In Feeding-Tube Case, Many
Neurologists Back Courts
October 26, 2003
By DONALD G. McNEIL Jr.
At the center of the court battle
over the immobile body of
Terri Schiavo, the 39-year-old Florida woman kept
a feeding tube, is a videotape made by her parents.
lasts only minutes but has been played so many times
television and the Internet that it all but defines
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
blinks rapidly but fairly normally. She seems to
mother's movements, but her mother's face is too
that to be clear. Her jaw is slack and her mouth
open, but at moments its corners appear to turn up in
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
leading neurologists say that it means no such thing,
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
"persistent vegetative state" - an official diagnosis
the American Academy of Neurology - since her brain
deprived of oxygen when she suffered a heart attack
years ago. Her feeding tube was removed on Oct. 15,
was reinserted six days later after the Florida
gave Gov. Jeb Bush the authority to override the
Patients in vegetative states may
have open eyes, periods
of waking and sleeping and some reflexes, like
jerking a limb away from pain or reacting to light or
noise. They may make noises or faces and even say
But they do not, according to academy
self-awareness, comprehend language or expressions,
interact with others.
A vegetative state "is the ironic
wakefulness without awareness," said Dr. James L.
Dartmouth Medical School neurologist and past
the academy's ethics committee.
Mrs. Schiavo's parents and the
groups working to keep her on the feeding tube insist
she is in a "minimally conscious state" - another
diagnosis. They note that on the videotape, her eyes
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,"
to say no, when he kissed her, and "unh-unh" again
asked her if she wanted him to kiss her. He described
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
environment." He was seeking to treat her by putting
an oxygen-rich pressure chamber.
A famous case of "minimally
conscious," said Dr. Michael P.
McQuillen, a professor of neurology at the University
Rochester, was that of a woman who appeared
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
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
neurologist said, but he later came to believe she
Vegetative states become persistent,
according to the
neurology academy's criteria, after about three
after which it is highly unlikely that they will end.
Patients like Mrs. Schiavo whose brains have been
of oxygen do worse than patients who suffer head
"Thirteen years is plenty long enough
to tell," said Dr.
Bernat, who said he had not examined Mrs. Schiavo or
any videotapes. "Assuming she is in a vegetative
can say with medical certainty that there is no
hope that she'll recover."
Dr. Bernat was part of a large
medical panel that in 1994
assessed thousands of patients' records and found
to 35,000 Americans were in persistent vegetative
Mrs. Schiavo's parents and a Web
have cited "miracle recoveries" by people who
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
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
testified in favor of her husband's request to
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
going to change that," Dr. Cranford said in a
interview. "This has been a massive propaganda
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
it is merely rapid eye movement.
More important, he said, "the CAT
scans indicate a massive
shrinkage of her brain, with its higher centers
destroyed, which indicates irreversibility."
The Schiavo case is the kind of
family fight that doctors
treating brain-damaged patients say they dread. "In a
like this, you're between a rock and a hard place,"
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