yet the neurologists have still not completely understood it. Have you asked an epileptic, especially one of temporal lobe epilepsy, what he feels when he seizes? Yet we seem to affirm that we know the state of the so-called persistent vegetative patients. Here's a link again for a philosophical and scientific discussion on this subject: "Responding to Patients in the Persistent Vegetative State". I think it makes a great and thoughtful read with consideration to competing theories and ideas.

Edit: Here's her discharge summary report from Humana Hospital - Northside, corroborating yet again the other linked entry: Discharge Summary. Official bone scan report.

 

[Gaard]

Isn't it a shame that a judge who ruled according to the law gets asked to leave his church? God must be proud of his followers.

 

[Grunt03]

If she wanted to die, let her die, who are we to question ones wish?
What good will come if she continues to live?

 

[Mokmo418]

I heard that her heart attack that caused the vegetative state was itself caused by an eating disorder...
Could someone clarify this ?

 

Originally posted by: Mokmo418
I heard that her heart attack that caused the vegetative state was itself caused by an eating disorder...
Could someone clarify this ?

It is all speculation. No one knows exactly what caused her collapse and cardiac arrest. The doctors were mystified too, but the closest they could suspect was a low potassium level (i.e., an imbalance of potassium and sodium). Hence, that is why people have been linking it to her alleged eating disorder. She is said to have drunk too much liquid, particularly iced tea. However, the link between the alleged eating disorder and her collapse is speculative--not the official medical diagnosis. Read the discharge summary that I linked to hear it from the horse's mouth.

Oh, by the way, the official statement does not say it was a heart attack. She had a cardiac arrest--not a heart attack.

 

[Yo Ma Ma]

Originally posted by: Gaard
Isn't it a shame that a judge who ruled according to the law gets asked to leave his church? God must be proud of his followers.

Would like to read, have a link?

BTW God is used to this kind of crappiness by now.

 

[preCRT]

The Schindlers wanted to take photographs and video of their daughter before she died, but Michael Schiavo opposed it and...Greer agreed with him

Can anyone explain why her family would want pics & video of her current state, rather than remember her as she was when she was truly alive and healthy, other than to possibly sell the gruesome pics to some tabloid? Make one wonder just how much this was truly all about the money on the Schindlers' part...

 

[0roo0roo]

The sad tale of Terri Schiavo, minus the three ring circus
http://arstechnica.com/news.ars/post/20050325-4737.html
with her brain scan pics

 

[BaliBabyDoc]

There's no reason for me to read Schiavo's medical record (primarily b/c it would be 15 years long). Excerpts from a partisan-hack site have no value to me whatsoever, so why waste my time.

Despite the tripe from the tort reformers, our judicial system is quite good. Medical experts hired by Schiavo testified to PVS, the Schindler "experts" testified to something else, the court appointed experts testified to PVS. Regardless, the FIRST question is would she want to live in this state. The courts have answered that question. The SECOND issue is whether she has the capacity to "experience" pain. It's the cortex that gives sensory input "meaning." In the absence of functional cortex, sensory input has NO meaning. In the outside chance that she can "feel" hunger pain, it can easily be treated as she enters the twilight of her life.