Gedanken Experiment addendum
I received some critical feedback on my previous post, Schiavo Case Gedanken Experiment, from a discerning reader . . . my wife. She questioned my certitude that Schiavo’s brain was so damaged that there was no hope of at least partial recovery. My response was that given the extent to which this matter has been litigated and reviewed by experts, the PVS diagnosis had to be solid. I also said that I assumed objective tests had validated the diagnosis.
Some days later, my wife sent me an email at work with a link to a site showing what was purported to be a CT scan of Schiavo’s brain. The MD who maintained the site opined that the CT scan didn’t show as much damage as claimed. My response was, irrespective of the provenance of this scan, it was my understanding that CT scans alone may be useless. I was aware of CT scans showing sizable displacements of cerebral matter or even large holes in the brains of people who are outwardly perfectly normal. I expressed surprise that an MD was making such a big deal of this given that PET scans and/or modern fast scan MRIs could show actual brain function or its lack and could be used to confirm a PVS diagnosis. Of course, as my wife well knows, my field is computer science, not neuroscience – she nonetheless seemed to accept this initial observation.
I, however, began to wonder about objective confirmation and started checking around. It turns out that the technology is not quite as advanced as I assumed. While my surmise that PET and MRI can provide a degree of objective confirmation was correct, this is a fairly recent development.
It’s important to understand that the diagnosis of PVS preceded by a few years the development the scanning technology that could show an actual brain functioning. Even then, it was quite a few more years before PET and MRI were used to study the brains of these patients. In part this was because the radionuclides used for markers in PET scans were initially very expensive to produce (they still aren’t cheap) and were not readily available and the early MRIs weren’t fast enough. Thanks to Moore’s Law, the computing power necessary to process the MRI data became available but some time still elapsed before MRI technology was used to study PVS patients.
Today, scanning technology can tell us quite a bit about the parts of the brain involved in running the “person program”. However, the technology is not yet able to provide the sort of stand-alone diagnostic confirmation I’d want to see before it would be permissible to declare someone diagnosed with PVS “person dead”. In Brain function in the vegetative state by Laureys, et al., we can see the technology can definitely tell us what is and isn’t going on in a PVS brain but the paper itself states the following:
“Functional neuroimaging cannot replace the clinical assessment of patients with altered states of consciousness. Nevertheless, it can describe objectively how deviant from normal is the cerebral activity and its regional distribution, at rest and under various conditions of stimulation.”
In the case of Terri Schiavo, I’ve been unable to find evidence that the diagnosis of PVS, though originally stipulated to by all of the parties in the case, was confirmed by PET or fast MRI technology. In light of this technology, which was largely unavailable in 1990, should the court(s) have mandated its use?
My wife, who is an attorney, offers the following additional observation.
The resistance to revisiting trial court findings of fact is buckling just a bit in death penalty cases, where new technology – in particular, DNA analysis – can provide factual information that could not have been presented to the original trial court. The same rationale applies, in spades, where diagnostic techniques that can greatly enhance the reliability of a PVS diagnosis were either unavailable earlier, or were too new and radical to be used by the typical reputable practitioner. In both cases, someone is due to be put to death by deliberate intervention. In Terri’s case, there is no doubt whatsoever that she does not deserve this death – if she is, in any meaningful sense, still alive.
(As for whether removing the feeding tube is a “deliberate intervention” when the tube itself was an intervention – c’mahhn. Putting someone in jail is an intervention, and thereafter he’s dependent on you for nutrition and hydration – but cutting him off from same would be a deliberate intervention of its own.)
Good points. If there are diagnostic tools available that will validate a diagnosis then they should be used. And, based upon the current state of technology, I’ll have to put the idea of an objective diagnosis of “person death” on the shelf for the time being.