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For health and legal professionals with an interest in bioethics
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When doctors can't be trusted
A FURORE over a single brain-damaged Florida woman might seem like hysteria. But as details of how Terri Schiavo has been treated emerge under the white-hot spotlight of the international media it has become obvious her doctors gave up too easily. Here are the facts about Terri Schiavo. In 1990, at 26, she had a heart attack and fell into a persistent vegetative state, known as PVS. Eight years later, her husband Michael applied to have her feeding tube removed. Ever since, he and Terri's parents have been duelling in the courts. Michael's lawyer reportedly contends Terri is little better than a houseplant. Her parents say that she is interactive, alert and curious. If her husband's application succeeds, Terri will die after two weeks of thirst and starvation. With all this kerfuffle, you would think that Terri Schiavo was a terminal case. Not so. She is not in pain. She is not on a ventilator. She is not being battered by over-zealous doctors. As long as she receives food and water and simple nursing care, she can live for years. Feeding through a tube in the stomach is not even necessarily uncomfortable. You would think that her husband had done everything possible to ensure a proper diagnosis. Not so. The woman at the centre of the most bitterly litigated right-to-die case in history has never had an MRI scan or a PET scan. Dozens of American neurologists have called for a re-evaluation of her condition. In any case, according to a 1996 study in the British Medical Journal there is a 43 per cent error rate in the diagnosis of PVS. In the words of Bill Frist, the majority leader in the US Senate and a former heart and lung transplant surgeon, ``if you are going to put somebody to death I would think you would want a complete neurological exam in reaching that conclusion''. You would think that the courts would have relied upon objective advice from neutral experts. Not so. The principal medical witness in support of a PVS diagnosis was Dr Ronald Cranford, an outspoken advocate of the right to die movement and doctor-assisted suicide. There are lessons for Australia here. A case very much like Terri Schiavo's occurred in Melbourne two years ago. A 68-year-old woman known as BWV was allowed to starve to death because she had a particularly disabling kind of dementia. Justice Stuart Morris ruled that her food and water represented artificial life support. Just as in the Schiavo case, he used evidence from a prominent euthanasia advocate, Dr Rodney Syme. There will be 500,000 Australians with dementia by 2040. How careful will doctors be about diagnosing PVS and irreversible comas then? Indeed, how careful are they now? A doctor friend told me recently about his aged aunt who had slipped into a coma. He was told by the hospital doctor that it was irreversible and that he would order food and water to be stopped. Reluctantly my friend agreed. Soon afterwards he visited the ward with his son. The three-year-old leapt on to the bed to give the old woman a cuddle. She blinked. My friend was shocked. He shouted at her and shook her and his aunt responded even more actively. Then he started shouting for the doctor. Food and water resumed and now the old woman is back home, frail but fit. What the soap opera in Florida has proved to the world is that diagnoses can be careless and superficial, relatives may not have the best interests of patients in mind and experts can be prejudiced. It ought to lead to a reassessment of how Victoria deals with severely mentally disabled patients who are not suffering and not dying. BED-RIDDEN people who cannot communicate have not lost their humanity. Unless you are a fan of Professor Peter Singer, people are people, not vegetables. However disabled they may be, doctors should order adequate nursing care for them, not a lingering death from starvation and thirst. mcook@australasianbioethics.org -- MICHAEL COOK is the editor of BioEdge, an email newsletter on bioethics
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