Wednesday, June 15, 2005

Terri Schiavo's Autopsy Results To Be Released:

Will Report Make "Outlandish" Claims?

The long-awaited autopsy report of Terri Schiavo will be released later today, according to reports in the Washington Post and elsewhere.

Pinellas County Medical Examiner Jon R. Thogmartin will hold a press conference on the autopsy report at 11:00 AM Wednesday.

What the report will conclude is not yet known, but the Schindler family and many supporters of Terri's right to live hope the autopsy will provide clues regarding the cause of the cardiac arrest which led to her anoxic brain injury in 1990. They also hope that the autopsy will provide evidence of the abuse of which they have accused Michael Schiavo.

I am not terribly optimistic that the autopsy will provide evidence of either the cause of Terri's cardiac arrest or any abuse. I think there was simply too much time between Terri's injury(ies) and her death for any such evidence to still be detectable.

What I am most interested to see is whether or not, as Michael Schiavo and his attorney George Felos hope, the M.E. purports to draw any conclusions regarding whether Terri was in a PVS (Persistent Vegetative State).

As many readers will recall, when George Felos announced that Michael would "permit" an autopsy (the matter was later shown to be completely out of his hands), he said that Michael wanted "definitive proof showing the extent of her brain damage".

Of course, as I pointed out back then, an autopsy cannot possibly "prove" whether Terri was PVS or not. Indeed, Dr. Bernardine Healy, a former Director of the National Institutes of Health and medical columnist for U.S. News & World Report, responded to Felos' announcement, in an appearance on MSNBC, by pointing out that an autopsy can tell us nothing about Terri's neurological function. She lamented the surreal reasoning by which Michael would permit an autopsy when Terri was dead, but refused the medical tests that could assess Terri's brain function while she was still alive.

The inability of an autopsy to retrospectively diagnose PVS did not stop some "talking heads" on cable news shows from offering ill-informed speculation. One pathologist, appearing on Greta Van Sustern's "On The Record" (partial transcript), said that though a determination that Terri was PVS could not be made with 100% certainty, nonetheless an autopsy could confirm the extent of Terri's brain damage - her "loss of neurons" - and whether she was in fact in a PVS.

Neurologists react to statements such as the above with incredulity. Dr. Mack Jones, a Florida neurologist I interviewed for my National Review Online article "Starving For a Fair Diagnosis", characterized such claims as among "the most outlandish statement[s] that I have ever heard". He continued, saying:
Autopsy findings cannot diagnose PVS. I expect evidence of severe brain damage consistent with hypoxic - ischemic injury to the cerebrum with subsequent atrophy. These findings nor any other findings have no bearing on the diagnosis of "minimal consciousness" or PVS.

In a March 31 article at MedPage Today, Dr. Michael De Georgia, head of the neurology/neurosurgery intensive care unit at the Cleveland Clinic Foundation, said that the PVS diagnosis "cannot be confirmed by autopsy." Dr. Mouhammed Kabbani, a neurologist at the University of Missouri, concurred with this evaluation, and added that an "autopsy can show the degree of brain damage and how much brain tissue survived the injury", but that "it cannot by any means tell about the patient's clinical status."

In the MedPage Today article, Harvard neuropathologist E. Tessa Hedley Whyte said that "the [pathologic examination of the] brain can't tell if there is a persistent vegetative state or not". But, unfortunately, that won't necessarily prevent excessive claims from being made. Dr. K.J. Oommen, Vice Director of Clinical Neuroscience at the Oklahoma University Medical Center, summed up the problem best, saying that "a pathologist can make such statements, because you cannot disprove them. The patient is already dead!"

While I don't know what the autopsy report will say, I'm going to go out on a limb here: I predict that the autopsy report will, in at least a tentative way, offer a conclusion that Terri was in a PVS. I say this for three reasons: Firstly (and perhaps this is just my cynicism coming out), it would fit the generally unfortunate and dishonest way that the rest of the Terri Schiavo saga has played out. Secondly, doctors with whom I have discussed the Schiavo case share my pessimistic outlook. Dr. Peter Morin, a Boston neurologist interviewed for my March 16 NRO article, said that he anticipated "gross overstatements regarding the implications of the neuropathology." Thirdly, this Philadelphia Inquirer article provides a hint of what is to come:
William A. Pellan, director of forensic investigations for the District Six Medical Examiner's Office in Largo, said the report would address whether Schiavo was in a persistent vegetative state.

There would be no point in mentioning the intent to "address" the issue of PVS if the report was not going to draw a conclusion on the matter. Furthermore, the autopsy cannot prove that Terri was not PVS. Thus it seems likely to me that the report will in some way be presented as "confirming" the diagnosis.

Such a conclusion would be in keeping with the way that various "memes" have governed the debate surrounding Terri Schiavo's fate. I discussed some of these memes in my article "The Death of Terri Schiavo", which appeared in the May 2005 issue (available online soon) of Catholic World Report. These memes, such as "9 (or 12 or 16) judges have all reviewed the case and found for Michael", and "all the doctors who examined Terri diagnosed her as PVS", were readily regurgitated by most of the MSM, as part of what Nat Hentoff described as the "disgracefully ignorant" coverage of Terri's case. If, as I predict, the Medical Examiner's report offers anything approaching a "conclusion" that Terri was PVS, then George Felos, the "right-to-die" advocates, and their accomplices in the media elite will have the final meme, with which they can tie up the Terri Schiavo case in a nice, neat bow. The Culture of Death will advance a little further, abetted by self-assured and willing acolytes.

Cross-posted at Blogs For Terri