Schiavo at a Slight Remove

We with access to computers, microphones, cameras, or simply our own voices have expended a vast amount of time and energy publicly wrestling with our opinions and/or attempting to convince others of the rightness of said opinions regarding poor, benighted, now deceased Terri Schiavo.

At this point I am willing to concede that she was not going to recover and that the life she was leading was likely that of utter vacuity: there was no there there, nor was there ever going to be. I am no less troubled by her case and sad, sad end, however.

An illuminating article in the New York Times sheds light on states of consciousness:

The most familiar unconscious state is sleep, which in its deepest phases is characterized by little electrical activity in the brain and almost complete unresponsiveness. Coma, the most widely known state of impaired unconsciousness, is in fact a continuum. Doctors rate the extent to which a comatose person shows pain responses and reactions to verbal sounds on a scale from 3, for no response, to 13, for consistent responses.

As in sleep, people in comas may move or make sounds and typically have no memory of either. But they almost always emerge from this state in two to three weeks, doctors say, when the eyes open spontaneously. What follows is critical for the person’s recovery.

Those who are lucky, or who have less severe injuries, gradually awaken.

…The primitive brain stem, which controls sleep-wake cycles as well as reflexes, asserts itself first, as the eyes open. Ideally, areas of the cerebral cortex, the seat of conscious thought, soon follow, like lights flicking on in the upper rooms of a darkened house.

But in some cases – Ms. Schiavo’s was one of them – the cortical areas fail to engage, and the patient’s prognosis becomes dire.

Neurologists were all but unanimous in diagnosing the condition of Ms. Schiavo, whose heart stopped temporarily in 1990, depriving her brain of oxygen. Brain cells and neural connections wither and die without oxygen, like marine life in a drained lake, leaving virtually nothing unharmed.

People with these kinds of injuries – Nancy Cruzan, whose case reached the Supreme Court in 1990 is an example – almost always remain unresponsive if they have not regained awareness in the first months after the injury.

…In an exhaustive review of the medical histories of more than 700 persistently vegetative patients, a team of doctors in 1994 reported that about 15 percent of those who suffered brain damage from oxygen deprivation, like Ms. Schiavo, recovered some awareness within three months. After that, however, very few recovered and none did so after two years.

…Ms. Schiavo showed no evidence of having ever entered a minimally conscious state, either in the early 90’s or later, neurologists say. An EEG of her cerebral cortex showed almost no electrical activity, said a neurologist who examined her, and a dozen experts interviewed about her case agreed that an M.R.I. scan would have added no information.

Alas, this in addition to all the diagnoses swirling around the case convinces me that she was indeed dormant, and after 15 years, not ever going to regain any form of consciousness.

But after reading that last night I had a dream. In it I was Terri Schiavo or someone in a similar state and to all the world I was “unresponsive,” had no control of my functions, nor did I appear to be aware that I even HAD functions.

But I did. I was trapped silent, immobile, unresponsive inside a body that had become a tomb. I was buried alive, but I was intensely aware of my surroundings, could feel pain, feel overwhelming hunger and thirst, think “normally,” but none of it registered to the outside world. It was horrifying, the ultimate torture.

I’m not saying this is what Terri Schiavo felt, or that anyone in a “persistent vegetative state” feels anything like this, but are we so positive that all who appear to be “unresponsive” are the equivalent of well-maintained corpses? Even assuming brain scans always reveal the inner truth, the euthanasia aspect also troubles me deeply.

The cliche is the “slippery slope,” but Stuart Taylor reveals the progress of that slope:

consider how legalized euthanasia has progressed in the Netherlands, as chronicled by Washington lawyer Neil Gorsuch in a Wisconsin Law Review article last year. In 1984, the Dutch Supreme Court exonerated a doctor for granting a request by a 93-year-old woman who wanted to die because she was bedridden by a hip fracture and unable to eat or drink. A decade later, the Court extended the euthanasia defense to a psychiatrist who had supplied lethal medication to a physically healthy 50-year-old woman who wanted to end her “unbearable” psychological suffering from misfortunes that included the suicide of one son and the cancer death of another.

In 2001, the Dutch Parliament authorized euthanasia at the request of any patient — including a child as young as 12, if the parents consent — whose physical or psychological suffering is “lasting and unbearable,” no matter how robust his or her physical health. And late last year, the Groningen University Hospital proposed guidelines for killing “suffering” malformed infants if their parents don’t want them.

Could that happen here? Should it? Euthanasia puts us on the slipperiest of slopes. The only stopping points can be seen as arbitrary: the line between deciding not to plug a patient into respirator, and pulling the plug; between such an “artificial life-support” machine, and a simple feeding tube; between withdrawing a tube to induce slow death by dehydration, and using a lethal dose of morphine to make it fast; between obtaining a competent patient’s considered consent, and implementing an unconscious patient’s living will; between that, and inferring intent from disputed testimony by feuding family members who claim to know what the living will would say had the patient thought of creating one; between the mental incompetence of a 90-year-old Alzheimer’s patient, and that of a newborn; between brain-dead, and persistently vegetative; and so on. Thus can the right to die morph into a right to kill.

I am very concerned about the “right to die,” and am more concerned still about seeing it codified, even to the extent of the Florida law that allowed Schiavo’s feeding tube to be removed on the word of her husband that it was what she would have wanted under the circumstances, which allowed her to die of dehydration over the course of 13 days against the extravagantly expressed wishes of her parents.

Realistically, we cannot prolong all life, no matter what, for as long as possible, but I also am inclined to “err on the side of life” for now.