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Schiavo was not the object of heightened clinical scrutiny.She was the object instead of heightened legal scrutiny.First and foremost is the newness of the diagnostic category.
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.
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.
Though his family believed that he was aware, their requests for more complete neurological assessment were dismissed. Schiavo was misdiagnosed does a disservice to some minimally conscious patients who, in contrast to the permanently vegetative, may harbor the potential for additional recovery. Fins in the following two passages: “This study [by a team of neuroscientists in New York, New Jersey, and Washington, D.
It seems likely that he migrated from the persistent vegetative state into the minimally conscious state before it became permanent. More nefariously, these conflations may engender false optimism for families who have loved ones who will remain permanently unconscious while fostering a therapeutic nihilism for the minimally conscious who might be helped. C.] gave me goose bumps, because it shows this possibility of this profound isolation, that these people are there, that they’ve been there all along, even though we’ve been treating them as if they’re not,” said Dr.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.In the window between the persistent and permanent vegetative states, patients can progress to the minimally conscious state (MCS).In those settings, the power of the initial—authoritative academic—diagnosis may be difficult to overcome in the face of episodic and inconsistent evidence of self, environment, or others which is characteristic of MCS.He observed that medicine and the law were “united in common quest, the quest for the rule of order, the rule of health and disease, to which for individuals as a society we give the name of law.” Ethical discernment must begin with the clinical facts, lest misinformation augment the heartache of families touched by severe brain injury.Although my comments were taken out of context, they do point to the sad fact that there is the potential for patients who are minimally conscious to be misdiagnosed because of systemic barriers to proper assessment.When the standing of the courts is questioned and clinical diagnoses are perceived as value choices and not the evidence-based assessments they are, civil society is weakened.Benjamin Cardozo summed this up in a talk to the New York Academy of Medicine while still Chief Judge of the New York Court of Appeals.