Wednesday, March 23, 2005

Schiavo Brain Dead-- New England Journal of Medicine

This is really all you need to know about the case: her EEG is flat. That's when doctors pull the plug every day.

I can see why many on the right wouldn't want the lack of higher brain function to be the legal standard of death. Legally, most of them would never have been alive in the first place.

Of course the doctors who peer review the New England Journal of Medicine don't know as much about this as Sean Hannity, Pat Robertson, or George W. Bush, a C student business major.

Somebody offered the husband a million dollars to leave her plugged in and he should have taken it. It's just an empty husk of a body, and she isn't suffering. If it makes her family happy to keep it as a memento, let them have it.

KEY EXCERPTS:
...she exhibited no evidence of higher cortical function. Computed tomographic scans of her brain eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms have been flat, indicating no functional activity of the cerebral cortex. Her neurologic examinations have been indicative of a persistent vegetative state, which includes periods of wakefulness alternating with sleep, some reflexive responses to light and noise, and some basic gag and swallowing responses, but no signs of emotion, willful activity, or cognition.

There is no evidence that Ms. Schiavo is suffering, since the usual definition of this term requires conscious awareness that is impossible in the absence of cortical activity. There have been only a few reported cases in which minimal cognitive and motor functions were restored three months or more after the diagnosis of a persistent vegetative state due to hypoxic–ischemic encephalopathy; in none of these cases was there the sort of objective evidence of severe cortical damage that is present in this case, nor was the period of disability so long.
FULL TEXT:
http://content.nejm.org/cgi/reprint/NEJMp058062v1.pdf

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