Comments on Doctor NOS: A Reply to a Chessmaster

No TJ, actually that was a glaring example of gran...

2005-03-25T04:25:00.000-08:00

No TJ, actually that was a glaring example of grandiloquence -- an exaggeration to make a point.

You also used the same rhetorical device when you said they should stop trying to "kill" her when you know that is not the case.

Hope you've enjoyed the English lesson and feel less ignorant on this subject.

RD : excellent post / comments / questions!MaryBis...

2005-03-24T17:31:00.000-08:00

RD : excellent post / comments / questions!

MaryBishop : "If she was reduced to a pinky finger they'd still find "scripture" to back up their desire to keep all living matter alive at all costs." ... not to be rude, but that is a glaring example of ignorance.

also MaryBishop : "They should stop exploiting her that way and stop showing those film snippets" ... my response to that, quite simply, is "They (the other they, that is) should stop trying to kill her and let her live".

/TJ
... NIF
... The Wide Awakes

Jean-Francois said... The sad thing about this 45 ...

2005-03-23T08:16:00.000-08:00

Jean-Francois said...
The sad thing about this 45 year old woman, is that she's gona be remembered as a vegetable; the way she had been for the last 15 years. Sad.
--

A vegetable with a wide open mouth.

They should stop exploiting her that way and stop showing those film snippets.

The sad thing about this 45 year old woman, is tha...

2005-03-22T13:59:00.000-08:00

The sad thing about this 45 year old woman, is that she's gona be remembered as a vegetable; the way she had been for the last 15 years. Sad.

The medical question is between PVS and minimally ...

2005-03-22T12:44:00.000-08:00

The medical question is between PVS and minimally conscious state. I assume you are asking me: what if I am wrong in my agreement with every independant neurologist (who isn't a crackpot) who diagnosed her with PVS, and the diagnosis is minimally conscious state?

Well, let me first address how likely that is. It is simply not the case.

However, that wasn't your question, and I, unlike many in the blogs, have the courage to answer such a wildly hypothetical question. I would answer it this way: if the situation were not as it is, then TS would still be unable to communicate her desires. Her next of kin would have to assume medical decision making capacity for her. He would have to ask himself, "would TS have wanted to prolong her life under this circumstance?"

No-one can answer that question other than her next of kin. And no civil person would take that right away from him, other than the revolting people in congress who tried to do so.

Docnos -You didn't answer my question. What if yo...

2005-03-22T11:52:00.000-08:00

Docnos -
You didn't answer my question. What if you're wrong. How can you be certain that you're right, and what if you're wrong?

RD:I appreciate you tying yourself in knots to try...

2005-03-22T10:51:00.000-08:00

RD:

I appreciate you tying yourself in knots to try to escape the facts of this case. Really. Because by doing so, by saying anything to escape the simple facts that TS is in PVS, that her wishes would be to remove the feeding tube, you are implying how damaging the facts are to your position.

But I'm sorry. The facts are the facts.

In addition, I'm saddened by the refusal to accept the fact that 20 courts have heard the case, all agree. These courts have all the information, not just the selected tidbits from the lowest-denominator-doctors or snippits of video.

Hi Doc Nos, Scott & others. (Hi Crystal!) A long...

2005-03-22T02:40:00.000-08:00

Hi Doc Nos, Scott & others. (Hi Crystal!) A long post - my apologies in advance. I posted a follow-up to your comment on Liberals For Terri that argues less from ad hominem assertions ("Michael Schiavo's guilty, therefore X, Y and Z") and builds a case for them ("Here's why Michael Schiavo is suspicious: X, Y and Z"). It examines falsifiable evidence (which may be flawed) and makes inferences and subjective judgments (which may also be flawed). The article which conjectures from the hypothetical to the specific is just the ice-breaker, and is subject to revision as both aggravating and mitigating circumstances surface.

I use one "epithet" (media lite) to refer to a softball agenda favorable to the right-to-die lobby because I suspect collusive behavior between them and the media. (Not criminal, but "voluntary yet undisclosed".)

In the meantime: this issue is not about euthanasia per se but about a lousy euthanasia test case for both sides of the issue. It's about a woman mistakenly trapped by powerful lobbies with a little help from her spouse. Your very advocacy against a PET scan, regardless of whether it's "needed", proves my point. She's trapped by the refusal to even dignify the request with any oxygen.

Michael Schiavo made a huge mistake on Larry King the other night and let slip that he doesn't know what his wife's wishes were. (Though he did blurt out what he wants. Oops!) By the way this was just three days after his attorney gave the pitch for the $10 million refusal.

This is not an ad hominem attack, you realize, since it's an assertion of fact (with style attributed). You can either refute the fact, or you can refute its implications, but you can't erase the fact (though you can mitigate its credibility in some eyes with an ad hominem counterattack). A heads-up: it's not just the right wing that wants to tear at (cry and deconstruct) the diagnosis of PVS. The issue is not anger over the conclusion per se but obvious contradictions demonstrated by her behavior, the opinions of doctors with an absence of conflict-of-interest concerns, and the fraudulent conditions under which that diagnosis was issued.

In case you're thinking fair is fair, and I ought to concede what you said earlier:

"It is a fact of the matter that TS's diagnosis is PVS.
This is simply the fact."

Yes. This falls in the "no kidding Sherlock" category. That was the diagnosis in a split decision (expected) where the court physician was the tie-breaker (expected).

So let me remind us both of the crucial difference:

The kind of factual event on CNN I am relaying to you is a very different kind of "fact" from the kind you presented. Yours is - in the end - an assertion of opinion not fact. Sure, the "fact" is the guy said "PVS" in open court, but that doesn't make the diagnosis "true", it just establishes that as the diagnosis.

BTW: Extrapolating a 3-2 decision into a legally definitive "diagnosis" is an arrogation of law as well as a medical fallacy. All it means is that, of the five doctors surveyed, three voted one way and two the other. The right-to-life champion George Felos was responsible for choosing three of them, which in and of itself is not incriminating, except that these doctors already have a bad reputation within their respective professions. They were procured specifically to render the desired verdict. (A charge, yes. But can you refute it or demonstrate their objectivity?)

It is also willful and petty to stick by the decision when there are 33 neurologists on the record - not right-wing ideologues, but "normal" doctors at the top of their professional careers - who believe the procurement of evidence in this case was "criminal". The decision to refuse further examination is driven not by the desire to be correct, but simply by the force of judicial will. Intimidation doesn't impress anyone.

As does yours, my point falls into the "no kidding Sherlock" category too. It does so because the fact is, Michael said it. Millions of people heard him say it. It's been recorded. And the fact of the matter is, Michael said the words, for the first time, "We didn't know what Terri wanted, but this is what we want..."

Keep in mind this is three days after his lawyer got high & mighty (my opinion :) on ABC about the $10 million his client was going to forego so that he could bravely and defiantly carry out his "wife's" wishes. The wishes he just denied even existed by a Freudian slip of momentous proportions.

You realize that the $10-million bluff makes him either a very noble, or a very guilty, man. There's no middle ground like there used to be, now that an awakening by the press has forced him to zero in on the story he's sticking to. My guess is that when his lawyer announced it he had no idea he would make a slip of the tongue three days later, but the fact is he did, and now he's been caught in the most absurd form of contradiction (one that I judge to be unintentional but deliberate!).

Anyhow: I suspect conflict of interest, medical & legal fraud in the Michael Schiavo case. I call shenanigans. If you want to help resolve the disconnect, I suggest we find out the answers to some unanswered questions:

* Who examined her, for how long, what tests were performed, and which side was represented
* What a CT / PET / MRI will show in diagnosing PVS
* How long a patient should be monitored (sleep/wake) in order to credibly detect PVS
* If the 30-70% false detection rate of PVS should be a mitigating factor in reconsidering the original finding of fact
* What other doctors have to say about the procurement of evidence

Some of these items are in dispute. I'm not asking just to bate, or because it frames an argument a certain way, but because these questions are important. You may not feel the same way, I realize that.

Thanks
RD

"Withdrawal of a feeding tube should be concidered...

2005-03-21T13:41:00.000-08:00

"Withdrawal of a feeding tube should be concidered unprofessional -- animals aren't even treated this way. I'm a supporter of the 'black' pill. It is certainly what I would want."

Rationally I do not find a difference between active and passive euthanasia, however, emotionally I do. As a doctor I feel I can't be frank, even as Doc NOS, but I agree with the current of your post, if not with every little ripple.

When the tube comes out, death comes within two weeks. It is peaceful. MB's and her mother's experience is typical. Two weeks will not make any difference in 15 years.

Anne, I agree with you that the setting - all arou...

2005-03-21T13:33:00.000-08:00

Anne,

I agree with you that the setting - all around, from blog to congress - is not optimal.

I think TS's husband deserves the benefit of any doubt. Life goes on. His life, unfortunatly without his wife, went on. I'm happy he found someone to share his life with. If I were in TS's situation (a thought that horrifies me), I'd hope Mrs. NOS would do the same.

Mr. DeLay, however, does not deserve the benefit of the doubt. He is clearly using this situation as a way to distract from the ethical breaches he will eventually have to answer for. He is the lowest of the low.

I know this appears to be a confusing case to you. Some of the comments regarding EEGs and whatnot confused me. Medically speaking, this does not appear to be confusing. Many neurologists have diagnosed TS with PVS. This is her diagnosis, it is not in doubt. One may watch 30 seconds of video in which she appears to respond, but 30 seconds of correlated activity to external stimuli out of 15 years does not change the diagnosis.

I thought I posted this but I can't find it. My m...

2005-03-21T13:13:00.000-08:00

I thought I posted this but I can't find it.

My mother had terminal cancer. When she could no longer eat or drink, they did *not* insert a feeding tube. She was days away from death and still had a well-functioning mind, but her body had given up.

I watched her die from the results of her own body rejecting food and water. It was peaceful and her choice.

I suppose now people like my mother will have tubes inserted against their will to keep Bush and the Religious Right happy.

I want to know when Congress got their MDs?

TS was married when she had her heart attack. Sorry mom and dad but her next of kin is her husband and your wishes don't mean crap...or shouldn't mean crap.

And certainly it's no other person's business what goes on with her except her husband.

Withdrawal of a feeding tube should be concidered ...

2005-03-21T12:48:00.000-08:00

Withdrawal of a feeding tube should be concidered unprofessional -- animals aren't even treated this way. I'm a supporter of the 'black' pill. It is certainly what I would want.

I'm with Doc and MB on this one. I think the poor...

2005-03-21T12:11:00.000-08:00

I'm with Doc and MB on this one. I think the poor woman should be allowed her dignity back and her right to die in peace. The poking and podding of this mechanically forced to breathe corpse is positively horrific and morbid.

It smacks of "Doctor Frankenstein" and I cannot believe the super-religious folk would not see the irony in this! Whose playing God here? Sure as hell sounds like the doctors are being forced to do so...and that's okay with them?

Now, who feels better if we keep TS alive? Not TS, that's for sure. She's not going to get better. I think this many years of vegetating would be enough proof for PVS, isn't that obvious?

This is just a righttolifer issue. Problem is: TS has NO LIFE and will never have a life again.

How about a right to death with dignity? Unfortunately, that is basically lost to her at this point. Why not end this tragedy and untold suffering? For rightwing politics? That's positively shameful!

If TS was just a head...or just a body...the right...

2005-03-21T11:15:00.000-08:00

If TS was just a head...or just a body...the right to lifers would fight to keep the head or the body alive if it were possible.

If she was reduced to a pinky finger they'd still find "scripture" to back up their desire to keep all living matter alive at all costs.

Sure hope everyone is prepared to stay alive at all costs -- we've got Bush and the congress making medical decisions now. Great.

DocNos, we won't agree on this situation because w...

2005-03-21T10:41:00.000-08:00

DocNos, we won't agree on this situation because we're coming at it from two entirely different worldviews, but I would like to clarify my blog post.

I noticed that you accuse me of the "early introduction of religiosity", when, in fact, I was responding to an emailer who brought that up in the second sentence of her email. I don't deny, though, that my faith influences my view on this, just as your deeply held beliefs influence yours.

Also, I would hardly characterize calling Terri Shiavo's husband an adulterer as an ad hominem attack. In fact, referencing his behavior in the situation is probably akin to your mentioning (in another post) of Tom Delay's past in relation to the current legislation to save Terri and your suspicions about him.

I've read so many contradictory things on the subject of this case. I read your opinion as a doctor. I've read opinions by other doctors, including neurologists, who disagree with yours. I've read you and others who say that withholding food & water results in a painless, peaceful death. And then I read this account from a woman who has experienced it. I've read about Michael Shiavo and the fact that he said she said she'd want to die in a situation like this, and then I've read contradictory statements. I've read statements from nurses who worked with Terri, and then I've read statements of others who question the motives of the nurses.

It's a confusing case. I sincerely hope my view is wrong. I hope that she would have wanted to die, that if the tube remains out that she dies in peace without pain, and I hope that Michael Schiavo's motives are pure. I hope that you are correct - that it's a cut & dried case and this is the correct decision.

But this is the part that I can't seem to shake: What if you and those who share your beliefs are wrong? What if she hasn't been accurately diagnosed? What if she's in agony right now? What if her husband is wrong, or worse - lying?
What if her parents are right?

And, I can't help but think about this from her mother's perspective. I'm a mother, and I can't think of much worse than seeing my own child in this situation, believing she's "in there" somewhere, and having no power to help her. I have to believe that the Schindlers don't enjoy the circus-type atmosphere and aren't pursuing every legal remedy just for fun or to use their daughter.

That's where I'm coming from. It is not at all my desire to use Terri as a pawn or to be a "chessmaster". This is a hard situation that is painful to think about. It's also hard, I think, to adequately convey my thoughts on a blog. It'd be much easier over a cup of coffee, I'd imagine, to explain where I'm coming from and to understand you better. I've tried to come up with a good analogy to convey my thoughts, but I haven't been able to. The closest I've come is to think about being on a jury that is contemplating convicting someone of murder. Many on the jury think that it's clear that the defendant is guilty, but some aren't quite convinced enough to cast their vote. There is some circumstantial evidence that leaves questions. Something holds them back - the fear that they're condemning an innocent man. The analogy is faulty, I know, but it's the best I can come up with on my first cup of coffee!;-)

Thanks for the comment you left on my blog and for this post. It's helped me to think more on this subject and to clarify my own thoughts.

Anne
PS - On a completely unrelated subject, have you ever thought of installing haloscan (www.haloscan.com) for comments and trackbacks? It allows people to leave comments without going through blogger (which is slower than molasses many days). The downside is that when you install it, you lose all current comments on your blog.

To the various amatures who insist on talking abou...

2005-03-21T10:15:00.000-08:00

To the various amatures who insist on talking about EEGs and brain scans: please stop. You have no idea what you're actually talking about. The idea that brain activity is filtered out when muscle activity is filtered is just plain silly.

Again, those who want to use TS to advance their cause want her to not have PVS. So they will do anything, including making medical sounding and completly false statements to try to make it go away.

"we (and many others!) do not believe Terri is in ...

2005-03-21T10:12:00.000-08:00

"we (and many others!) do not believe Terri is in a PVS, nor that she is necessarily irrecoverable."

Well, then you have a false belief. The facts point against you. Her diagnosis is PVS. End of story.

"we (and many others!) do not believe Terri is in ...

2005-03-21T10:07:00.000-08:00

"I promise a complete acknowlegement if there is a...

2005-03-21T10:03:00.000-08:00

"I promise a complete acknowlegement if there is an investigation of Michael Schiavo and Judge Greer and they are completely vindicated...Can you state the same if I am right?"

None of your conspiracy theory changes the facts of the matter now. Furthermore simply villifying TS's husband seems to ignore the fact he turned down 10 million bucks to step away. Instead, you're just throwing up a big old red herring, trying to distract away from the facts of the case - since of course the facts do not favor your position the best way to ignore them is to pay attention to other things.

But the diagnosis
Is hopeless.

PVS.

Guess what the case that determined she had bulimi...

2005-03-21T08:46:00.000-08:00

Guess what the case that determined she had bulimia was actually malpractice case that was "settled" and the doctor was later vindicated by the medical board. The bonescan wasn't even available...There has never been an investigation into the night TErri collapsed. I...Terri has not had representation...She had a guardian ad litem who suggested she have her own legal representation AND found Michael's claimed declaration of her not wanting to live like this was NOT credible...I am curious as to how you can even consider that a legitimate position...

1. Every independent medical examination has arri...

2005-03-21T08:05:00.000-08:00

1. Every independent medical examination has arrived at the exact same result: PVS. There's no need for more or different tests. There's no need to hear further from doctors hired by the other side - they had more than one opportunity to make their case in court. There are no more medical points to be made on this case. All of that territory has been covered and recovered. The result: PVS.

2. The kooky idea that Terri's husband is somehow responsible for her condition is just that - kooky. Surely you know that early after her heart attack there was a malpractice suit against the physicians who failed to diagnose her true problem: bulimia. Surely you realize that whatever doubts about the cause of her condition would have been investigated and vetted by that legal process. The verdict: Terri had bulimia and it caused a heart attack. Bone scan my ass.

How many times to these and other objections have to be argued in court before we accept the truths that invariably emerge from the process? Once wasn't enough. Twice wasn't enough. How many times? How many years before we finally let this poor woman refuse the medical treatment she didn't want? Will we keep her wasted body as a prisoner to our ignorance, sentimentality and emotionalism for the rest of her unnatural life?

I have a new definition of horror.

Terri's 1996 brain scan shows 75% normal brain tis...

2005-03-21T07:08:00.001-08:00

Terri's 1996 brain scan shows 75% normal brain tissue; not scar tissue. It is not all fluid. Her cortex is not missing; not at all. Some areas are thinned, probably due to hydrocephalus, with the fluid pushing against her brain. She is functioning, that's what's important. There are people who are a lot worse off than her, and they are talking. A brain scan taken two years ago showed improvement.

The EEG (electroencephalogram, which is a test of brain activity) showed there was no recognizable brain activity. However, three doctors said she was restless. Muscle activity gives a reading, just as the brain does, producing artifact. By filtering out the artifact, the brain activity was also filtered out. The EEG should have been taken at her bed where she could relax. Judge Greer refused further testing (because this test reflected his desired outcome). Dr. Hammesfahr said no further scan is needed because Terri is functioning, which obviously shows brain activity.

You're relying on the doctor of death's analysis and nothing more, not considering any of the other evidence, so why are you so hell bent on defending court-sanctioned murder against this handicapped defenseless woman?

Oh yeah. I forgot. You represent the culture of death.

Dr. Hammesfahr believes he can help her. He said so way back in 2001. He specializes in rehabilitating brain damaged people and stroke victims, rather than killing off the "inconvenient".

Terri's 1996 brain scan shows 75% normal brain tis...

2005-03-21T07:08:00.000-08:00

Stupid is as stupid does, and you can see that evi...

2005-03-21T06:56:00.000-08:00

Stupid is as stupid does, and you can see that evidence all over this blog.

It would have been considered malpractice for any attorney to retain and present an expert witness at trial if that witnesses’ opinion was contrary to my client’s position. Lawyers only present witnesses who help their clients. Thus, lawyers search out experts that they believe will probably come to conclusions that support the client’s position.

Thus–where else would George Felos–an advocate of the “right to die” himself–go to find an expert, but to a physician who has already shown a propensity for facilitating the death of people?

In most cases there is a counterbalance to this. The lawyer on the other side gets his own expert. In Terri’s case–who represented her interests? Who retained the expert–with equal qualifications–to counter Cranford? No one. She had no lawyer of her own. She had ad litems on occasion–but, in my experience, ad litems rarely have access to funds that would allow them to hire top-notch expert witnesses.

What is the impact of all this? Judge Greer has essentially heard testimony from only one side.

Many people have referred to the “medical evidence” that Terri has little to no brain matter remaining.

FACT: The only way to determine such a thing accurately is with an MRI or PET scan. Neither have been done, and they have been disallowed in her case per Michael Schiavo’s instructions. Dr. Ronald Cranford of the University of Minnesota, has repeatedly dismissed calls for MRI testing, and his opinion has prevailed.

Many people have spoken of the doctors who have “evaluated” Terri.

FACT: The primary evaluator, Dr. Ronald Cranford is a board-certified neurologist who specializes in PVS cases. Why do I mention this? Because he has also been on the board of the Euthanasia Society of America and has ties to the Hemlock Society. He is called as an expert witness for euthanasia in “Right to Die” cases. Dr. Cranford has also advocated denial of SPOON-FED feeding.

Dr. Ronald Cranford is one of the most outspoken advocates of the “right to die” movement and of physician-assisted suicide in the U.S. today. In published articles, including a 1997 op-ed in the Minneapolis–St. Paul Star Tribune, he has advocated the starvation of Alzheimer’s patients. He has described PVS patients as indistinguishable from other forms of animal life. He has said that PVS patients and others with brain impairment lack personhood and should have no constitutional rights.

In the cases of Paul Brophy, Nancy Jobes, Nancy Cruzan, and Christine Busalucci, Cranford was the doctor behind the efforts to end their lives. Each of these people was brain-damaged but not dying; nonetheless, he advocated death for all, by dehydration and starvation. Nancy Cruzan did not even require a feeding tube: She could be spoon-fed. But Cranford advocated denying even that, saying that even spoon-feeding constituted “medical treatment” that could be licitly withdrawn.

In cases where other doctors don’t see it, Dr. Cranford seems to have a knack for finding PVS. Cranford also diagnosed Robert Wendland as PVS. He did so in spite of the fact that Wendland could pick up specifically colored pegs or blocks and hand them to a therapy assistant on request. He did so in spite of the fact that Wendland could operate and maneuver an ordinary wheelchair with his left hand and foot, and an electric wheelchair with a joystick, of the kind that many disabled persons (most famously Dr. Stephen Hawking) use. Dr. Cranford dismissed these abilities as meaningless. Fortunately for Wendland, the California supreme court was not persuaded by Cranford’s assessment.

Expert witnesses in court are supposed to be unbiased: disinterested in the outcome of the case. Part of the procedure in qualifying expert witnesses is establishing that they are objective and unbiased. But given Dr. Cranford’s history of advocacy in the “right to die” and euthanasia movements, and given his track record of almost always coming down on the side of PVS and removal of nutrition and hydration, one might question his objectivity.

And you sir, are an ignorant rube.

So is it a "rudimentary" response that Terri recon...

2005-03-21T06:52:00.000-08:00

So is it a "rudimentary" response that Terri recongnizes her parents and other loved ones when they visit? Or maybe she is afflicted with "PVSWMML"?

(PSV With Minimal Memory Loss)

Get real batboy.

Doctor Schmocktor......did anyone else ever notice that doctors "practice" medicine? I don't knwo about you but I wouldn't hire a plumber that was "practicing" plumbing.