This has been discussed in other threads, but bears repeating. A COMA is not the same as a PERSISTENT VEGETATIVE STATE is not the same as BRAIN DEATH.
Terri Shiavo is in a PVS, which can be characterized by periods of ‘sleep’ and ‘wakefullness’, unlike a coma in which someone appears continously asleep. The ‘wakefulness’ experienced in PVS is caused by continued functioning of the reticular activating system of the brain. This should not be confused with ‘consciousness’ or ‘awareness’, however. It is possible to show signs of wakefulness such as spontaneous opening/movement of the eyes without having any higher brain function. Patients in a PVS can also show varying degrees of responsiveness to their environment, but these responses are reflexive. Thus a loud noise or flashes of light may elicit some response, like a ‘startle’ or turn of the head. Stretching a limb may result in a muscle contraction. These type of responses are ‘wired’ in the nervous system at a very primitive level, and should not be taken as signs that higher brain function is preserved. In Schiavo’s case, it appears (from reports of the physicians that have actually examined her and reviewed her records, as opposed to those who have only seen her on video) that her cerebral cortex has long since been reabsorbed and replaced by cerebrospinal fluid. In essence, the layers of the brain that we do our ‘thinking’ with are no longer present in Terri. She continues to breathe on her own because her most primitive brain structures are still intact.
Patients who are brain dead, on the other hand, have no function of even these most primitive brain structures. They do not breathe spontaneously and show no reflexes of the cranial nerves like the gag reflex or corneal reflexes. They can still show some body reflexes like the patellar tendon reflex because these are mediated by the spinal cord, not the brain. These patients may have beating hearts but there is no chance that they will recover because their entire brain is dead.
Wow, I didn’t know that was possible (for someone’s entire brain to be dead, including the “lower brain”, and still be alive). Thanks for fighting my ignorance.
In effect yes. According to a fairly long report on The News Hour With Jim Lehrer a panel of physicians and others studied 4 hours of video tape of her reactions to stimuli of various kinds. Their conclusion was that her reactions such as smiling, nodding etc. were random and neither correlated with or responsive to the stimuli.
The conclusions of those physicians who actually know the full medical story do not seem to have been arrived at hastily nor was the latest decision of the judge an off-the-cuff conclusion.
People, such as the physician Congressman from Florida whose name escapes me who appeared on The News Hour, are essentially accusing the medical team that is actually responsible for the patient’s care of malpractice, apparently based only on each others’ rumors.
In general, if you can establish that a person is brain dead, this means that they are legally dead, even if their heart is still beating. The legal requirements vary from state to state and can vary between pediatric and adult patients - a variety of tests can be performed to establish brain death, from bedside reflex/breathing drive tests to nuclear medicine scans of brain glucose consumption to angiograms of brain blood flow. In some states, multiple tests performed over a period of time are required. Some places require that the tests be performed by a neurologist, or multiple physicians, etc. etc.
Once brain death has been established, organ harvest for transplant is possible, even though the heart is still beating (if the heart was not beating, there would be no need for a ‘brain death’ determination). Patients that are brain dead are on ventilators because they have no spontaneous drive to breathe (this drive depends on brainstem function). The heart, however, has its own ‘pacemaker’ and will continue to contract as long as it is provided with oxygenated blood - hence the feasibility of heart transplants, where the nerves to the heart are severed.
As a matter of practice, the hospital staff don’t just run into the room and yank out all the tubes and wires as soon as a determination of brain death is made. The situation is explained to the family and they are encouraged to discontinue ongoing care, since it is futile. Clergy, hospital administration, social workers, and others are called in if needed. The death certificate is filled out at the time the vent is stopped, not at the time the brain death determination is made.
Someone please slap me if this is a rude hijack, but I have another question about this case.
When they say Ms. Schiavo is not responding to stimuli, can I assume that means that she does not feel pain?
Because while I understand that she is not going to regain consciousness, nor does she know what’s going on around her, I still find it rather shocking that they will STARVE her to death. This is why I keep coming to the Kevorkianesque question of whether it wouldn’t be less cruel for both her AND her family if they would give her a morphine overdose, rather than let her organs shut down while she dies of starvation.
Yes, I understand the legal distinction. And yes, I do agree that if she can’t feel anything and isn’t really “there” anymore than letting her go this way is appropriate.
By the way, does anyone else think it’s squinky that the woman at the center of this case has a last name that translates into “slave” in Italian?
sigh How many times does it have to be said, in how many threads, with how many links?
Her cerebral cortex is GONE. She cannot feel pain, or hunger, or thirst, because there is no consciousness there. Maybe the nerve endings could react in a way that we could define as “pain”, but there’s no brain there to register it.
Okay, okay. I apologize for the short-sighted question. But wading through 9 million threads on the same subject seemed a bit overwhelming. Thanks for the answer anyway.
Simple mistake. I type facing away from the computer screen, you see.
Yes, the normal brain is the one with the label “healthy brain” which has all the stuff inside it. Terri’s brain is one where there is practically no brain.
Possibly also true, but does this only happen to poeple who feel no pain? If it happens often there is a good statistical chance that there are people starving to death who can feel it and who may be aware of it but can do nothing about it.
IMHO if we are going to allow doctors to perform assisted suicide or whatever other euphemism we have for this then it has to be done with some thing fast acting and painless.
The legislation proposed by Congress applies only to Mrs. Schiavo. If removing feeding tubes from patients in a permanent vegetative state is SOP around the country, why have they chosen to “save” only Mrs. Schiavo? What exactly is it they (Sen. Frist, et al) want? They have absolutely no business in this.
It’s a slippery slope of the most heinous kind. If Congress gets away with challenging Mr. Schiavo’s say as next-of-kin in this, who do they go after next?
There is considerable agitation over what are called “activist judges.” Where is the outrage over activist legislators? It seems to me that many in Congress have lost their senses and the others have had a backbone removal operation.
I’ve searched the Constitution and can’t find in it any power for Congress to interfere. To those who cite the 14th amendment and “equal protection” I say faugh. Whatever happened to “original intent?”
This would not be SOP if it caused undue stress and harm to the patients. Remember “do no harm”.here is one Doper’s experience with passive euthanasia. Doper eleanorigby has also stated that when she began her career as a healthcare worker, severely deformed infants who could not survive were labeled “do not feed”.
I would rather that someone in that position were given a humane injection and allowed to die quickly rather than slowly fading away.
I’m thinking not just of the patient but also the family, isn’t it more humane to allow them to die quickly rather than putting the patient and the family in the unenviable position of watching them die over a period of time. Even if the patient does not suffer, the family would.
If it was me or a relative in that position I would rather an alternative was available that did not involve starving to death.
That’s exactly so. For all this talk about medical ethics, it’s still a fact that we put dogs down with more mercy than what is being shown to a human being. Where’s the ethics in that?