The Commander was shouting as he burst in. “My Lord! My Lord! They have arrested your son!”

“I knew they would.” came the calm reply.

“But my Lord,” protested the Commander, “he has never done anything wrong!”

“I know.” The reply was as calm as before. “When I sent him among them, I knew that most of them would not want to hear what he had to say. This was their response.”

“If you knew this was going to happen, then why did you send him?”

“I sent him for those who would receive him.”

“But there are so few!” protested the Commander.

“They are enough. They are a beginning.” replied the Lord.

“Then your son’s mission is finished, my Lord. Let me go rescue him.”

“NO!” The answer was swift and final. “His mission is not yet finished. You are to return and watch. No more.”

The Commander saluted. “As you wish, my Lord.” Then with a bow he was gone.

A short while later he was back, even more agitated than before.

“Yes, Commander?” asked the Lord.

“They’ve held a trial, my Lord. He has been condemned to death!” The Commander was almost visibly shaking.

“So he has.” replied the Lord.

“But my Lord,” cried the Commander. “It was not even a fair trial! They held it in the middle of the night. They had false witnesses who told lies about him. And even though your son told the truth, they would not believe him. In fact, they based their sentencing on his own words! This was not justice, my Lord. This was…”

“Condemning him for their own faults.” interrupted the Lord.

“Yes, my Lord.” said the Commander.

“This was also part of his mission.”

“I, I don’t understand my Lord,” the Commander stammered.

“Then return and watch, Commander. That is your mission; to watch and learn.”

“As you wish, my Lord.” And once again, the Commander was gone.

“A murderer!” the Commander shouted.

“Excuse me, Commander?”

The Commander was almost beside himself. “A murderer, I said. They chose a murderer over your son!”

“Please elaborate, Commander.”

“After the trial, they took your son to the local governor for execution. After talking with your son, he realized that your son did not deserve to be put to death. So he decided to offer a choice to the crowd that was watching. He let them choose between freeing your son or the most rotten murderer in his prison. I was sure they would choose to free your son. But they chose to free the murderer instead. Please, my Lord, please let me rescue him!”

“No, Commander. That cannot be.”

“But why, my Lord?”

“His mission is still not finished, Commander. There is more for him to do.”

“How, my Lord? How can he complete his mission in the midst of such obvious hostility? Some of those people that called for his death were the same people that welcomed him into the city only one week ago! It’s almost as if…”

“As if they too want to blame him for their own faults and failures.”

“Yes, my Lord,” replied the Commander. “Is this also part of his misson?”

“It is, Commander. Now it is time for you to return and watch.”

“As you wish, my Lord. But I still do not understand.”

“You will, Commander. You will.”

The Commander was back. This time, the agitation was gone.

“Yes, Commander?” asked the Lord.

The Commander’s voice was shaking. “It’s over, my Lord. Your son is dead.”

“I know, Commander. I know.” The softness of the reply startled the Commander.

“My Lord, you’ve been crying!”

“Yes, Commander.”

“Did you know this would happen, my Lord?”

“Yes, Commander.”

“Then why did you send your son?”

“Because there was no other way, Commander. I sent my son to bring the people back to me.”

“But my Lord, how can he bring anyone back to you if he is dead?”

“Return and watch, Commander. Then you will understand.”

Three days later, the Commander finally understood.

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.

Kim du Toit, a man I both respect and sometimes strongly disagree with has finally posted his opinion on the case of Terri Schiavo. His opinion is that Terri is already brain dead and should be “allowed to die.” (Food and water is not medical intervention. If you think it is, try claiming your grocery bill as medical expenses on your next tax return!) Even more importantly, he thinks it’s a constitutional crisis and that Congress is shredding the Constitution to protect Terri.

I agree that it is a constitutional crisis, but I think he is dead wrong on everything else.

Persistent Vegetative State

First, let’s start with one basic fact. Judge Greer has ruled that Terri Schiavo is in a Persistent Vegetative State from which she will not recover. In other words, she is brain dead and nature must be allowed to take its course. That ruling is the centerpiece of the firestorm raging all over the internet and in the comments in response to Kim’s piece.

So what is a Persistent Vegetative State? When I started researching the definition, most of what I found was appallingly vague. It almost seemed like Jakie (say the J like a “ch”) and Amos were taking a break in the back 40 one day discussing PVS. “Vell, it’s almost lak a coma, but not quat, don’cha know. Dare eyes sorta open but dey don’ see nothin’.” “Yeah, da laghts iz on but no one’s home, okay?” The most concise definition I found was from this page from the Medical College of Wisconsin.

A persistent vegetative state, which sometimes follows a coma, refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment but retain noncognitive function and a perserved sleep-wake cycle.

It is sometimes described as when a person is technically alive, but his/her brain is dead. However, that description is not completely accurate. In persistent vegetative state the individual loses the higher cerebral powers of the brain, but the functions of the brainstem, such as respiration (breathing) and circulation, remain relatively intact. Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey commands. Patients in a vegetative state may appear somewhat normal. They may occasionally grimace, cry, or laugh.

In short, a person is not in PVS if they speak or try to speak, swallow, or otherwise respond to their environment beyond simple reflex. There is significant evidence that Terri is actually in fact, not brain dead and that the PVS ruling is not factually correct, including video, evidence from a neurologist who spent 14 hours examining her over a two week period (note: the doctors who claim PVS spent a total of 45 minutes with her, including one who promotes killing Alzheimer’s patients), and sworn affadavits from numerous nurses and aids. Not only is Terri able to interact with her environment, she is also capable of limited speech.

That this single central question is so heavily debated, even among experts, clearly shows that we cannot assume that the issue is settled enough to irreversibly end someone’s life. In fact, as I agrue below, the government (including the federal government) has a duty to err on the side of preserving life.

The Constitutional Side

Why do we even bother with the problems caused by governments? The Declaration of Independence gives us the answer:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. —That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,

Kim (and others) have complained that the government has no right to step in here because it interferes in a marriage. But it doesn’t take a genius to realize that spouses often do violate each others’ most basic human rights. That’s why we have domestic violence laws. It’s also obvious that we don’t look the other way when a spouse commits murder. In fact, I think that it’s a given that whenever there is a murder, the spouse is automatically at the top of the suspect list until they are cleared.

Marriage is not a carte blanche for one spouse to do anything they want to another. In fact, The Mrs. (who has also weighed in in the comments) has often written with great eloquence on the problems of domestic violence and the need for women to escape the abusive relationship. (BTW, I’ve agreed with those articles wholeheartedly.) While society recognizes that a marriage relationship is crucial and therefore allows more benefit of the doubt when one spouse appears to be mistreating the other, such leeway is not absolute.

As the Declaration points out, the only reason for the existence of the government — as dangerous as it can become — is to protect the rights of its citizens. In situations where the life of a spouse is being threatened, not only does the government have the right to step in, it has a duty to step in. If the government has no such duty, then we should abolish it immediately and save ourselves a lot of trouble.

Has Michael Schiavo abused Terri? Did he even try to kill her? There have been allegations that he abused her and that there are xrays showing the abuse, that he stalked her, and that he stalked another girlfriend he had after Terri’s injury. There have been reports that he denied her even the most basic of care (refusing to allow brushing her teeth and antibiotics to treat an infection). There have been allegations that she was injected with insulin in an attempt to kill her. It’s obvious that he has not stayed true to his marriage vows in spite of his sworn testimony supporting those vows during the malpractice suit. He has also broken the laws of Florida which require him to make sure Terri gets therapy.

It also seems that Michael may not be motivated solely by the money. Offers of millions of dollars if he just divorces her and returns her care to her parents and offers of absolution from the parents have all been ignored. It is clear that Michael wants her to die. Is it because he is truly certain that Terri wants to die? Or is it possible that he was the cause of Terri’s injury and he’s terrified that she will recover and get him put away for attempted murder? I don’t know for certain which is the case. We do not condemn criminals to death if there is reasonable doubt, why condemn the innocent to death when there is such doubt?

Even if there is no fire there is definitely plenty of smoke. No legitimate fireman would fail to investigate smoke which could indicate a fire. Neither should a legitimate government shirk its duty to investigate questionable circumstances. To my knowledge, no such investigation has taken place. As long as such doubt remains, the government has a duty to protect the life of its only material witness about whether or not Michael may have abused her: Terri Shiavo.

Activist Judges

Here is where I’m really surprised about Kim’s post because he misses the true constitutional crisis. The problem is not the intervention of the federal government, it’s the complete lack of accountability of judges which is the real crisis.

Both the legislature and the executive branches of the Florida state government have opposed the rulings of Judge Greer. Yet, his will has prevailed so far. Why? Because judges have been assumed to have final authority. In what was supposed to be a government system of checks and balances, there is no check or balance on the judge, not even the law. (Here is a petition of impeachment listing 38 specific charges of either violating or failing to uphold very specific laws. Update: More on broken laws.)

Kim himself has railed time and again against activist judges violating the Constitution, violating laws, and creating their own laws in violation of the Constitutional separation of powers. The principle behind those rants is sound. Judges are empowered only to judge whether or not a law was broken and set the penalties when they are. That principle must be held even when a judge’s ruling supports a personal preference.

When judges ignore the laws they are sworn to upheld, they must be held accountable and punished for their actions. The appropriate avenue for such punishment is impeachment. It is the responsibility of the legislature to impeach a judge when he violates duly established laws. While such a move should never be taken lightly, to fail to do so produces tyranny — a tyranny of the men in the black robes who answer to no one, not even the supreme laws of this country. Judges who are not held to the simple and practical standards of obeying the laws and the separation of powers eventually become a law unto themselves, trampling our system of government and the rights of everyone under their power. When that happens, we are forced to turn once again to the Declaration of Independence:

That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn, that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.

I certainly do not want to engage in such a duty. And for all his cussing and spitting on the topic, I sincerely doubt Kim is any more anxious to engage in a shooting war than I am. Yet by choosing the side of the activist judge in this case — rather than smacking him down as Kim usually does — I’m afraid Kim is helping to push us closer to just such a convulsion.