:: Running from the Thought Police ::

:: Thursday, March 31, 2005 ::

Something Died, But Was It Terri?

CNN.com, and likely every other news source in the country, is covering the death of Terri Schiavo - or, at least, that of her body. The ambiguity over what exactly died is the root of the the controversy. Was it Terri who died today, or just a corpse with a functioning hindbrain and limbic system? That this case happened at all is a result of the medical advances of the past half-century. Terri became hypokalemic as a result of her bulimia, had a heart attack as a result of her hypokalemia, suffered ischemic hypoxia (lack of oxygen due to lack of blood flow) as a result of the heart attack, and sustained major damage to her cerebral cortex as a result of the hypoxia. Without medical intervention, the hypoxia due to the heart attack would have caused her to die within minutes. Instead, she recieved medical treatment, and since only her higher brain functions have been affected, her body remained alive.

It is at this point that the morality of the subsequent actions surrounding Terri Schiavo are determined. Most, if not all states in this country accept whole brain death as a reason for declaring a person dead. The Catholic Church also accepts this criterion (whether or not the Ragemonkeys do). This reflects a specific understanding of what it is to be alive as a human: the ability to do things, participate, and have a life history. These are all products of consciousness. Whether or not one's heart is beating, or one's lungs are breathing, a body is just a sack of water, carbon, nitrogen, and a few other things without a brain to run the show. Demonstrating the death of the whole brain unequivocably shows that the patient in question will never regain consciousness.

Terri didn't experience whole brain death - her hypoxia was treated early enough that only her cortex suffered major damage. Her brain stem, cerebellum, limbic system, and the like all survived relatively unscathed. Extending on the reasoning behind the recognition of whole brain death, any situation in which a person is unconscious and will never regain consciousness would be sufficient to declare the person dead. Currently, our legal system doesn't recognize this criterion, partially because there are no unequivocal means of determining that a person will never regain consciousness. However, if we use this definition for death, which many physicians appear to do (through the use of the PVS diagnosis), then there is no moral wrong committed by withholding anything from such a patient, because they are already dead. If Terri was unable to regain consciousness after her heart attack, then she effectively died over fifteen years ago.

The problem with the diagnosis of a Persistant Vegetative State is that, for many people, the idea of a breathing person being effectively dead is counter-intuitive. The danger of misdiagnosis is also incredibly high - if the criteria aren't strictly determined and enforced, someone who is "locked in" but still conscious may have their life support withdrawn. In Terri's case, a long set of tests, including a CAT scan, an electroencephalograph, and long term observation, were all done to evaluate her cognitive state and potential. The doctors running these tests, as well as the majority of neurologists who have since been called on to comment on the case, agreed that the damage was so severe that Terri would never regain consciousness. While I lean towards agreeing with the doctors involved, I still hold minor reservations as to the permanancy of her state. Even so, she has had no improvement in the past fifteen years, which lends credence to the case for PVS.

Many, including Terri's own parents, refuse to accept her diagnosis. As brought up by Dr. Chuck Rangel of RangelMD,

It would appear that the proponents of keeping Terry Schiavo alive indefinitely have a basic inability to understand or accept the fact there can be a complete disconnect between brain damage and wakefulness in a patient who suffers from a persistent vegetative state. In short, a patient with severe brain damage can appear to be awake like Mrs. Schiavo does.

This explains the emotional effectiveness of the video of Terri supposedly interacting with her environment - even though the shots of the video are culled from hundreds of hours of footage just to provide that small amount of apparent consciousness. Supporters of Terri's parents used these random occurances to argue that she was conscious, though heavily brain damaged, and that she therefore was alive.

Morally, the conflict wasn't between a group that wanted to kill Terri and one that wanted to keep her alive, but between a group that said she was alive and another that maintained that she was already dead. Personally, I think that the person known as Terri Schiavo died fifteen years ago and that it was a pile of a trillion or so cells that died today. However, I will admit that we, as a society, currently lack the knowledge (and, apparently, the maturity) to effectively create a set of criteria for PVS that would demonstrate, unequivocably, that a patient would never regain consciousness and was effectively dead. Because of this current lack of understanding, I think it was wrong to withhold food and water from Terri, if only because her diagnosis had questionable criteria.

Until medical science and society both come to a better understanding of the underlying ideas and criteria for what defines life and death, the best any one individual can do is to make their wishes very well known before a tragic event happens. As my biomedical ethic proffessor said in lecture today, Terri's case demonstrates that, if anything, there is a dire need for everyone to have advance directives, living wills, and/or assigned durable power of attorney.

:: The Squire 3:18 PM :: email this post :: ::
...