Do we know any Neurological facts about Schiavo

Judge Greer accepted the testimony of doctors who said Ms. Schiavo, 41, is in a "persistent vegetative state," meaning damage to her cerebral cortex has made her incapable of emotion, memory or thought.

``It's so common, many hospitals don't require these kinds of decisions to be brought before an ethics panel anymore,'' said Laurie Zoloth, a professor of medical ethics Northwestern University.

American Medical Association guidelines bar doctors from performing euthanasia or participating in assisted suicide, but also require physicians to respect a patient's wishes to forgo care, even if it is life sustaining.

In cases where the patient is unable to communicate, the association recommends a spouse or closest relative be given the power to decide whether to withdraw life support. The guidelines allow physicians to discontinue treatment, even if the patient is not terminally ill or permanently unconscious.

Family disputes do happen, said Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania. Almost none winds up in court.

Most find a way to agree on whether their loved one would have wanted to be kept alive artificially.

``If there is one single lesson to take out of this, it is to fill out a living will, and discuss it with your family,'' he said, referring to a document that specifies a person's end-of-life wishes.

A persistent vegetative state is something different, "sort of like being in an awake coma," said Dr. David A. Goldstein of the Keck School of Medicine at the University of Southern California. The patients' eyes are open, they have sleep-wake cycles, and it often appears that they are interacting with visitors, which makes it very hard on families.

The brain of such patients is functioning only at a very rudimentary level, said Dr. Kenneth V. Iserson of the University of Arizona Health Sciences Center in Tucson. They cannot feel pain, express themselves or receive communication.

They may even have grimaces or smiles or other facial movements that look like they are reflecting emotions, but "there really isn't a significant relationship with the outside world," Goldstein said.

And the longer the state persists, "the less likely they are to come out of it," Keane added. Schiavo has been in this condition for 15 years, "and it is very, very unlikely she would wake up," he added.

A persistent vegetative state, which sometimes follows a coma, refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment but retain noncognitive function and a perserved sleep-wake cycle.

It is sometimes described as when a person is technically alive, but his/her brain is dead. However, that description is not completely accurate. In persistent vegetative state the individual loses the higher cerebral powers of the brain, but the functions of the brainstem, such as respiration (breathing) and circulation, remain relatively intact. Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey commands. Patients in a vegetative state may appear somewhat normal. They may occasionally grimace, cry, or laugh.

Most of Schiavo's cerebral cortex has been completely destroyed, replaced by spinal fluid; Dr. Ron Cranford, a neurologist at the University of Minnesota assessed Schiavo's brain function in 2001 as part of a court-ordered assessment. He was quoted in Florida Today as saying "[Schiavo] has no electrical activity in her cerebral cortex on an EEG (electroencephalogram), and a CT (computerized tomography) scan showed massive atrophy in that region." [10] [11]

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Mr. Schiavo, and the doctors he has chosen to care for and evaluate her, such as Dr. Ronald Cranford, contend that she is indeed in a persistent vegetative state, that her occasional apparent responses are actually reflex or random behavior common to PVS patients, and that therapy would be fruitless. Accordingly, Schiavo halted most therapy for his wife in 1994, including speech and occupational therapy. In 1998 Mr. Schiavo initiated legal action to withdraw his wife's life support.


In 2002, a trial was held to determine whether or not any new therapy treatments would help Schiavo restore any cognitive function. A new computed axial tomography scan (CAT scan) was done, as was an electroencephalogram (EEG). The CAT scan showed severe cerebral atrophy.


Five doctors were selected: two by Schiavo's parents, two by Michael Schiavo, and one by the court. These five doctors examined Terri Schiavo's medical records, brain scans, the videos, and Mrs. Schiavo herself. The physicians were divided in their conclusions. The two doctors selected by Schiavo's parents (one of whom was a radiologist, not a neurologist; the other of whom made several claims about therapies supposedly developed by him which the court found spurious) supported their conclusion; the two doctors selected by Schiavo's husband and the doctor appointed by the court supported Mr. Schiavo's position. Greer ruled with the latter that Mrs. Schiavo was in a PVS and was beyond hope of significant improvement. [12]