Wednesday, March 23, 2005

They're killing her

And the best part is they don't care.

From an affidavit filed today by Dr. William P. Cheshire:

Based on my review of extensive medical records documenting Terri's care over the years, on my personal observations of Terri, and on my observations of Terri's responses in the many hours of videotapes taken in 2002, she demonstrates a number of behaviors that I believe cast reasonable doubt on the prior diagnosis of PVS. These include:

1) Her behavior is frequently context-specific. For example, her facial expression brightens and she smiles in response to the voice of familiar persons such as her parents or her nurse. Her agitation subsides and her facial demeanor softens when quiet music is played. When jubilant piano music is played, her face brightens, she lifts her eyebrows, smiles, and even laughs. Her lateral gaze toward the tape player is sustained for many minutes. Several times I witnessed Terri briefly, albeit inconsistently, laugh in response to a humorous comment someone in the room had made. I did not see her laugh in the absence of someone else's laughter.

3) Although I did not hear Terri utter distinct words, she demonstrates emotional expressivity by her use of single syllable vocalizations such as "ah," making cooing sounds, or by expressing guttural sounds of annoyance or moaning appropriate to the context of the situation. The context-specific range and variability of her vocalizations suggests at least a reasonable probability of the processing of emotional thought within her brain.

5) There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to unnoticed at the time. At 2:44 pm, Dr. Hammesfahr had just turned Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well, after he ceased applying the stimulus and had returned Terri to a comfortable position, he says to her parents, "So, we're going to have to roll her over...." Immediately Terri cries. She vocalizes a crying sound, "Ugh, ha, ha, ha," presses her eyebrows together, and sadly grimmaces. It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr's comment and signals her anticipation of pain. This response suggests some degree of language processing and interpretation at the level of the cerebral cortex. It also suggest that she may be aware of pain beyond what could be explained by simple reflex withdrawal.

6) According to the definition of PVS published by the American Academy of Neurology, "persistent vegetative state patients do no have the capacity to experience pain or suffering. Pain and suffering are attributes of consciousness requiring cerebral cortical functioning, and patients who are permanently and completely unconscious cannot experience these symptoms." And yet, in my review of Terri's medical records, pain issues keep surfacing. The nurses at Woodside Hospice told us that she often has pain with menstrual cramps. Menstrual flow is associated with agitation, repeated or sustained moaning, facial grimmacing, limb posturing, and facial flushing, all of which subside once she is given ibuprofen. Some of the records document moaning, crying, and other painful behavior in the setting of urinary tract infections.

7) ...The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitively resolve that ambiguity to everyone's satisfaction. There would be value, I think, in obtaining a functional MRI scan if that is possible.


But for the decision to withdraw her feeding tube, Terri cannot be considered medically terminal. But for the withdrawal of food and water, she would not die.


Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state. This distinction makes an enormous difference in making ethical decisions on Terri's behalf.

Like I said earlier about lawyers, I'm not a doctor, no one in my family is a doctor. But how, in the name of simple common-sense, can testimony such as this be ignored completely? Yet the bench is simply unwilling to seek additional answers to any questions in this case.

They're going to kill her and the only thing I can deduce is that they don't care. Either that or they want to and frankly, that is too sick to contemplate.

I want to puke.

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