March 28, 2005
Medical Fact Should Decide Terri's Fate, Not Partisan Posturing
By Mort Kondracke

Having personally experienced the agonies that propel both sides in the Terri Schiavo case, I come to this conclusion: The best solution would be to keep her alive long enough to determine, for once and for all, if she is indeed in a persistent vegetative state with no hope of improvement.

If the diagnosis of PVS is correct, then she should be allowed to die, as her husband argues. If it isn't, then she should receive rehabilitative therapy, which her parents are willing to oversee.

The amazing fact is that, through the 15 years of her illness and 11 years of bitter legal wrangling - now highly politicized -Schiavo has never had an MRI (magnetic resonance imaging) or a PET (positron emission tomography) scan, which would quickly determine whether she is really beyond hope of recovery.

She once received a CT scan (computed tomography) that supported one of several past diagnoses of PVS, but MRIs and PETs are more modern technology that would give definitive information.

Chances are, she is beyond recovery, based on information collected in 2003 by Jay Wolfson, a lawyer and public health expert appointed to advise the Florida courts and Gov. Jeb Bush (R) on the case.

After reading 30,000 pages of court records, interviewing health professionals who had treated Schiavo and dozens of other experts, and after visiting her and interviewing her husband and parents, Wolfson concluded that Schiavo's "neurological tests and CT scans indicate objective measures of the persistent vegetative state. These data indicate that Theresa's cerebral cortex is principally liquid, having shrunken due to the severe anoxic [oxygen deprivation] trauma 13 years ago.

"It is noteworthy to recall that from the time of her collapse, and for more than three years, Theresa did receive active physical, occupational, speech and even recreational therapy. ... In the observed circumstances, the behavior that Theresa manifests is attributable to brain stem and forebrain functions that are reflexive, rather than cognitive."

Last week, this medical consensus was challenged, principally by Senate Majority Leader (and heart surgeon) Bill Frist (R-Tenn.) and a neurologist from the esteemed Mayo Clinic.

The thalamic implant makes an MRI impossible, but a PET scan would tell whether there is any activity in Schiavo's cerebral cortex.

If there's anything encouraging to be taken from the Schiavo controversy, it's this: The public is overwhelmingly on the side of allowing someone to die who is beyond hope of recovery.

That's important for the future of medicine and the economy in this country. A significant proportion of overall U.S. medical costs are paid to care for people in the last weeks of life.

Where lives can be saved, obviously the cost is "worth it." And, in unclear circumstances, it is right to "err on the side of life."

At the same time, the hospice movement and the growth of "palliative medicine" offer humane alternatives to heroic medical intervention when a person's case is hopeless. Polling on the Schiavo case indicates strong public support for these developments.

It's also encouraging that, amid the mad rush by most Republicans to the "right to life" side of the Schiavo argument and most liberal Democrats to the opposite side, some politicians managed to think independently.

Democrats such as Sen. Tom Harkin (Iowa), a longstanding defender of the disabled, sided with Republicans on the Schiavo case, only to be pilloried by liberal columnists for lacking the guts to stand up to the forces of right-wing "theocracy."

I can sympathize with the passions felt by the participants in the Schiavo dispute, husband Michael Schiavo and Terri's family, the Schindlers. What's harder to stomach is the certitude of the political combatants.

My wife, Milly, descended in late 2003 into something like PVS because of a "Parkinson's-plus" syndrome known as Multi-Aystem Atrophy. A PET scan confirmed this was happening.

Yet like Schiavo's parents, I hoped beyond hope that Milly was "there." I was sure I saw signs of responsiveness that others - including my daughter, a doctor - said were not there.

Last summer, like Schiavo's husband, I finally concluded that Milly was "gone." In conformity with her "living will," I resolved to stop her feeding tube in August. She died naturally on July 22, sparing me the final agony.

But I understand why Michael Schiavo would resist an outside intervention in what was inherently - and legally - his business, and declared to be so in past cases by the U.S. Supreme Court.

The Wolfson report shows that, contrary to allegations of neglect, he provided consistent, loving care to Terri.

"It is notable that through more than 13 years after Theresa's collapse, she has never had a bedsore," Wolfson wrote. On the other hand, I can understand the Schindlers' desperate desire to keep their daughter alive and their rage at Michael Schiavo's decision to "kill" her.

What's dismaying is the knee-jerk tendency among liberals and conservatives to rush so passionately to one side or the other in this case. It has more to do with winning the culture war than helping Terri Schiavo, whose fate should rest on medical fact, not political posturing.

Mort Kondracke is the Executive Editor of Roll Call.

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