I love this version of a living will! (It’s been modified from this original.)

If I wind up severely brain damaged you will perform all the tests. You will not rely on the word of some clown who’s too lazy or stupid to do a proper examination, you will do an MRI and a PET. Poking me with car keys does not constitute a proper test to determine my mental acuity. A slap to the forehead is not a valid measure of my pain threshold. Forty-five minutes is not enough time to make a diagnosis that will get me killed. Do it right, with a real doctor who has no connection to the Hemlock Society. I hate those creeps.

You will engage me in conversation. You will stimulate what remains of my mind. I will be taken outside for daily walks, given dogs and cats to pet (as well as I am able), and otherwise involved in the world. You will not keep me locked up away from the world, the better to expedite deterioration and death.

I will have rehabilitation. If there is even the slightest chance I can improve you will encourage that improvement.

Anyone who has no knowledge of my case who claims that I am in a persistent vegetative state shall be taken to court for defamation. The money gained from such suits will go to my support. The same applies to those who do examine me, and then lie about my condition. Especially if they have ever had any connection to the Hemlock Society, or Planned Parenthood, or the NEA (either NEA—I’m not choosy) (I would also include the ACLU in this list. -Ed). If it turns out they have had such associations, then sue those groups too. They have lots of money that would be better used making me well.

If I need a feeding tube any attempt to remove said feeding tube shall be considered attempted homicide and prosecuted accordingly. In addition, if said action was ordered by a court of law the judge presiding is to be charged on civil rights grounds and prosecuted to the full extent of the law.

Any pundit of any stripe who states that I would not want to be in such a state is to be stripped naked, his skin rubbed raw with scrubbing pads, salt placed on the wounds, and then tossed into a vat of carrion beetles. After being given drugs that heighten sensation. This action will be taped and distributed on the internet.

If provided with a guardian and said guardian petitions to have me killed, that guardian is to be charged with attempted murder and prosecuted to the fullest extent of the law. See above paragraph for hints of my other wishes involving said guardian.

I’ll die when I die. You will not rush matters. You will leave well enough alone. Death happens soon enough for us all, don’t be so damn eager to hurry it up.

Doggon! I wish I had written this. It’s just sooooo good!

It used to be that you needed a living will to tell the doctors, family and courts when to stop trying to keep us alive when we were dying. How the heck has our country gone a full 180 to the point where we need a living will to tell those same people (especially the courts!) to not murder us if we become disabled?

Here are some more excellent articles on Terri’s situation:

• Fearfully and Wonderfully Made from Agent Tim. An interview with a disabled woman.
• Bloggers’ Best for Terri Schiavo, Part Eight from Wittenberg Gate
• FOCUS: Bigotry and the Murder of Terri Schiavo Excellent!
• Terri Schiavo: Judicial Murder
• Religious Bigotry in Action from Imago Dei
• Meet Judge Greer’s pastor from WorldNetDaily
• Jeb Bush is courting dereliction of duty by Alan Keyes

Update: Added two more articles to the list.

Howard Kurtz of The Washington Post recently participated in an online chat. He was pressed about why he considered Terri Schiavo’s situation to be similar to the death of Tom DeLay’s father:

Evansville, Ind.: You said, “As I wrote last week, there have been many, many cases like this (including, we now know, that of Tom DeLay’s father), that didn’t rate a paragraph in the paper.” But DeLay’s father’s had a brain hemorrhage and broken ribs; he needed a tracheotomy and ventilator to assist his breathing; and his body was full of infections. Terri Schiavo’s vital functions are working perfectly well; she simply needs a feeding tube because she cannot swallow on her own.

Unlike Terri Schiavo, he was in a state of steady deterioration and at death’s imminent doorstep within days of his accident. Unlike the Schiavo case, there was a family consensus among the DeLays and no dispute over what the father would have wanted. Moreover, DeLay was not the primary decision-maker in the family’s choice to withhold heroic treatment. That role fell to his mother and another brother and sister.

Why say they’re similar?

Howard Kurtz: Similar in this respect: The family had to make a decision on whether to end the life of a seriously ill person with no realistic hope of recovery. Obviously the medical details of every case are different, and in some cases family members are in agreement and in others they’re not. But the question, which the Schiavo case has underscored, is whether family members, in consultation with doctors, get to make the decision, or whether government gets to intervene.

There is one very vital difference between Terri Schiavo’s case and that of Mr. DeLay which Mr. Kurtz and his ilk are glossing over. Mr. DeLay was about to die within a number of days in spite of any efforts to the contrary. Terri Schiavo was in no danger of dying as long as her basic needs for food, water and air were met; needs shared by every human being on this planet.

Anyone who attempts to downplay this difference is either woefully ignorant, completely lacking in critical thinking skills, or they have an agenda. Those who are ignorant or thickheaded can be pitied. It’s those with an agenda who are dangerous. Their underhanded attempts to create a so-called “Right To Die” for those who are not actually dying is nothing more than demanding the power to have the weak and disabled “put out of our their misery for our their own good.”

There is a vast difference between ceasing to struggle when a battle has already been lost and actively killing someone who is not engaged in a battle for their life.

When death cannot be stopped, continuing treatment can only cause harm. That is the premise of a legitimate right to die. For example, a patient suffering from incurable cancer cannot be saved by doing chemotherapy. If they’re given chemo anyway, not only is the patient still dying, they’re also made more miserable by chemotherapy’s side effects.

When death is not near, as in Terri’s case, having a doctor stop food and water violates the cardinal rule of medicine: “First do no harm.” Without this rule in place, we set the practice of medicine back 2,400 years to the time before the Hippocratic Oath; a time when doctors might not have the patient’s best interests at heart.

Without a solid prohibition against taking life, it is one small step to move from a “Right To Die for the Living“ to a “Duty To Die” and society killing the unwanted and defenseless without regard for their “wishes.” This mistake has been made in the past with devastating consequences. I pray that our country realizes the danger of this path before we also reenter the meat grinder of history because we ignored its lessons.

(Also be sure to read this article on euthanasia.)

(HT: Michelle Malkin)

Peggy Noonan struggles to understand those who want to see Terri dead in “In Love With Death”

I do not understand the emotionalism of the pull-the-tube people. What is driving their engagement? Is it because they are compassionate, and their hearts bleed at the thought that Mrs. Schiavo suffers? But throughout this case no one has testified that she is in persistent pain, as those with terminal cancer are.

Curtis of a-sdf does an “If - Then” analysis of the fight over Terri.

WorldNetDaily reports that Judge Greer has received campaign contributions from several lawyers involved on Michael’s behalf, a clear violation of Florida’s rules of judicial conduct.

In this post American Digest discusses how money may still be a motivating factor for Michael even if all the settlement money is gone.

WorldNetDaily is reporting that investigations by the DCF into allegations of abuse have been summarily shut down with no explanation.

Terri’s attorney and sister have decided to enter official testimony (subject to perjury penalties if they lie) that Terri tried to say “I want to live” when she learned that the feeding tube was to be removed. The inevitable argument by skeptics is that this testimony was just made up as a last ditch attempt to save her. However, WorldNetDaily (among others) reported on the incident hours after it occurred.

According to reports (here and here) Governor Jeb Bush did send law enforcement agents to take Terri into protective custody. But he recalled them when it became apparent that the sheriff would not back down. It seems to me that Governor Bush realized two things. First, such a confrontation could very well have lead to law enforcement actually shooting at each other. Second, according to our system of government, the sheriff is the highest law enforcement authority within his county, superseding both state and federal law enforcement.

What can be learned from someone in Terri’s condition? Marianne Jennings is faced with two family members who need such care. She shares what she has learned in “Sandwiched between feeding tubes: The lessons”

But those of us who live with and care for these magnificent souls question the analyses hurled about as cherished life hangs in the balance. I offer my lessons from a decade of exposure to the “vegetative state.”

Just go read it. Now.

Over the last couple of days I’ve collected quite a number of facts about Terri’s case. Here is what I’ve found (in no particular order).

Myths vs. Facts

It’s clear that many people are unclear Terri Schiavo’s situation. TerrisFight has a page which discusses various myths vs. facts about Terri’s situation.

The Full Report

Dr. William Hammesfahr is a neurologist who has spent more time evaluating Terri than any other neurologist involved in the case. (10 hours vs. 45 minutes total for the doctors who want her dead.) Here is his complete report from September 2002. Here is a summary of some of the information from the report:

The patient is not in coma.

She is alert and responsive to her environment.  She responds to specific people best.

She tries to please others by doing activities for which she gets verbal praise.  

She responds negatively to poor tone of voice. 

She responds to music. 

She differentiates sounds from voices. 

She differentiates specific people’s voices from others.

She differentiates music from stray sound. 

She attempts to verbalize.

She has voluntary control over multiple extremities

She can swallow.

She is partially blind

She is probably aphasic and has a degree of receptive aphasia.

She can feel pain.

The patient can clearly swallow, and is able to swallow approximately 2 liters of water per day (the daily amount of saliva generated).  Water is one of the most difficult things for people to swallow.  It is unlikely that she currently needs the feeding tube.

Diagnosing PVS

I spent a fair amount of time searching the internet for what the medical standards are for diagnosing PVS. What I found is that PVS is incredibly difficult for the medical establishment to define, let alone accurately diagnose. Here are the most authoritative references I could find without having to pay money:

This article was reprinted from Issues in Law and Medicine. It discusses a consensus statement on PVS which was hammered out by a group of professional neurology associations. This review of the article highlights just how difficult it is to even define just what PVS is. From the conclusions:

It is possible to argue that people who have been diagnosed as having PVS might indeed be better off dead. The difficulty is that the Multi-Society Task Force is not willing to admit to the public - are perhaps not prepared to admit to themselves - that these benefits may have attached costs. They would seem to believe, perhaps rightly, that if they concede any considerable degree of uncertainty in the situation of PVS patients they will not be permitted to bring these benefits about. This means that any such gains - the reassurance of families, the status of physicians, the arguments of ethicists, the reform of hospital budgeting - are effective only because they are founded on lies. The truth is that none of these benefits can be obtained without taking a high risk that some people who are or will become conscious and aware will be treated as if they were irretrevably insentient.

(Note: I had not found the original article in the New England Journal of Medicine until just now, so I haven’t had a chance to read it yet. You can find it here. And here is part 2.)

I have seen numerous references to a study which showed that 43% of patients who had been diagnosed as PVS were incorrectly diagnosed. The study results are here. The quick summary is 40 patients transferred to a nursing home with a diagnosis of PVS were studied. 17 of them (43%) were found to have been misdiagnosed. Here is the study’s conclusion:

The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

Remember, the doctors who testified that Terri is PVS spent a total of 45 minutes with her.

I found the end results of the study even more fascinating than the 43% number. Of the remaining 23 patients who were accurately diagnosed, only 10 of them remained in a PVS by the end of the study. In other words, more than half of the patients who were accurately diagnosed regained consciousness. So out of the original 40, only 25% of the patients stayed that way.

I also found this article (a PDF file) which was printed in the Journal of the American Medical Association in January 1990. It makes several very interesting points including a very strong recommendation that a PET scan should be used, a statement that an EEG is essentially worthless (or worse) and one statement about diagnosis which was directly addressed by one of the videos.

First the PET recommendation and comparison to EEGs:

The greatest difficulty lies in deciding if the various sounds and movements occasionally encountered in a totally demented, speechless person reflect cognitive responses to internal or external stimuli or, rather, merely have a reflex or instinctive origin emanating from deep undamaged cortical structures. A less difficult problem, but one that has arisen in some legal disputes over decisions to remove life support, consists of distinguishing PVS from the “locked-in” syndrome or de-efferented state. … Positron Emission Tomography studies in such patients indicate that cerebral energy metabolism is only moderately reduced below normal in contrast to the profound disturbances observed in PVS. EEGs do not distinguish between vegetative and locked-in patients, since vegetative persons can have near normal EEGs, and abnormal EEG-blocking responses have been found in persons awake and self-aware but totally paralyzed from peripheral neuropathy.

But Dr. Cranford — who Judge Greer found to more credible than the rest of the AMA — wrote this when he replied to the article in the National Review:

A PET scan was never done in this case because it was never needed. The classic clinical signs on examination, the CT scans, and the flat EEG’s were more than adequate to diagnose PVS to the highest degree of medical certainty,

It’s obvious that Dr. Cranford’s idea of “medical certainty” is far different from the AMA’s standards.

And finally, I found this statement on diagnosis extremely interesting:

PVS patients neither fixate upon nor consistently follow moving objects with the eyes,

Just by itself, this statement, plus this video (RealMedia) of Terri tracking a balloon makes it clear that the only medical certainty in Terri’s case is that she is not in a PVS.

When I watched the video, I made an interesting observation. As Terri’s eyes are tracking the balloon, it was apparently moved to where she had to look up. As she did so, she also moved her eyebrows up so she could see higher. That is a coordinated muscle movement which only makes sense if she is actually looking at something. (Remember, a PVS patient cannot look at anything.) She did it twice.

If you don’t believe me, try this experiment. Look as high as you can without moving your head. Now notice what you did with your eyebrows. You lifted them up because otherwise they blocked your field of view. Now close your eyes and look up. More than likely, you did not life up your eyebrows because they weren’t in the way. (As a variation of this experiment, try looking at your eyebrows.) Coordinating those two different muscle actions requires a functioning brain!

A Dissenting Opinion

Media Culpa reports on the dissenting opinion in the appeal to the Federal Appeals Court. Judge Wilson had a lot of excellent things to say, including this gem:

Plaintiffs have demonstrated that the issuance of an injunction is essential to preserve the federal courts’ ability to “bring the litigation to a natural conclusion.” Klay, 376 F.3d at 1102. By failing to issue an injunction requiring the reinsertion of Theresa Schiavo’s feeding tube, we virtually guarantee that the merits of Plaintiffs’ claims will never be litigated in federal court. That outcome would not only result in manifest injustice, but it would thwart Congress’s clearly expressed command that Plaintiffs’ claims be given de novo review by a federal court.

(Note: A de novo review is a reexamination of the facts. Appeals courts normally assume the original judge got the facts correct. Therefore they typically rule only on procedural errors.)

Looking At Dr. Cranford

WorldNetDaily takes a look a Michael Schiavo’s favorite expert witness: Dr. Ronald Cranford. While he may not have earned the nickname “Dr. Death,” he certainly seems interested in claiming it. In fact, Dr. Cranford’s record reminds me of this bit from Monty Python and the Holy Grail:

The Dead Collector: Bring out yer dead.
[a man puts a body on the cart]
Large Man with Dead Body: Here’s one.
The Dead Collector: That’ll be ninepence.
The Dead Body That Claims It Isn’t: I’m not dead.
The Dead Collector: What?
Large Man with Dead Body: Nothing. There’s your ninepence.
The Dead Body That Claims It Isn’t: I’m not dead.
The Dead Collector: ‘Ere, he says he’s not dead.
Large Man with Dead Body: Yes he is.
The Dead Body That Claims It Isn’t: I’m not.
The Dead Collector: He isn’t.
Large Man with Dead Body: Well, he will be soon, he’s very ill.
The Dead Body That Claims It Isn’t: I’m getting better.
Large Man with Dead Body: No you’re not, you’ll be stone dead in a moment.
The Dead Collector: Well, I can’t take him like that. It’s against regulations.
The Dead Body That Claims It Isn’t: I don’t want to go on the cart.
Large Man with Dead Body: Oh, don’t be such a baby.
The Dead Collector: I can’t take him.
The Dead Body That Claims It Isn’t: I feel fine.
Large Man with Dead Body: Oh, do me a favor.
The Dead Collector: I can’t.
Large Man with Dead Body: Well, can you hang around for a couple of minutes? He won’t be long.
The Dead Collector: I promised I’d be at the Robinsons’. They’ve lost nine today.
Large Man with Dead Body: Well, when’s your next round?
The Dead Collector: Thursday.
The Dead Body That Claims It Isn’t: I think I’ll go for a walk.
Large Man with Dead Body: You’re not fooling anyone, you know. Isn’t there anything you could do?
The Dead Body That Claims It Isn’t: I feel happy. I feel happy.
[the Dead Collector glances up and down the street furtively, then silences the Body with his a whack of his club]
Large Man with Dead Body: Ah, thank you very much.
The Dead Collector: Not at all. See you on Thursday.
Large Man with Dead Body: Right.

This bit of satire is incredibly funny precisely because it’s so unthinkable. But it’s profoundly disturbing to realize that it is almost exactly what seems to be happening in Terri’s case.

DCF’s Neurologist Reports

K.J. Lopez quotes from and links to the report by Dr. William Cheshire in several posts at the NRO Corner. Dr. Cheshire is a neurologist who is working with Florida’s Department of Children and Families. He reviewed her case this month.

From his affidavit:

There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to go unnoticed at the time. At 2:44 p.m., Dr. Hammesfahr had just turn Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well after he ceased applying the stimulus and had returned Terri to a comfortable position, he says to her parents, “So, we’re going to have to roll her over….” Immediately Terri cries. She vocalizes a crying sound, “Ugh, ha, ha, ha,” presses her eyebrows together, and sadly grimmaces. It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr’s comment and signals her anticipation of pain. This response suggests some degree of language processing and interpretation at the level of the cerebral cortex. It also suggests that she may be aware of pain beyond what could be explained by simple reflex withdrawal.

The Hanging Judge

WorldNetDaily reports on another “right-to-die” case handled by Judge Greer. In this case, he ruled against the man’s wife and in favor of the man’s children. The man suffered a heart attack and was on a ventilator. He also had a living will stipulating that he was to be removed from life support if there was “no reasonable expectation” of recovery. Judge Greer ruled that the man was to be removed from life support. So far, that seems to be the correct ruling.

It’s when I look at the dates that more questions of Judge Greer’s prejudices appear. The man had his heart attack on September 9th, 2000. Judge Greer handed down his decision on October 24th of the same year — just barely over one and a half months later! Even without some of the information I’ve been learning about brain damage, that seemed to be an awfully short period of time. In the various literature I’ve looked at, three months seems to be the minimum amount of time needed to determine a patient’s prognosis with 12 months being appropriate in some cases.

So once again, Judge Greer was in a hurry to have someone die, this time ruling against the principle of “the spouse is always right.” While 2 cases is hardly enough to establish a pattern — especially when details of this other case are sketchy — it’s starting to look more and more like Greer is a hanging judge. The only problem is that the people he is having put to death are the one’s he is supposed to be protecting!

Miscellaneous Stuff

Over this past weekend, ABC news ran a poll which purports to show that most Americans favor removing Terri’s feeding tube. As Captain’s Quarters shows, the poll used completely biased questions and misstatements of facts.

Lance Salyers is a prosecuting attorney who runs Ragged Edges. He has written a fabulous and detailed post on why he doesn’t trust Michael Schiavo.

Here is an excellent interview with Robert George, the McCormick professor of jurisprudence at Princeton University, among other things. I found what he had to say fascinating.

Dr. Boyle of CodeBlueBlog is an experience radiologist. He takes a look at Terri’s CT scan and draws some very interesting conclusions. Be sure to read the comments too.

Here is a link to various legal documents related to Terri’s case.

WorldNetDaily has posted an overview of Terri’s case.

Harriet Johnson has posted an excellent article about Terri’s case.