In Feeding-Tube Case, Many Neurologists Back Courts

October 26, 2003

At the center of the court battle over the immobile body of
Terri Schiavo, the 39-year-old Florida woman kept alive by
a feeding tube, is a videotape made by her parents. It
lasts only minutes but has been played so many times on
television and the Internet that it all but defines her.

On the tape, Mrs. Schiavo, propped up in bed, is greeted
and kissed by her mother. She is not in the deep,
unresponsive sleep of a coma. Her eyes are open, and she
blinks rapidly but fairly normally. She seems to follow her
mother's movements, but her mother's face is too close for
that to be clear. Her jaw is slack and her mouth hangs
open, but at moments its corners appear to turn up in a
faint smile.

To many supporters of Mrs. Schiavo's parents, who say she
should be kept alive on a feeding tube, the tape
demonstrates that she can still think and react. But many
leading neurologists say that it means no such thing, that
the appearances of brain-damaged patients can be very

Florida courts have ruled, after hearing from several
experts who examined her, that Mrs. Schiavo has been in a
"persistent vegetative state" - an official diagnosis of
the American Academy of Neurology - since her brain was
deprived of oxygen when she suffered a heart attack 13
years ago. Her feeding tube was removed on Oct. 15, but it
was reinserted six days later after the Florida Legislature
gave Gov. Jeb Bush the authority to override the courts.

Patients in vegetative states may have open eyes, periods
of waking and sleeping and some reflexes, like gagging,
jerking a limb away from pain or reacting to light or
noise. They may make noises or faces and even say words.

But they do not, according to academy criteria, show
self-awareness, comprehend language or expressions, or
interact with others.

A vegetative state "is the ironic combination of
wakefulness without awareness," said Dr. James L. Bernat, a
Dartmouth Medical School neurologist and past chairman of
the academy's ethics committee.

Mrs. Schiavo's parents and the conservative Christian
groups working to keep her on the feeding tube insist that
she is in a "minimally conscious state" - another official
diagnosis. They note that on the videotape, her eyes appear
to follow a silver balloon waved before them.

Her father, Bob Schindler, visited her on Thursday night
and said later that she had made the sound "unh-unh," as if
to say no, when he kissed her, and "unh-unh" again when he
asked her if she wanted him to kiss her. He described that
as a sign that she could hear and answer questions.

In 2001, Dr. Richard Neubauer, director of the Ocean
Hyperbaric Neurologic Center in Florida, said in an
affidavit that said he found Mrs. Schiavo "not in a
vegetative state" and "at least semi-responsive to her
environment." He was seeking to treat her by putting her in
an oxygen-rich pressure chamber.

A famous case of "minimally conscious," said Dr. Michael P.
McQuillen, a professor of neurology at the University of
Rochester, was that of a woman who appeared vegetative but,
on overhearing her sister on the phone making funeral
arrangements for a favorite uncle, began to cry.

Mrs. Schiavo is fed by tube and incapable of making
decisions for herself. She cannot swallow, though her
parents argue that with help she might be able to relearn
swallowing so she could be spoon-fed.

Early in Mrs. Schiavo's illness, her husband, Michael, sent
her to California to have a nerve stimulator implanted, one
neurologist said, but he later came to believe she would
never recover.

Vegetative states become persistent, according to the
neurology academy's criteria, after about three months,
after which it is highly unlikely that they will end.
Patients like Mrs. Schiavo whose brains have been starved
of oxygen do worse than patients who suffer head trauma,
neurologists say.

"Thirteen years is plenty long enough to tell," said Dr.
Bernat, who said he had not examined Mrs. Schiavo or seen
any videotapes. "Assuming she is in a vegetative state, I
can say with medical certainty that there is no realistic
hope that she'll recover."

Dr. Bernat was part of a large medical panel that in 1994
assessed thousands of patients' records and found that up
to 35,000 Americans were in persistent vegetative states.

Mrs. Schiavo's parents and a Web site,,
have cited "miracle recoveries" by people who supposedly
woke up, speaking and moving, after years in comas.

Dr. Bernat said his 1994 panel looked into more than 70
"alleged late recoverers" and found that "there wasn't a
single one that was verified, so I'm very skeptical."

Dr. Ron Cranford, a Minneapolis neurologist who was Dr.
Bernat's predecessor on the academy ethics committee,
examined Mrs. Schiavo as part of the original trial and
testified in favor of her husband's request to discontinue

He was adamant that she would never get better, and he says
he is furious about the popular videotape.

"She's vegetative, she's flat-out vegetative, there's never
been a shred of doubt that she's vegetative, and nothing's
going to change that," Dr. Cranford said in a telephone
interview. "This has been a massive propaganda campaign,
which has been very successful because it deludes the
public into thinking she's really there."

Her eyes do not steadily track objects, he said, and when
she appears to look at her mother or a camera for a moment,
it is merely rapid eye movement.

More important, he said, "the CAT scans indicate a massive
shrinkage of her brain, with its higher centers completely
destroyed, which indicates irreversibility."

The Schiavo case is the kind of family fight that doctors
treating brain-damaged patients say they dread. "In a case
like this, you're between a rock and a hard place," said
Dr. McQuillen of the University of Rochester.

He added that keeping Mrs. Schiavo alive artificially could
be a burden on her.

For many terminally ill patients, he pointed out, "food is
an absolute burden - it increases secretions and makes them