3.21.2005

When to Let Go

Craig in comments brings up a good point in discussing someone he worked with who was in a coma for about a year but came back from it. There are definitely cases like this, although (sadly) pretty few and far between. And we're still learning about the human brain. Technology, while not perfect, also gives us various scans and analysis devices that can give us a much more accurate reading on the state of the brain - electrical, chemical, and physical - than we had even a decade ago.

However, even owing to mystery and science yet to catch up, there are some things that seem like pretty clear indicators of a brain that cannot recover at the state of medicine today. Many people who suffer comas, for example, do not necessarily experience - and may not for some time - the kind of physical, chemical, and electrical changes that get put in the grab bag we call "brain death". Comas develop for a number of reasons - including some illnesses like the one I had a couple of years ago which we treat by inducing coma.

Terri Schiavo, very sadly, lost a great deal of her functioning brain on the day she had her cardiac crisis 14-15 years ago. She's not in a coma but a permanent vegetative state (they call it persistent on the news but once you reach the year mark, it's called permanent). Most of her brain has no detectable brain activity. Between 40-60% of her brain had been replaced by fluid. For her, there is not going to be a time when she will be able to control any bodily event, let alone live by our common definition of same.

If Terri did not have this extent of damage, if there had been ANY sign in 15 years that she might ever have progress, I don't think we'd be here. The only thing actually that has kept Terri alive so long is the fact that her husband achieved a settlement for her to pay for her custodial care. Yet he's being villified.

So yes, I think we have to be very careful about who we consider "lost" because, like Craig's friend and two people I've met, there can be recovery. But we know there isn't recovery and regeneration of various parts of the brain, and Terri, sadly, is missing more than one key part.

But the same Congress and president who pushed this through have written law to endanger people with more quality of life than Terri and to allow health care facilities and NOT family to decide when to discontinue support. So why Terri's case has become so hot is very much open to question.