Fred Plumâ the American neurologist who, along with Dr. Bryan Jennett, a Scottish neurosurgeon, originally coined the term PVS syndrome . The unique training afforded Drs. Barclay and Engstrand by Dr. Plumâthe doctor whose contribution to science was the PVS diagnosisâis no small matter.
This begs a question. With these two as well as more than three dozen other experts weighing in and offering their services, why would
Judge Greer claim that all of the credible evidence pointed to a lack of cognitive activity? Furthermore, why would Judge Greer ignore the findings of two neurologists who did see Terri?
Take neurologist Dr. William Cheshire Jr., for example. Certified by the American Board of Psychiatry and Neurology, Dr. Cheshire was appointed by Floridaâs Adult Protection Services to offer his objective medical review for the Department of Children and Families during its investigation of abuse and neglect charges. Although neither he nor any other doctor was permitted by Michael and the court to actually examine Terri at that point, here are highlights from his seven-page sworn affidavit after an in-room, ninety-minute observation of Terri in March 2005:
I came into this case with the belief that it can be ethically permissible to discontinue artificially provided nutrition and hydration for persons in a persistent vegetative state. Having now reviewed the relevant facts, having met and observed Ms. Schiavo in person, and having reflected deeply on the moral and ethical issues, I would like to explain why I have changed my mind in regard to this particular case. . . .
Terri Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurological diagnosis of a persistent vegetative state. Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurological consideration, would not be expected in a persistent vegetative state.
Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state. This distinction makes an enormous difference in making ethical decisions on Terriâs behalf.
As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration. No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others.
Keep in mind, this observation was the only one permitted (due to a court order) in the last year of Terriâs life. In that sense it is critically important and underscores the dubious rationale for putting Terri to death due to PVS, coupled with hearsay evidence that prior to her collapse she had made general comments when watching TV programs about people on life-support machines that she ââwould not want to live like that.ââ
Notice Dr. Cheshireâs observation, similar to mine and othersâ, that Terriâs face brightens in the company of other people. Patients in a PVS condition do not respond to such stimuli.
Some members of the press, however, have been critical of Dr. Cheshireâs report. They argue that Dr. Cheshire failed to conduct a full neurological examination of Terri, and therefore, they dismiss his review as being invalid. Itâs true. Dr. Cheshire ââobservedââ rather than ââexaminedââ Terri. Why? He was forbidden to do so by the court and by the guardian, Michael Schiavo. 1 Itâs worth pointing out that Dr. Cheshireâs observations were strikingly similar to what Dr. David Young noted in his affidavit. Dr. Young also personally observed Terri in 1998 when Michael first
This begs a question. With these two as well as more than three dozen other experts weighing in and offering their services, why would
Judge Greer claim that all of the credible evidence pointed to a lack of cognitive activity? Furthermore, why would Judge Greer ignore the findings of two neurologists who did see Terri?
Take neurologist Dr. William Cheshire Jr., for example. Certified by the American Board of Psychiatry and Neurology, Dr. Cheshire was appointed by Floridaâs Adult Protection Services to offer his objective medical review for the Department of Children and Families during its investigation of abuse and neglect charges. Although neither he nor any other doctor was permitted by Michael and the court to actually examine Terri at that point, here are highlights from his seven-page sworn affidavit after an in-room, ninety-minute observation of Terri in March 2005:
I came into this case with the belief that it can be ethically permissible to discontinue artificially provided nutrition and hydration for persons in a persistent vegetative state. Having now reviewed the relevant facts, having met and observed Ms. Schiavo in person, and having reflected deeply on the moral and ethical issues, I would like to explain why I have changed my mind in regard to this particular case. . . .
Terri Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurological diagnosis of a persistent vegetative state. Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurological consideration, would not be expected in a persistent vegetative state.
Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state. This distinction makes an enormous difference in making ethical decisions on Terriâs behalf.
As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration. No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others.
Keep in mind, this observation was the only one permitted (due to a court order) in the last year of Terriâs life. In that sense it is critically important and underscores the dubious rationale for putting Terri to death due to PVS, coupled with hearsay evidence that prior to her collapse she had made general comments when watching TV programs about people on life-support machines that she ââwould not want to live like that.ââ
Notice Dr. Cheshireâs observation, similar to mine and othersâ, that Terriâs face brightens in the company of other people. Patients in a PVS condition do not respond to such stimuli.
Some members of the press, however, have been critical of Dr. Cheshireâs report. They argue that Dr. Cheshire failed to conduct a full neurological examination of Terri, and therefore, they dismiss his review as being invalid. Itâs true. Dr. Cheshire ââobservedââ rather than ââexaminedââ Terri. Why? He was forbidden to do so by the court and by the guardian, Michael Schiavo. 1 Itâs worth pointing out that Dr. Cheshireâs observations were strikingly similar to what Dr. David Young noted in his affidavit. Dr. Young also personally observed Terri in 1998 when Michael first
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