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June 5, 2005

Annihilating Terry Schiavo

Topics: Medical Issues

Dr. Paul McHugh, a professor at Johns Hopkins University, discusses the meaning of the Schiavo case in his essay Annihilating Terry Schiavo. Joe from Life at the Frontier comments that he has missed some of the disputes about certain 'facts' in the case but seems to have a handle on the opposing world views involved, and the practical effect on patients and medical professionals. Here are a few exceprts I found interesting:

Conspicuously missing from the chorus of voices arguing over the meaning and implications of the Schiavo case have been the views of a class of people with a uniquely relevant body of experience and insight: namely, the doctors and nurses who customarily provide care to patients like Terri Schiavo. As a result, few people appear to have grasped that the way she died was most unusual. That, instead, it has been widely understood to be not only a proper but also a perfectly commonsensical way to die, a way approved of by most doctors and nurses, can only be explained by a deep change that has taken place over the last decades in our thinking about how to care for the helpless and the disabled among us.

... I use the term "life unworthy of life" advisedly. The phrase first appeared a long time ago--as the title of a book published in Germany in 1920, co-authored by a lawyer and a psychiatrist. Die Freigabe der Vernichtung lebensunwertes Leben translates as "Lifting Constraint from the Annihilation of Life Unworthy of Life." Terri Schiavo's husband and his clinical and legal advisers, believing that hers was now a life unworthy of life, sought, and achieved, its annihilation. Claiming to respect her undocumented wish not to live dependently, they were willing to have her suffer pain and, by specific force of law, to block her caregivers from offering her oral feedings of the kind provided to all terminal patients in a hospice--even to the point of prohibiting mouth-soothing ice chips. Everything else flowed from there.

Contemporary bioethics has become a natural ally of the culture of death, but the culture of death itself is a perennial human temptation; for onlookers in particular, it offers a reassuring answer ("this is how X would have wanted it") to otherwise excruciating dilemmas, and it can be rationalized every which way till Sunday. In Terri Schiavo's case, it is what won out over the hospice's culture of life, overwhelming by legal means, and by the force of advanced social opinion, the moral and medical command to choose life, to comfort the afflicted, and to teach others how to do the same. The more this culture continues to influence our thinking, the deeper are likely to become the divisions within our society and within our families, the more hardened our hatreds, and the more manifold our fears. More of us will die prematurely; some of us will even be persuaded that we want to.

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Posted by tim at June 5, 2005 11:27 AM


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Why is this doctor assuming that Terri's condition stemmed from bulimia? I thought that had pretty well been ruled out. This is an avenue that should be explored more, though; that is the medical community's input on euthanasia, bioethicists, etc.

Posted by: mary et. al. at June 5, 2005 12:35 PM

Mary, this is why I have been spending the time trying to disprove that Terri was bulimic in the first place. As a result of the malpractice lawsuit being won many people actually believe that Terri really did have bulimia.

It is a side issue but it is one that allowed MS to kill his wife by judicial order. What a neat little piece of deception

Posted by: Maggie4life at June 6, 2005 3:50 AM

I think Juleni is going to be posting an article about the history of this death march written by an RN. So the medical community is beginning to weigh in.

Posted by: mary et. al. at June 6, 2005 11:16 AM

"As a result of the malpractice lawsuit being won many people actually believe that Terri really did have bulimia."

Well... Michael DID win. Not a bad reason to believe that. The case went to a jury. The jury ruled in Michael's favor.

The case was examined by a court-appointed doctor (Dr. Jay Wolfson). This is part of one of his reports:

"The cause of the cardiac arrest was adduced to a dramatically reduced potassium level in Theresa's body. Sodium and potassium maintain a vital, chemical balance in the human body that helps define the electrolyte levels. The cause of the imbalance was not clearly identified, but may be linked, in theory, to her drinking 10-15 glasses of iced tea each day. While no formal proof emerged, the medical records note that the combination of [Theresa's] aggressive weight loss, diet control and excessive hydration raised questions about Theresa from Bulimia, an eating disorder, more common among women than men, in which purging through vomiting, laxatives and other methods of diet control become obsessive."

Posted by: FishyFred at June 6, 2005 5:37 PM

There is also reason to believe that she was strangled--at least as much reason as there was for bulimia.

Posted by: mary et. al. at June 6, 2005 8:43 PM

There is no evidence that Terri was strangled by her husband. The official investigation that I cited points to the contrary. The burden of proof is currently on you.

Posted by: FishyFred at June 6, 2005 9:34 PM

You said it yourself, my fishy friend, "no formal proof emerged" the theory of bulimia was merely adduced. There is, however, proof of x-rays taken showing broken bones, from which spousal abuse can be even more readily adduced.

Posted by: mary et. al. at June 6, 2005 10:42 PM

FishyFred,

What exactly is your point? Is it that there was nothing wrong with the judicially sanctioned execution of Terri? I believe the very document you quote to bolster your argument that Terri's condition was caused by bulemia is weak at best. Note the intro phrase: "While no formal proof emerged..." The rest of that statement is mere speculation. No formal proof means no formal proof.

Posted by: Tom Spence at June 6, 2005 11:35 PM

I noticed that the document mentioned "no formal proof." However, the document went on to say that bulimia was the likely culprit. When you are in such poor physical condition, a fall and attempted CPR can do quite a bit of damage.

Terri was in terrible physical shape. Had she been beaten by Michael, her skeleton may very well have shattered. As it happened, her brain was dead when she hit the hospital bed. Since you can't execute a dead person...

Posted by: FishyFred at June 7, 2005 12:30 AM

It appears you know something no one else knows, Fishy. Terri was holding down a full time job and talking to her friends about divorcing michael before her sudden "collapse". If she was in such terrible shape that her bones would have shattered, how did she manage to go on with her life and hide her condition from everyone, family and friends.

When was the last time you saw a corpse breathing? Do you then, advocate the burial of breathing cadavers?

Posted by: mary et. al. at June 7, 2005 12:36 AM

Fishy,

you make two obvious errors. First of all the malpractice suit was won because Michael deceptively claimed that he was going to use the money to help his wife. As soon as the money was received he placed a DNR on Terri's chart. Juries have been wrong in the past. They are fallible.

The second error that you make is using the report of Jay Wolfson, who is not a medical doctor. He could only report upon the papers that were placed before him. We do not know what papers were not included. As much as I respect Jay Wolfson, I also think that he is prone to error, and that he did not probe the original cause of the incident. He went on the malpractice suit which happens to be won under very doubtful conditions.

When it comes to reports there were several that Greer preferred to ignore. In fact any report that cast any kind of suspicion on Michael Schiavo as an unsuitable guardian was rejected. This is what happened to the report of the first guardian ad litem, Richard Pearse, who in fact wrote in his report that he thought that Michael Schiavo did not have Terri's best interests at heart.

The issue of whether or not there was an attempted strangulation is an issue that is not easily resolved. The evidence for attempted strangulation is a lot stronger than the evidence for bulimia.

The reason that a dx of bulimia is not acceptable is that from what I have read Terri did not display any of the other character traits of a bulimic. She showed no signs of obsessive behaviour (not the same as obsessive compulsive disorder). It was hinted that Terri made herself sick but the evidence was totally weak. In other words, if Terri needed to go to the toilet when she was eating with friends there is no proof that she went to the bathroom to throw up her food.

The other reason why the idea of bulimia is in error happens to be that the lawyer who handled the malpractice suit has been heard to give incorrect information on television interviews. He claimed that Terri was in the act of throwing up her food after eating dinner with Michael when she collapsed. This is totally inaccurate since the collapse happened somewhere between 5:00 and 6:00 in the morning.

The ordeal that Terri suffered as she was finally murdered proved once and for all that thee was nothing wrong with her heart. She never did suffer a heart attack, which was a part of the bulimia myth that Michael used to cover up his own complicity in her collapse. Terri suffered a cardiac arrest because she was deprived of oxygen. She did not suffer a brain injury because she was deprived of oxygen whilst having a heart attack as had been claimed.

Once you start removing the Michael Schiavoese from what really happened, the truth does begin to emerge. The finger is pointed at Michael Schiavo who made multiple attempts to kill his wife.

Posted by: Maggie4life at June 7, 2005 3:23 AM

Maggie4life,

You don't help further your cause by being inaccurate or possibly even deliberately deceptive in your responses.

#1. On what basis do you proclaim that Jay Wolfson is "prone to error"? Do you mean in his career or just in this particular case?

#2. Why would Jay Wolfson have "investigated" the cause of her collapse? Was that ever given to him as a task to perform in regards to his responsibility to the court?

#3. Where is this evidence of strangulation? How is it that this evidence "is stronger" than the evidence bulimia?

I would like to see the truth come out.

Strangulation doesn't appear to be a viable theory for a number of reasons:

The only doctor ever mentioning strangulation was a nuerologist and his comments comparing the case to one other similar case were not exactly deterministic or evidential- in fact the statements he made were clearly outside the scope of his expertise as he had no formal training in forensics or even rehabilatative medicine.

She was intubated. They would have used equipment to visulaize the structures of her throat in order to intubate her. They would have noted problems visualizing the structures of her throat, they would have reported anything abnormal (such as tissue damage, bleeding, swelling, displaced or CRUSHED structures,etc) that they encountered as they intubated her. No petechial hemmorhage was ever noted and they would have looked carefully at her eyes.

In fact many of the specifics of an intake examination would have been repeated by multiple doctors.

They had a young adult female admitted to hospital after collapsing who was in a coma, seizuring and not responsive. Multiple doctors and nurses involved. Not likely they would have missed much.

One of the officers that responded to the scene had gone to the ER in order to get more information. He would have spoken to her doctors. If they had any suspicions they would have IMMEDIATELY voiced them to the cop. The cop looked and found no evidence of a beating and made no mention of suspicious marks on her neck or even that he was entertaining the idea that she might have been strangled.

So tell me, Maggie4Life, where is the evidence of strangulation?

Did you know, Maggie4Life, that at 3.0 potassium the heart can be affected? Did you know that upon Mrs Schiavos admission to hospital hers was 2.0 ? And this is in a world where the tenths are not small steps so the distance between 2.9 and 2.0 was very problematic for her?

Every one brings up the argument against heart attack based on Hammesfuhr stating that the blood work was not indicative of heart attack.

Hammesfuhr NEVER said anything about arrythmia.

It is very clear from the records that she was in arrythmia when the paramedics began with the first of SEVEN defibrillations they administered in an effort to restore a normal rythum.

Oddly enough non medical people assume a defibrillator is used to START the heart. Its actually quite the contrary- it is used to stop a heart that is quivering, or fibrillating and not producing useful work from uncoordinated contractions. Once stopped the SA node or rthyum center of the heart is able to take over and be the origin of a coordinated rythum. This is assuming that some blood chemistry issue isn't creating conditions that make the heart muscle overly sensitive to stimulation- in which case it will just start fibrillating again.

Did you know it is unusual to administer more than THREE defibrillations?

Did you know that with her extrememly skewed blood chemistry (potassium of 2.0) that it was miraculous that they were able to restore a normal rythum at all?

Did you know that medically such a low potassium level can have 3 primary origins- vomiting (excessive or chronic), diareahhea (again, to an EXTREME) or excessive urination (usually caused by the misuse of diuretics)

Did you know the presumptive diagnosis with such a low potassium in an otherwise normal (no apparent sickness causing excessive vomiting or diarehea) is an eating disorder?

This coupled with her biographical information and the information from friends that she would retreat to the restroom after meals has all been interpreted by EXPERTS in the treatment and diagnosis of eating disorders to conclude that Mrs Schiavo suffered from an eating disorder.

Did you know that many persons younger than Mrs Schiavo have died from eating disorders? The usual cause is sudden cardiac death from arrythmias induced by hypoalkemia (abnormal low potassium). This is what makes eating disorders so dangerous. Some of the affects are hidden and are cumulative. They sneak up on you and take you unexpectedly.

Posted by: Amazed at June 7, 2005 12:16 PM

Wrong, Amazed. I am on lisinopril which leeches potassium from the body. Your accuracy is definitely questionable on this but more so on the scenario you played out about what the doctors and nurses would have done. They are not machines, not programmed to go through a set series of actions. At best you can claim that they should have--never can you claim they did or would have done, as you put it. I hope you are not being deliberately misleading.

Posted by: mary et. al. at June 7, 2005 1:52 PM

It was my doctor who told me these pills leech potassium and that I must eat bananas daily. If you would like to correct him, he is Dr. Kirkpatrick on the staff of Scott and White Medical Clinic, Killeen, TX

Other than the broken bones, reports of Terri's friends that she was planning on divorcing Michael, and that Michael was so possessive of Terri that he even checked her odometer, there is no proof of anything that I am aware of. No proof of bulimia, no proof of strangulation, nothing. As Fishy said, it was adduced to be bulimia. But none of the above proofs were brought before the jury who adduced this. That Michael was a violent man can be testified to by Terri's sister who he attacked. That marks of strangulation are not necessarily discernable I can testify to because my first husband strangled me until I passed out on numerous occasions before I escaped him. I did not have marks, only a neck so stiff I had to lift my head with my hands. And when I did escape him I didn't tell him I was going because I knew I wouldn't get out the door. He was also very possessive. I believe Terri made the mistake of telling Michael, as she told her friends, that she was leaving him. But Maggie has done quite a lot of research into this and plans to do more and hopefully get to the bottom of this. If Michael did start to kill Terri and only finished the job 15 years later, then justice needs to be served. Right now there are people out there who think Terri deserved what she got because of her bulimia. Terri is the victim and the victim again under these circumstances. And Michael has gotten away with murder, enriched himself and even possessively denied Terri's family even the comfort of visiting her grave.

A lot of us who watched and waited, prayed and fought through Terri's murder feel attached to her, even as members of her family. We are not satisfied with what the jury adduced from the limited information they were given. There is absolutely no proof of bulimia, but there is proof of trouble between Terri and Michael and plenty of experts in domestic violence to say this is consistent with domestic violence. Never mind the fact that Michael was adamant that Terri should be dead and no one should have her or take care of her, nor even possess her dead body.

As for what the doctors and nurses did or didn't do when Terri was admitted or subsequently, I think only God knows that for sure. I'm not accusing them of shoddy work, but only of humanity which does not run like clockwork and cannot be second guessed. Who knows what else was going on demanding their attention or otherwise interfering with procedure. One can say, had everything gone perfectly it would have gone like this. But how often does anything go perfectly? It should have gone as you said, perhaps, (I wouldn't know) but there is no way we can know that it did go like that. Here again, there is no proof either way. That Michael received a lot of money can be proven. That he ordered Terri to be neglected after he got that money can be proven. Jesus said, "You will know them by their fruits." I have always found that to hold true. Listen to Maggie, she has and is doing her homework.

Posted by: mary et. al. at June 7, 2005 10:48 PM

Well Amazed you have not proven anything with this little hissy fit that you have thrown as you distort precisely what I stated.

1. I did not say that Jay Wolfson is error prone. I said that he made errors concerning his analysis. He is not infallible and like every other human being he is quite capable of making mistakes.

2. Jay Wolfson is not a medical doctor and therefore he cannot make a medical dx. He can only report or comment upon what he was told. If that information was tainted and in fact I believe that the information was more than tainted, being in part outright lies, I consider that he did his job but nothing more. His evidence is not of the kind that means it should be held up as the only evidence that is accurate. It is not.

3. Jay Wolfson failed to report on the obvious points regarding Michael Schiavo's push to murder his wife.

His report is only as good as the information that was provided to him. He failed in a lot of ways, yet he did state that further tests should be done before any decision was made. This advice was ignored.

4. Jay Wolfson is not a disinterested and independent party because of his own affiliation with Suncoast Florida Hospice.

I do consider that he attempted to be unbiased and I applaud his efforts. However, I also believe that he was not the most highly qualified person for the task.

Why do you ignore the report of Dr. Chesire. He is a qualified neurologist and his report was also ignored by George Greer. This last report by a neurologist was probably the most critical when it came to an honest assessment of Terri's condiditon. This doctor was the man who was the most independent of the whole bunch who had examined Terri. Yet, he was vilified by certain sectors of the community because he gave a report that stated that Terri was not as bad as stated by Cranford, Schiavo, Felos et al.

The whole thing is an absolute disgrace and a blot on the justice system of the United States of America.

Do I consider Jay Wolfson to be qualified to give a medical opinion about Terri? Absolutely not. He does not have the qualifications to assess a person in that condition. He seemed to be unaware of the possibility that someone could have tampered with Terri's feeding so that she would appear to be non-reactive.

There are a lot of options that people like yourself refuse to consider because all you want is to promote the culture of death. Well one thing is certain, by the time I am finished investigating every single aspect of this case, I will look forward to cleaning the egg off your face.

I have only scratched at the surface of the Terri Schiavo case. Even at the surface levels it is obvious that there were problems that were ignored.

The biggest hole, and I believe the one hole that will see MS serving time in prison in the near future, has to be the lie about Terri's wishes. This is a man who could not remember his wedding anniversary, are you going to tell me that his memory was so good that he could suddenly remember after a period of 10 years that Terri would want to die. My response to that is "bull" and the mushrooms will thrive from what is produced by bulls.

Posted by: Maggie4life at June 8, 2005 3:25 AM

Geez....getting on here is a chore at times...
ahem...anyways...
Bulimia?? YOu've got to be kidding. Are we to believe Terri had bulimia suddenly? The major reason for her demise? Yea, right...and pigs fly as well.
I'm sure whoever wanted/wants too, you could probably come up with all kinds of nonesense about Terri's medical conditions. It'll still amount to rot-gut.

This garbage about what the JURY said/declared. Big whoop. What was the JURY ALLOWED to see? What did the JUDGE allow INTO evidence?
If I tell you, Joe Blow is innocent of rape, and leave out particular bits of information, you'll probably acquit the man of rape. Now, never mind if that person has a history of sexual assaults running back 25 years. Gee, you'd think you should KNOW about that, right??

This Bulimia crap, aired a while back. I tried to say it was crap then, it's crap now. Many others, I'm sure, felt/said the same thing. Bulimia. Please. Get real.

Smoke and mirrors won't help cover what we know to be true: Michael Schiavo lied in court. Judge Greer ordered the murder of this woman, based on hearsay. ( BTW, when was THAT allowable in court as evidence? ) HE SAID SHE SAID stuff. Amazing.

Now, some whack job wants to debate the difference between 2.9 and 2.8 of potassium in the blood, as a reason why she died. Amazing.

Never mind, that she lived thru what she did for so long.....Gee, you think that mattered? Never mind, she held out longer than even the DR's thought possible....gee, do you THINK she WANTED to die?? If that woman was bulimic, then holy cow, what better way to go, than right there and then!! All Terri had to do was, give up!! Simple!!

Unfortunately for SOME people, she didn't just, GIVE UP. She fought. She attempted to LIVE.
Cry a river, give up any excuse you wish ( even include aliens from Mars if that makes you happy )
Blame Star Wars, Yoda, OBI-WAN, Dark Vadar, President Bush, Condoleca Rice.......Dark Wing Duck if it floats your boat.

All of it will be crap. She was murdered, that sorry SOB Michael had a hand in it, Judge Greer ordered it, and that piece of ***** Lawyer for Michael gloried in it.

Anything else and everything else, is irrelivant.

Bulimia....pffffffffffffffffffft

( Hugs for Maggie ) Give em Hell!!!!

Posted by: LNaranjoiv at June 8, 2005 1:04 PM

LNaranjoiv,


I couldn't have said it better! Bravo!!

Posted by: CeCe at June 8, 2005 1:43 PM

Her K on admission to the ED was 2.0. Even if we accept your bald assertion that she was not suffering from bulemia, what other explination can you offer for her drastically low potassium?

Terri Schiavo suffered a tragic fate in 1990, made all the more tragic by the lies that folks like you have used in an attempt to hijack her case for your own ends.

Posted by: JohnClark at June 9, 2005 3:39 PM

JohnClark,

I believe you mistyped, and forgot a word in your brilliantly biting parting remark. You sould have said "... attempt to hijack her case for your own *EVIL* ends." I see that in your universe, it is evil and wrong to resist the legal execution of an innocent. But answer this, to what ends? Unlike your motivation, we do not stand to make any money.

Posted by: Tom Spence at June 9, 2005 8:33 PM

So far from making money, we spend it and our time with only the hope that we can save others from the same "tragedy" Terri went through. Our reward, if we get any, will be in the form of lives saved, tragedies averted. But that will only happen for those who are open to the truth, as they alone will seek it so that they may be free. For those who prefer to be spoon fed, there is no hope.

Posted by: mary et. al. at June 10, 2005 12:33 AM

Dear Mr Clark,

Are you suggesting, that Terri HAD bulimia?
If you're telling me I"M making a ' bald assertion that she DIDN"T ' have bulimia, then You sir, are just as BALD making the same assertion that she HAD bulimia.
Low potassium? Please.......Next time a husband beats his wife and she ends up in the hospital, are we going to argue over her Potassium count, to justify her hospitalization?

What was the explanation of Michael Shaivo's denying her medical care at the BASIC level? Potassium levels? No dental care? Cause of her bulimia?

Again, now and in the future, You people that attempt to justify her murder consistantly come up short and lacking. Make whatEVER excuse you want to make, use what EVER medical jargon mumbo-jumbo that makes you feel better. Fact is, she was murdered by her husband, on orders of a Florida Judge to the glee of the husbands attorney.

You sir, like so many others of this argument, would be the FIRST to cry, " save that person, they're choking to death! Give them first aid! "
Why?? If they're choking, let em go! Isn't that a NATURAL death?
A child drowns, will you aid that child, or stand there and say, it's a natural death?
Why can't we starve the prisoners on death row?
It's " euphoric " isn't it? I'm sure they'd be happy and go quietly, don't you agree?

If you sense utter contempt and sarcasim here? You're right. Fry an innocent, yet keep convicted murders on the lamb forever.

Understand this, for those of you who TRY to white wash this womans death:

Once you blow someone's brains out with a .44 Magnum, trying to convince the world it was ' euphoric ' won't cut it. No matter how you say/cut/attempt to change the facts, bottom line is, you blew someone's brains out with a .44 magnum.

Terri was murdered.

All YOU people are trying to do, is justify her death, to help you SOOTH the guilt you carry.

You'd all probably feel better, if you just cheer for her murder, like WE all know you really want too.

Posted by: LNaranjoiv at June 10, 2005 12:04 PM

"Fact is, she was murdered by her husband, on orders of a Florida Judge to the glee of the husbands attorney."

Taking Michael out of this equation for just a second - because, to be quite honest, the pro-removal view wasn't exactly in love with him either - you are taking the demonization of the other side too far. There is no "culture of death." NOBODY wants to see another person die for no reason.

You make them sound like ritualistic killers. They aren't. They just look at the evidence available and believe that it points to Terri being a shell of a human and that she did not want to be kept alive like this.

Posted by: DisneyDime at June 10, 2005 7:24 PM

Wrong, Disney Dime, there is a culture of death. A few too many people these days think that the answer to everyone's problems is death. If they're less than perfect, kill 'em. We have quite a few Dr. Death Crandalls running around promoting death, we have a LOT of abortion promotors (and those babies do die eventually). Some of the things going on in this country are beyond sickening. Such as vivisection sans anesthetic, experiments on live humans, now cloning for the purpose of creating human guinea pigs, rushing people to death to harvest their organs. The list is long and utterly nauseating. There is a huge market for human bodies and body parts and laws have been enacted in New Jersey, California and Connecticut allowing experimentation on live humans. If you are healthy and all of your body parts could be used, just the sale of your body would run about $150,000--and that doesn't include all the doctor and transportation fees that are taken in as a result of placing all your parts here and there. One man likened the human tissue companies to automobile "chop shops". Do you find it hard to believe that someone wouldn't be glad to do you under for that amount of money?

Posted by: mary et. al. at June 10, 2005 8:40 PM