Editorial

On March 18, 2005, when the feeding tube was removed from Terri Schiavo after years of legal wrangling prompted by her husband's desire to end her tragic life, what did Terri know?

How aware was she that the clock had begun ticking and the withdrawal of food and hydration was for the purpose of ending her life, which would come 13 days later? Was Terri cognizant that her husband, with the compliance of the judicial system and in the wake of the failure of federal and state legislatures and Florida's chief executive to stop him, was seeking to end her life because she had mysteriously and catastrophically suffered severe brain damage 15 years earlier?

What did Terri know?

I've often pondered this question in the 18 months since Terri Schiavo died-quite unnaturally. It's a question that should haunt every person involved in this saga-every citizen, every elected official, every judge, and, not the least of which, Michael Schiavo who today is a celebrity campaigning for politicians who have earned his political action committee's support.

What did Terri know?

The honest answer is: only God knows what Terri's state of consciousness was following the incident that caused her severe brain damage in 1990, leaving her unable to speak and to incontrovertibly communicate her wishes. Only God knows what Terri's awareness was in the ensuing years, and especially during the last 13 days as she helplessly awaited her fate in a Pinellas Park hospice as her parents, siblings and other family members sought to give her comfort.

Still, "startling" results of testing on a severely brain-damaged 23-year-old woman unable to communicate and judged to be in a "persistent vegetative state"-just like Terri Schiavo was-should indeed haunt Michael Schiavo and others who were willing to allow Terri to be starved and dehydrated to death.

Reported in the Sept. 8 issue of the journal Science, a team of neurologists from the United Kingdom and Belgium, using functional magnetic resonance imaging (fMRI)-the very kind of testing which Terri's parents sought and were denied for her-found that the woman was able to communicate with researchers.

According to The Washington Post, "Without any hint that she might have a sense of what was happening, the researchers put the woman in a scanner that detects brain activity and told her that in a few minutes they would say the word, 'tennis,' signaling her to imagine she was serving, volleying and chasing down balls. When they did, the neurologists were shocked to see her brain 'light up' exactly as an uninjured person's would. It happened again and again. And the doctors got the same result when they repeatedly cued her to picture herself wandering, room to room, through her own home."

Lead scientist Adrian Owen said, "I was absolutely stunned. We had no idea whether she would understand our instructions. But this showed that she is aware."

Don't miss the last three words-"... she is aware." This severely brain-damaged woman, although completely unable to communicate with those around her, was aware enough of her existence and surroundings that she was able to imagine activities when prompted-and in a fashion "indistinguishable" to those of healthy patients, reported BBC News.

According to BBC News, Owen asserted, "We see this as a proof of principle: we have found a way to show that a patient is aware when existing clinical methods have been unable to provide that information."

Kate Bainbridge, who was previously diagnosed as being in a vegetative state and participated in the testing, told BBC News, "I can remember when I couldn't respond and it was so scary." She communicates now through a keyboard.

Inevitably, news accounts of this development turned to the implications of these findings in the Schiavo case. Researchers were careful to note that not all PVS patients are the same and that these results were from only one person, whose brain damage was not as severe as was Terri Schiavo's.

"I'm quite confident that [Schiavo] would not have responded in this way," James L. Bernat, a neurologist at Dartmouth Medical School, told The Post. Nevertheless, even Bernat conceded, "It's a little disturbing. This suggests there may be things going on inside people's minds that we can't assess by interacting with them at the beside."

The results of this test is a reminder that scientific truth is not fixed-if you don't believe that, talk to those who are mourning the demotion of Pluto from planetary status. Because scientific truth is not final, science cannot answer ultimate questions of life and death and ethics-and those answers never change.

It is always wrong to kill persons who are guilty of no crime punishable by death. It is always wrong to deny food and water to any person simply because the "quality" of that person's life is judged to be unworthy of life. It is always wrong for the state to assist a spouse in killing his wife.

An imminent neurologist, William P. Cheshire, spoke to the medical and ethical questions of Terri Schiavo in an affidavit filed five days after her feeding tube was removed. After examining Terri at the request of the Florida Department of Children and Families, Cheshire offered the medical opinion that she was actually in a "minimally conscious state," rather than in PVS.

Even more critically, Cheshire concluded, "How medicine and society chose 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 doubt exist as to whether a cognitively impaired person is or is not consciously aware, even if those doubts cannot be conclusively resolved, it is better to err on the side of protecting vulnerable life."

While no one can know for sure what Terri was thinking, her family maintained from the beginning that she was aware of their presence and especially their love. Videos of her family's interaction with Terri seemed to validate those claims, whether she followed with her eyes brightly colored balloons or smiled with the apparent recognition of her mother or when she cried as soon as her family had to leave.

What did Terri know?

The day her feeding tube was removed for the last time, attorney Barbara Weller was in the hospice room with family members visiting with Terri. Weller took Terri's face in her hands and told her, "Terri, if you could only say, 'I want to live,' this whole thing could be over today," she reported in a March 21, 2005, account.

"To my enormous shock and surprise, Terri's eyes opened wide, she looked me square in the face, and with a look of great concentration, she said, 'Ahhhhhhh.' Then, seeming to summon up all the strength she had, she virtually screamed, 'Waaaaaaaa.'"

According to Weller, Terri "yelled so loudly" that her brother-in-law and "the female police officer who were then standing together outside Terri's door, clearly heard her.

"At that point, Terri had a look of anguish on her face that I had never seen before and she seemed to be struggling hard, but was unable to complete the sentence. She became very frustrated and began to cry. I was horrified that I was obviously causing Terri so much anguish."

After the exchange, Weller told the story to the assembled media outside of the hospice. The account was derisively dismissed by Michael Schiavo's attorney and his other supporters. After all, since Terri was in a persistent vegetative state, how could she possibly attempt to communicate?

But the haunting question remains, what did Terri know? What if Terri was in fact attempting to say, "I want to live"? What if all along she was aware that her husband was seeking court permission to end her life? What if Terri was aware that she was being starved and dehydrated to death?

No one will ever be able to convince me that what happened to Terri Schiavo was not a monstrous miscarriage of justice. March 31, 2005, the day Terri died, should be etched in our nation's collective conscience as a day of great infamy.

What did Terri know?