Unfortunately, I’m not very well versed in neurological medicine, so much of Dr. Hammesfahr’s statement I cannot adequately evaluate. However, reading his descriptions and comparing them to this definition of Persistent Vegetative State from Wikipedia, what he describes does match that of PVS:

Most PVS patients are unresponsive to external stimuli and their conditions are associated with different levels of consciousness. Some level of consciousness means a person can still respond, in varying degrees, to stimulation. A person in a coma, however, cannot. In addition, PVS patients often open their eyes, whereas patients in a coma subsist with their eyes closed (Emmett, 1989).

PVS patients’ eyes might be in a relatively fixed position, or track moving objects, or move in a disconjugate (i.e. completely unsynchronized) manner. They may experience sleep-wake cycles, or be in a state of chronic wakefulness. They may exhibit some behaviors that can be construed as arising from partial consciousness, such as grinding their teeth, swallowing, smiling, shedding tears, grunting, moaning, or screaming without any apparent external stimulus.

Individuals in PVS are seldom on any life-sustaining equipment other than a feeding tube because the brainstem, the center of vegetative functions (such as heart rate and rhythm, respiration, gastrointestinal activity), is relatively intact (Emmett, 1989).

Also, a correction that I discovered in searching for more information on Dr. Hammesfahr. He was apparently not nominated for a Nobel Prize. There are several google results on this.

Regarding his statement that he could treat Terri, I discovered an entry on Quackwatch.org, unrelated to this particular case, that questions some of his treatment techniques.

Ultimately, is statement has not made the issue much clearer for me. Quite beside which, it does nothing to address the problems in Ms. Iyer’s testimony. The weaknesses I mentioned still exist and have not been mitigated by anything in Dr. Hammesfahr’s statement.

Tom, please keep in mind that I am addressing only what you are presenting and am not offering opinion or judgment of Mr. Schiavo. There is a good bit of stuff that I’ve seen suggesting he’s a bit of a jerk, to be mild, but as far as the legal case goes, I do not know enough about the case or the evidence, let alone the specific legal minutiae involved, to come to a sound conclusion.

At any rate, your persistence on discussing the Schiavo case is off-topic, having no bearing on Phil’s post. Ethics issues aside, once again, please note that the overall legal issues are different. You raised a valid question regarding the ethics of “legal” vs. “illegal” death and attitudes toward them, but the conversation has since veered way off course.

Dr. William Hammesfahr, who examined Terri in person, concluded just the opposite – that she was NOT in a nonrecoverable vegetative state. I think a live examination by a world-renowned expert in brain injury carries more weight than an autopsy report. BTW, the autopsy report which is at:

http://www.michaelschiavo.org/docs/autopsy.pdf

does not contain the word “vegetative” anywhere in it. I’m not sure where you are getting that information from.

“she was no longer capable of higher cognition in 2005.”

Again, that is disputed by a neurologist who examined her in 2002.

“While you can certainly argue that his testimony was of dubious validity”

I would say it Michael’s testimony was more than dubious. It was a flat-out lie. Here is yet another affidavit from a former girlfiend of Michael Schiavo:

http://www.michaelschiavo.org/docs/trudy.pdf

“…KRT asked me if Schiavo ever confided in me regarding Terri’s case. I told her that Michael confided in me all the time about Terri. I did say, “I will tell you one thing: Michael never knew what Terri wanted. He never knew.” He would say to me all the time, “I don’t know what to do. I don’t know what to do with her. I just don’t know.” I told KRT that if he said anything different he was a liar and that he said to me many times that he had no idea what her wishes were…”

Terri Schiavo Can Still be Rehabilitated, Nobel Prize-Nominated Doctor March 7, 2005

Clearwater, FL (LifeNews.com) — Despite the contention of Terri Schiavo’s estranged husband Michael and courts that have allowed him to starve her to death, a doctor nominated for the Nobel Prize says he believes medical therapies are still available that could help Terri party recover from her disabled state.

Dr. William Hammesfahr is an internationally recognized expert on cases of brain-injured patients. He has been identified in helping patients with chronic brain injuries from many causes actually leave long term disability, and return to work.

Terri Schiavo’s injury, hypoxic encephalopathy, is a type of stroke that he treats every day with success.

“We, and others I know, have treated many patients worse than Terri and have seen them regain independence and dignity,” Hammesfahr said.

“There are many approaches that would help Terri Schiavo,” Dr. Hammesfahr explained. “I know, because I had the opportunity to personally examine her, her medical records, and her X-rays.”

“It is time to help Terri, instead of just warehousing her,” he added. “She would have benefited from treatment years ago, but it is not too late to start now.”

This isn’t the first time Hammesfahr has discussed Terri’s plight.

Last year, he explained that, after examining Terri, he believed that she could eventually eat and drink on her own. He also said he believes Terri would be able to talk and have good use of one arm and one hand should be given proper rehabilitative treatment.

Hammesfahr also said he thought Terri would eventually be able to transfer herself from a wheelchair to a bed.

“The patient is not in a coma,” concluded Hammesfahr said after observing Terri. “She responds to specific people best. She tries to please others by doing activities for which she gets verbal praise.”

He says Terri’s eyes clearly fixate on her family and she tries to follow the simple commands her parents give her.
“She looks at you, she can follow commands,” Hammesfahr said.

Dr. Hammesfahr was nominated for the Nobel Prize in Medicine and Physiology in 1999.

@Pat “On the contrary; given the fact that her testimony contradicts the medical testimony (again, that I’ve read, you may have other references to cite) done by the actual brain experts”

O.K. guys, so you won’t take the word of a lowly RN. You apparently require the word of a doctor. Well, how about this testimony from a neurologist who examined Terri Schiavo on September 3rd and 4th, 2002. Interesting how Dr. Hammesfahr’s testimony backs up and confirms what Carla Iyer was saying, now isn’t it?

http://libertytothecaptives.net/hammesfahr_dr._report.html

Complete report of Dr. William Hammesfahr, a world-reknowned neurologist
September 12, 2002

Re: Terri Schiavo

I was asked to examine Terri Schiavo per the request of the Second District Court of Appeal. They requested that current information about her present medical condition be obtained. They also requested that an evaluation be performed to ascertain treatment options.

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Medical examination and evaluations were performed on Ms Schiavo on September 3 and 4 with videographers present. Medical reviews of the charts provided were carried out, from which the above history is obtained.

On September 3, I spent from approximately 11AM until 4PM with Ms. Schiavo, returning the next day to also observe Dr. Maxfield and complete my portion of the exam (which duplicated that of Dr. Maxfield, so I observed without myself specifically repeating that part of the exam that same day).

The exam was videotaped at my request.

The exam started with the setting up of the video camera by the videographers, with Mr. Michael Schiavo present. I then came into the room and introduced myself to Ms. Schiavo. The patient was looking at the ceiling in a chair. She had a wide-eyed look to her. She appeared to be aware of my presence with slight facial changes and tone changes in her body, She did not look at me, or turn to look in the direction of my voice, continuing instead to look directly forward. Her mother then entered the room, coming toward her and speaking her name. THE DAUGHTER IMMEDIATELY SHOWED AWARENESS OF THE PRESENCE OF HER MOTHER, LOOKING FOR HER, THEN FINDING HER VISUALLY WHEN THE MOTHER WAS APPROXIMATELY 8 INCCHES FROM HER FACE. SHE THEN SMILED AND MADE SOUNDS. Her father also entered the room with further apparent recognition by the daughter.

The first part of this exam included observing her interactions with her mother and her father. Here SHE CLEARLY WAS AWARE OF THEM AND ATTEMPTED TO INTERACT WITH THEM: THE SOUNDS, FACIAL EXPRESSIONS, AND SEARCHING OUT AND TRACKING THEM. There are several previous reports by medical personnel and others of her responding to live piano music. Accordingly, I asked the mother to bring a tape of piano music. Two separate pieces were listened to. The first she appeared aware of the sound, but would not sing or interact significantly. The second she did interact making sounds with the music. SHE STOPPED MAKING THESE SOUNDS, WHEN THE MUSIC STOPPED.

During this time, she would move her head and track her head and eyes to the sound of music, or her mother’s voice. I started my exam first on her right side, introducing myself and then examined her contracted right arm, the goal being to get a blood pressure, as neurological abilities are very sensitive to blood pressure. SHE LOOKED AT ME AND WOULD TRACK ME WITH VOLUNTARY FACIAL AND UPPER TORSO MOVEMENTS. I later moved to the left arm and attempted to release contractures there. In order to get significant relaxation of the arm to a degree necessary to obtain a blood pressure, I worked for approximately 35 minutes to release the contractures enough to get arm extension to approximately 140 degrees. During this time, the patient would track the mother or the father, depending on who was interacting with her. Interestingly, she appeared to respond to her mother or father by tone of voice. At one time, after working on her arm for approximately 20 minutes, and no further extension of the elbow was to be had, the father walked up and started speaking reassuringly to his daughter. The elbow immediately extended approximately another 20 degrees. This was during a time period that I had been talking with Ms. Schiavo, and the music was also running. Yet with neither the addition of the music nor my voice did the elbow extend. WITH THE FATHER COMING TO HIS DAUGHTER AND SPEAKING, SHE IMMEDIATELY EXTENDED THE ARM FURTHER. At other times, he ould speak more sharply to her, and she would immediately tighten, and appear to lose her spot of visual focusing, and her expressions would change. At times during and immediately after this part of the exam, she would also appear to voluntarily move her right upper extremity.

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The general facial exam was significant for acne, probably due to a chronic stress induced steroid responses. No bruits were identified. Cranial nerves were intact, and THE PATIENT WAS ABLE TO SWALLOW and handle all secretions.
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Alertness: The patient was alert throughout essentially the entire exam.

Responsiveness:

The patient would immediately respond to sound, tone of voice and to touch and pain. With respect to responding to those around her, she had limited responsiveness to me personally until approximately 45 minutes into the exam. SHE STARTED TO LOOK AT ME, against her traditional right gaze preference, about the same time that we started getting significant relaxation in her contracted left arm (the arm that had been contracted for several years.) She appeared to identify the sound of my voice, with the relaxation of the arm. From that point, she would generally look toward the sound of my voice when heard, attempt to find me visually, then track the sound of my voice in its movements, or track me if I was within approximately one foot of her eyes. Prior to that time, she did not track me, or try to locate me visually. When playing music, SHE HAD A CLEAR PREFERENCE TO THE SPECIFIC SOUND TRACK PLAYED, and would listen to piano music, but change levels of listening depending on the track played. Her attention to the music would not wander during the track she preferred. She would pick out her mother’s voice or her father’s voice separate from the music or other voices or sounds in the room, and re-fix her gaze to those people. She would tend not to blink when watching those people. She ignored her husband’s loud foot-tapping that went on for approximately five minutes at one point. SHE ALSO IGNORED HIS VOICE AND DID NOT TRY TO SEEK HIM OUT VISUALLY when he would at times interject comments during the exam or immediately afterwards.
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Following Commands: At various times during the exam, I asked her to close her eyes, or open her eyes widely, look towards her mother, or look towards me. At times, SHE APPEARED TO PROPERLY FOLLOW THESE COMMANDS. Interestingly, some of the commands, such as close your eyes, open your eyes, etc. she tended to do several minutes after I gave her the command to do so. She had a delay in her processing of the action. However, when praised for the action, she would then continue to do the action repetitively for up to approximately 5 minutes. As we had moved on to other areas of the exam, at times she was continuing to do the previous command, then at inappropriate times since the focus of the exam had changed. During different portions of the exam, I would ask her to squeeze my hand on command, or, in the lower extremities, to pick up her right lower leg to command.
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COMA PATIENTS CANNOT DIRECT THEIR GAZE TO SPECIFIC THINGS AND MAINTAIN THEIR GAZE ON THOSE THINGS REGARDLESS OF HEAD MOTION OR MOTION OF THE OBJECT. SHE CAN DO THESE THINGS. She appears to see things best at approximately the.8-12 inch area. She was best able to track large reflective objects like aluminum balloons or sparkling lights (for which a focal length limitation is not an issue.)
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Sensory Exam: The patient was tested to light touch, pressure, and sharp touch and pain in all four extremities and on her face. The pain portion in the extremities was conducted by pinching the nail beds of her hands and feet. SHE CLEARLY FEELS PAIN AS THE VIDEOTAPES SHOWS.
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Impression:

The patient is not in coma.

She is alert and responsive to her environment. She responds to specific people best.

She tries to please others by doing activities for which she gets verbal praise.

She responds negatively to poor tone of voice.

She responds to music.

She differentiates sounds from voices.

She differentiates specific people’s voices from others.

She differentiates music from stray sound.

She attempts to verbalize.

She has voluntary control over multiple extremities

She can swallow.

She is partially blind

She is probably aphasic and has a degree of receptive aphasia.

She can feel pain.
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Communication: She can communicate. She needs a Speech Therapist, Speech Pathologist, and a communications expert to evaluate how to best communicate with her and to allow her to communicate and for others to communicate with her. Also, a treatment plan for how to develop better communication needs to be done.
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Interestingly, I have seen this pattern of mixed brain (cerebral) and spinal cord findings in a patient once before, a patient who was asphyxiated.
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William M. Hammesfahr, M.D.”

But that may be completely beside the point. As said in a previous post, when someone is suffering from diabetic ketoacidosis, you know something is wrong. The point where any sensible parent would take their child to see a doctor would have been reached long before her condition turned critical.

Where I think the biggest problem is going to enter into this case is whether the Neumanns actually believed that what they were doing was sufficient help to their daughter. If they really, truly thought that their prayers were just as good, if not better than insulin shots, can they still be charged with neglect, or would they be able to get off on something like an insanity plea? (<- actual legal question. anybody?)

It has been brought up that we don’t know what Kara’s wishes would have been had she been in any position to make them known. Two reasons this is a moot point. First, she was 11 years old. For seven more years, it is her parent’s responsibility to make the choice that is best for her. Unfortunately, they failed this one quite spectacularly. Secondly, even if she did favor faith healing over western medicine, all that proves is that her parents had succeeded in indoctrinating her to their faith. I suppose in a way you *could* say that the parents are victims as well, but victims turned victimizers, in the sense that victims of domestic abuse often perpetuate the cycle.

> An autopsy conducted on woman who died as the result of being deprived of
> food and water for 13 days is of limited utility.

I don’t know that this is true; I’ll readily admit I’m not a Medical Examiner. However, there is analysis of the autopsy report by doctors that state that the autopsy shows she was in a nonrecoverable vegetative state. If you’re challenging that statement, you need to establish your bona fides for doing so.

> As you are probably aware, signing an affidavit is the equivalent of
> sworn testimony in most jurisdictions.

Certainly.

> Thus, if Iyer was lying in her affidavit she opened herself up to a possible
> perjury prosecution.

Of course.

> I think you have to tell us what her motive for lying would be.

On the contrary; given the fact that her testimony contradicts the medical testimony (again, that I’ve read, you may have other references to cite) done by the actual brain experts, I think the burden is instead upon you to explain why an RN is more capable of providing an analysis of a patient’s state than several doctors… especially when there are multiple possible explanations for the RN’s testimony other than outright lying.

> BTW, in many murder cases defendants are sent to death row on the
> testimony of a single witness. Thus, your assertion that a single witness
> account without confirmation is not credible is completely absurd.

Your pardon, I was not clear. I’m not talking about whether or not a legal case can be made against Michael Schiavo. I’m talking about whether or not your argument is going to sway someone who is weighing all the evidence in question outside of the legal context. Quite simply, I don’t find a single eyewitness account to be a credible basis for counterclaim against a volume of contradictory evidence, and you’re not going to convince me without lots more. Inside of the legal context… well, more on that later.

> LOL. She misinterpreted guttural sounds for “Help me” and did so hundreds
> of times. Yeah, right.

She can misinterpret a sound ten times and remember it as a hundred. And I can think of several thousand guttural combinations that sound like “help me”; certainly it is likely that someone hearing them in a context where they expect to *hear* the phrase “help me”. If you don’t believe this is not only possible but probable, hang out with new parents. They interpret baby babble as words well before an infant is actually using words.

> An autopsy conducted in 2005 after Terri was starved to death and
> dehydrated for 13 days cannot have any bearing on the possible
> effectiveness of treatment back in 1996.

Again, I’m not an ME. However, if you’re claiming that starvation and dehydration will reduce the size and composition of your brain significantly, you’re going to have to back that up somehow.

> Please provide the reference for that.

http://www.northcountrygazette.org/articles/062506SchiavoNurse.html

From that, I quote:

HEMMER: So you heard those words, “mommy” and “pain” and “help me?”

IYER: Correct.

HEMMER: Why was there no videotape taken of that speaking opportunity?

IYER: That was back in ‘95 and ‘96. There’s four hours of videotape that the judge has put a gag order on.

HEMMER: But you’ve seen it, you say, and that was not entered into court, that’s your claim?

IYER: Correct.

> Well, what you don’t address is that Michael Schiavo was in effect a
> bigamist living in a common-law marriage with another woman. This is
> not even in dispute by Mr. Schiavo himself. Thus, he has a basic conflict
> of interest. Any claim he asserts concerning a supposed conversation
> with Terri cannot be taken at face value because he has a motive for lying.

Even if Michael Schiavo was not involved with another woman, his claims cannot be taken at face value any more than the parents’ claims can be taken at face value. There is certainly a large volume of doubt that anyone in this sort of situation can be relaying the complete truth; it stands to reason that both sides suffer from confirmation bias. That said, if Michael Schiavo’s testimony as to Terri’s wishes was accepted without challenge, she would have ceased receiving food and water permanently in 1998. While you can certainly argue that his testimony was of dubious validity, one can also argue that the parental testimony was of dubious validity, and the court decided between 1998 and 2005 that Michael’s claim was of less dubiousness. If you accept the framework of the Florida law (http://bressler.com/news/publications/BA&R%20Health%20Care%20Proxy.pdf) regarding health care proxies, then it’s quite simple… barring an advanced directive, the right of health care proxy (as far as determining life sustaining treatment) falls to a judicially appointed guardian, not the parents, and not the spouse. If you’re ruled to be in a persistent vegetative state and the judicially appointed guardian chooses to pull the plug, that’s it for you. Your rights are spelled out, right there.

> Ah yes, the appeal to personal preference. You wouldn’t want such and such
> to happen to you. Therefore it is reasonable to think that Terri wouldn’t
> want it either, unless there was documentation to the contrary.

That’s not an appeal to personal preference, it’s my own stance. If I happened to be assigned by a court to make a health care proxy decision in Terri’s case, that’s what I would have decided, based upon the evidence that I’ve seen. That is to say, it’s certainly reasonable to judge that both the parents and the husband have dubious validity as to Terri’s wishes, and they both certainly have vested personal interests in Terri’s state (regardless of Terri’s actual wishes). I would choose that particular path because of the medical testimony; IMO, regardless of the cause or when precisely she was no longer capable of higher cognition, she was no longer capable of higher cognition in 2005.

> And I suppose now you will tell us that if you were in a similar state as
> Terri, you would prefer to be slowly starved and dehydrated to death
> over a long period of 13 days. After all, it’s the only humane thing to do.

If I’m no longer capable of cognition, I don’t think my preferences matter a damn. I’m gonzo; I’m either passed on to the afterlife or (if there isn’t such a thing) I’m no longer a person (my personal belief in an afterlife being irrelevant here) … in either case what happens to the carcass is of no direct import to me. That said, I personally would wish that should I get into such a state I’d be allowed to die, so that the people who are left behind can actually get some closure and the resources that are being used to keep me alive can be redirected at someone who could benefit from the care. The most humane thing to do in such a case is probably to simply stop the heart, but such an option isn’t currently available legally. So yes, given the current options available, I would rather my wife choose to pull the feeding tube than keep what remains of my body running.

Of course, I wouldn’t want my wife to *have* to make this decision (since it’s obviously an emotionally traumatizing event, one should spare one’s loved ones from having to make this call), so I’ve already made that clear.

Consider the case of Gary Graham who was executed in Texas on June 22nd, 2000. Only a single eyewitness fingered him for the murder of Bobby Lambert. There was no other forensic evidence linking him to the crime.

http://www.crimelynx.com/nostop.html