What ensued was a hugely controversial legal battle that landed on the U. If anything, debates about whether, when, and how it is appropriate to end a patient’s life — and about the role that the state should playing in facilitating this — have intensified since then.Readers of will no doubt be familiar with two high-profile cases in the United Kingdom where the parents of infants with bleak prognoses fought to keep them alive.In the window between the persistent and permanent vegetative states, patients can progress to the minimally conscious state (MCS).
In the light of the autopsy findings, i.e., of a commonly observed bone pathology associated with prolonged immobility and bone loss—and all of this noted one and a half decades ago—we find it particularly egregious that Didion, if not asserting belief or disbelief in the accusations, repeated allegations of physical abuse against Schiavo’s husband. In a CNN interview on the day the autopsy results were made public, the chairman of neurosurgery at Emory, Daniel L. D., addressed this point: I think what the autopsy demonstrated …was that there was marked atrophy or shrinkage of the brain.
Clearly Didion’s essay was an expression of a sincerely held view on life, but in the light of the facts, would she now care to modify her advice to doctors and families; or, like the unfortunate young woman’s parents, does she feel she has a sufficient command of complicated neurological conditions to refuse to accept the two pathologists’ findings? And that really serves, I think, as a surrogate for determining the amount of brain damage. Schiavo’s condition as presented in the autopsy findings as “incompatible with any desirable state of existence.” This is not a judgment I would attempt to make, which is by no means to say that I “refuse to accept” the autopsy findings. They neither originated in a courtroom nor ventured to designate “desirable states of existence,” as did so much else in this case.
Briefly, the autopsy findings included extremely severe brain damage, incompatible with any desirable state of existence, and despite modern advances in management, incapable of rehabilitation or recovery. Emeritus Senior Attending Rush University Medical Center Chicago, Illinois D. Schiavo’s brain damage had resulted in a persistent vegetative state, which was in turn “proof” that the decision to withhold food and hydration had been justified.
That she was also cortically blind illustrates the complexities that caring doctors encounter in helping families whose interpretations of brainstem activity are so often based on understandable hope rather than reality. As the pathologists who performed the autopsy stated clearly, the diagnosis of a persistent vegetative state is clinical, i.e., based on observation of a living patient, and so cannot be determined by autopsy.
In that case…a brain-imaging test—once it has been standardized—could help determine whether brain damage has extinguished awareness.”Dr. Schiavo was “sufficiently evaluated by neurologists for the Florida Supreme Court to rule that there was clear and convincing evidence that she was in a persistent or permanent vegetative state,” a judgment “substantiated by the assessment of the independent guardian ad litem, Jay Wolfson, appointed by Governor Jeb Bush.” Jay Wolfson is not a neurologist, but a professor of law and public health at the University of South Florida. Professor of Neurological Sciences Rush University Medical Center Chicago, Illinois My intention was neither to “advance a thesis” nor to give “advice to doctors and families.” I wanted instead to examine the way in which the inflammatory climate surrounding this case had led to a general hardening of convictions based on thin or no evidence.
As for the complaint that questioning “legal authority and received medical wisdom” undermines “the two learned professions upon which society depends,” and so brings about a “weakened civil society,” I would suggest only that the sturdiness of those professions rests not on any presumed infallibility but on their willingness to consider and address the very questions that Dr. To the Editors: Now that the autopsy report on this unfortunate young woman has become generally available, we wonder whether Joan Didion would care to revise the thesis she advanced in her recent article [“The Case of Theresa Schiavo,” NYR, June 9]. Such hardened convictions extend now even to the reaction to the autopsy findings, which were widely received as “proof” that Mrs.
Notations by hopeful families who observe evidence of awareness can be too easily dismissed as wishful thinking or denial.
Such was the case of Terry Wallis, who was in a nursing home for nineteen years following traumatic brain injury before he began to speak. Chief, Division of Medical Ethics Professor of Medicine Professor of Public Health Professor of Medicine in Psychiatry Weill Medical College of Cornell University Director of Medical Ethics New York Presbyterian Hospital–Weill Cornell Center New York City The New York Times piece cited, “New Signs of Awareness Seen in Some Brain-Injured Patients,” refers to Dr.
There is not a clear correlation at all between the size of a human brain and its function….
I think [the extent of atrophy] supports the clinical impression of those who felt that she was in a persistent vegetative state, but it certainly does not prove that.