Friday, June 17, 2005

I Was Wrong...

On Wednesday morning, I predicted that the autopsy report for Terri Schiavo would in some way purport to draw the conclusion that Terri was in a PVS.

I was wrong about that. But that's the kind of thing I'm happy to be wrong about.

I was pleasantly surprised to find that Dr. Thogmartin, the Pinellas County Medical Examiner, and Dr. Stephen Nelson, the consulting neuropathologist, were quite measured and reasonable in the conclusions they made concerning Terri's neurological state. They stated clearly in the report, and reiterated several times during Wednesday's press conference, that PVS is a clinical diagnosis and cannot be confirmed by autopsy. They confined themselves to stating that Terri had severe brain damage, and that such damage was "consistent with" a diagnosis of PVS.

A reporter questioned Dr. Nelson about whether Terri's autopsy results meant that Terri's family could not have interacted with her, as they claimed. Dr. Nelson, to his credit, said quite emphatically, "no, not at all". He again reiterated that pathological studies cannot confirm PVS. This conforms with what other neurologists have observed, that there is no correlation between the size of the brain, or the number of neurons present, and a person's cognitive function.

But I Was Right...

Unfortunately, the measured, reasonable conclusions of the autopsy report have not stopped ignorant journalists and pundits from making erroneous and outrageous claims about what the autopsy "proved". In my previous post, I quoted Boston neurologist Dr. Peter Morin, saying that he expected "gross overstatements regarding the implications of the neuropathology." Dr. Morin's pessimistic expectations have been realized: News reports such as this AP story describe the autopsy report as "vindicating" Michael Schiavo in his contention that Terri was a vegetable, when in fact it does no such thing. Joe Scarborough, on his MSNBC program Scarborough Country, asserted that the Medical Examiner said that Terri had "no brain activity". Tampa Tribune columnist Daniel Ruth, in a screed directed mainly at talk-show host Glenn Beck, claimed that the autopsy "confirmed" that Terri was in a PVS. Even more egregiously, he put words in Dr. Nelson's mouth, writing that the doctor stated that Terri had "no cognitive capability, " when he had neither said nor written any such thing.

It seems to me, barring the rage-induced excesses of Ruth and his ilk, that the pundits and reporters have made a fundamental logical error. They have interpreted the pathologists' statements that the condition of Terri's brain is "consistent with" PVS as somehow meaning "indicative of" or "supportive of" the PVS diagnosis. And that's not at all what the words mean. To say that something is "consistent" with something else is merely to say that they can co-exist - that one is not contradictory of the other. "Consistent with" is not synonymous with "indicative of" or "probative". To say that the condition of Terri's brain was "consistent with" PVS does not eliminate or exclude other explanations or conclusions.

And there is evidence to support other conclusions. Dr. Morin, elaborating on the lack of correlation between the amount of brain tissue and consciousness, said "No one knows how many neurons are necessary for consciousness." Indeed, patients with surprisingly little brain tissue are sometimes seen to have remarkably high function. Florida neurologist Dr. Mack Jones said "What is seen grossly doesn't always tell the story." He recalled the case of a patient who suffered from severe hydrocephalus: The patient had "a rim of cerebral cortex" only a few millimeters thick. "And yet", he said, "the young woman by all appearances functioned normally. If her brain were examined at autopsy without a clinical history, one would assume that this individual couldn't have had much useful function at all."

Now, clearly Terri was not going to regain anything like "normal" function. But the above case indicates how little we really know about what goes on in the brain, and how little we can conclude regarding the "awareness" of Terri, or any brain-injured patient. In short, the autopsy "proved" very little regarding Terri's level of consciousness or awareness. The pathologists made sober, reasonable judgments. But those reasonable and sober judgments were lost, apparently, on the opinion-arbiters of the MSM. The distortions and outright misrepresentations continue apace.

It may be just my cynicism again, but perhaps it was too much to expect otherwise.

Cross-posted at Blogs For Terri

Who Has Something To Say?

In a comment over at The Curt Jester, someone opined:

"Everybody has something to say, period."

I would concede the literal probability of that statement: I'm pretty sure that most of humanity has "something" to say.

However, I would add that a great many people have nothing to say that's actually worth listening to.

Hat tip to Kathy.

To Be Or Not To Be A Priest

While the bishops are meeting in Chicago, yesterday's Chicago Tribune had this quite detailed, and very well-done, feature on the young men discerning their vocation to the priesthood at St. Joseph College Seminary in Chicago.

I especially appreciated the generally symmpathetic presentation of the seminarians' faith.

More, please!

Looking for Another Great Blog To Read?

Then you'd do well to take a look at Gathering Goat Eggs. Blogmistress Kathy is a hoot - I especially appreciated her no-nonsense advice in "Safe Sex For the Star-Struck".

Perhaps another reason I have a certain fellow-feeling for her is that, like her, I too am a genius:

Your IQ Is 140

Your Logical Intelligence is Genius
Your Verbal Intelligence is Genius
Your Mathematical Intelligence is Genius
Your General Knowledge is Genius

Great minds think alike!

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

I've Added A Link

To my National Review Online article "Starving for A Fair Diagnosis" in the list of my "Published Works" to the right.

A Big Change Coming For Me!

I have been the Associate Pastor here at St. Joseph Catholic Church in St. Joseph, Michigan for just about four years now. And I have enjoyed my tenure here very much. I have loved the town of St. Joseph, which is a picturesque village on the southeastern shore of Lake Michigan. And I have loved my parish, and the wonderful people here.

But all things must come to an end, this side of heaven. And so, at the end of the month, I will be leaving St. Joseph, and moving on. James A. Murray, Bishop of the Diocese of Kalamazoo, has asked me to become Pastor of St. Stanislaus Parish in Dorr, Michigan. Dorr is a small community about 1/2 hour North of Kalamazoo. The parish is a small, rural one of about 250 families, with its own school. I am particularly happy to have a parish with a school, as I am a staunch supporter of Catholic Education, and it has been my experience that parishes with schools are usually more active and vibrant than those without. St. Stanislaus parish boasts one of the prettiest churches in my diocese: it was built in the early 1900's, and still has its high altar and full complement of statues. The church still even possesses its communion rail! Unlike so many beautiful churches, it managed to pass through the 70's and 80's without being "renovated". I'll post some pictures of my new church in the next few days.

I will also be given the care of St. Stanislaus' mission, Sacred Heart Church in Watson. Sacred Heart has 50 familes, and also boasts a little gem of a church.

For those of you who may wish to get some idea of where Dorr is, here is a map of the region:

Map From

I take up my new assignment on June 29. I do intend to continue my blog after taking over at St. Stanislaus, but obviously I can't predict yet how much time I'll have to devote to blogging. It should also be obvious that my blogging may be a little spotty for a while, until I get settled in.

I am grateful to Bishop Murray for the confidence he has shown in me by giving me this assignment. I am humbled and grateful to Our Lord for making me His priest. I ask all of you to pray for me, that I serve the people of St. Stanislaus and Sacred Heart well.