Wednesday, February 3, 2010

Terri Schiavo And A New Study That Looks at the Vegetative State.

One study, three sources. I'll spend more time analyzing the study tomorrow but in the meanwhile, let's use the case of Terri Schiavo and see how each publication addresses the study. I'll also track down commentary at pro-life blogs tomorrow to see how the study is discussed.

The research inevitably raised questions about patients such as Terri Schiavo, the Florida woman in a persistent vegetative state whose family dispute over whether to discontinue her care ignited a national debate over the right-to-die issue that eventually led to congressional intervention. Schiavo's brother, Bobby Schindler, said the new study highlights the limits of medicine to provide an accurate diagnosis.

"They are completely unreliable," Schindler said in a telephone interview. "I wish this could have been used on my sister to see what could have been done to help her."

But Owen, Schiff and other experts stressed the research does not indicate that may patients in vegetative states are necessarily aware or have any hope of recovery. Many, including Schiavo, have suffered much more massive brain danger for far longer than the patients in this study.

"In some cases, the damage to the brain is so severe that it is simply inconceivable they could produce any responses," Owen said.

As many as 20,000 Americans are in a vegetative state -- meaning they are alive and awake, but without any sense of awareness, while 100,000 to 300,000 are in a related condition known as a minimally conscious state, in which they exhibit impaired or intermittent awareness.

Seattle Post Intelligencer:

They also noted that the positive signals appeared only in people with traumatic brain injury - not in patients whose brains had been deprived of oxygen, as can happen when the heart stops. Terri Schiavo, the vegetative woman at the center of a national controversy before her feeding tube was removed and she was allowed to die in 2005, suffered oxygen deprivation.

The new work, published online Wednesday by the New England Journal of Medicine, came from researchers in Britain and Belgium. One author is Dr. Steven Laureys at the University of Liege in Belgium. He made headlines in November by showing awareness in Rom Houben, a 46-year-old man who had been diagnosed as being vegetative for 23 years. (Houben was excluded from the new study because he could not keep his head still enough in the brain scanner to produce a usable scan; his awareness was revealed by bedside behavioral tests).

The New York Times:

Nor does the finding apply to victims of severe oxygen depletion, like Terri Schiavo, the Florida woman who became unresponsive after her heart stopped and was taken off life support in 2005 during an explosive controversy over patients’ rights.

Moreover, experts said the new test was not ready for wide use as a diagnostic tool; serious technical challenges remain to be worked out.

Still, the experts agreed that the new study exposed the limits of the current bedside test for diagnosing mental state: checking whether patients’ eyes can track objects, and carefully looking for any signs — eye blinks, finger twitches — in response to questions or commands.

“I’m convinced as an observer that in these few cases, the M.R.I. technique, in these researchers’ hands, gives us a window into human consciousness that we have not had and that potentially adds to the clinical exam we currently use,” said Dr. James L. Bernat, a neurologist at Dartmouth-Hitchcock Medical Center in New Hampshire.

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Anonymous Amazed said...

Mrs Schiavos multiple CT scans clearly demonstrated hydrocephalus ex-vacuo.

A major reason (but not the only reason) it is an oft quoted comment from media interviewed scientists and doctors that Terri Schiavo isn’t comparable to patients such as Rom Houben is that no doctor has suggested that hydrocephalus ex-vacuo is an aspect of Rom Houbens condition.

It has never been indicated, implied or plainly stated that ANY of the other patients being discussed (in the more recent medical journal cases and medical studies) had the demonstrable hydrocephalus ex-vacuo of Mrs Schiavo or anything close to it.

It isn't just the mechanism and cause of the injury that differentiates these patients (anoxic injury versus traumatic injury) but the very obvious and well documented extent of the damage in Mrs Schiavos case.

These doctors and scientists are trying to maintain a level of credibility and respect for themselves and their work.

They know full well that even attempting to draw comparisons between what was left of Mrs Schiavos brain and the brain(s) of the patients in these latest studies would be absurd- but of course the reporters don't have a clue about the ridiculous nature of such questions or the aburdity of such questions and so the question always gets asked.

Quinlan used to be the favorite case that reporters felt everyone could relate to. Now its Schiavo.

February 6, 2010 at 10:12 AM  

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