Neurologist argues Schiavo is not ‘PVS,’ withdrawing food and water wrong

TALLAHASSEE (FBW) – Writing that “huge uncertainties” remain concerning Terri Schiavo’s “true neurological status,” a neurologist with Jacksonville’s Mayo Clinic has filed an affidavit arguing that the 41-year-old brain-damaged woman at the center of an international “right-to-die” controversy is not in a “persistent vegetative state,” as determined by the court, and, therefore, it is unethical to remove her food and water.

“I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state,” wrote William P. Cheshire Jr., after the board certified neurologist recently visited the severely brain-damaged woman for 90 minutes and examined her medical records.

“This distinction makes an enormous difference in making ethical decisions on Terri’s behalf. If Terri is sufficiently aware of her surroundings that she can feel pleasure and suffer, if she is capable of understanding to some degree how she is being treated, then in my judgment it would be wrong to bring about her death by withdrawing food and water.”

Schiavo’s PVS status is at the center of her husband’s claim that she would not wish to live on “artificial life support,” including nutrition and hydration, which courts have repeatedly ruled he may remove to hasten her death.

Cheshire’s affidavit was filed along with a March 23 motion with the Sixth Judicial Circuit in Pinellas County by the Department of Children and Families seeking another opportunity to intervene in the Schiavo case, noting that the department received reports of abuse of her as recently as March 21. Cheshire offered his views acting as a volunteer with DCF’s Adult Protective Services team.

At a March 23 news conference a state attorney appearing alongside Gov. Jeb Bush said DCF “could take protective custody” of Schiavo.

Bush was asked specifically if officials were planning on moving in to take custody.

“That won't be my decision,” he said.

At the request of Michael Schiavo’s attorney, George Felos, Pinellas Judge George Greer issued an emergency order late Wednesday enjoining the governor from taking Schiavo into protective custody.

In his affidavit, Cheshire wrote that he was called on March 1, 2005 by DCF to “provide an independent and objective medical review of allegations of possible abuse, neglect, or exploitation” of Terri Schiavo.

Noting that “nearly three years have passed since Terri has had the benefit of a neurological consultation,” Cheshire asks, “how, then, are we to be certain about her current neurological status? There remain, in fact, huge uncertainties in regard to Terri’s true neurological status.”

Cheshire writes that Terri has never had certain testing including a positron emission tomography (PET) or functional magnetic resonance imaging (fMRI) and that “new facts have come to light in the last few years that should be weighed in the neurological assessment of Terri Schiavo.”

Citing a recent study published in the journal, Neurology, Cheshire writes “there is still a great deal we do no know about what previously unsuspected cerebral cortex functions may yet be occurring in the minds of persons who have sustained profound brain damage and are no longer able to communicate outwardly what their thoughts may be.”

Cheshire continues, “Based on my review of extensive medical records documenting Terri’s care over the years, on my personal observations of Terri, and on my observations of Terri’s responses in the many hours of videotapes taken in 2002, she demonstrates a number of behaviors that I believe cast a reasonable doubt on the prior diagnosis of PVS.”

Cheshire writes, “To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead or in some neurological sense no longer there. … As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration. No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others.”

Terri “demonstrates behaviors in a variety of cognitive domains that call into question the previous neurological diagnosis of persistent vegetative state. Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurological consideration, would not be expected in a persistent vegetative state.”

Cheshire notes that Terri’s situation differs “fundamentally from end-of-life scenarios where it is appropriate to withdraw life-sustaining medical interventions … . Terri’s feeding tube is not a burden to her. It is not painful, is not infected, is not eroding her stomach lining or causing any medical complications. But for the decision to withdraw her feeding tube, Terri cannot be considered medically terminal. But for the withdrawal of food and water, she would not die.”

Cheshire concludes his affidavit: “How medicine and society choose to think about Terri Schiavo will influence what kind of people we will be as we evaluate and respond to the needs of the most vulnerable people among us. When serious doubts exist as to whether a cognitively impaired person is or is not consciously aware, even if these doubts cannot be conclusively resolved, it is better to err on the side of protecting vulnerable life.”

[Editor’s note: To read Cheshire’s entire affidavit, please click here.]