October 12, 2005
Was the autopsy the final word?Topics: Commentary
Results reported as 'confirmation,' 'vindication,' but others beg to differ - by Diana Lynne
In the minds of many Americans, the results of the autopsy performed on Terri Schiavo served as the final word on the debate over whether the 41-year-old brain-damaged Florida woman should have been dehydrated to death per court order. News outlets across the board delivered the results released June 15 to their audiences as "vindication" for Michael Schiavo for having fought seven long years in court for the right to remove his wife's feeding tube and end her life. At the same time, journalists vilified the Schindlers, Terri's parents and siblings, for having opposed him. "End of story," many say, while others beg to differ.
The body of Terri Schiavo was whisked to the coroner's office on March 31 within hours of her succumbing to 13 days with neither fluids nor food after Pinellas County Circuit Court Judge George Greer ordered her feeding tube removed and barred oral nutrition and hydration.
Nearly 11 weeks later, Pinellas-Pasco County chief medical examiner Dr. Jon Thogmartin confirmed Terri Schiavo died of "marked dehydration," even though he listed the exact cause of death as "complications of anoxic encephalopathy," or brain damage. He declared Terri's heart to be strong and estimated she would have lived another decade if not for the feeding-tube removal.
Thogmartin couldn't provide an answer for the $64,000 dollar question, although the media were largely persuaded he had and variously reported the autopsy "backed Schiavo" in his longtime assertion that his wife was in a persistent vegetative state, or PVS.
Thogmartin and consulting neuropathologist Dr. Stephen Nelson stressed in the autopsy report that PVS is a clinical diagnosis made through physical examination of a living patient not a pathological diagnosis made postmortem. Still, Nelson reported that pathological and anatomical findings, such as her shrunken brain and dilated ventricles, were "consistent" with the PVS diagnosis reached in the court. He pointed out that Terri's brain weighed 615 grams, which is less than half of the expected weight for an adult her age. He also pointed out Terri's brain weighed less than her famous vegetative predecessor Karen Ann Quinlan.
Thogmartin conceded it is unknown how much the long duration of dehydration contributed to the shrinkage of Terri Schiavo's brain.
At the press conference held to announce the autopsy findings, Nelson went further in lending support for the court's diagnosis of PVS. He emphasized the pathological findings were "very consistent" with PVS, but admitted he could not rule out the possibility Terri Schiavo was in a minimally conscious state, or MCS, because there are no published studies on pathological correlations to the clinical diagnosis of MCS.
In a critique of the autopsy posted on her weblog, ErosColoredGlasses.blogspot.com, physician and scientist Dr. Sherry Eros called it "medically reprehensible" for Nelson to have stated to the press that the autopsy results are either "consistent with" or "not inconsistent with" a PVS diagnosis, without emphasizing "that it is illegitimate to use postmortem findings to retroactively make the clinical diagnosis of PVS." Eros further questions the relevance of findings that are "consistent" with PVS.
"When the scientific and medical data is equally consistent with both x and non-x as in the Schiavo case, then it is utterly meaningless to suggest ... that it supports or establishes one or the other as true," she wrote. "It is only when the physician or the ME can use data to "rule out" something, by finding that the data is 'not consistent with' such a diagnosis, or cause of death, that something meaningful has been said." Eros further derisively equated Nelson's phrase "very consistent" with the nonsensical "very pregnant."
Many thanks to Diana Lynne for granting permission to reproduce a portion of her commentary. Dianna has a newly released book on the Terri Schiavo saga, titled "Terri's Story: The Court-Ordered Death of an American Woman."
Posted by tim at October 12, 2005 4:56 PM
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