Ethical Analysis and the Facts

Irresponsible

In the column Food for Terri Schiavo (ethics notebook, 11/24), John F. Kavanaugh, S.J., notes that some assertions made about Terri Schiavo’s actual condition seem to be irresponsible. We believe that some of his assertions are also irresponsible.

Without acknowledging that the Second District Court of Appeal, in Lakeland, Fla., published an opinion containing findings of fact about the Schiavo case, he opineson the basis of conversations with a swallowing expert at the Mayo clinicthat most patients on tube’ or peg’ feedings can, with care, swallow. From that conversation he concludes we should let volunteers spend time feeding Terri Schiavo to help her taste the sweet and cool. Nowhere in this scenario does Kavanaugh note that the court found with clear and convincing evidence that Terri Schiavounlike most patients being tube fedhas for 10 years been in a persistent vegetative state that has robbed her of most of her cerebrum and all but the most instinctive of neurological functions, with no hope of a medical cure.

Lest there be doubt of the extent of destruction to Terri Schiavo’s brain, the court writes, The only debate among the doctors is whether she has a small amount of isolated living tissue in her cerebral cortex or whether she has no living tissue in her cerebral cortex.

More irresponsible than his failure to comment on the Court of Appeal’s findings was Kavanaugh’s attack on the neurologist whom he quoted from a New York Times article as saying, There’s never been a shred of doubt that she is vegetative, and nothing’s going to change that. Kavanaugh advises that the physician might want to rein in his hubris. Kavanaugh also notes that this physician spent a mere 45 minutes examining Terri Schiavo while another physician, [who] after more than 25 hours with her, judged her not to be vegetative. Kavanaugh concluded from this evidence that the first doctor needs not only humility but also further training.

Ronald Cranford, M.D., the first physician, is perhaps the premier expert in the United States on patients in a persistent vegetative state. He is the neurologist who testified as an expert witness in such landmark PVS cases as those of Brophy and Cruzan. He has served on the American Academy of Neurology’s task force on PVS, chaired the Academy’s ethics committee, which set the norms and standards for treatment of patients in that condition, and served as a consultant to the U.S. president’s Commission for the Study of Ethical Problems in Medicine. His statement in The New York Times is exactly the same conclusion to which the trial court came after reviewing the detailed medical evidence presented in the case.

Kavanaugh does not identify the physician who purportedly spent 25 hours with Terri Schiavo and pronounced her not vegetative. The Florida Court of Appeal identifies three physicians who so opined. The New York Times article identifies a fourth physician who had provided an affidavit that Terri Schiavo was not in a persistent vegetative condition. Only one of the four is trained in neurology. The Court of Appeal noted that even that physician’s proposed treatment vasodilation therapy and hyperbaric oxygen therapyis worthless for patients like Terri Schiavo. In the court’s words, such treatment cannot replace dead tissue.

The trial court, after an extensive review of the medical evidence, concluded that the judgment of those physicians who believed Terri Schiavo was not in a permanent vegetative state was incorrect. That finding, as the Court of Appeal noted, was entered several years ago and has [four times] been affirmed by this court.

An essay entitled Brain Death, Pro-life and Catholic Confusion, co-authored by Dr. Cranford, which was published in America in 1982 (12/4/82), stressed the importance of clarity and precision of terminology with regard to such critically important issues as brain death and persistent vegetative condition. Its conclusion remains an imperative for those who provide ethical analysis or commentary on public policy: [O]ur task...is to be informed on developments in medicine, to consult widely and wisely in this area and to formulate positions that are both prudent and in accordance with [the reality of the human condition].

We believe that John Kavanaugh’s article fails to meet those standards.

John J. Paris, S.J.
James Keenan, S.J.
The authors teach ethics at Boston College.

The Author Replies:

I appreciate the judgment of Fathers Paris and Keenan. My observations on the possibility of mouth feeding were also based on a week’s stay at a unit for the brain-damaged in France. The neurologist (also a scientist) there assured me that the PVS patients, some in the state for years, could be fed by mouth if there were sufficient time and resources. One can find expert medical and legal opinion on both sides of this issue. Thus I do not think any court or expert is a final authority. I do know cases of PVS patients who have been reanimated, in various degrees; thus it was the absoluteness of Dr. Cranford’s judgment that was my complaint. Finally, my words about further training were due to my own rhetorical hubris, which I regret. Perhaps my correspondents could pass on my apology.

John F. Kavanaugh, S.J.
St. Louis University

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