The Terri Schiavo Tragedy
Mitchell S. Felder, M.D.
by Mitchell S. Felder, M.D.
the time of the Holocaust the Nazi SS sadistically punished rebellious
prisoners by simply putting them in a cell without food or water.
The hapless victim would be driven insane with hunger and thirst
and would die a horrific, excruciating death. This would serve as
an example to the other victims of the utter hopelessness of their
condition. The man-made laws of Nazi Germany enabled the legal murder
of millions. Likewise, the distorted logic of the American legal
system has allowed a patient to be condemned to death in the cruelest
a board certified attending neurologist, I would immediately question
the constant refrain during this tragedy that "Terri didnít
feel a thing" during her forced starvation. I would contend
that the opposite is much more likely. Terri was brutally trapped
in the worst of all worlds. Widespread laminar necrosis of the cerebral
cortex is typically found after the anoxic encephalopathy that Terri
initially suffered. However, the more primitive areas of Terriís
brain: the hypothalamus, amygdala and brain stem remained intact.
As Terri was starved, the primitive factors that regulate food intake
such as blood glucose and amino acid concentrations set off the
physiologic equivalent of an air raid siren in the feeding center
of the hypothalamus screaming "feed me." However, the
cortical area of her brain which would have allowed for a cognitive
comprehension of this dilemma was dysfunctional. Likewise, a massive
transmission of pain signals flooded into her hindbrain and thalamus
without a subsequent cognitive interpretation. In order to begin
to disprove my conviction that Terri suffered during her forced
starvation her doctors would have had to perform an (1) EEG (electroencephalogram)
showing cortical brainwave activity (2) PET (Positron Emission Tomography)
Scan to show a reduction in cerebral metabolism (3) SSEP (Somatosensory
Evoked Potential) to show brainstem neurophysiologic functioning
and (4) MRI scan of her brain to show anatomical disruption. I understand
that either these tests had not been performed in years or were
never done in the first place. Although Terri was judicially condemned
to death, she met almost none of the standard Harvard criteria for
the time that I first started practicing as a neurologist I was
called by my hospitalís emergency room doctor to see a comatose
patient. He was apologetic in asking me to come in to see a patient
with the absolute worst type of malignant brain tumor, a Glioblastoma
multiforme. When I arrived in the ER I was met by the patientís
former wife, who between loud sobs, pleaded with me to "save"
her ex-husband. At that point, I wouldnít have given this 63-year-old
profoundly comatose patient a thousand to one odds for remaining
alive another hour, let alone having any future life. Reluctantly,
I went through the motions of putting the patient in the ICU and
putting him on steroids in a cookbook fashion. Miraculously, the
man slowly improved, left the hospital and lived another eight years,
during which time he joined a number of local clubs. Likewise, even
when considering Terriís purported diagnosis of a persistent vegetative
state (in my opinion, not properly supported by the above elucidated
tests) "The occurrence of rare instances of very late recovery
in adults must be acknowledged." (Adam and Victorís Principles
of Neurology, Seventh Edition, p. 370). Even more disturbing,
in this standard teaching textbook of neurology, is the statement
on the same page, "At no time after the onset of coma was it
possible to distinguish patients who would remain in a vegetative
state from those who would die." Killing Terri destroyed the
hope for any possible future potential therapeutic modality such
as stem cells, hyperbaric oxygenation or neurotransmitter treatment.
There have been at least four confirmed cases of patients with persistent
vegetative state who have recovered some neurologic functioning.
Dr. Ronald Cranford, the neurologist who diagnosed Ms. Schiavoís
condition, was the attending physician in one of those cases. Dr.
Cranford later admitted, "Yes, I made a mistake and to this
day no one can explain these cases." Isnít it obvious that
this could be yet another "mistake"? The most basic principal
in medicine, based on the Hippocratic Oath is to "do no harm."
I would tend to believe that actively killing oneís patient violates
this most basic principal.
forced death of Terri by our judicial system sets a horrific precedent.
Should we now begin starving anyone with a neurodegenerative condition?
That would include patients with Alzheimerís Disease, Multiple Sclerosis,
Parkinsonís Disease, ALS, Tay-Sachs Disease, Canavanís Disease,
and the list goes on and on.
a society must be judged by the manner in which it treats its most
vulnerable members. Like the one and one-half million children slaughtered
by the Nazis, Terri Schiavo was totally helpless and vulnerable.
The tragedy of her needlessly imposed death greatly lessens us all.
S. Felder, M.D. [send him mail]
is a board-certified attending neurologist at UPMC Horizon in Pennsylvania.
© 2005 LewRockwell.com