Late last night, I took the time to read the 39-page autopsy report of Terri Schiavo–something which, it is clear to me, most of the callous gloaters on the other side of this debate have not bothered to do. And will never do. These are people who can only talk about the sanctity of life if it’s enclosed in ghost quotes and pronounced with a sneer.
You do not need a medical examiner’s license to see that the report raises many more questions than it answers, though from the (once again) misleading media coverage, we are led to believe that the matters of Terri’s life and murder are resolved. They are not.
Here’s a typical example from an article headlined, “No trauma before Schiavo collapse:”
An autopsy report on a brain-damaged woman at the centre of a long legal battle in the US has shown that she suffered no trauma before her collapse.
But on page 4 of the M.E.’s summary, what the report actually says with regard to possible strangulation is this:
Autopsy examination of her neck structures 15 years after her initial collapse did not detect any signs of remote trauma, but, with such a delay, the exam was unlikely to show any residual neck findings.”
Michael Schiavo and his supporters and doctors have long maintained that Terri suffered from an eating disorder. In interviews with Larry King, in countless newspaper articles over the past 15 years, and during his successful malpractice trial against Terri’s primary care physician, Michael Schiavo stressed his wife’s bulimia-related low potassium level as the cause of her initial collapse. Schiavo won $1 million in damages on the grounds that Schiavo’s obstetrician had failed to diagnose bulimia.
Unquestioning journalists ran dozens of stories echoing the claim: “Eating disorder is real issue in Schiavo case,” “Terri’s life a lesson in dangers of bulimia,” “The lost lesson of Schiavo case: the dangers of eating disorders,” etc.
The autopsy report spends three-and-a-half pages debunking Schiavo’s claim, as well as the related claim that she had a heart attack (or, more medically precise, myocardial infarction). But if mentioned at all, the news reports I have seen have downplayed and buried these astonishing revelations (revelations which bear directly on Schiavo’s credibility regarding his claim that Terri would have wanted to die).
In Michael Schiavo’s favor, the autopsy report also casts doubt on the Schindler family’s long-held view that a 1991 bone scan indicated traumatic injury. The report notes that Terri had severe osteoporosis and that the bone scan findings might have also reflected “the aftermath of remote intense CPR, infection, bone turnover, artifact or intense physical therapy. In summary, any rib fractures, leg fractures, skull fractures or spine fractures that occurred concurrent with Mrs. Schiavo’s original collapse would almost certainly ahve been diagnosed in February 1990 especially with the number of phsyical exams, radiographs, and other evaluations she received in the early evolution of her care…”
However, the report notes this caveat: “Without the orginal bone scan and radiographs from that period, no other conclusions can [be] reasonably made.”
With regard to Terri’s alleged persistent vegetative state, most news articles inaccurately portray the report as supporting that diagnosis. But the disability rights group Not Dead Yet has it right:
[C]ontrary to articles stating the autopsy report “supported” the diagnosis of “persistent vegetative state (PVS),” a neuropathology expert today was careful to say that PVS is a clinical diagnosis rather than a pathological one. He added that nothing in the autopsy was “inconsistent” with a PVS diagnosis.
The real elephant in the living room, of course, is whether or not we can really know how conscious anyone labeled “PVS” really is. Several studies have revealed high misdiagnosis rates, with conscious people being mistakenly regarded as totally and irrevocably unaware.
The autopsy also documented significant brain atrophy, and the medical panel called the damage “irreversible.”
This is not the same as saying she had no cognitive ability.
“It’s always seemed to us that PVS isn’t really a diagnosis; it’s a value judgment masquerading as a diagnosis,” said Stephen Drake, research analyst for Not Dead Yet, a national disability rights group that filed three amicus briefs in the case. “When it comes to the hard science, no qualified pathologist went on the record saying she couldn’t think or couldn’t experience her own death through dehydration.”
Diane Coleman, president and founder of Not Dead Yet, agreed. “The core issues remain the same. Protection of the life and dignity of people under guardianship, and a high standard of proof in removing food and water from a person who can not express their own wishes. These are issues of great concern to the disability community – evidenced by the 26 national disability groups that spoke out in favor of saving Terri Schiavo’s life over the past few years.”
It is not clear to me from the neuropathology report when and over what period the much-talked-about brain shrinkage occurred. I have also noticed that some are already mocking the claim that Terri recognized visitors (note that the report also does not appear to indicate when and over what period that loss of sight occurred).
For God’s sake.
Terri Schiavo, a profoundly disabled woman who was not terminally ill and who had an army of family members ready to care for her for the rest of her natural life, succumbed to forced dehydration at the hands of her spouse-in-name-only.
This is something to gloat about?
Finally, here’s the last paragraph of the medical examiner’s report:
It is the policy of this office that no case is ever closed and that all determinations are to be reconsidered upon receipt of credible, new information. In addition to fading memories, the 15-year survival of Mrs. Schiavo after her collapse resulted in the creation of a voluminous number of documents many of which were lost or discarded over the years. Receipt of additional information that clarifies outstanding issues may or shall cause an amendment of her cause and manner of death.
In other words, the medical examiner has pledged to keep something rare in this still unresolved tragedy: an open mind.
More blog reax…
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