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Deciding our Life and Death

Do you have a will? No, we don’t want you to donate your riches to this magazine after your death, but we were wondering about letting people know what should be done with us after we die. The frightening thing is that we’ve had to start discussing what should people do if we almost die. That’s what our medical community has allowed us to do— we’ve had to start thinking about when we think we have to let go and stop playing God, so to speak.
Medicine has allowed us to prolong our life, and our medical community has created enough devices to help prolong our lives when we are gravely ill. I was in a car accident years ago where my condition was so bad that I was in a coma for eleven days, unable to breathe on my own. At the hospital, they kept an Intracranial Pressure Monitor on my head to monitor the swelling of my brain. They inserted a Vena Cava filter into an artery, so that a potential blood clot from my being sedentary so long would not travel to my heart and kill me. They piped a nutritional liquid into me for weeks until I could eat on my own. They waited until the last minute before giving me a tracheotomy — I started breathing on my own the morning before they were going to slice my throat open so I would no longer need a tube to help me breathe.
Science and medicine are wonderful for helping save a life.
But the question begs itself: is there a point when our medical feats go too far in trying to preserve our lives? I ask this because we have seen two deaths recently, Pope John Paul II, who decided to not have a lot of machinery and who decided to just let his time pass, and Terri Schiavo, after she did not make it known what she would want to happen to her, then fell into a coma in 1990, suffered severe brain damage. In 1991, Terri was in a persistent vegetative state (PVS), which is an incurable condition, and on March 18, 2005, her feeding tube was removed, which led to her passing away March 31, 2005.
Everyone has stood by Pope John Paul II’s wishes, and we can never know what Terri Schiavo’s wishes were. The best we can do is look at the evidence to come to the most rational conclusion.

•••

Let’s start with some background: on February 25, 1990, Terri Schiavo (wife to Michael, daughter of the Schindlers) around 5:30 a.m. EST, Schiavo collapsed in the hallway of her St. Petersburg apartment, where she then went into cardiac arrest and suffered severe brain damage. The cardiac arrest is believed to be due to a bulimia nervosa-induced hypokalemia (insanely low potassium), and while waiting for the paramedics to arrive, she experienced a loss of oxygen to the brain. Schiavo remained unconscious and fell into a coma. To keep her alive, Schiavo was intubated, ventilated and trached; she was also given a percutaneous endoscopic gastrostomy (PEG) to provide nutrition and hydration. She came out of the coma two and a half months later, but never regained consciousness nor had any evidence of higher cortical function.
Schiavo was discharged to the College Park Skilled Care and Rehabilitation facility on May 12, 1990. The court appointed Michael Schiavo as Terri’s legal guardian without objection from the Schindlers in June, and Terri Schiavo was transferred to Bayfront Hospital for further rehabilitation. She went home to her family in September 1990, but partially because of being overwhelmed with Terri’s needs, she was sent back to the College Park facility. Michael even then tried experimental treatments for his wife in California, but returned to Florida with her in January 1991.
Since she was hospitalized (in 1991), Michael studied nursing to better care for his wife, later becoming a respiratory therapist and an emergency room nurse. After three years of trying to help her, he became quite imposing on the people caring for her, to give her more attention. Michael Schiavo accepted the diagnosis of an irreversible persistent vegetative state, sometimes referred to as a permanent vegetative state, and stopped forcing treatment on his wife.
The problem with seeing someone in a permanent vegetative state, is that in this state they can have wake cycles, you can see them move their eyes and sometimes occasionally make a noise (though incoherent). Seeing these things leads people to believe that the patient must somehow be functioning. This was how Terri’s parents believed that she was functioning, even though not only courts, but all medical opinions (other than the opinions of doctors without all of the information about the patient, on the Schindlers’ request), disagreed. The courts sided with the medical authorities, and not the parents of Terri Schiavo. Her parents said she made child-like attempts to speak, but no one else ever head these things (apparently Terri only tried to talk around her parents...). Since 1991 the Schiavo’s personal physicians and six different court-appointed physicians have concluded that Schiavo is in a persistent vegetative state (a state of wakefulness without awareness). Her parents repeatedly said she tried to speak or deal with others, but doctors continued to state that her level of brain damage makes responsiveness impossible, and that her behavior represents reflex or instinctive actions (behaviors that makes people think she is trying to communicate, when she is incapable of anything at all).
I could go on about what doctors said... Dr. Ron Cranford in 2001 stated that Terri Schiavo “has no electrical activity in her cerebral cortex on an EEG (electroencephalogram), and a CT (computerized tomography) scan showed massive atrophy in that region.” Dr. Leon Prockop even noted that Schiavo’s scan exhibits the “most severe brain damage as I’ve ever seen”, and Dr. Walter Bradley said that he “doubts there’s any activity going on in the higher levels of her brain”.
Schiavo brain scan

CAT scans (on left: normal brain, on right: Terri Schiavo’s CAT scan).

In 2002, they even did another CAT scan to see if any therapy would work on her, and they still found severe cerebral atrophy. That and an additional EEG in 2002 still showed no measurable brain activity. If you look at CAT scans, you can see that close to eighty percent of Terri’s brain was destroyed due to the loss of oxygen in her 1990 accident. The only portion of her brain intact was the stem, which controlled her basic functions, like breathing, or keeping a heartbeat. She could live on her own, but she needed a feeding tube to survive.
I tell you what the doctors repeatedly said, because people look at Terri and believe that she has to have some cognitive function. I keep reiterating this point, because in a permanent vegetative state, looks can be deceiving.
Her parents made many requests to keep her alive, and Michael, on ABC News’s Nightline on March 15, 2005, said that her family expressed willingness to keep Terri alive by multiple extreme measures, including quadruple amputation if needed. This is why he explained that he had to keep custody of Terri, to avoid having her blood family doing harsh things to her in their effort to keep her alive.
Michael knew after a few years of trying desperately to help Terri that there was nothing that he or the medical community could do. Michael even startd to move on with his life (meeting a woman and having two children, after his wife had been, for all intents and purposes, gone for fifteen years), but because of the way he feared her parents may treat her, Michael remained married to her, and her guardian.
It sounds harsh. But when you’re married to a woman who becomes so injured that there is nothing medically that cane be done for her, when you fear that other members of her family will treat her like a guinea pig in a vain effort to make her better, you may be forced to make the same kind of decisions.

•••

an existing blog for Terri Schiavo

Terri Schiavo’s Blog. Credit remains with the creators of http://durrrrr.blogspot.com/

Now, I’ve been going on about how Michael’s a good guy, despite hearing every Republican under the sun talk about how he started dating and had children with another woman, and how he wanted the over 1 million dollars awarded in a malpractice suit for himself. But when it comes to the money, Michael has stated that only fifty thousand is left (because money was spent under a judge’s supervision on medical care for Terri). Michael also said that if the Schindlers stop further legal action referring to Michael and Terri, he would donate whatever his inheritance may be to charity, but the Schindlers would not take him up on his offer and leave them alone.
And Michael has stated that he has not divorced Terri because he would lose guardianship over her, and he wants to make sure he can carry out her final wishes. He didn’t accept money offers from other sources (one was for ten million dollars) to give up custodian rights, and he didn’t divorce her, so that he could make sure Terri’s final wishes were carried out.
Well, he seems to have an answer for everything.
I hear of Republicans (you know, like the likes of Shawn Hannity) talk about the individual research they have done, where they have talked to a few nurses who think Terri had cognitive function.
Wait, nurses may try, but they don’t have enough education to be a doctor, and I’d guess they may take the same stance as any individual who saw Terri occasionally flinch, and assume she was cognisant with them.
Wait, I’m sounding rude. Forgive me.
Wait, don’t forgive me. I’m making a point here. Republicans across the board here are all for preserving her life, by not “playing God” and removing the feeding tube, when they may have been playing God for fifteen years by unnaturally keeping her alive. Republicans can’t talk to me about not playing God. That’s all they do sometimes.
When looking at the evidence I could find about her case, it seemed that Michael was able to answer everything, and consider Terri’s best interests (though we’ve never heard beyond a reasonable doubt what Terri’s finally wishes were, because he claims she only told him once, and there is no printed record of her beliefs).
But he may possibly choose to not let people know all of the truths. For example, a bone scan was revealed, which showed evidence of multiple fractures all along her legs and two in her ribs, and it looked like there was a possible blow to the head which caused her originals fall. People wondered if there was a history of beatings between of Michael on Terri, but some understand that when someone is bulemic there is nutritional loss, causing fragile and more brittle bones, which can commonly lead to fractures like the ones in Terri’s bone scan. Courts wouldn’t listen to the bone scan testimony, because it had nothing to do with the post-accident condition of Terri.
Oh, so now we get to the part of this fiasco where the government involved itself. You see, the government would never have come into this if Terri’s parents didn’t protest so much. That sounds rude, but making the decision to end lives like this is not uncommon, that decision is made quite regularly in this country, but the Schindlers protested Michael’s legal guardianship of his wife, and they protested his decisions for years.
So I tried to listen to other stories, but I don’t know how many of them are accurate. One example is that my husband heard an announcer on the radio discussing that the Schindler family didn’t visit her at all when she was first injured, but only after they heard that Michael was granted guardianship that they started to protest and fight for rights over their daughter.
Now, I have no way to prove that statement at all — it may be completely wrong. We tried to learn about the Schindler family visitation history, but all we could find was that the Schindlers have been in battle with Michael for a decade — which is five years after her accident and problems began. So I guess this means that we can’t take that bit of news seriously, until we can prove it. But I can continue looking for other media forms, which may be accurate. When I tried to to search for more information:
Michael admitted on Larry King Live (probably more accurate) that he didn’t know what Terri wanted (I thought he said he knew her wishes?). His lie about Terri’s wishes is the basis of the court’s approval of euthanizing Terri (oh, so maybe he wasn’t for her death, the way people assume he was trying to get her death over with).
In both a 2003 court affidavit and her March 22 cable appearances, Carle Sauer Iyer said that Terri was “alert and oriented” while she cared for her (from April 1995 to July 1996), “saying such things as ‘mommy,’ and ‘help me.’ “ Iyer said, “Michael Schiavo was focused on Terri’s death. Michael would say ‘When is she going to die?’ ‘Has she died yet?’ and ‘When is that bitch gonna die?’ ”. And when Terri was not doing well, “He would blurt out ‘I’m going to be rich,’ Iyer also believed that “Michael injected Terri with Regular insulin” to make her sick. In her affidavit, Iyer also said that when she called the police, she was terminated the next day. She even said in an FNC interview that when Terri had a urinary tract infection, Michael “would be excited, thrilled, even hoping that she would die soon.”
Judge Greer dismissed Iyer’s charges, saying that affidavits given by both Carle Sauer Iyer and Heidi Law (another nurse who cared for Terri Schiavo) were “incredible to say the least” and that “either in the testimony nor in the medical records is there support for these affidavits.”
Basically, although nurses talked of Michael behaving rudely and seeing responsiveness in Terri, Judge Greer found no substance in their charges and dismissed them.
Now, when Terri’s tube was ordered removed by the courts, the Department of Children and Families filed a petition that contains 30 new allegations of “abuse, neglect or exploitation” between the Schiavos. But then again, the DCF said the allegations only came through its anonymous abuse hot line, so no proof could ever be made of the claims.
It seems that all subsequent proofs for mistreatment of Terri is all clouded in a lack of evidence.
I could go on... Barbara Weller, an attorney for Terri Schiavo’s parents (of course no one else heard this...), said Terri cried and yelled out that she wants to live after being told her life-sustaining feeding tube would be removed by court order. Or... Dr. Hammesfahr said that not only has Terri never had a heart attack, she also never even had a cardiac arrest (her heart never stopped). I’m sure doctors would agree with him...
I don’t know who to side with. We can say that Michael was a criminal according to Florida state law, because he was in an adulterous relationship. But beyond that, we have no proof of anything, and we just have to rely on our own ethical and moral opinions.
Which is an interesting though, because USA Today ran an editorial April 3rd of 2005, where Paul Rogat Loeb started by talking about Terri Schiavo, then segued into the concept of abortion. Their theory was that “You’d think this (right-to-die) belief ... would also raise support for maintaining the right to abortion,” while historically abortion laws have become more stringent over the years, and the number of abortions has (on average) actually gone down over the past decade.
Is USA Today trying to get people up-in-arms about one subject while talking about another? They’re starting to sound like me then, going off on one tangent to another, while trying to cover one issue. But the answers to the questions the Schiavo case raises may only be ones we as individuals can answer on our own — for our own lives. That’s why I asked in the beginning of this editorial if you know what you want done if something like this happens to you. Because people don’t question Pope John Paul II when he makes a choice about the upcoming end of his life, because he let people know. Maybe we should know what we want for ourselves, too.







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