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March 20, 2005

Comments

Chuchundra:

I agree in part. However, their behavior has gone way past anything excusable in their viciousness toward Michael Schiavo. They can make their pleas without falsely attacking him, but have found it expedient to do so.

hilzoy:

Thanks for the Cruzan cite -- it is an interesting case. Factually, it is very similar to Schiavo although it presents a very different legal issue (since the parents want their daughter to be denied life-sustaining treatment, but the state won't acknowledge their wish). The legal result is also something of a mess since their is no clear majority decision as to the reasoning.

Cruzan indicates that there is a Constitutional right to refuse medical treatment (which would include a feeding tube according to the court). Scalia is the only exception -- he makes the point that the state's right to prevent suicide should include its de facto equivalent of refusing medical care, but no one else accepted this argument.

The case then discusses what procedural obstacles are proper for the state to impose when a surrogate is making the decision (because the patient left no clear written expression on the question). Cruzan upheld the procedure that was also followed in the Schiavo case (clear and convincing evidence standard to determine that the patient would refuse medical treatment, including a feeding tube).

Cruzan creates a very strong argument that the new federal act for Schiavo is unconstitutional since it improperly interferes with the patient's decision to refuse medical treatment that would sustain a vegetative state, as determined by a proper state procedure for adjudicating that wish when the patient is no longer able to express that wish.

Schiavo actually presents the better case for upholding the right to withhold medical treatment, since the issue has been litigated in a highly adversarial atmosphere (unlike the situation in which no one other than the State is resisting the surrogate's indication that the patient would have wanted medical care refused).

Schiavo actually presents the better case for upholding the right to withhold medical treatment, since the issue has been litigated in a highly adversarial atmosphere (unlike the situation in which no one other than the State is resisting the surrogate's indication that the patient would have wanted medical care refused).

This is an interesting point. I'm trying to understand why the adversarial process in this case is considered different from that of Hudson and Nikolouzos, which were also adversarial in nature. I have to imagine that the reason why the Hudson or the Nikolouzos cases do/did not attract the same attention is through a rarified version of the notion of a Calvinistic elect. The fact that the Schindlers (presumably) have the financial resources to care for her, this is indicative that God wants Terry Schiavo to live, but the fact that Hudson and Nikolouzos are indigent indicates that God doesn't want extraordinary measures to be taken. (needless to say, this is not my opinion, but if you scratch the surface, I feel that some sort of reasoning like this would pop up)

I've been googling and found that the term 'terminal wean' for the process of disconnecting life support, but most cases are when the patient can't breath on their own and are removed from the ventilator. Two links that I thought were interesting
This paper by Philip Schneider on Medical Decisions to End Life and this abstract (it is a google cache, the original is behind a subscription wall) with a number of interesting points about critical care. This particularly caught my attention

In the formative period of critical care medicine, physicians felt it was their duty to use all the resources at their disposal indiscriminately and feared legal reprisal if they did not. Families of critically ill patients balked at limitless intensive care and the "life at any cost" maxim. They went to court to save their loved ones from pointless life supporting technology. Then, as healthcare access evolved more toward autonomy, patients and their surrogates evolved to desire "everything done" because it was their right as citizens living in a civilized society. Paradoxically, physicians went to court to save their patients from pointless life-supporting technology.

Being the cynic, I believe that physicians did this more because they were folded into the administrative structure of HMOs, which promoted cost reduction. At any rate, FWIW.

I'm thinking of becoming an elite republican like Tom Delay so that I can believe the following things simultaneously:

Wal Mart's health benefits are adequate and I will accept campaign contributions from them to keep the evil government from forcing them to offer better benefits;

Medicaid and Medicare pick up some of the slack of these inadequate benefits but I, along with Wal Mart republicans, will vote to slash both programs and eventually to destroy them, in the name of God and Ayn Rand;

When Terry Schiavo gets better, and she will, I will simultaneously do the following for her and to her: I will use my pull to get her a job as a greeter at Wal Mart. I will deny her health benefits. I will cut Medicaid and further deny her care. I will use her as a poster child in my fight against greedy trial lawyers and patients in my fight for tort reform. When she suffers a relapse, I will fire her and I will call the cops when she needs to be evicted from her home. I will pray for her. I will contribute one dozen chocolate chip cookies to the $61 bake sale we'll have to pay for her care. I will convince her to change her name to Elian Gonzalez and apply for a special visa to the United States. I will cut Medicaid some more because immigrants are flooding the system. I will impregnate her so that there is a foetus thrown into the mix and thereby further prove that liberals are Godless, murderous filth. I will not let said liberals deny her food and water; nor shall I let the evil ones deny her botulism and mercury. I will rid this country of the Federal court system so that when I begin prosecuting liberals through the Homeland Security legal framework, they have nowhere to run. I will arm Terry Schiavo so that she can protect herself.

So I think that stuff Katherine said about the soul explains a lot of the hoopla of the fervent religious people regarding the story of Terri Schiavo.
But I've put my personal debate on the religious issue on my own blog instead
(For 2 reasons. 1) speaking frankly about my personal spiritual beliefs is nearly tantamount to discussing my views on sex & as such I will only discuss it on my own terms, and 2) I don't want to clutter up this thread further with a religious debate of any type. I would feel awkward about doing either.)

On the topic of Michael Schiavo's "infidelity"... Man, I hope when I get married, my love for my spouse will be so true that I would not vindictively & selfishly think & feel that my spouse, or any loved ones, should give up living life were my ability to live a life be cut short for some reason.
But of course I realize there are those people so jealous that they even go so far as to bully their spouses into promise never to remarry should they be widowed.

If I fall into a medically vegetative state, my wife is permitted to date, etc., but in return I get to send suggestive letters to the young Julie Christie and pursue that relationship as far as possible.

This we have vowed.

John
Write it up as a contract and you'll be set. Bonus points for naming the acts with titles that no one could disagree with.

"Adultery"?

Sorry, try again. Michael Schiavo isn't an adulterer. He's effectively a widower.

Thanks for a great post! I'm linking to you as well, since I've dealt with the issue twice in the last week.

XT

There are quite a few comments here, so if issue I'm going to bring up has been dealt with I apologize.

I'm lazy and have a lot of work to do, so I'm going to just cut and paste an argument from my blog and see what people think about it.

I do not understand how medical care and nutrition are analogous. Medical care comes up when something unusual occurs; without care, the person will die. If we accept the concept of autonomy, we must obey her wishes. But nutrition is an entirely different idea.

Let's compare food and hydration to air. Let's say a person needed a tube to supply air. Would we respect her wishes if she asked to have the tube removed? I would have to guess Hilzoy would say yes. But can we place a bag over her head? Why not? We aren't actually killing her. We are just preventing her from receiving air. And if we believe in autonomy and know she would want to receive no more air, what's the difference?

Maybe the difference is there's a tube sticking into her body and keeping it there violates her right to autonomy while placing a bag over her head has nothing to do with autonomy. But let's say we developed some Star Trek gizmo that allows us to beam the oxygen directly into her lungs. Would that be ok even if she didn't want it? Is the right of bodily autonomy merely about preventing people from sticking things into our body? I doubt it. The idea seems to be rooted in allowing us to make crucial decisions about our life. If we choose to have no more food or drink or even air, even if those necessities could be administered without a single cut, should our wishes be denied?

The truth is, under Hilzoy's analysis, we should be able to place a bag over Terri's head. Yes, she can breath alone, but she wanted to die, and as long as we take no affirmative action to kill her (which is an act that stops the body from keeping up its vital processes), I see no reason to distinguish between removing the tube and placing a bag over her head.

This is an excellent post, with excellent comments. I applaud hilzoy and everybody else in this thread. Including the troll(s) for sharpening the debate.

I must repeat: families decide to remove, or not to insert, feeding tubes all the time, every day in America.

I would really encourage people to think carefully and educate themselves on these issues before they accuse them of doing the moral equivalent of smothering their relatives with a plastic bag.

Food and water are essential to life. So is oxygen. Artificially providing them any of these through a machine is an invasive medical treatment. Not having a plastic bag placed over your head is not a medical treatment.

I see no reason to distinguish between removing the tube and placing a bag over her head.

See Katherine's response directly above. In addition, it is my understanding that regardless of whether you (or any of us) recognize a distinction, the law itself does: the former is considered withdrawal of care and the latter is considered murder, predicated on the difference between passive withholding of invasive care and actively ending another's life.

For myself, as an individual, I would be perfectly happy with the eventual body-death being administered by lethal injection rather than starvation if the law so permitted; I frankly don't see the difference in such a case and, inasmuch as one can regard such decisions as "humane", find the thought of a lethal injection more humane than inexorable starvation. However, this is all subject to the fact that a) this is contingent upon the conclusion, reached by the courts under the auspicies of due process and the Guardian ad Litem, that this is in keeping with Terri Schiavo's wishes; and that b) as an individual or as a member of the body politic, it's none of my goddamn business what happens in this case anyway.

if her cerebral cortex is fluid, why not simply allow for a MRI to confirm? remove the plates in her head and do an MRI to confirm. michael schiavo has exhibited questionable behavior - enough to introduce doubt. i'm all for right to die, i would want to if i was brain dead. but i've had a F***ing MRI for minor back injury. PLEASE GIVE ME ANOTHER MRI BEFORE YOU YANK MY GODDAM FOOD TUBE. [was that so hard?]

if her cerebral cortex is fluid, why not simply allow for a MRI to confirm? remove the plates in her head and do an MRI to confirm. michael schiavo has exhibited questionable behavior - enough to introduce doubt. i'm all for right to die, i would want to if i was brain dead. but i've had a F***ing MRI for minor back injury. PLEASE GIVE ME ANOTHER MRI BEFORE YOU YANK MY GODDAM FOOD TUBE. [was that so hard?]

She has a thalamic implant, to damp down involuntary tremors. Removing the implant requires very specialized surgery, and is tricky enough that bits of its silicon could break off and be left in the tissue.

Then, there would need to be another major surgery to re-install the implants.

I have no idea what the odds are of a person who'se been in a PVS state for 15 years surviving not one, but two, major surgeries.

I have no idea what an MRI would tell you that the current CAT scan hasn't.

Under those circumstances - the risk, and the questionable value of an MRI - I think it would be difficult to find a surgeon willing to perform the procedure. If she died on the table, god knows what her parents would do: sue the surgeon for malpractice, maybe.

As I type these words, the US Congress is preparing to meet in extraordinary session to decide whether to pass a bill granting Terri Schiavo's parents the right to take her case to federal court.

I've heard people saying that the bill just passed is unconstitutional on its face, since it's (constitutionally) a Bill of Attainder. Is this the general concurrence of the lawyers present, or does the fact that the bill only requires de novo consideration by the Federal court exempt it from this restriction?

Anarch: consensus seems to be: no. Apparently a Bill of Attainder involves inflicting a penalty on a person. The argument, at least, is that this bill just provides for yet another venue in which the case can be heard. I think it's arguable that while this is not a penalty, reinserting the feeding tube would be, if she would not have consented to it, since then it violates her liberty interests. I have no idea what to make of a case in which whether or not what a bill provides is a 'penalty' is itself one of the points to be adjudicated, and one must inflict this penalty in order to pursue the adjudication (since otherwise she'll die and the issue will be moot.) My puny knowledge of the law reached an end long before this point; a mere 24 hours ago, I thought that a bill of attainder was a law that singled out a single person.

Katherine:

My question implicitly asked why, if the basis for removing medical care is autonomy, do we limit legitimate means of ending her life to withdrawing medical care? In both the bag over her head case and the taking her off the respirator case we are doing an action that results in her no longer having access to oxygen (which means we are passively killing her). If we believe that she should be able to make decisions about her life, why distinguish between different types of passive ways of doing it?

Anarch:

The law says lots of things. I don't have to agree.

Somewhat off topic, but: this post seems to be #4 if you do a Yahoo search for cerebral cortex liquified.

Ugh.

Nephtuli
if the basis for removing medical care is autonomy, do we limit legitimate means of ending her life to withdrawing medical care? In both the bag over her head case and the taking her off the respirator case we are doing an action that results in her no longer having access to oxygen (which means we are passively killing her). If we believe that she should be able to make decisions about her life, why distinguish between different types of passive ways of doing it?

With this discussion going on in 2 or 3 different threads, I've written stuff that I don't know if I posted, so apologies if this is repetition, but I think this is an artifact of our legal system, which represents our cultural thought processes, in that a sin of omission is less problematic than a sin of commission. Unfortunately, Oregon is the only state that has specifically addressed the issue, which, of course, is being challenged by the federal government.

We have no trouble at all understanding the difference between refusing medical care and killing when the patient can express his wishes. I'm not sure why it suddenly eludes people when the patient cannot, or the patient has done so only in the past.

I'm going to say just one thing about this issue: I'm fairly sure that no one going on about how painful and terrible it is to die from the cessation of nutrition and water has actually had the experience of a beloved go through this in the past year, or in recent years.

Because then they'd know what the f*ck they're talking about.

Of course, if I'm wrong, and anyone here expostulating what it's like actually does have direct experience with a loved one dying this way recently, please feel free to post, and I'll apologize to them.

Meanwhile, I'll go with, along with everything I've read on the subject -- which was mostly some months ago, not this month -- my own personal knowledge of it being peaceful and unpainful, under the proper medication and care, recognizing that this is only anecdote to anyone else who doesn't also have personal experience of someone close to them dying this way.

I sometimes do short posts on my journal when I have nothing much to say to add what's already been said, but where I want to keep various links in one place where I know where to find them and can easily link to them for others.

I meant this entry to be something like that, but then when I started writing it down it occurred to me (how do I know what I really think until I see what I say?) that, given that I don't believe Terri Schiavo can be aware of anything consciously - the part of her that could be aware is gone - while I sympathize with Michael Schiavo's wish to have it ended as Terri would have wished, and think it wrong - very wrong - that Congress should do this to frustrate the agreed-to process of justice, the worst wrong in all this matter is the lies being told to Terri Schiavo's parents.

Granted, and understandably, they want to believe that their daughter somehow may still recover, may still be aware. But it's an act of unbelievable cruelty and horror to tell them lies like this, no matter how much they want to believe those lies. And I suppose the con artists who have told these lies to Terri's parents will likely get away with it - no matter how much grief and misery they cause.

If we believe that she should be able to make decisions about her life, why distinguish between different types of passive ways of doing it?

Because placing a plastic bag over someone's head is no more "passive" than wrapping a cord around their neck and pulling it tight.

On CNN, a nurse named Carla Sauer-Iyer claims that she was Terri Schiavo's nurse from April 1995 to July 1996 with claims of not only swallowing but speech on the part of Terri Schiavo during that time, along with alleged insulin injections by Michael Schiavo. She also claims that the judge's gag order has prevented these facts from coming out. A google yields a huge number of hits on this and google news brings up a few news articles. If true, there is a Roswell like conspiracy, if false, it is the most pathetic ploy (which is really saying a lot)

CNN also just had Pat Mahoney from the Christian Defense Coalition decrying the judge. Interestingly, googling Christian Defense Coalition gets this link that says this:

We Are Equipped to Provide You With Earned Media

When a topic is hot, reporters are told by their editors to cover it (whether they want to or not); talk-show producers must find a guest to speak on this "hot topic." And there are "hot topics" developing throughout the day, every day. If fate ties you to a hot topic, a breaking news item, you will have to beat the press away with a stick.

More often, the case is that you need help making the press recognize a connection between you and a breaking story. That's where we come in--we do it everyday for somebody. Why not for you?

We find a way to make you, your position, your expertise, tied to the hot topic. Then we take you, and your "hot topic" to reporters and news producers who need of what you have. We find a way for you to be the "go-to" guest. We find a way for you to be quoted in newspapers worldwide.

In other words, we get you earned media.

Everyday the beast (the mass media) must be fed. All we do is make you an easy meal for the beast. They use us, we use them.

The website also has a 'Florida Wire Service' Unbelievable.

One last comment on the MRI versus CT controversy: Apparently, Terri Schiavo has had some sort of hardware implanted in her brain. Part of an experimental therapy from what I can gather from various sources (not all necessarily very accurate.) In any case, one absolute contraindication to an MRI is metal anywhere in the body. Put someone with metal in their bodies into an MRI and the metal will either heat up or start rotating. In short, unless the intent is to end this controversy very quickly by destroying Schiavo's brainstem, an MRI is out.

Thanks, Dianne: if true, a not-so-obvious fact that has me wondering why this has not been mentioned more in all the Terri Schiavo brouhaha. I remember that the court report stated that Terri was given "experimental treatment" (unsucessful) in 1994, but wasn't aware that she had any metal bits remaining in her head. Do you have a cite?

Thanks, Dianne: if true, a not-so-obvious fact that has me wondering why this has not been mentioned more in all the Terri Schiavo brouhaha. I remember that the court report stated that Terri was given "experimental treatment" (unsucessful) in 1994, but wasn't aware that she had any metal bits remaining in her head. Do you have a cite?

The main point in all of this is: Who makes the call? I don't get to have a say in whether Terri Schiavo gets continued treatment or not; it's simply NOT MY PLACE. It's not my place; it's not Cella's place; it's not Katherine's place, and it sure as shit isn't Bill Frist's place. Michael Schiavo, the Schindlers and 3rd parties that both have WILLINGLY turned to are the ONLY PEOPLE ON PLANET EARTH who have any business saying ANYTHING about Terri Schiavo's treatment.

Michael Schiavo - the presumptive guardian as husband - actually handed that decision off to the Florida courts, because he and the parents disagreed, and THE COURT decided that Terri would not want continued treatment. No subsequent hearing has altered that basic finding. The rest of us don't get to play Monday morning quarterback on this decision. We simply don't have the right.

"to pass a bill granting Terri Schiavo's parents the right to take her case to federal court"

It's not "her" case. Her case is represented by her husband. It is "their" case.

Jay C: I have to admit, that the first references to the thalamic implants I found were on some random blog sites. I did, however, finally find a statement from her husband which discusses them. Here it is

Now that it's been dealt a setback, DeLay is pissed:
The judge's decision is obviously disappointing. Congress explicitly provided Terri Schiavo's family recourse to federal court, and this decision is at odds with both the clear intent of Congress and the constitutional rights of a helpless young woman. Section two of the legislation we passed clearly requires the court determine de novo the merits of the case - or in layman's terms, it requires a completely new and full review of the case. Section three requires the judge to grant a temporary restraining order because he cannot fulfill his or her recognized duty to review the case de novo without first keeping Terri Schiavo alive.


"Disheartening as the judge's decision is, I know the Schindler family is appealing to the 11th Circuit, and as long as there's still a chance to save Terri, this fight is not over. I firmly believe the circuit court will give the case a full and appropriate review.

Isn't this statement from Delay: "Section three requires the judge to grant a temporary restraining order because he cannot fulfill his or her recognized duty to review the case de novo without first keeping Terri Schiavo alive." make this a bill of attainder if the courts have decided this is against her wishes? Her punishment would be being forced to recieve medical treatment against her wishes. Whether you believe there is conflicting testimony or not? The courts have already ruled on this, thus making the act punishment.


Section 3 does no such thing. It reads:

After a determination of the merits of a suit brought under this Act, the District Court shall issue such declaratory and injunctive relief as may be necessary to protect the rights of Theresa Marie Schiavo under the Constitution and laws of the United States relating to the withholding or withdrawal of food, fluids, or medical treatment necessary to sustain her life.
The judge determined that the suit was likely to fail on merit, so no relief was in order. DeLay's statement is factually incorrect. I'm not surprised.

I'm not surprised either, JerryN. But I believe that DeLay sincerely thinks that the Bill could actually order a District Court to issue such an injunction, regardless of merit. That actually creeps me out much more than the thought of DeLay just being wrong about the facts.

Well, aireachail, that would have been a bill of attainder. I'd certainly hope that someone on DeLay's staff would have explained that to him.

If we believe that she should be able to make decisions about her life, why distinguish between different types of passive ways of doing it?

Because placing a plastic bag over someone's head is no more "passive" than wrapping a cord around their neck and pulling it tight.>>

The two situations are not comparable. Putting a bag over someone's head merely prevents air from entering his mouth. That's similar to taking him off a respirator because in both cases, the action of removing the access to the air leads to the act of omission which is not helping him get air.

Wrapping a cord around someone's neck is preventing the air already in his body from reaching his lungs. That's stopping a natural process which is comparable to shooting someone in the neck, which also prevents the air from reaching his lungs.

I still don't see how putting a bag over someone's head is different than removing a respirator. Let me illustrate by syllogism:

It's permissible to allow someone to die by not acting to save him.
Taking someone off a respirator is not saving someone.
Therefore it's permissible to take someone off a respirator.

My guess is that most people on this blog would agree with both premises and the conclusion.

Now let's apply it to putting a bag over someone's head:

It's permissible to allow someone to die by not acting to save him
Putting a bag over someone's head is not saving someone.
Therefore it's permissible to put a bag over his head.

Obviously both these syllogisms only apply if we believe a person has a right to autonomy that requires us to not save him.

The only argument I can see that differentiates the two syllogisms is that my minor premise (Putting a bag over someone's head is not saving someone) is incorrect. The reason why that might be true is because we would have to act to put the bag over his head. But we also have to act to take a person off a respirator. So what's the difference? Am I misconstruing the everyone's argument?

Here's a better syllogism for you:

It is permissible to allow someone to die by ceasing to interfere in his or her bodily functions
Turning off a respirator is ceasing interference in a person's bodily functions
Therefore, da da da da da da

compare and contrast with:

It is permissible to allow someone to die by ceasing to interfere in his or her bodily functions
Putting a plastic bag over someone's head is not ceasing to interfere in a person's bodily functions
Therefore (exercise for reader)

That is what you are missing.

Oh, for heaven's sake:

I would like to suggest an extension of our voices in opposition to the crimes being committed against Terri. I say we make a strong and symbolic stand. I think we should send food and water BY THE BOXFULLS to the Hospice Center. Keep sending and encouraging people to send until they decide to stop this murder and feed Terri. cite (via the Anchoress)

She can't swallow, people. That's why the feeding tube. Boxfuls of food? Better suggest someone sends a blender, too.

This is beyond grotesque. I hope the hospice can find something useful to do with these food donations. Homeless shelter nearby?

I’m a left liberal Australian; I’m an atheist; I’m in favour of voluntary euthanasia; I’m not bigoted about involuntary euthanasia; but -

No, PVS isn’t that simple or that final. The misdiagnosis rate is huge, the definition is shifty, and the consequences horrendous. Have a look at http://home.vicnet.net.au/~borth/PVS.htm and see whether you disagree with any of it.

I’m not jumping on any bandwagon; the first paper on the site was published in 1995.

Killing Schiavo is fine by me. Hell, being starved to death would be a month in the country compared to some of the things they do to patients labelled PVS. But the price of killing her seems to be agreement to the proposition that people in PVS can't feel pain, which leads inevitably to even more frequent hideous cruelties to the thousands of people diagnosed as PVS who are still hanging around.

I simply have to get this off my chest: I don't believe in God, or Christianity, or any of the rhetoric the conservatives are using to justify the continued torture of Ms. Schiavo. But to use their logic for a moment, and to assume that only "god" can decide when it is time for someone to die -- then it seems to me, that "god decided" Terri Schiavo should die 15 years ago when she went into cardiac arrest, and that "man" took it upon himself to "decide" that she should keep living. To me, that is where the ethical breach happened to begin with, and it is most confusing why no one seems to be acknowledging that.
It also terrifies me to think of myself in this situation. As an adult who has been living with a partner for ten years now, there is no question that my partner knows better what I want than my parents would. And my parents, as born again christians, would most certainly fight against my partner to keep a vegetative me alive, despite the fact that they do not, and have not known me closely, in many years.
Must go now, must write living will. Thank you for letting me voice my measly opinion...it is far from the most important thing said about this tragic situation, but I feel a heck of a lot better having said it. Terri Schiavo, may you one day rest in peace.

My quick 2 cents on Terri Schiavo, and that’s it


What if poor Mrs. Schiavo’s face, the face we see in a small selection of repetitive undated video clips, was contorted into an hideous scowl or panged with horror and fright instead of her current uncontrolled hapless angelic idiot grin? You think there would be the same outpouring of sympathy and interest from the general public in keeping this woman alive?

Hi,
I've just read through your post and most of the comments. I'd like to respond to some things. In the post you wrote:
"In one case, for instance, they testified that she had made a remark supporting their position when she was an adult, but it turned out that she had said it when she was 11 or 12.)"
Actually - she had remarked on the Karen Ann Quinlan case. The judge said she would have been 11 or 12 when that happened as it would have been in the 1970s. However her friend who testified was referring to a conversation in the 1980s. Here's a link (one of many):
Clear and Convincing Evidence.
On the CT scan issue - I don't dispute that it shows severe damage. However you have a person who may be humorous when he/she says they are a neuroscientist and qualified to study the brains of fish and insects then commenting on a human CT scan. Obviously the study of neural ganglia of insects give no adequate preparation for reading the results of a human CT scan. An MRI scan is a standard requirement. Removing the implants is not major surgery - it is a simple procedure. While the CT scan shows damage it does not indicate what function remains. No-one has stated that she will recover completely - however it is plausible that therapy would assist with some function - particularly swallowing. And this is where the information in your post is at odds with other information I have read - you state she had 8 years of therapy. She collapsed in 1990. That same year she was given a brain stimulator and showed improvement. I believe this is the implant you have referred to. This is from Dr. Hammesfahr's report to the court:"Ms Schiavo was in her usual state of good health until 2/25/90, when her husband reported that he was awakened from sleep approximately 6 AM by her falling. He reports that she was unresponsive. Paramedics were called, and aggressive resuscitation was performed with 7 defibrillations en route. In the Emergency Room, a possible diagnosis of heart attack was briefly entertained, but then dismissed after blood chemistries and serial EKG's did not show evidence of a heart attack. Similarly, a pulmonary or lung cause of the disorder was ruled out in the Emergency Room after normal blood gases and Chest X-Rays were obtained. The possibility of toxic shock syndrome was also entertained. The diagnosis of the cause of her condition was unknown. Her admission laboratory studies showed low potassium level, markedly elevated glucose level, and a normal toxic screen without evidence of diet pills or amphetamines. The abnormal potassium level and sugar level were found on admission to the Emergency Room and were successfully corrected by the hospital staff over the next several days. The patient had a difficult hospital course with the development of poorly controlled seizures and prolonged coma state requiring, for a time, ventilator support. However, the staff noted improvement, and it was recommended by several physicians that she be discharged to an intensive rehabilitation center. She was eventually transferred to Mediplex in Bradenton for intensive rehabilitation. She was poorly responsive. However, after a brain stimulator was placed in 11/90, the staff started to report greater interactions of the patient with her environment, including intermittently apparently following commands, turning her head to voice, tracking visually, etc. This pattern continued even after discharge to a nursing home, although her course from that time on included multiple medical problems including recurrent urinary tract infections and hospitalizations, at times with severely low episodes of blood pressure due to a lack of treatment of urinary tract infections ordered by the husband and subsequent urinary sepsis requiring hospitalization. During 1998, she was evaluated by Dr. James Barnhill, neurologist, who testified that he examined her for ten minutes and determined that she had no chance for recovery, and was in a persistent vegetative state."

His whole report is Here

It is disputable that Michael Schiavo was pursuing therapy when in fact he ordered that Terri Schiavo not be treated for a urinary tract infection in 1993. He admitted in his deposition that he ordered that she not be treated as he knew she could die from an untreated infection. Here is an excerpt:
"November 1993
Michael Schiavo Deposition, Guardianship Hearing

Q. What was her bladder condition?
MS. She had a UTI.

Q. What is that?
MS. Urinary tract infection.

Q. What did the doctor tell you treatment for that would be?
MS. Antibiotic usually.

Q. And did he tell you what would occur if you failed to treat that infection? What did he tell you?
MS. That sometimes urinary tract infection will turn to sepsis.

Q. And sepsis is what?
MS. An infection throughout the body.

Q. And what would the result of untreated sepsis be to the patient?
MS. The patient would pass on.

Q. So when you made the decision not to treat Terri's bladder infection you, in effect, were making a decision to allow her to pass on?
MS. I was making a decision on what Terri would want.

Q. Had the bladder condition been treated?
MS. Yes.

Q. And was...what was the reason that the bladder condition was treated?
MS. Sable Palms Nursing Home said they could not do that by some Florida law which wasn't stated.

Q. But you didn't change your opinion or your decision to not treat the bladder condition?
MS. We did change it.

Q. Correct?
MS. Repeat the question.

Q. You did not change your decision not to treat the bladder condition, correct?
MS. I had to change my decision.

Q. Sable Palms changed it for you?
Attorney Nillson Objection

Q. Okay. Is there any reason that you would not make the same decision that you previously made if the problem came up again?
MS. Repeat your question. You're losing me here.

Q. Let me be more specific. If your wife developed another condition that could result in her death, is there any reason that you would not take the position that you're not going to treat that condition and you're going to instruct the doctor not to treat that condition?
MS. I wouldn't instruct anybody, no.

Q. You instructed the doctor not to treat the condition, correct?
Attorney Nillson Objection

Q. You did instruct the doctor not to treat her bladder condition, correct?
MS. Uh-huh. Yes.

Q. If a similar...would you do the same?
MS. I'm thinking.

Q. Take your time.
MS. I probably wouldn't instruct the doctor to do it.

Q. So you've changed your opinion?
MS. Sort of, yeah.

Q. Why have you changed your opinion?
MS. Because evidently there is a law out there that says I can't do it.

Q. Is that the only reason?
MS. Basically, maybe.

Q. What you're telling me is, is that there is nothing in your belief or feelings that have changed. The only thing that has changed is the fact that you perceive the law prevents you to do what you intended to do?
MS. Correct.

Q. What did you do with your wife's jewelry?
MS. My wife's jewelry?

Q. Yeah.
MS. Um, I think I took her engagement ring and her...what do they call it...diamond wedding band and made a ring for myself.

I can't link directly to this. It is available here under court documents. I realise you may not like this site as a source - however I find no reason to question the authenticity of the documents contents. It may be available elsewhere on the web. I have found no documentation that verifies 8 years of therapy. What records show is therapy measures until shortly after the malpractice suit was decided in favour of Michael Schiavo.

I have no interest in pillorying the man or demonising him. However the facts are at odds with your post. I don't have time to continue this comment further unfortunately. I think there is definitely a lack of clear medical consensus on this issue, and the diagnosis of PVS is not at all conclusive.

Catez, my understanding is that of the several doctors who have examined the CT scan, the only two who say that the cerebral cortex is not gone completely (or only shreds remaining) are the two appointed by the Schlinders.

Of those, Doctor Hammesfahr has no credibility in my book - he touts himself as a "Nobel Prize nominee" when he was recommended to the Nobel Prize committee by his Congressman (who is not one of the 3,000 or so people in the world who are able to make Nobel Prize nominations).

Doctor Maxfield's qualifications are not at first glance dubious, but he is not a practicing radiologist: he currently works at a clinic that offers hyperbaric oxygen therapy, a form of therapy that was apparently tried on Terri Schiavo but proved to offer no benefits.

The other doctors, both those appointed by Michael Schiavo and those appointed by the Florida courts, agree that the CT scan shows she has no cerebral cortex and is in a permanent vegetative state - most likely since well before 1996.

Michael Schiavo has been responsible for his wife's care since the heart failure in 1990. I have not, I admit, looked at the full record of what has and has not been done to help her, but I think it significant that in 15 years without any voluntary muscle control, requiring 24-hour care, Terri Schiavo has apparently never had a bedsore. Michael Schiavo is reported to be a headache to nursing home administrators. To me, this says a good deal.

Catez
You raise some interesting points, but there are some problems that I see. The first is that the court documents from the site you list do not appear to be the entire set of documents, especially since the only documents are listed from 2002, with the exception of a 1997 letter and there are no documents from 1993. Several of the documents give a 404 page as well. In googling, the documents seem to be here. However, there is quite a bit of editorial commenting and the pages only say that they are 'excerpts'. Also, it seems that if Michael Schiavo were lying (as the page suggests) he would be guilty of perjury and thus be relieved of his position as guardian. That this hasn't happened suggests that either the excerpts were taken out of context or that they were manufactured.

The second problem is that you started blogging about this issue only 18 Feb, so the perspective that you are offering seems to be driven more by your beliefs rather than a neutral examination of the evidence. The webste's citation of Pease's guardian ad litem report without noting that the points were contradicted by Wolfson's report is also disturbing. As the Wolfson report notes (page 33, all the documents can be accessed through the wikipedia link for Terrie Schiavo), the diagnosis of PVS was previously agreed by both parties (Michael Schiavo and the Schindlers) and it is 'only recently' (presumably around 2003 when the report was submitted) that the argument was made that Terrie was not in a PVS.

I am sure you have the best of motives for making your arguments, but I find the contradictions in what you report and in other sources to weaken your points considerably.

And now the whole thing has just careened out of control. I swear, Congress has lost what remains of its collective sanity.

Firstly, this is from a radiologist who does know how to read CT scans:This is brilliant. He notices a shunt present in the scan. I admit noticing it but didn't pick up on the importance of that. He also observes that cortex is present - quite true. His observations and questions are very good.

http://codeblueblog.blogs.com/codeblueblog/2005/03/csi_medblogs_co.html

Now - so you are the one who googled me eh? Firstly yes I started blogging about it - and the key word is blogging. I'm not writing scientific journal articles on my blog - I'm writing what I want and what I have time to do. Secondly - the date I started blogging on this is irrelevant. Thirdly - the fact that I have personal beliefs does not in any way mean that I cannot look factually at biomedical data or other reports. Some of my posts are more about my beliefs and written quickly. Others take longer and are designed to be factual. Nice try to try dismiss my factual basis - but your comment is irrelevant to the facts I have put forward.
1. There is a serious discrepancy between Judge Greer's decision on the date of the Karen Ann Quinlan reference and the date the witness was actually referring to.
2. There has not been 8 years of therapy.
3. The CT scan is not evidence in itself for a diagnosis of PVS and an MRI should be done. Removal of an implant is not difficult.

The link I've provided in this comment is so far the best medical opinion on the CT scan purported to that of Terri Shiavo. You will note I said purported. The post at the link explains why.

Everyone has beliefs, and I note a number of different beliefs on this comment thread. However I do not dismiss information because some-one has a belief - it needs to be assessed for accuracy and in some cases veracity.


Sorry - I should have hyperlinked it. Here's the radiologists read on the CT scan

BTW - I don't dispute that the site I linked to may not have all the court documents, or may have excerpts of some. However that has no bearing on the contents of the deposition I have referred to in my previous comment. It is quite clear that Terri Schiavo was not treated for a UTI on the instructions of Michael Schiavo, and that he believed this could result in her death. My previous comment links this timewise. 'nough said for now.

It is quite clear that Terri Schiavo was not treated for a UTI on the instructions of Michael Schiavo, and that he believed this could result in her death.

Yes. Michael Schiavo concluded, based on what he knew about his wife - which is thoroughly backed up by independent testimony - that she did not want to be kept alive in a persistent vegetative state. The command "do not resuscitate" is fairly common in such cases. Making the decision to let someone in that state die through witholding medical intervention does not mean that the person who makes that decision does not care about the person in that state.

There's a good timeline here, and a link to Jay Wolfson's report on Terri Schiavo.

Interesting Wikipedia info. It contains this:

Some four dozen board-certified neurologists, including several professors of neurology at major medical schools, all say that Terri's condition should be reevaluated, and that they doubt the accuracy of Terris diagnosis of PVS. Terri's diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. Dr. Peter Morin, a researcher specializing in degenerative brain diseases, with both an M.D. and a Ph.D. in biochemistry from Boston University, reacted with shock when told that Terri had not had an MRI or PET scan. "That's criminal," he said. "How can he continue as guardian? People are deliberating over this woman's life and death and there's been no MRI or PET?" He said that, "a CT scan is useful only in pretty severe cases, such as trauma, and also during the few days after an anoxic (lack of oxygen) brain injury. It's useful in an emergency-room setting. But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke." Dr. Thomas Zabiega, who trained at the University of Chicago, said, "Any neurologist who is objective would say 'Yes'" to the question, "Should Terri be given an MRI?" [21]

And this:

In March, 2005, neurologist William Cheshire, M.D., M.A., F.A.A.N., examined Terri for the Florida Department of Children and Families, and concluded that her diagnosis of PVS is "faulty." [23] (http://www.terrisfight.net/documents/032305cheshire.pdf)

Mrs. Schiavo could be evaluated with a PET scan in her current condition. However, an MRI cannot be done without first surgically removing experimental electrodes which were implanted within her brain in 1992, something which was recommended by the doctor who implanted them, but which Mr. Schiavo has chosen not to do. [24]

With regard to your comment that the Schindlers did ot dispute the PVS diagnosis - I'll check it out. However it is not up to the Schindlers to make a PVS diagnosis. It is a matter of having the correct tests done. That hasn't happened. See the info above.


Catez: He said that, "a CT scan is useful only in pretty severe cases

...which this clearly is, yes?

Also from the Wikipedia: Since 1991, the Schiavos' personal physicians, and six different court-appointed physicians, have concluded that Schiavo is in a persistent vegetative state (PVS). [16] (http://washingtontimes.com/upi-breaking/20050323-051313-8081r.htm)

"Yes. Michael Schiavo concluded, based on what he knew about his wife - which is thoroughly backed up by independent testimony - that she did not want to be kept alive in a persistent vegetative state.

This is not entirely factual. The independent testominy is conflicting - and you are bypassing the discrepancy on the Quinlan reference here. It's an important point.
Secondly, when the order not to administer antibiotics was made by Michael Schiavo he had no court authority to do so - there was not at that time any credence to his claim that his wife would want to die, nor that she would consent to die from sepsis. I say this not to demonise the man but purely on the facts of the case. I would add that there is still no credence to his claim while there is the unresolved discrepancy on what a witness referred to and what the judge assumed had been referred to. That discrepancy should have been addressed in the judicial system.

Because many of you might not otherwise I recommend the following read today http://www.townhall.com/columnists/nealboortz/nb20050324.shtml> Because she’s earned it . Try and get by the first couple paragraphs and finish the article if you will.

The timeline that Jes cites is particularly good, and I would direct attention to the testimony of Father Murphy.

Also, I must raise the point that the radiologist's blog that you link to earlier argues that:
it is my opinion that the most likely reason for these bone scan findings in March of 1991 is that someone either was physically abusing Terri or they dropped/mishandled her severely. Earlier, he suggests that the CT scan is not Terrie's. Just before that, he has this:

Although my take on this case has not been politically oriented, it seems that the lines have been drawn between Democrats and Republicans. As stated by NPR this A.M.: Democrats are coming down hard on the side of pulling Terri Schiavo's feeding tube.

Why are the Democrats so hell bent on killing Terri Schiavo? This is quite baffling. Democrats, who demand life be preserved for
# homicidal maniacs who have low IQ's
# homicidal maniacs who are 17 years old
# sea turtle eggs

How can one simultaneously insist on preserving turtle eggs and not preserving a living woman?

I would be remiss if I didn't note that there is a blog entry for 8 March suggesting that Clinton has AIDS or cancer. This leads me to wonder if this is the best medical opinion concerning this.

We're getting into trickier territory here. Nevertheless, I should say at once: I think there is sound evidence of Michael Schiavo's good will towards his wife, and his care for her. (As Wolfson says in his report, the fact that in thirteen years without voluntary muscle control Terri Schiavo has never had a bedsore says a great deal about Michael Schiavo's fearsome sense of responsibility towards her.) There is no evidence that he was a wife batterer, and some evidence that he is not motivated by financial gain. (He has offered to relinquish any claim to Terri Schiavo's estate if her parents will agree to let her die.)

That out the way: I agree there's an ethical case to be made for letting Terri Schiavo continue to live, even in a permanent vegetative state.

Catez: The independent testominy is conflicting

Her parents disagree with her friends. Of the two sources, I'd say her friends were more likely to know.

Catez: Secondly, when the order not to administer antibiotics was made by Michael Schiavo he had no court authority to do so - there was not at that time any credence to his claim that his wife would want to die, nor that she would consent to die from sepsis

He had no court authority, but he did have the legal authority as Terri Schiavo's guardian. His assertion that in a PVS, Terri Schiavo would want to die, has since been backed up by solid evidence. As Terri Schiavo is in a PVS, she would never know what she was dying of - or even that she was dying.

That aside, I can see why the nursing home disregarded his instructions at that time - for the reasons you outline. My point is that it is unfair to judge Michael Schiavo for making that decision: the courts have independently and consistently found that it was the right decision to make.

Blogbuds: Try and get by the first couple paragraphs and finish the article if you will.

Thanks for the link, the warning :-), and the article. Well worth reading.

Catez: He said that, "a CT scan is useful only in pretty severe cases

Jesurgislac ...which this clearly is, yes?

Catez: I didn't say it wasn't. But why do you pull out one sentence and ignore the context? Useful does not mean conclusive. I quote Wiki on doctors, and you quote Wiki on doctors. As I expected. We could go into each doctor too. This underscores the need for MRI and PET, in conjunction with neurological tests for function - and there should be doctors who are clearly qualified and independent doing these.

I still find no valid refutation of the radiologists read of the CT scan that I provided a link to. So he doesn't like Democrats? Big deal. Show me where his science is at fault. There does seem to be a tendency on this comment thread to look at a persons beliefs rather than the facts they present. Odd.

I can't spend all day here although it is enjoyable. However, I think that a person should not have their gastric feeding tube removed when there are serious and unresolved issues regarding their wishes and diagnosis. It sems to me a simple matter to continue with feeding until testimony on her wishes is clarified, and if necessary the witness recalled, and the standard PVS testing is done.

Catez: But why do you pull out one sentence and ignore the context?

The context is that this is a doctor who hasn't seen Terri Schiavo's CT scan, and is speaking generically about what CT scans can be expected to show. As the CT scan shows Terri Schiavo has no cerebral cortex, an MRI scan to see if the cerebral cortex is functional would seem to be futile, wouldn't it? If it's not there, it can't be functional.

As doctors who are clearly qualified and independent have established that she has no cerebral cortex, it's really kind of pointless to run tests on the non-existent cerebral cortex to see if the tissue that isn't there is functional.

However, I think that a person should not have their gastric feeding tube removed when there are serious and unresolved issues regarding their wishes and diagnosis.

I agree. But this does not apply to Terri Schiavo's case. The "unresolved issues" are those of her parents, and the only good reason I can think of for not letting her die is to allow her parents some time to make their peace with the fact that she is gone from them. On the one hand, they've had fifteen years to do that - but on the other hand, it appears that they have been cruelly lied to by charlatans and con artists.


Her parents disagree with her friends. Of the two sources, I'd say her friends were more likely to know.

Well the testimony which needs to be considered was from a friend. Her firend testifed and gave the Quinlan reference. The judge assumed a date. It was not the date the friend was referring to. See my previous comments and the link to "Clear and Conclusive Evidence". As I said, just one of many links. As to who would be more likely to know - irrelevant, even though it is the testimony of a friend that has been misinterpreted by the judge.

As the CT scan shows Terri Schiavo has no cerebral cortex

Says who? This is highly disputable.

Now - back to the radiologists post. So far rebuutals have consisted of peripheral issues. He clearly demarcates between his read and his suggestions. Show me what is wrong with his read of the CT scan.

I was away from my computer yesterday, and so didn't reply to Catez at the time. However:

First, I did not write that Michael Schiavo had provided eight years of therapy for his wife. I wrote: "Eight years later, after various attempts at therapy and a successful malpractice suit ..." I was moving from Terri Schiavo's collapse to Michael Schiavo's request that the court determine her wishes, and wanted to mention those bits of the intervening eight years that seemed relevant. I did not mean (nor did I say) that the attempts at therapy had gone on for the whole eight years, and more than I meant to imply that the malpractice suit had gone on for all eight years.

Second, about neurologists and the brain scan: I am not a neurologist. This means that I am not competent to read her scan, as I said in my original post. I do know that those neurologists I have spoken to since writing this feel that there is massive loss of brain tissue. I also know that the courts have spent more time than I have (or than I intend to spend) examining the views of neurologists chosen by both sides, and also independent experts chosen by the court, and have concluded that she will not recover. If I were a neurologist, or even a doctor with neurological training, I might be competent to disagree. But I'm not. So I have to rely instead on my views on a question I am competent to answer, namely: given a choice between (a) relying on the fact that a few members of a profession can be found who will say X, where the truth of X is important to a highly charged debate, and (b) relying on the fact that courts charged to discover the consensus opinion in the medical community found that X is false, and were upheld every step of the way, and moreover that when I read the record of the court's proceedings it seems to me thorough and (no pun intended) judicious, which should I choose? I choose (b). Your mileage may vary.

I looked for and found a timeline:

1976- New Jersey’s Supreme Court permits parents to disconnect Karen Ann Quinlan’s respirator.

And then she kept on breathing until 1985. So really, at any time between 1976 and 1985, Terri Schiavo could have made comments about Quinlan in the present tense. But I would have thought that it would be more likely that it would have been in 1976, if the joke was about "what her parents are doing to her". That would make it a comment made when she was nine years old - too young (I would hope) to understand that Quinlan's mind was gone and would never come back.

Catez: Says who? This is highly disputable.

It's not, you know. If you are so uninformed of the medical facts not to know that the medical dissension is really not over whether she has a cerebral cortex, but over what the absence of a cerebral cortex means, then I suggest you do some more thorough reading.

For the record: my last comment was not meant to imply some sort of blind faith in courts. I do not have any such blind faith. I think that a lot depends on the quality of people's legal representation, for starters. If there were evidence that the Schindler's lawyers had slept through the trial, or disregarded important information, I would be worried. But no one has suggested that they haven't received good legal representation. Also, a lot depends on the quality of the judge. Some judges are idiots, in my humble opinion. But having read through the various decisions, I don't think that these judges are. And I also think it's relevant, here, that the various rulings have been exhaustively appealed: that means that it's not just one judge's views that we have to rely on, but a whole bunch of them.

I'm not disputing that there is severe damage to the cerebral cortex (and yes I do know what it is and have handled human brains). However it is erroneous to say that there is no cerebral cortex.

I still find no valid refutation of the radiologists read of the CT scan that I provided a link to. So he doesn't like Democrats? Big deal. Show me where his science is at fault. There does seem to be a tendency on this comment thread to look at a persons beliefs rather than the facts they present. Odd.

I have to say (with a hattip to bbm, thanks for that article) that I don't want Terrie to die or live. I really don't care. I do get upset when people try to adduce that I 'want Terrie to die' because it seems that they are trying to set me up as some sort of bad guy. I duly burrow thru the links, and when you suggest that some post is the best medical opinion for it, and I scroll down and see that hydrocephalus is simply the theory du jour (actually, it is not, the du jour offering is that Terrie's brain injury was caused in the hospital, which one would think would be something that the Schindlers would have brought up) along with the notion that Dems want her dead (if you think about it, the Dems have pretty much backed off and made no statements one way or the other), to observe that juxtaposition is not to simply dismiss the blogger because he doesn't like Dems, but to point out that it is quite possible that the neutral opinion you claim is not really so neutral.

Your blog suggests that you are a devout person, so I would again recommend you read Father Murphy's testimony linked earlier.

As for contrary views of the CT scan, try here. However, my take is precisely as hilzoy, that the court, charged to find a consensus medical opinion, has found this (and the 2nd circuit court noted that It is likely that no guardianship court has ever received as much high-quality medical evidence in such a proceeding.), you have to posit some sort of total conspiracy and I am not prepared to do that.

I note that the Supreme Court has just denied the appeal (and Kennedy apparently referred it on to the full court rather than simply deciding for court on his own and SCOTUS had this for almost 12 hours), so if a conspiracy is the explanation, the Supremes are in on the fix.

Thanks for the replies Hilzoy. You wrote:
I also know that the courts have spent more time than I have (or than I intend to spend) examining the views of neurologists chosen by both sides, and also independent experts chosen by the court, and have concluded that she will not recover.

The issue is not recovery. The issue is that the PVS diagnosis has not been made on the basis of standard testing. It really is not unreasonable to expect that given the serious nature of the outcome of such diagnosis there would be MRI and PET before removal of a gastric feeding tube. Which leads to my reply to Jesurgislac - the issue with the Quinlan testimony is that the witness was not recalled. We can speculate on when it was said, but the point is the witness was misinterpreted. I see no reason to question the credibility of the witness.

And back to Hilzoy - when several judges rule on the same incomplete testimony or incomplete testing then the issues are not dealt with. It's well known that this happens in cases. The number of judges does not change any of the following:

1. Testimony regarding Terri Schiavo's wishes has been misinterpreted and the witness has not been recalled.
2. Standard testing for PVS has not been done. On the basis of a disputed CT scan she has been diagnosed PVS.

Some comments on those points from me. In reality there is no living will. There is conflicting testimony regarding her wishes. This testimony is really heaarsay. As it conflicts it brings the issue back to square one - Terri Schiavo's wishes are not known.

That leads to the PVS diagnosis. This is an incomplete and therefore disputable diagnosis. MRI and PET in conjunction with neurological tests for function would resolve this issue.

Given that these issues are outstanding, there should not be removal of the gastric feeding tube.

Catez: However it is erroneous to say that there is no cerebral cortex.

No, it's not erroneous to say that. The space in her skull that would be occupied by a cerebral cortex in a normal healthy brain has been shown, via two CT scans, to be full of liquid. There is apparently some solid tissue left, but not much, and nothing to say whether it's shreds of cortex tissue or scar tissue.

I can think of two or three ways to make an ethical case for not letting Terri Schiavo die even though she has no cerebral cortex. But to make them, it's necessary first to accept the fact that she doesn't have a cerebral cortex. No mind. No memory. No sensations - if there is anything left in her skull that is her, she cannot feel, see, hear, taste, or smell, because one of the functions of the cerebral cortex is sensation. If Terri Schiavo's ego or soul or whatever remains (I am not going to argue one way or the other) she has been unable to experience anything, except possibly pain, for fifteen years, and unable to move a muscle of her own volition in all that time. Without mind or memory, this might not be as awful as it feels to us, who have both: the ego or soul hypothesised would neither be able to remember the past nor anticipate the future. It would all be one neverending now of non-sensation.

To liberal japonicus: I have not put forward my personal beliefs on this comment thread. It seems very important to you to mention them. I admit this is irritating me a little because it seems that you are not up to a factual discussion. I am not interested in reading Fr. Murphy's blog. I came here to talk about the facts of the case.

Jesurgislac (that is difficult to spell correctly when typing fast - why such a convoluted handle?) we could disagree all day. I hold it is erroneous to say there is no cerebral cortex. You may not like the views of the radiologist but no-one has yet to dispute his read of the scan. Once again the argument turns to beliefs and peripherals. Although I must say to you personally I've enjoyed the discussion. As I've said, MRI and PET would resolve the issue.

To Hilzoy: I can appreciate trying to condense 8 years into something concise. Yhe malpractice suit went on for approx. 2 years and was settled in 1992. Shortly after that therapy was denied.

An aside - there seems to be agreement that Michael Schiavo should not be demonized. However it is evident from some comments that this same principle is not extended to the Schindlers. Not a consistent approach.

Catez: I can only direct you to the various opinions I've seen (e.g., here and here, to the effect that a CT scan tells us whether tissue is present or absent; that when tissue is present, an MRI can tell us what's up with that tissue; that for this reason an MRI is extremely useful in diagnosing PVS in patients whose cortex is still there but possibly not working; but that it is unnecessary in patients whose cortex is largely gone, since obviously if it's not there, it won't be functioning.

Catez: Jesurgislac (that is difficult to spell correctly when typing fast - why such a convoluted handle?)

Every time this comes up I tell myself I should do a post about this on livejournal and then just link to it. Then I never do, because it always seems so egotistical unless someone asks. It's Je Surgis Lac, technically (an almost-anagram, in French, of my real name) but I never mind anyone shortening it in any direction - "Jes" seems the standard. At the time, it seemed like a good idea to have a username that no one could mistake for anyone else's and that was clearly unique. But it is complex to type, and rest assured, I don't hold it against anyone if they misspell it or shorten it for convenience. ;-)

Catez: You may not like the views of the radiologist but no-one has yet to dispute his read of the scan.

Huh? That read of the scan has been formally disputed.

"Although the physicians were not in complete agreement concerning the extent of the daughter's brain damage, they all agreed that the brain scans showed extensive permanent damage to her brain. The only debate between the doctors was whether she had a small amount of isolated living tissue in her cerebral cortex or whether she had no living tissue in her cerebral cortex." -June 6, 2003, 2nd District Court of Appeal, Florida. (Emphasis mine.)

Indeed, as far as I know, no other medical opinion agrees with Doctor Maxfield's read of the scan: most of the medical experts whom the Schindlers got to give an opinion didn't refer to the scan at all.

Jes, I'm referring to the radiologist post I linked to. Although I also have in mind the large number of specialists who are saying an MRI should be done. It does keep coming back to that.

Hilzoy - I've looked at Rivka's and realise I've read it before. I'm not convinced by it. Interesting to note that in rebutting Hammesfield there is reference not to complete absence of cortex but to atrophy. I haven't checked the other - but the problem is that the CT scan opinions are disputable. I really do not understand the resistance to MRI and PET. Any scientist knows that no result is still a result, i.e. if what is proposed is correct and there is no cerebral cortex it will be evident from the MRI. And if there is cerebral cortex - which I hold - that will show. I do not find any compelling argument for not conducting standard tests for PVS. As I said - I do not understand such strong resistance to them being conducted, in conjunction with neurological testing for function.

Gotta go now.

Jes, Google translates you as "I emerged lake."

The pen of my aunt is in the garden.

To liberal japonicus: I have not put forward my personal beliefs on this comment thread. It seems very important to you to mention them. I admit this is irritating me a little because it seems that you are not up to a factual discussion. I am not interested in reading Fr. Murphy's blog. I came here to talk about the facts of the case.

I admit that I do not have the legal or the medical background to evaluate the evidence. I think it is important to note that apparently, you do not either. I have provided links to factual data and have noted that your sources selectively choose data. Also, the Father Murphy link is not to a blog, but to testimony given to a judge in this case. He notes that Terrie could not be considered to be a practicing Catholic, which is significant, since the main thrust of the Schindler's attorney has been to argue that given Terrie's Catholic upbringing and beliefs, she would not agree to have the feeding tube removed.

I would suggest that the 'facts' in this case are not as clear as you claim them to be (especially since PVS is a diagnosis based on a clinical examination as the Multi Society definition points out. It is:

Definitions. The vegetative state is a clinical condition of complete unawareness of the self and the environment accompanied by sleep-wake cycles with either complete or partial preservation of hypothalamic and brainstem autonomic functions.

Criteria. The vegetative state can be diagnosed using the following criteria. Patients in a vegetative state show:
•No evidence of awareness of self or environment and an inability to interact with others;
•No evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli;
•No evidence of language comprehension or expression;
•Intermittent wakefulness manifested by the presence of sleep-wake cycles;
•Sufficiently preserved hypothalamic and brainstem autonomic functions to permit survival with medical and nursing care;
•Bowel and bladder incontinence; and
•Variably preserved cranial nerve (pupillary, oculocephalic, corneal, vestibulo-ocular, gag) and spinal reflexes.

The persistent vegetative state can be defined as a vegetative state present at 1 month after acute traumatic or nontraumatic brain injury, and present for at least 1 month in degenerative/metabolic disorders or developmental malformations.

The permanent vegetative state means an irreversible state, a definition, as with all clinical diagnoses in medicine, based on probabilities, not absolutes. A PVS patient becomes permanently vegetative when the diagnosis of irreversibility can be established with a high degree of clinical certainty, ie, when the chance of regaining consciousness is exceedingly rare.

Diagnosis of PVS. PVS can be diagnosed on clinical grounds with a high degree of medical certainty in most adult and pediatric patients after careful, repeated neurologic examinations. The diagnosis of PVS should be established by a physician who, by reason of training and experience, is competent in neurologic function assessment and diagnosis. Reliable criteria do not exist for making a diagnosis of PVS in infants under 3 months old, except in patients with anencephaly. Other diagnostic studies may support the diagnosis of PVS, but none adds to diagnostic specificity with certainty.

You have conceded that recovery is not an issue, so you are arguing that Terrie Schiavo exists in some in between zone where she cannot recover, but nonetheless is not in PVS.

I would also note that there are apparently 10,000 to 25,000 adults and 4,000 to 10,000 children live in PVS in the United States. If she is in a PVS (realizing that you, contrary to all of the court appointed physicians disagree) and these doctors can help them, why have they not helped these other patients? (please note that the link presents an argument for supporting PVS patients. I neither agree or disagree, I just feel that this is a private matter. I could understand both courses and I would not be able to judge one better or worse than another.)

You also claim that the Schindlers are being demonized, but I don't see where you are getting that impression. Perhaps quoting would clear that up.

Catez: Although I also have in mind the large number of specialists who are saying an MRI should be done. It does keep coming back to that.

Well, yes. But then, those specialists have not looked at the CT scan. As has been said numberless times: the point of an MRI is to determine if the brain tissue is functioning. When the CAT scan determines that the cerebral cortex tissue is not there (or at most, mere shreds) there is no point in having an MRI to determine if the tissue which is not there is functional or not.

if what is proposed is correct and there is no cerebral cortex it will be evident from the MRI.

Why do you think that? That there is no cerebral cortex is evident from the CT scan. Those who dispute the evidence of the CT scan have no reason not to also dispute the evidence of the MRI.

I do not find any compelling argument for not conducting standard tests for PVS.

Nor do I. Nor do I see any compelling argument why you ignore the fact that those tests have already been carried out, and Terri Schiavo is in a permanent vegetative state according to those tests. Why do you think those people who are ignoring the evidence of the tests that have already been carried out, would any more readily accept the evidence of fresh tests? It would appear that the only consistent attribute on this side is the willingness to ignore or claim as "disputed" all evidence that shows Terri Schiabo is in a permanent vegetative state. I see no reason why this willingness to ignore the evidence should end when more evidence is provided: it never has before, why should it change now?

An aside - there seems to be agreement that Michael Schiavo should not be demonized. However it is evident from some comments that this same principle is not extended to the Schindlers. Not a consistent approach.

In comments here? Where? The worst I can find is someone calling the Schindlers' diagnosis of Terri pathetic. Hardly demonization, especially compared to the "Michael is an unrepentant cad who wants to murder his estranged wife for money" meme, which I have encountered in spades on other sites, despite the wide availability of information that casts doubt on several of these assumptions.

Is the Constitution worth a damn anymore? This is a dispute between two parties in Florida, it is a case for the Florida courts only. The Federal Government has absolutely no jurisdiction over this case. Period. Having the President speak on this matter, or having the Congress or Supreme Court rule on this matter, makes a mockery of everything this nation once stood for. Individual rights. There are over 30,000 other cases exactly like this one each year, yet people have become fanatical about this, a woman and her kids even broke into her hospital room to try to feed her and were arrested to cheers by protesters outside. Is this what we have come to as a society? The media, the government, and those buying into their hyper-propoganda should be ashamed. If we still followed the Constitution we would not be having this debate, it would be a matter for the courts of Florida to decide and to try to make Terri's husband and her family agree.

I think that man is HORRIBLE !!!!! He should die not her. Starving someone is the worst thing to do. Especially to her. I Support everyone that is helping her. Our government is suppose to be stopping unconstitutional acts!! Well this is one of those acts. How can you decide sombody's that can't think, or do anything for herself. This must be STOPPED !!!
God Bless Terry !! <3<3<3<3 Sorry for her family

I totally understand that if I'm unable to make decisions for myself, that it's up to my "next of kin". That is how it should be. No law should change that. I understand why the courts are ruling the way they are except for the fact that her husband (who is the one making the call here - correct?) has waited several years to "honor her wishes". If he were truly all about honoring her wishes, would she be on the front page of the newspaper right now?

I could go with the scenario "this woman's heart stopped for 15 minutes and a week later she was dead". What's so hard to understand is why after all this time I'm supposed to believe that *now* he's honoring *her* wishes. Seems to me he's only been honoring his own wishes all along.

It's barbaric to murmur a disabled human being by starvation for so many days in order to free carer's responsibility. Starvation can kill any human being if it lasts long enough, regardless whether the person is disabled or not. Such precedent can lead to genocide-type of murdering of elderly suffering from strokes and children from cerebral palsy. The legal system and social attitude supporting such messacre is reflective of uncivilization inferior to a third word country. How hypocritic it is to see someone being punished for cruelity towards animal but not for murdering a disabled human being.

Just to be clear, once again: the courts have found that Terri Schiavo would not have wanted to be kept alive. Their ruling has been upheld repeatedly. This is about her wishes. And it is not murder, but withholding treatment to which the patient, according to the courts, would not have consented. And it is certainly not unconstitutional.

The alternative is to say that even when there is clear and convincing evidence of a person's wishes, that person can be kept alive against those wishes by having surgery forced on her.

This comment should be shared by both Hilzoy and Michael Schiavo: I was so pleased to see that you included a disclaimer when you referred to Ms. Schiavo's brain as a "balloon bobbing around in there." What kind of trip are you on? I have never read such an arrogant piece of trash in my life. Now that I have aired my extreme irritation with your pompous attitude, I do have a few comments of my own to make. When Michael Schiavo petitioned the courts to remove his wife's feeding tube, he didn't simply request THEIR opinion. He petitioned for the courts to allow the tube to be removed. You chose your words very carefully when you stated that he petitioned the courts for their opinion on what Terri would have wanted. Don't you find it interesting that Mr. Schiavo didn't come forward with this revelation until 7 yrs. after her collapse that Terri said she didn't want to be kept alive. It appears that at some point along the way Michael got tired of this "burden" and decided it was time to move on. Indeed, he had already moved on in his own life when he chose to pick a new "wife" to shack up with and have a family with. How inconvenient to still be strapped to the old wife! My irritation with this joker is that HE doesn't want the old wife but he won't give her up to the people who TRULY love her and would welcome the burden in their lives. How selfish of Michael Schiavo! And how CRUEl of him to STILL limit the amount of time he allows her parents to spend with her knowing that they have so little time left with her! I was appalled to see some chick (friend of Michael Schiavo) interviewed by Greta on Fox news tonight. SHE was allowed in the room last Tuesday as a friend of Michael Schiavo. SHE DIDN'T EVEN KNOW TERRI!! What is going on here when she is allowed to take up precious visitation time that the Schindler family could be spending with their daughter? I am disgusted by the entire Schiavo crowd. I don't know what control game he is playing but I'm not buying any of it. The icing on the cake was his recent appearance on Larry King when he told Larry that "I really shouldn't have to be here trying to explain my side to everybody. I should be in my wife's room holding her hand and comforting her." Which wife, Mr. Schiavo? I'm confused. This woman was not on a ventilator or being kept alive by machines. I have never heard of a feeding tube referred to as an extraordinary means for keeping someone alive. What was the big damn rush, Schiavo????

Here are my questions: 1)Why can our they do this to her... but when Jack Kevorkian did it they put him away?... and 2)Who puts away those who put people away, when they commit crimes? I don't usually keep up with alot of the BS that is in the media... but this Terri Schiavo situation absolutely burns my a*s, and I know that I am not the only person who feels this way! Can you believe that they arrested a 10 year old boy and two 13 year old girls for TRYING TO GIVE HER WATER?!?!? I'm sure it isn't just me here but I've always been taught the notion of preserving life, and this, to me, is just crazy. It is starving someone to death... just today I read on Yahoo! that her eyes and her mouth are bleeding... and her husband wanted to... comfort her through THAT... I'm not sure here... I mean I've never been starved or intentionally dehydrated but I'm sure that wouldn't feel too nice regardless of my physical or mental conditions.

Here are my questions: 1)Why can our they do this to her... but when Jack Kevorkian did it they put him away?... and 2)Who puts away those who put people away, when they commit crimes? I don't usually keep up with alot of the BS that is in the media... but this Terri Schiavo situation absolutely burns my a*s, and I know that I am not the only person who feels this way! Can you believe that they arrested a 10 year old boy and two 13 year old girls for TRYING TO GIVE HER WATER?!?!? I'm sure it isn't just me here but I've always been taught the notion of preserving life, and this, to me, is just crazy. It is starving someone to death... just today I read on Yahoo! that her eyes and her mouth are bleeding... and her husband wanted to... comfort her through THAT... I'm not sure here... I mean I've never been starved or intentionally dehydrated but I'm sure that wouldn't feel too nice regardless of my physical or mental conditions.


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General : Terry Schiavo y el derecho a la vida.
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From: Hugo (Original Message) Sent: 3/26/2005 8:38 AM

Terry Schiavo .

Robot es llamada la máquina.
Eliminar las Baterías .
Ya no la pueden programar.
Se escapo de sus almas.
Un reloj que suena .
La sangre que corre por todo
su cuerpo.
No somos dueños de nuestro
propio destino.
Un cuerpo.
Una marioneta .
Altos Tribunales.
Deciden el destino .
En juego: La vida .
Por Que?
Opiniones divididas.
Ver al vecino de frente.
Hay que desechar la chatarra.
Comentarios de algunos.
Hay que darle sentido a la vida.
Comentarios de otros.
Una apuesta de casinos.
Las cartas.
El Rey es el que manda.
Sus Padres.
No tienen derechos.
Criar a la criatura.
Formarla y llegar a ser adulta.
Quieren quitarles un pedazo de
carne.
Por Que?
El reloj de Arena.
Caen los segundos,
Caen los minutos,
Caen las horas,
Caen los días.
Un mensaje de un hombre.
No la dejen morir.
Permiso amigos.
Quiere vivir.
Y dejemos que salga el Sol .

Un Poeta Ingenuo de Venezuela.
Reflexionar antes de que sea tarde.

Hugo A Valecillos La Riva.


[email protected]
[email protected]






Don't Forget.


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General : Terry Schiavo y el derecho a la vida.
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Prev Discussion Next Discussion

Reply
Recommend Delete Message 1 of 1 in Discussion

From: Hugo (Original Message) Sent: 3/26/2005 8:38 AM
Terry Schiavo .

Robot es llamada la máquina.
Eliminar las Baterías .
Ya no la pueden programar.
Se escapo de sus almas.
Un reloj que suena .
La sangre que corre por todo
su cuerpo.
No somos dueños de nuestro
propio destino.
Un cuerpo.
Una marioneta .
Altos Tribunales.
Deciden el destino .
En juego: La vida .
Por Que?
Opiniones divididas.
Ver al vecino de frente.
Hay que desechar la chatarra.
Comentarios de algunos.
Hay que darle sentido a la vida.
Comentarios de otros.
Una apuesta de casinos.
Las cartas.
El Rey es el que manda.
Sus Padres.
No tienen derechos.
Criar a la criatura.
Formarla y llegar a ser adulta.
Quieren quitarles un pedazo de
carne.
Por Que?
El reloj de Arena.
Caen los segundos,
Caen los minutos,
Caen las horas,
Caen los días.
Un mensaje de un hombre.
No la dejen morir.
Permiso amigos.
Quiere vivir.
Y dejemos que salga el Sol .

Un Poeta Ingenuo de Venezuela.
Reflexionar antes de que sea tarde.

Hugo A Valecillos La Riva.


[email protected]
[email protected]






Can you believe that they arrested a 10 year old boy and two 13 year old girls for TRYING TO GIVE HER WATER?!?!?

Um, you know, this shouldn't need to be pointed out, but SHE CAN'T SWALLOW, WHICH IS WHY SHE'S BEEN BEING FED THROUGH A TUBE. If she could swallow water or food, do you think she'd have had a gastric tube in the first place? Pouring water in her mouth would drown her, which is pretty much attempted murder. Perhaps this ten-year-old boy and two thirteen-year-old girls should have been in school, learning some common sense.

hilzoy, your post must have been linked to somewhere with some real deep thinkers.

How gutless. Using your 10 year old kid, not mature enough to understand the real issues underlying this story, to 'take water to Terri'. Way to go Mom and Dad. Your kid is in handcuffs now because of you and your "mission". He ought to be out playing with his friends.

What a sickening spectacle outside that hospice. Those 'righteous' folks sitting in their lawnchairs with their "Save Terri" signs or "praying" for Terri-- They're taking so much interest in a person they don't even know, but they can't be troubled to spend quality time with, or even just talk, to their own children, or be kind to their neighbours. I can't think of anything else that better illustrates what is wrong with America today.

I believe in the Terri schiavo case. That the feed tube should have never be taken out. Her husband has moved on with his life and should never ever be able to make a decision in his wife's care when a lot of people believe that he don't care at all of his wife. When a person stands by his wife until he gets money for her behave and don't even try to get her rehibiallation after he gets money for her. Puts her in a hospice to die. Then he should'nt have the right to ever decise about her care. I as a human being would not even treat a animal like this women is being treats. I have never seen the law stand behind a man to allow this man to let him kill his wife. Which are people that we are suppose to trust on putting killers away is allowing this man to kill. What kind of country are we living in I thought are country is suppose to stand up and do what is right. In this case I am so disappointed in my country.

THANK YOU

I also wanted to add the this country wants people to where there seat belt and to not commit suicide. When some people don't want to where seat belt and don't want to live but, a women that might want to live and the only way that they don't think she does not want to is because of her husband. That is not a very good husband at all. Is being sentenced to death by no food and no water. I bet if it had to do with the someone getting money and could hand out a parking ticket or a seat belt ticket and make money off this case they would be stepping right in. For Terri's life.

In comments here? Where? The worst I can find is someone calling the Schindlers' diagnosis of Terri pathetic.

There are commenters on other sites (Washington Monthly leaps to mind) who've referred to the Schindlers as "pathetic whiners" or something of that sort, but they're few and far between. I tend to agree that the Schindlers are being pathetic but it's not a contemptuous view of them; rather, I feel deep sorrow towards a family so desperate have their daughter back that they'll cling at even imaginary straws. One could argue, as I occasionally do, that the best thing about letting Terri's body die is that it will finally force her family to come to terms with their loss, and with their grief.

sandra: I as a human being would not even treat a animal like this women is being treats.

Oh, GIVE ME A BREAK. A companion animal in the same state would have been allowed to die long ago, most likely euthanized by lethal injection, not kept on life support for years at a cost of hundreds of thousands of dollars. An animal would not have gotten a lengthy serious of court battles. Jeb Bush and Congress would never have interceded on behalf of an animal.

We regularly use dogs and cats in medical experiments in this country, to say nothing of countless small animals such as mice, guinea pigs, and rabbits. There are puppy mills set up for the explicit purpose of providing an endless supply of test subjects for medical research -- research like that which has helped keep Terri Schiavo alive for the past 15 years. Researchers induce conditions like Terri Schiavo's in these animals so that they can study them and test therapies. Don't try to tell me that Terri Schiavo getting a peaceful death is an atrocity compared to what we do to animals in this country, because you are only going to end up looking really uniformed.

And for the record, I'm not trying to make a point on the subject of animal research right now, other than to say that the comparison to the way we treat animals, which I see made over and over again in these discussions, is completely off-base. Even as she is dying she is being treated far better than most animals ever will be.

i think that it is untollerabel too put this woman under this kind of misreary. she should be put down no one with any kind of sence would want to live with a non-functional brain

In America it appears that Liberalism means death for the weak and those who cannot speak for themselves. The arguement goes like this. The Liberal says that if you cannot speak and appear to be unresponsive you are a ‘vegetable’ and as a ‘vegetable’ you should die, because no Liberal would want to live as a ‘vegetable’. The Judges say that the way to kill you is to starve you to death, this is OK because you are a ‘vegetable’ and ‘vegetables’ have no rights. Husbands can order the death of ‘vegetables’.
Now stangely in America the right wing who often advocate the death penalty for wrongdoers say that ‘vegetables’ have the right to life, whereas Liberals says these people have the right to life and oppose the death penalty. Strange world

Well, it appears one more person has failed to read the thread or educate themselves on the basic facts of the case, preferring to let loose with a drive-by, posting-rules-violation-ridden diatribe for the pleasure of reading their own words.

Sarah, the question is not whether she is suffering, but whether we can know with confidence whether she would want to be kept alive in a PVS. It is Terri's call, and the process that has taken place has been with the purpose of determining and ultimately carrying out her wishes.

And Ken, first, this debate does not delineate neatly into liberal and conservative camps. Neal Boortz supports the withdrawal of food and hydration and Ralph Nader has reportedly called for the tube to be re-inserted. As much as you may want to demonize the left over this, you'll have to demonize much of the right as well, since this crisis has driven a big fat wedge between libertarian-leaning and fiscal conservatives and their socially-conservative brethren. And even that is a simplistic breakdown of the matter.

The remainder of your comment is largely fact-free. As such I'll only suggest that you actually read some of the arguments on the liberal side of the political spectrum, starting with hilzoy's excellent posts on the subject. What I believe you will find is a strong argument in favor of personal autonomy, in support of a painstaking fact-finding process, and against abuses of legislative and executive power. What you will find in short supply are arguments of the sort that you have characterized in your comment here.

Ken Dixon: if you can find one place where I have ever, in my life, said something like this: "if you cannot speak and appear to be unresponsive you are a ‘vegetable’ and as a ‘vegetable’ you should die, because no Liberal would want to live as a ‘vegetable’." -- I will personally eat several hats, prepared as you see fit, video the entire thing, and post it to this weblog.

hilzoy: Does it count if I falsify the record? 'cause I have to admit, I really really really want to see that ;)

'cause I have to admit, I really really really want to see that ;)

Pervert!

i did a statistical study to figure out if there is a significant and quantifiable correlation between political denomination and the an individual's opinion in the Terri schiavo's case...

check out the results

http://best.modblog.com

i did a statistical study to figure out if there is a significant and quantifiable correlation between political denomination and the an individual's opinion in the Terri schiavo's case...

check out the results

http://best.modblog.com

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