Patterico's Pontifications

4/8/2005

Here we go again

Filed under: General,Schiavo — See Dubya @ 3:44 am



We’re picking up speed down a slippery slope, and I fear we burned out the brakes trying to save Terri Schiavo from destruction. From Fr. Rob Johansen, emphasis mine:

The similarities of Mae Margourik’s situation and Terri Schiavo’s are obvious: Once again we have a family divided over what care should be given to a seriously ill relative. And once again, we have a judge playing God with someone’s life. But what is different, and in a sense worse, is that Mae is being deprived of food and water in clear contravention of her own stated wishes, and at the request of someone who should have no standing under Georgia law.

God help us.

(h/t: the Dawn Patrol.)

UPDATE: The granddaughter says “She has glaucoma and now this heart problem, and who would want to live with disabilities like these?”

Well, I for one would prefer it to the alternative, and apparently, judging by her CLEARLY WRITTEN LIVING WILL expressing a desire NOT TO BE TAKEN OFF LIFE SUPPORT, so would Mae Magourik.

UPDATE FROM PATTERICO: Tom Maguire has an interesting angle on this.

66 Responses to “Here we go again”

  1. […] @ 7:55 pm Blogs for Terri reports that Mae Magouirk has had her feeding tube reinstated, and is being airlifted from the hospice […]

    Patterico's Pontifications » Some Good News at Last (0c6a63)

  2. Isn’t standing something that can be raised de novo at any time? at least we won’t need tom delay.

    actus (f9abe0)

  3. Slippery Slope Watch
    Thrown Back, by Fr. Rob Johansen (via Patterico), this story:85 year-old Mae Margourik of LaGrange, Georgia, is currently being deprived of nutrition and hydration at the request of her granddaughter, Beth Gaddy. Mrs. Margourik suffered an aortic disse…

    Shot In The Dark (9bd2a3)

  4. Yes, it is, assuming Georgia judges know more Latin than federal ones do.

    Xrlq (c51d0d)

  5. Yes, Virginia (Georgia), There IS a Slippery Slope
    A barrier has now been broken. The state has proven its willingness to execute an innocent, despite the lack of a living will, and despite the protests of family members who have offered to provide ongoing care. This willingness borders on enthusiasm a…

    DOUBLE TOOTHPICKS (6ed3f8)

  6. I don’t care how many judges, state or federal, they pile on. This is wrong. Objectively morally wrong. It is state-sponsored murder. More over at DOUBLE TOOTHPICKS.

    Steve Bragg (9279e5)

  7. I heard about this on the radio this morning where the nephew was being interviewed. Things may clear a little more with time to see if it is as said. I can easily believe it as as advertised from my experience as a physician and even more from family experience.
    “Those who live by the sword shall die by the sword.” If this woman dies, and/or her sister who reportedly has been living with the condition for a number of years and has had complications in the last 24 hours because of the stress of the situation (increased BP from stress opening the tear in the aorta again) let there be wrongful death suits. I will volunteer as a medical witness (travel and housing fees would be appreciated, though).

    MD in Philly (b3202e)

  8. “Yes, it is, assuming Georgia judges know more Latin than federal ones do. ”

    I wonder if they know “sui sponte.”

    actus (e137d7)

  9. Nah, I doubt they read blogs.

    Xrlq (e2795d)

  10. FRIDAY’S COMPENDIUM
    IT’S ALL ABOUT HIM AGAIN: The maniacally egotistical Bill Clinton again thinks he’s the center of attention, tries to grab the spotlight from the Pope: He could work a crowd. He could build a crowd. He could move a…

    The SmarterCop (5b2dcc)

  11. The Birdman of Bubble Wrap
    Today’s dose of NIF – News, Interesting & Funny

    NIF (59ce3a)

  12. She has glaucoma as a reason to die?

    WHAT THE FUCKING FUCK?

    I have glaucoma. All it needs is fucking eyedrops. Doesn’t hurt or do anything else really as long as you stick those suckers in every night.

    And besides, when is blindness, the worst that can happen, “hey, let’s euthanize them” material?

    The Angry Clam (280c3c)

  13. Even Peter Singer said in a lecture I heard a couple years ago that myopia wasn’t sufficient reason to terminate an infant. (He wears glasses.) So eye problems are kind of a grey area even for Professor Death.

    My grandad got surgery for his glaucoma when he was about 88. And it was all better. he had some heart trouble too, but we didn’t decide to put him down like a sick dog or starve him to death.

    See-Dubya (3275fb)

  14. The “real issue”, as I understand it, is that she has a very serious condition where the aorta has developed a tear in it’s wall. (The aorta is the large artery in the middle of the chest coming directly from the heart. The medical term is an “aortic dissection”.) This is a life threatening situation with the definitive treatment being a major operation (“major” meaning more dangerous than “typical” open heart surgery). She is not judged to be a good surgical candidate, hence is thought likely to die. The glaucoma comes in as her “only underlying disease” but is really beside the point. The big problem it seems is going from a dengerous situation with a high chance of dieing to one of 100% cahnce of dieing by dehydration- not called for.

    MD in Philly (b3202e)

  15. The “real issue” is the woman’s living will, which makes all this quite illegal.

    Bostonian (0198d8)

  16. Bostonian-
    Just to clarify, when I referred to the “real issue” I was referring to the “real medical issue” at hand, that glaucoma alone was not the medical issue.
    I do not have time now to discuss this further, but while your point about the living will is completely true, there is much to be said about why having a living will is not the complete answer, even if it is a “good” living will.

    MD in Philly (b3202e)

  17. Patterico, you say that there are similarities to Terri’s case. It just dawned on me that the Florida court in Terri’s case has to be satisfied beyond reasonable doubt that Terri is PVS. Whether they made a right or wrong finding of fact on whether Terri is PVS according to Florida law is another question. [ see section 765.101(12) & 765.401(3) and 765.305(2) Chapter 765 Health Care Advance Directives, Florida Statutes]. You would need to refer to the precise Georgia statute to see if the standard of proof of the patient is PVS or such other conditions as they may have prescribed.

    If the lady’s condition is not within the Georgia precribed medical condition, then the second issue of what is her wish per living will or etc, does not even arise.

    I submit that the first thing to consider is does the patient come under the specific state’s medical condition that calls for her right to have treatment withdrawn.

    [ While the proof of clear and convincing evidence is for the second stage enquiry of the lady or Terri’s wish to refuse treatment or otherwise, the first preliminary issue would be, do they fall into the statutory classification to allow the court to determine whether her wish is relevant & the first stage preliminary enquiry is on beyond reasonable doubt at least in Florida.]

    Your view please, Patterico and anyone.

    Yi-Ling (f87a0d)

  18. MD from Philly, is there a difference between medical definition of PVS versus legal definition of PVS?

    Legal definition of PVS is at Section 765.101 (12)Chapter 765 Health Care Advance Directives of Florida Laws.

    Section 765.101 (12) “Persistent vegetative state” means a permanent and irreversible condition of unconsciousness in which there is:
    (a) The absence of voluntary action or cognitive behavior of any kind.
    (b) An inability to communicate or interact purposefully with the environment.

    What is medical definition of PVS especially when there is also this medically defined group called MCS?

    What is the likelihood that medical MCS is caught under legal definition of PVS under Florida law?

    As Terri’s case revolves around legal definition of PVS, is there a medically authoritative definition of PVS & MCS that courts can take note of, or that legislatures can take note of?

    Has there been any advance in medicine that PVS has been accepted as different from MCS and if so, when, Philly & how would that affect Terri’s case, if it does.

    Yi-Ling (f87a0d)

  19. MD from Philly, from your parsing

    (1) Florida law http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0765/SEC401.HTM , and
    (2) Father Rob’s article on MCS contention, that, you posted http://www.nationalreview.com/comment/johansen200503160848.asp
    (3) other sources you have

    [ Section 765.101 (12) Chapter 765 Health Care Advance Directives of Florida Laws :

    “Persistent vegetative state” means a permanent and irreversible condition of unconsciousness in which there is:
    (a) The absence of voluntary action or cognitive behavior of any kind.
    (b) An inability to communicate or interact purposefully with the environment. ]

    would you say that Terri is legally PVS, in that, Terri has all these five characteristics that I surmise are necessary for a beyond reasonable doubt proof of PVS of Terri:

    (1) a permanent and irreversible condition of unconsciousness
    (2) there is absence of voluntary action AND
    (3) there is absence of cognitive behavior of any kind AND
    (4) an inability to communicate purposefully with the environment AND LASTLY,
    (5) an inability to interact purposefully with the environment.

    Yi-Ling (f87a0d)

  20. Patterico, would you agree that this is the only legal reading of the legal requirements of PVS according to Florida law as to have been applied in Terri’s case?

    Five legal elements required to prove that Terri is PVS under Florida law :

    (1) a permanent and irreversible condition of unconsciousness; AND SECONDLY
    (2) there is absence of voluntary action; AND THIRDLY
    (3) there is absence of cognitive behavior of any kind; AND FOURTHLY
    (4) an inability to communicate purposefully with the environment; AND FIFTHLY & LASTLY,
    (5) an inability to interact purposefully with the environment.

    Yi-Ling (f87a0d)

  21. To: Patterico, & all legally trained persons,

    Would you agree that this is the only legal reading of the legal requirements of PVS & standard of proof of PVS, according to Florida law as to have been applied in Terri’s case?

    Five legal elements required to prove “beyond reasonable doubt” that Terri is PVS under Florida law :

    (1) a permanent and irreversible condition of unconsciousness, proven beyond reasonable doubt by petitioner [ Michael] seeking court order to remove Terri’s feeding tube; AND SECONDLY

    (2) there is absence of voluntary action, proven beyond reasonable doubt by petitioner [ Michael] seeking court order to remove Terri’s feeding tube; AND THIRDLY

    (3) there is absence of cognitive behavior of any kind, proven beyond reasonable doubt by petitioner [ Michael] seeking court order to remove Terri’s feeding tube; AND FOURTHLY

    (4) an inability to communicate purposefully with the environment, proven beyond reasonable doubt by petitioner [ Michael] seeking court order to remove Terri’s feeding tube; AND FIFTHLY & LASTLY,

    (5) an inability to interact purposefully with the environment, proven beyond reasonable doubt by petitioner [ Michael] seeking court order to remove Terri’s feeding tube.

    Applying this suggested test of each of the five elements for PVS and standard of proof of each of the five elements of PVS, how did the case, on review, go?

    Why did the affidavits of neurologists of Terri’s condition on MCS, or of asking for further testing to conclude whether PVS or not, not raise a reasonable doubt on each or all or any of the FIVE LEGAL ELEMENTS OF PVS???? Puzzled!!!

    Yi-Ling (f87a0d)

  22. See my post on “Heartless Jerk”

    MD in Philly (b3202e)

  23. MD from Philly,

    I have replied your post at your designated place and ending with http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?14@232.4dlkbf8b0XR^0@.ef272cd/15543 .

    Over to you, Philly.

    c.c. Xrlq – special thanks
    c.c. Dick Bennet- thanks

    Yi-Ling (09d77d)

  24. Philly,

    Dusky [10:38am Apr 12, 2005 (7780.1.1.1 13006/13033) ] said “He did not refuse any MRI; he refused ANY MORE MRIs.”

    I noticed that Father Rob had said at http://www.nationalreview.com/comment/johansen200503160848.asp

    “How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?”

    Doctors for Michael Schiavo have said that an MRI and PET are not necessary for Terri because PVS is primarily a “clinical” diagnosis, that is, one arrived at on the basis of examination of the patient, rather than by relying on tests. And the neurologists I have spoken to agree on the clinical nature of the diagnosis, while insisting that advanced tests nonetheless are a necessary part of it. But the star medical witness for Michael Schiavo, Dr. Ronald Cranford of the University of Minnesota, has repeatedly dismissed calls for MRI testing, and his opinion has prevailed.

    Philly, which one is true?

    Dusky says Michael had a MRI done for Terri, while Fr Rob says Michael never had any MRI done for Terri

    Yi-Ling (d126df)

  25. Philly, for your information,

    B. Proud, what was your “legal based” purpose & intent of raising section 765.101 (4) Chapter 765 Fla. Stat.? Here I assume you have “good faith” beyond reasonable doubt : -)

    • (1) Is it to create a back door for your prior “What are the differences between PVS and MCS, that we would grant the wish to refuse treatment of someone in the former, and deny it to the latter?” ?

    • (2) Is it to explore everything from first principles?

    • (3) Is it to see if the facts of Terri’s case can be caught under section 765.101 (4) Chapter 765 Fla. Stat.?

    If it is (1), please confirm and then explain, your original basis of understanding and your new basis of understanding. I will assume, that you have a or an original legal basis for saying “What are the differences between PVS and MCS, that we would grant the wish to refuse treatment of someone in the former, and deny it to the latter?” in the first place.

    If it is (2), it is a big job, and I am not up to it. Its like looking at http://www.nybooks.com/articles/1237 , http://www.internationaltaskforce.org/amicus_curiae_brief.htm , http://wings.buffalo.edu/faculty/research/bioethics/brf-frc.html and then working out the entire philosophical, medico-legal, social basis for each part, so that the whole Christmas tree can light up. I rather buy.

    If it is (3), it’s a bit late. Actually 8 years too late. It is also a non available option. I explain myself.

    • If section 765.101 (4) were to be considered, as you now ask us, as a factual situation of Terri’s condition, [ if applicable] then it should have been in Michael Shivao’s original petition, when he petitioned the probate court, for an order that Terri’s feeding tube be removed.
    • As the petitioner never pleaded section 765.101 (4), but just pleaded Terri is in a PVS, the court has to decide on a PVS. Taking the clue from Dusky, when she talks of tradition, ”They followed the tradition of judicial decision making of deciding the case before you rather than worrying about hypotheticals that have not been presented. Since they found ample evidence that she was in PVS, they did not have to address other hypothetical situations. “
    • I do not know what exactly the petition contained, and whether they referred to a PVS per Section 765.101 (12) Fla. Stat. I guess they must have, for that appears in the judgment of 2000.
    • I will also assume that its either both counsels did not do enough homework, to cite the precise the Fla. Stat. they are relying on, or that if they did, it is Greer who omitted to mention the precise the Fla. Stat. for removing the feeding tube.
    • More likely, all of them overlooked this F.S. § 765.401(3) and F.S. § 765.305(2)(b) Chapter 765 Health Care Advance Directives for one reason or another.
    • But we know of this F.S. § 765.401(3) and F.S. § 765.305(2)(b), because you brought it to our attention.
    • It could have been spotted on appeal,& noted then, even way before DCA order of March 16, 2005, when another section of Fla. Stat. was cited by the Chief Judge.
    • The fact that Greer proceeded on case law than latest applicable Fla. Stat. is worrisome, as to whether there is a significant critical difference between applicable case law of earlier date 1990 and later applicable Fla. Statute of 1997, then obtaining at time of hearing and order of 2000.
    • If the difference is not material and does not cause injustice, it is just lack of citing right authority, but if the difference is material and significant and causes injustice, then, there would be another ground for complaint of miscarriage of justice.

    It is also of concern that Section 765.101 (12) Fla. Stat. was not dealt with element by element, addressing each element of Section 765.101 (12) separately –

    • (a) a permanent and irreversible condition of unconsciousness; AND
    • (b) there is absence of voluntary action; AND
    • (c) there is absence of cognitive behavior of any kind; AND
    • (d) an inability to communicate purposefully with the environment; AND
    • (e) an inability to interact purposefully with the environment.

    Without addressing each element of Section 765.101 (12) Fla. Stat. separately, it raises concern whether each and every one of the elements have been addressed.

    All the above is besides the point whether factually end stage conditions= MCS. I think not, as even the name itself MCS does not suggest end stage. But I know not enough of MCS to comment medically.

    Yi-Ling (bd7892)

  26. Philly, which one is true?
    Dusky says Michael had a MRI done for Terri, while Fr Rob says Michael never had any MRI done for Terri.

    Dusky is technically correct, but Fr Rob’s point is basically right. Terri Schiavo did indeed have an MRI in 1990, which revealed significant brain damage, but did not suggest that her cerebral cortex was gone completely, as the 1996 CT scan did. To show whether her brain really did deteriorate that badly over the years would have required a post-1996 MRI or PET scan, which didn’t happen. That doesn’t stop anti-tubists from parroting the true but meaningless “but Terri did have an MRI” line.

    Xrlq (e2795d)

  27. Yi-Ling,

    I have not been forgetting or ignoring you, there are just too many debates (or too many windmills to capture, I hope not). My posts on this site contain some of what you have asked:

    I agree with Xrlq on the MRI matter.

    MD in Philly (b3202e)

  28. Philly,

    I did not think you are ignoring me personally, but that, you are busy getting your brief out for us. I shall try to put to Dusky, your and Xrlq’s understanding of the MRI. I did think that is an important point to clear up otherwise Fr Rob seems to have got critical facts wrong. But I do wonder why he did not put it the way that Xrlq and you have done.

    Xrlq,

    Thanks for the MRI clear up. I have a strong inclination to believe the facts as Fr Rob reports them, as he is a matured man, though initial year/s as Catholic priest, but with prior education to MA before he went to seminary. Late bloomers type, in search of truth, and so, I do not think he would make much error in his reporting. However the way he puts across his understanding of Greer and court process leaves room to be improved upon. It is a report that also does not help us understand why courts went one way and part of public opinion another way. I think Philly is looking into that for us.

    Yi-Ling (a1c172)

  29. Xrlq,

    Further to post No. 25 above, & in relation to unseen influence of “good faith standard” at section 765.109 , I had a response that went,

    As for the PVS, s. 765.305(2) says “the surrogate must be satisfied” as to an end-stage, terminal, or PVS condition. This IS the applicable standard. We cannot just read some other requirement into it. Yes, it is a subjective one.

    Elsewhere, he is required to consult with physicians and to act in good faith, but that only requires him to not abuse his authority; it does not change the standard to an objective one.
    Greer’s expressions of “beyond all doubt” and “without a doubt” seem to me to be expressions of his own level of comfort with the evidence presented. They are not indications of any standard of proof required by law. They could, although I think they do not, indicate what standard he personally required, but he has no authority to change the applicable legal standard; it remains the proxy’s good faith satisfaction.

    Can you unpick for me the above? IT seems as if the poster mix up the standard of proof at point of making the decision and the different and lower standard of proof at point of defending the decision in a law suit. Is that it, Xrlq? Your views please.

    Yi-Ling (a1c172)

  30. Philly,

    To your post No. 28, on http://majikthise.typepad.com/majikthise_/2005/03/dr_william_ches.html
    I rechecked http://www.nationalreview.com/comment/johansen200503160848.asp and did not see any reference by Fr. Rob to this “Dr. Cheshire” though I have seen references to him on some blogs in support of Terri not being MCS.

    I take the position that truth should out, and its better that we admit weak points where they are and reconfirm strong points. I would rather get to the bottom of the medical assessment, which is still blur to me. For that reason, I ask, “Was there a particular reason you raised this Dr. Cheshire?”

    Yi-Ling (122c6d)

  31. To Xrlq post No. 26

    “Dusky is technically correct, but Fr Rob’s point is basically right. Terri Schiavo did indeed have an MRI in 1990, which revealed significant brain damage, but did not suggest that her cerebral cortex was gone completely, as the 1996 CT scan did. To show whether her brain really did deteriorate that badly over the years would have required a post-1996 MRI or PET scan, which didn’t happen. That doesn’t stop anti-tubists from parroting the true but meaningless “but Terri did have an MRI” line.”

    and Philly post No. 27 : “I agree with Xrlq on the MRI matter.”

    I am having second thoughts on your joint answer, Xrlq and Philly, on the part that suggests the CT scan 1996 shows the cerebral cortex is completely gone. This would mean to me, there is really no point going further if the cerebral cortex is completely gone! I am not quite sure what is the cerebral cortex or what it does, though, but it sounds pretty important part of the brain and I assume without it, one cannot go on somehow…

    quoting you : “but did not suggest that her cerebral cortex was gone completely, as the 1996 CT scan did.”

    What would both of you say to Fr Rob’s “Dr. Morin explained that he would feel obligated to obtain the information in these tests before making a diagnosis with life and death consequences. I told him that CT (Computer-Aided Tomography) scans had been done, and were partly the basis for the finding of PVS. The doctor retorted, “Spare no expense, eh?” I asked him to explain the comment; he said that a CT scan is a much less expensive test than an MRI, but it “only gives you a tenth of the information an MRI does.” He added, “A CT scan is useful only in pretty severe cases, such as trauma, and also during the few days after an anoxic (lack of oxygen) brain injury. It’s useful in an emergency-room setting. But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.” http://www.nationalreview.com/comment/johansen200503160848.asp

    The HTML here is different from another board’s. Can someone tell me, how to indent, bold, italic, parts , not all. I tried for italics and it affects entire post , without break. I did not know how to break it. Thanks. I can only for end line :-)

    Yi-Ling (122c6d)

  32. As the events of Truman’s defeat were exagerrated, so are the comments about the CT etc. To say that the cortex was liquified and was no longer there, etc, is just not a good description at all. Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”. PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.

    Dr. Cheshire is the neurologist last sent to evaluate Terri at the request of the Fla Children and Family services. He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report, and he was getting trashed in that one blog and I wanted to inject some objectivity.

    Good night.

    MD in Philly (b3202e)

  33. To: MD from Philly,

    Philly- “To say that the cortex was liquified and was no longer there, etc, is just not a good description at all. Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”. PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.”

    Philly, your medical reply [quoted above] is quite deep & too succinct for a non medical person like me to fully grasp and understand the FULL IMPLICATION and impact of what you have just expressed. Can I ask you to explain-

    # (1) Philly – To say that the cortex was liquidfied and was no longer there, etc, is just not a good description at all.

    Me- You mean some not all of the cortex was not there? You mean that some not all of the cortex was liqiudfied? By the way, what causes the solid [ if that is the word as opposed to liquidfied cortex ] cortex to be liquidfied? When you have part solid and part liquidfied cortex, what does that mean? Also will the liquid seep into the solid part and affect the solid part of the cortex? If yes, how so?

    #(2) Philly- Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”.

    Me- What did it show? Significantly reduced cortex and brain volume? Where was this “significantly reduced cortex and brain volume” shown ? In which report, which test, which year? By whom? For whom? At whose request?

    #(3) Philly- PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.

    Me: You are referring to the long period of testing or observation of the patient instead of few hours or few days spent? Are you saying that EITHER the doctors should have (A) spent longer period of several months observing OR (B) done the functional scans? Or you require BOTH to be done to meet medically accepted ideas of clear and convincing evidence? Please elaborate your expectations, from a medical point of view. Thanks, Philly.

    Yi-Ling (c32edf)

  34. Philly- “Dr. Cheshire is the neurologist last sent to evaluate Terri at the request of the Fla Children and Family services. He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report, and he was getting trashed in that one blog and I wanted to inject some objectivity.”

    Me: Oh, okay. I get your point. Understood. Another part that I am unclear about is the “heading” at the top of the article, you linked http://majikthise.typepad.com/majikthise_/2005/03/dr_william_ches.html which reads, “Dr. William Cheshire not nominated for Nobel Prize, either.”

    I have seen one or two blogs that says, there is a Nobel Prize nominee or was it winner who has said that Terri is not in a PVS. Would they be referring to this Dr William Cheshire or someone else?

    If they are referring to this Dr. William Cheshire & if you also have seen those blogs, and if he is not a Nobel Prize nominee/winner, and the blog/s cite some article that claims he is, perchance would you know who spread this error, and how this error came about, and also whether this error has any bearing of what you said of Dr Cheshire, “…He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report…”

    Do you mean he has a good reputation as a neurologist ?

    Do you mean he has written a report on Terri not being PVS? If yes, perchance do you have access to this report or the link for it? Thanks.

    Yi-Ling (809e2f)

  35. To: Xrlq,

    Xrlq, your answer as follows-

    “Dusky is technically correct, but Fr Rob’s point is basically right. Terri Schiavo did indeed have an MRI in 1990, which revealed significant brain damage, but did not suggest that her cerebral cortex was gone completely, as the 1996 CT scan did. To show whether her brain really did deteriorate that badly over the years would have required a post-1996 MRI or PET scan, which didn’t happen. That doesn’t stop anti-tubists from parroting the true but meaningless ‘but Terri did have an MRI’ line”.

    drew forth this reply posted for your attention:

    Dusky :

    ” I am no medical expert, but since we are all throwing around poorly recollected hearsay, I may as well toss mine out. I seem to recall hearing on the radio that there were two MRIs, showing progressive deterioration. This “but there was no MRI after 1996″ line parroted by the zombiists, while technically true, is also misleading. There is no amount of evaluation that would have satisfied them. If there had been an MRI in 1996, they would have demanded another after 1997, or some other arbitrary date. It just goes right along with the parents’ demands for ENDLESS retesting and reassessment, so as to never have to face the truth.

    Even the comments that you quoted are full of contradiction. They say the 1990 MRI showed “significant brain damage” but just ignore that fact. Then they admit that the 1996 CT scan showed her condition had deteriorated even from that. But they insist you cannot be sure of the additional damage shown by the CT scan without another MRI. Assuming this is true, you still CAN be sure of the ORIGINAL “significant” damage shown by the 1990 (and later?) MRI(s). What would be the point of proving beyond a doubt that her cortex was completely gone versus half gone? Nothing except the same old stringing it out, endlessly playing for time, so that … nothing could continue to happen.”

    c.c. Philly: I take note of your very well intended and “metasis” position as expressed on findlaw. All the best, peace to you and God blessings be with you, from a non theistic Buddhist.

    Yi-Ling (ab9f4b)

  36. Dusky’s an idiot. The bit about there being two MRIs is complete horsecrap; he simply made that up. Ditto on his unfounded assumption that a post-1996 MRI wouldn’t convince anyone of anything. Who the hell is this jerk to tell other people what they think?

    The only thing dumber than his made up MRI and his wild speculations about how other people think is his idiotic question about what difference it makes whether someone has half a cerebral cortex vs. none at all. If he really can’t tell the difference between brain damaged and brain dead, then perhaps he’s past due for an MRI himself.

    Xrlq (c51d0d)

  37. To: Xrlq,

    I can’t exactly quote your reply ad verbatim. How about, I amend like this [ trying the HTML if it works] and post your comment/reply as below? Okay with you?

    Dusky’s an idiot. The bit about there being two MRIs is complete horsecrap; he simply made that up. Ditto on his

    her

    unfounded assumption that a post-1996 MRI wouldn’t convince anyone of anything. Who the hell is this jerk to tell other people what they think?
    The only thing dumber than his

    her

    made up MRI and his

    her

    wild speculations about how other people think is his

    her

    idiotic question about what difference it makes whether someone has half a cerebral cortex vs. none at all. If he

    she

    really can’t tell the difference between brain damaged and brain dead, then perhaps he’s past due for an MRI himself.

    [If I got the HTML wrong, it will show up funny, in which case, I shall amend without strike-outs and repost.]

    Yi-Ling (be3e20)

  38. To: Xrlq,

    I can’t exactly quote your reply ad verbatim. How about, I amend like this [ trying the HTML if it works] and post your comment/reply as below? Okay with you?

    Amended for your approval, Xrlq:

    “Dusky, the bit about there being two MRIs is complete horsecrap. Unfounded assumption that a post-1996 MRI wouldn’t convince anyone of anything. Wild speculation about how other people think whether it makes a difference whether someone has half a cerebral cortex vs. none at all. If you really can’t tell the difference between brain damaged and brain dead….”

    [I did get the HTML wrong, mistaking the block quote for bold quote. I also touched up a bit for continuity of ideas. ]

    Yi-Ling (be3e20)

  39. On second thoughts, it boils down to “you know” without citing your source of “she had an MRI in 1990” while she, knows because she, Dusky heard “it” on talk radio that “Terri had two MRI”.

    Honestly, how am I to know which one of you is right, as from what I know of Dusky, over past few years, she is not one to intentionally lie, even if I differ from her in many views, I nonetheless respect her principle stand, even when I disagree with her on her principled stand.

    To top it all, it was just “1” for you, her & Philly, and “0” for Father Rob. And now the numbers have increased , with her hearsay evidence that its actually “two MRI.”.

    I am standing outside and one person says “No MRI.” Second person says “One MRI.” Third person says, “Two MRI”. How am I to know which of the three persons is saying the right thing, as it can only be either none, one or two. I hope no one comes along now and says he/she heard on talk radio that “she had three MRI done.”

    So unless, your revised reply, takes into account, this issue, of 0,1,or 2 MRI, and the evidence for either 0,1,or 2 MRI, it is hard to persuade her or any reader trying to get to the bottom of this dispute.

    That is besides the point that Philly thinks no MRI is also okay [“As the events of Truman’s defeat were exagerrated, so are the comments about the CT etc. To say that the cortex was liquified and was no longer there, etc, is just not a good description at all. Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”. PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.”] , but elsewhere he did say, to the effect that longer time is needed to diagnose PVS.

    So the ball is in your court now, Xrlq. I am looking for a persuasive convincing answer that most people would buy when they read it. I appreciate your distinction between “brain damaged” and “brain dead” as your basis for a 2nd MRI to ensure it is brain dead than mere brain damaged. That I understand. I think most people would also appreciate your highlighting this major difference.

    Over to you, Xrlq.

    [ if HTML is wrong, it is trial stage, pls excuse :-)]

    Yi-Ling (0dfa55)

  40. Xrlq,

    The evidence of “PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.”]
    or in my lay terms, “0” MRI is also okay, is here, from Philly.

    “Briefly Yi-Ling, (in my opinion)

    The report By Dr. Cheshire from Mayo Jacksonville requested by the State of Fla. Child and Family Services would appear to be adequate testimony to at least cause a longer evaluation to be necessary, if not in itself being adequate to put the diagnosis into reasonable doubt.

    I think it could be argued that since the diagnosis of PVS requires a prolonged evaluation over time that none of the Schiavo-hired or court appointed physicians spent enough time with her to make the diagnosis. (Logically it is always hard to prove a negative, to prove there is NO consciousness ever if much tougher de novo than demonstrating minimal consciousness).
    But, “a man hears what he wants to hear and disregards the rest…” More later..

    Comment by MD in Philly — 4/11/2005 @ 6:56 am

    End of quote, for it, see item # 11 at http://patterico.com/2005/04/02/2838/michael-schiavo-heartless-jerk/#comment-11207

    Yi-Ling (0dfa55)

  41. If you’re going to address her directly, you might want to put it a bit more diplomatically than I did. How about this:

    Dusky, I don’t know where you got the idea the Terri Schiavo had two MRIs, but it is factually incorrect. Your claim that “they” wouldn’t be satisified with a 1997 MRI is presumptuous in the extreme. Who are you to tell other people what they supposedly think?

    The difference between half a cortex and no cortex is the difference between having cognitive thoughts and not having them. If it were so insignificant, as you suggest, then why did so many anti-tubists make a big deal of the “fact” that Terri Schiavo’s cerebral cortex was gone completely in 1996, and not merely damaged as we all knew it was in 1990? By relying on an inherently fuzzy CT scan and refusing to order a much more reliable MRI or PET scan, Michael Schiavo and Judge Greer acted as if they didn’t really want to know.

    Xrlq (c51d0d)

  42. Xrlq,

    On your first para, can I suggest I post it to her, without this line “Who are you to tell other people what they supposedly think?” . She{Dusky] is I think an attorney, who takes on court assigned juvenile cases & has a big heart and good mind. However she genuinely believes and feels that it is good to put Terri out of her bad state, and she genuinely believes and think, Terri is better off dead than in her state she was in for 15 years. That’s her belief, and from what I understand from Philly, that

    The issue has shifted from freedom to withhold treatment in a situation to let it take its own course, for better or worse, as opposed to withholding care where it is clear that the act of withholding the care, especially when it is mere nutrition through the person’s own stomach, is the instrument of death. In the terms that bioethicists use, the duty to do good is no longer defined as minimal efforts that support ongoing life, but recognizing that the person’s life is no longer worth living and to do good is to permit death by neglect of basic necessities.

    For your approval, please.

    now where you got the idea the Terri Schiavo had two MRIs, but it is factually incorrect. Your claim that “they” wouldn’t be satisified with a 1997 MRI is presumptuous in the extreme. Who are you to tell other people what they supposedly think?

    [ see if the HTML works, if not, I will repost] :-)

    Yi-Ling (f8020a)

  43. Testing how to use underline function , testing whether its :-) Readers, pls ignore

    On your first para, can I suggest I post it to her, without this line

    also trying

    Yi-Ling (f8020a)

  44. Philly, Xrlq,
    It didn’t work, putting the linbk, so once more…

    FYI, this is my reply on Philly’s http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?11@151.nN5VbkV30Vs^7@.ef272cd/15589

    Yi-Ling (86973f)

  45. Yi-Ling,

    If I remember correctly, while your English is very good, it is not your first language, correct? There has been a lot of very imprecise language and sarcasm in many posts. I find sarcasm can be very difficult to understand across languages.
    The brain is composed of solid tissue that is floating/suspended within clear fluid. If brain tissue is destroyed, the brain shrinks, and a larger percentage of the space within the skull is filled with fluid. To some degree this happens with age in everyone.
    The first neurologist who testified on behalf of the Schindlers was often referred to as a “Nobel Prize” nominee, which was not on accurate claim. In fact, he made many claims that were pretty outrageous and self serving. In regard to this, the thread referred to started off in a derogatory and sarcastic way trying to equate Dr. Cheshire with the previous MD.

    Yes, I meant that Dr. Cheshire is respected as a neurologist (the Mayo Clinic is regarded as one of the top medical institutions in the US). Here is a link to a copy of his report, which may have not been available when Father Johanson wrote his piece.
    http://www.floridabaptistwitness.com/chesireaffidavit.pdf

    One last thing, Yi-Ling, I am not sure how people interreact in your professional circles, but in the US there is often not a commitment to intellectual honesty and a commitment to finding “the truth” of a matter, but rather finding a way to justify what one prefers or wants to believe. I think this is a universal part of human nature, but perhaps some cultures and individuals practice it to a higher degree than others.

    MD in Philly (b3202e)

  46. That didn’t work either, one more time , third post at http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?13@102.ZxwuaGEdqrE^3@.ef272cd

    Yi-Ling (86973f)

  47. Philly,

    Its unfortunate you read it as sarcasm. I thought I would prepare you for questions and criticism that could be thrown your way, with the link. In fact I have seen such criticisms abound on it. If you are prepared to handle it, it would have been an excellent working it out.

    If you look at Dusky’s critique you will find that it did echoed what was coming. Maybe I am used to cross examining my clients so that I can get the best out of them. That does not mean, I am being sarcastic. I am just helping them prepare their case.

    I do not disagree that we often try to gloss over the weakness and emphasise only the strong points, where I have been, here in US or in UK or the Far East.

    It depends on why we are looking into the matter, if it is the pursuit of truth on the matter. You came across as someone intent on knowing the truth of the matter. To the extent that your call tugged on my heart string, I responded the best I could within the limitations I had. But if you find it inadequate and sarcastic and totally unhelpful, I am sorry and shall desist, as it is pointless to aid when it is uncalled for and mistaken for “poison”.

    Yi-Ling (86973f)

  48. Yi-Ling,

    I was not referring to ANYTHING you said as sarcasm. I was referring to THE LANGUAGE OF OTHERS about things such as “cortex liquifing” and the descriptions of Dr. Cheshire. Very sorry for the misunderstanding!?!

    MD in Philly (b3202e)

  49. On your first para, can I suggest I post it to her, without this line “Who are you to tell other people what they supposedly think?”

    Feel free to quote whatever portion of my post you want. I think it’s a valid point, but if you’d rather not pass it along, that’s up to you.

    She{Dusky] is I think an attorney, who takes on court assigned juvenile cases & has a big heart and good mind. However she genuinely believes and feels that it is good to put Terri out of her bad state, and she genuinely believes and think, Terri is better off dead than in her state she was in for 15 years. That’s her belief,

    And she’s entitled to that. What she’s not entitled to do is make up facts (2 MRIs rather than 1) or to speculate idly as to what other people’s beliefs are. If any MRI between 1990 and 2005 had shown that Terri Schiavo had no cerebral cortex, I for one would be 100% satisfied she was as good as brain dead – and I resent other people – particularly someone like Dusky, whom I’ve never even met – telling me I would not be.

    Xrlq (ffb240)

  50. Xrlq,

    I am referring to your Post No. 42 here and above, Post 51 here. Okay, I am allowed to take out the line that I thought would distract and detract from the key subject of the state of Terri-PVS or not. I have also taken your last para and paraphrased them into your proposed post to clarify the purport of your post.

    For your approval, please:

    “Dusky, I don’t know where you got the idea the Terri Schiavo had two MRIs, but it is factually incorrect. Your claim that “they” wouldn’t be satisfied with a 1997 MRI is presumptuous in the extreme.

    You are entitled to your probable belief that Terri is better off dead than in her last present state, whatever we call it- as it is in dispute- but you are not entitled to make up facts (2 MRIs rather than 1) or to speculate idly as to what other people’s beliefs are- example: my belief that “If any MRI between 1990 and 2005 had shown that Terri Schiavo had no cerebral cortex, I for one would be satisfied under Florida law, that she was as good as brain dead.”

    Further, the difference between half a cortex and no cortex is the difference between having cognitive thoughts and not having them. If it were so insignificant, as you suggest, then why did so many anti-tubists make a big deal of the “fact” that Terri Schiavo’s cerebral cortex was gone completely in 1996, and not merely damaged as we all knew it was in 1990? By relying on an inherently fuzzy CT scan and refusing to order a much more reliable MRI or PET scan, Michael Schiavo and Judge Greer acted as if they didn’t really want to know.”

    Yi-Ling (f7bc92)

  51. To: Xrlq,

    Done.

    Yi-Ling (bca2db)

  52. To: Philly,

    I refer to Post No. 34 and No. 47,
    [ Philly, it could be force of habit acquired over the years to be clear as to subject matter under discussion that, I would point out the Post No. or subject matter specifically]

    Going through that thread Post No. 34 again, and putting your medical clarification at Post No. 47 now before me : “The brain is composed of solid tissue that is floating/suspended within clear fluid. If brain tissue is destroyed, the brain shrinks, and a larger percentage of the space within the skull is filled with fluid. To some degree this happens with age in everyone.” I am revisiting my comments at Post No. 34.

    The numbers in curly brackets refer to Post No. for ease of tracking/tracing-

    (34) You: “To say that the cortex was liquified and was no longer there, etc, is just not a good description at all. Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”. PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.”

    (34) Me: Philly, your medical reply [quoted above] is quite deep & too succinct for a non medical person like me to fully grasp and understand the FULL IMPLICATION and impact of what you have just expressed. Can I ask you to explain-

    (55) [ Firstly, I have no awareness or knowledge of this fact you point out at Post No. 47, “The brain is composed of solid tissue that is floating/suspended within clear fluid. If brain tissue is destroyed, the brain shrinks, and a larger percentage of the space within the skull is filled with fluid. To some degree this happens with age in everyone.”]

    (34) # (1) Philly – To say that the cortex was liquidfied and was no longer there, etc, is just not a good description at all.

    (34) Me- You mean some not all of the cortex was not there? You mean that some not all of the cortex was liqiudfied? By the way, what causes the solid [ if that is the word as opposed to liquidfied cortex ] cortex to be liquidfied? When you have part solid and part liquidfied cortex, what does that mean? Also will the liquid seep into the solid part and affect the solid part of the cortex? If yes, how so?

    (55) [Because I had no prior knowledge of “The brain is composed of solid tissue that is floating/suspended within clear fluid. If brain tissue is destroyed, the brain shrinks, and a larger percentage of the space within the skull is filled with fluid. To some degree this happens with age in everyone.” the question posed above are reasonable legitimate expected innocent and genuine questions to understand the subject matter and see the FULL IMPLICATION of the liquidfied versus solid cortex . ]

    (34) #(2) Philly- Even if it was, that is not what it shows (significantly reduced cortex and brain volume, yes, but not “nonexistent”.

    (34) Me- What did it show? Significantly reduced cortex and brain volume? Where was this “significantly reduced cortex and brain volume” shown ? In which report, which test, which year? By whom? For whom? At whose request?

    (55) [ Its reasonable that, the answer to above, would either yield a forceful point for no clear and convincing evidence of a PVS or otherwise. If the answer DID indeed yield a forceful point for no clear and convincing evidence of a PVS, THEN, it would be relevant to know the date of the report, who asked for the report, etc, so that these precise details can be submitted as cogent and convincing arguments, for the case that there is no clear and convincing evidence of a PVS. I took great pains to enquire who asked for the report- to address whether it was as court directed report, example- Court asked Guardian Ad Litem to prepare a report on some issues. Another example- If we recall there are 5 doctors with 3:2 decision, it could be that, the doctors appointed by Schindlers prepared some report, or the doctors appointed by Schiavo prepared some report or the doctor appointed by the court, in the absence of an agreement between the Schindlers and Schiavo, on the appointment of the 5th doctor, prepared a report too. Who asked for the report and who prepares it are material to assess the possible degree of bias that can arise in a report. That is not to say, the report prepared by a Guardian Ad Litem, appointed by the court, will always be without bias. But if you compare the testimony of the doctors appointed by Schindlers and that appointed by Schiavo, the fact that Greer found the medical evidence [ and I do not know whether there was a report accompanying or adduced with their evidence] of the doctors appointed by Schiavo corroborated with the medical evidence of the doctor appointed by the court, rise to the degree of clear and convincing evidence that she is in a PVS, is indication of possible bias in reports [if any] prepared by doctors appointed by parties to the adversarial case. ]

    (34) #(3) Philly- PVS can be made as a diagnosis with or without CT or MRI findings. Failure to do the functional scans is evidence of not wanting to subject the diagnosis of PVS to further scrutiny.

    (55) : [ As this has been said earlier by you,

    “In particular is the concern over the inability to accurately diagnose PVS in a limited time period, etc. Some of the things in his piece [ Father Rob’s piece at http://www.nationalreview.com/comment/johansen200503160848.asp ] about the importance of a MRI scan are perhaps over emphasized, unless you want to think of “functional” MRI scans which give more information than just architecture.”

    It seems inconsistent on the face of it with the need for an MRI to ascertain the PVS, and thus clarification was sought. Often times inconsistent facts can be reconciled as one attempt to do that is as posed below , if that was your intent. Also in your first re-look at Fr Rob’s , I recall you did view that Fr Rob made too much of the MRI. It could be your medical view that an MRI is not needed as long as there is longer diagnostic testing of several months than an hour or so. Here I was seeking your clarification. ]

    (55): [ Another sub question that would arise, is whether there is a difference between MRI and fMRI where “f” stands for “functional” and thus “fMRI” or functional MRI. I do not know what is the meaning and impact of the addition of an “f” to MRI or adding function to MRI. ]

    (55) : [With this http://www.floridabaptistwitness.com/chesireaffidavit.pdf
    that you linked, is this the basis for your contention that, “In particular is the concern over the inability to accurately diagnose PVS in a limited time period, etc. Some of the things in his piece about the importance of a MRI scan are perhaps over emphasized, unless you want to think of “functional” MRI scans which give more information than just architecture.” Or is the basis for it independently arrived at or sourced elsewhere? ]

    (55) : From page 3 of your http://www.floridabaptistwitness.com/chesireaffidavit.pdf
    Affidavit of Dr William P Cheshire:

    “Although Terri has undergone structural imaging studies of her brain (such as CT scan which I have reviewed) she has not, to my knowledge, undergone functional imaging studies, such as positron emission tomography (PET) or functional magnetic resonance imaging (MRI). The structural studies have shown substantial loss of cerebral cortex which was deprived of blood supply for more than 40 minutes in 1990, but there does remain some cortex. ….

    Of particular interest was the fMRI study published just this year by Schiff and colleagues of two patients at Cornell University. When these patients who had been diagnosed as being in a minimally conscious state, listened to narratives read by a familiar person, large areas of the cerebral cortex, normally involved in language recognition and processing lit up. The presence of metabolic activity in those brain cells was far more than expected given their inability to follow simple instructions reliably or otherwise demonstrate at the bedside evidence of comprehension or communication. From this one study one may conclude that there is still a great deal we do not know about what previously unsuspected cerebral cortex functions may yet be occurring in the minds of persons who have sustained brain damage and are no longer able to communicate outwardly what their thoughts may be.”

    (55) From page 6 of your http://www.floridabaptistwitness.com/chesireaffidavit.pdf Affidavit of Dr William P Cheshire:

    “The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitely resolve that ambiguity to everyone’s satisfaction. There would be value, I think, in obtaining a functional fMRI can if that is possible.”

    # Philly, I reply your Post No. 47 for your clarification, if any.

    Yi-Ling (03f365)

  53. To:

    Philly, the second part of your Post. No. 47 in reply to my Post. No. 35.

    (35) Philly- “Dr. Cheshire is the neurologist last sent to evaluate Terri at the request of the Fla Children and Family services. He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report, and he was getting trashed in that one blog and I wanted to inject some objectivity.”

    (35) Me: Oh, okay. I get your point. Understood. Another part that I am unclear about is the “heading” at the top of the article, you linked http://majikthise.typepad.com/majikthise_/2005/03/dr_william_ches.html which reads, “Dr. William Cheshire not nominated for Nobel Prize, either.”

    (35) I have seen one or two blogs that says, there is a Nobel Prize nominee or was it winner who has said that Terri is not in a PVS. Would they be referring to this Dr William Cheshire or someone else?

    (47) You: The first neurologist who testified on behalf of the Schindlers was often referred to as a “Nobel Prize” nominee, which was not on accurate claim. In fact, he made many claims that were pretty outrageous and self serving. In regard to this, the thread referred to started off in a derogatory and sarcastic way trying to equate Dr. Cheshire with the previous MD.

    (56) [ Philly, in legal drafting, I try to catch all situations, and it’s a force of habit to ask if it is this “Dr William Cheshire or someone else?” ESPECIALLY when the heading of the article you gave [ its an article you gave. Its not an article I gave, Philly] said, ““Dr. William Cheshire not nominated for Nobel Prize, either.” The EITHER, rings a warning bell that there is someone else too. It is a very legitimate careful reasonable innocent question. I also did not fully capture the impact and meaning of the post you made earlier,

    “In the original trial Felos/Schiavo had 2 neurologists as expert witnesses who are used to this and are pro euthanasia, the court appointed neurologist likewise. Schindler team had a radiologist (off hand I wouldn’t think the most useful) and a self-promoting neurologist who made outlandish claims to the point of not being credible.”

    I did NOT connect the “self-promoting neurologist who made outlandish claims to the point of not being credible” to the neurologist who is “nominated for Nobel Prize,” or “not nominated for Nobel Prize,” as the case may be . Here, as I do not know whether this “self-promoting neurologist who made outlandish claims to the point of not being credible” is nominated or not for the Nobel Prize, I am using the legal jargon, and common legal catch phrase in legal drafting “as the case may be.”

    (35) Me: If they are referring to this Dr. William Cheshire & if you also have seen those blogs, and if he is not a Nobel Prize nominee/winner, and the blog/s cite some article that claims he is, perchance would you know who spread this error, and how this error came about, and also whether this error has any bearing of what you said of Dr Cheshire, “…He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report…”

    Do you mean he has a good reputation as a neurologist ?

    Do you mean he has written a report on Terri not being PVS? If yes, perchance do you have access to this report or the link for it? Thanks.

    (47) You: Yes, I meant that Dr. Cheshire is respected as a neurologist (the Mayo Clinic is regarded as one of the top medical institutions in the US). Here is a link to a copy of his report, which may have not been available when Father Johanson wrote his piece.
    http://www.floridabaptistwitness.com/chesireaffidavit.pdf

    (56) : I wanted to get the facts right, first, whether it is Nobel Prize winner or Nobel Prize nominee. And who is it? Since some blogs cast aspersions on this doctor who is really NOT Nobel Prize winner or Nobel Prize nominee as the case may be, I wanted to know how the error arose, and whether it was intentional and for what purpose or objective? If the error was innocent, then the less colorful fact could be explained away. I was looking for some explanation.

    (56) : Your statement, “that Dr. Cheshire is respected as a neurologist (the Mayo Clinic is regarded as one of the top medical institutions in the US).” would be helpful to show that his medical opinion is credible. I was looking for this.

    (56): Your statement, “Here is a link to a copy of his report, which may have not been available when Father Johanson wrote his piece.
    http://www.floridabaptistwitness.com/chesireaffidavit.pdf
    is
    helpful to show the precise medical opinion given, which opinion is credible for reason stated above, at least to non medical persons.

    Thus Dr. William Cheshire’s opinion that “The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitely resolve that ambiguity to everyone’s satisfaction. There would be value, I think, in obtaining a functional fMRI can if that is possible.” is good and should be known by us seeking to know whether Terri is in a PVS.

    Yi-Ling (4036ca)

  54. (repost because of error in keying in HTML for Post 56)

    To:Philly,

    Philly, the second part of your Post. No. 47 in reply to my Post. No. 35.

    (35) Philly- “Dr. Cheshire is the neurologist last sent to evaluate Terri at the request of the Fla Children and Family services. He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report, and he was getting trashed in that one blog and I wanted to inject some objectivity.”

    (35) Me: Oh, okay. I get your point. Understood. Another part that I am unclear about is the “heading” at the top of the article, you linked http://majikthise.typepad.com/majikthise_/2005/03/dr_william_ches.html which reads, “Dr. William Cheshire not nominated for Nobel Prize, either.”

    (35) I have seen one or two blogs that says, there is a Nobel Prize nominee or was it winner who has said that Terri is not in a PVS. Would they be referring to this Dr William Cheshire or someone else?

    (47) You: The first neurologist who testified on behalf of the Schindlers was often referred to as a “Nobel Prize” nominee, which was not on accurate claim. In fact, he made many claims that were pretty outrageous and self serving. In regard to this, the thread referred to started off in a derogatory and sarcastic way trying to equate Dr. Cheshire with the previous MD.

    (56) [ Philly, in legal drafting, I try to catch all situations, and it’s a force of habit to ask if it is this “Dr William Cheshire or someone else?” ESPECIALLY when the heading of the article you gave [ its an article you gave. Its not an article I gave, Philly] said, ““Dr. William Cheshire not nominated for Nobel Prize, either.” The

    EITHERong> that there is someone else too. It is a very legitimate careful reasonable innocent question. I also did not fully capture the impact and meaning of the post you made earlier,

    “In the original trial Felos/Schiavo had 2 neurologists as expert witnesses who are used to this and are pro euthanasia, the court appointed neurologist likewise. Schindler team had a radiologist (off hand I wouldn’t think the most useful) and a self-promoting neurologist who made outlandish claims to the point of not being credible.”

    I did NOT connect the “self-promoting neurologist who made outlandish claims to the point of not being credible” to the neurologist who is “nominated for Nobel Prize,” or “not nominated for Nobel Prize,” as the case may be . Here, as I do not know whether this “self-promoting neurologist who made outlandish claims to the point of not being credible” is nominated or not for the Nobel Prize, I am using the legal jargon, and common legal catch phrase in legal drafting “as the case may be.”

    (35) Me: If they are referring to this Dr. William Cheshire & if you also have seen those blogs, and if he is not a Nobel Prize nominee/winner, and the blog/s cite some article that claims he is, perchance would you know who spread this error, and how this error came about, and also whether this error has any bearing of what you said of Dr Cheshire, “…He is from Mayo Jacksonville which has a good reputation. He has articles in peer reviewed journals, he wrote a good report…”

    Do you mean he has a good reputation as a neurologist ?

    Do you mean he has written a report on Terri not being PVS? If yes, perchance do you have access to this report or the link for it? Thanks.

    (47) You: Yes, I meant that Dr. Cheshire is respected as a neurologist (the Mayo Clinic is regarded as one of the top medical institutions in the US). Here is a link to a copy of his report, which may have not been available when Father Johanson wrote his piece.
    http://www.floridabaptistwitness.com/chesireaffidavit.pdf

    (56) : I wanted to get the facts right, first, whether it is Nobel Prize winner or Nobel Prize nominee. And

    whogs cast aspersions on this doctor who is really NOT Nobel Prize winner or Nobel Prize nominee as the case may be, I wanted to know how the error arose, and whether it was intentional and for what purpose or objective? If the error was innocent, then the less colorful fact could be explained away. I was looking for some explanation.

    (56) : Your statement, “that Dr. Cheshire is respected as a neurologist (the Mayo Clinic is regarded as one of the top medical institutions in the US).” would be helpful to show that his medical opinion is credible. I was looking for this.

    (56): Your statement, “Here is a link to a copy of his report, which may have not been available when Father Johanson wrote his piece.
    http://www.floridabaptistwitness.com/chesireaffidavit.pdf “ is helpful to show the precise medical opinion given, which opinion is credible for reason stated above, at least to non medical persons.

    Thus Dr. William Cheshire’s opinion that “The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitely resolve that ambiguity to everyone’s satisfaction. There would be value, I think, in obtaining a functional fMRI can if that is possible.” is good and should be known by us seeking to know whether Terri is in a PVS.

    Yi-Ling (b075b6)

  55. Nope, the reposting made it worse :-) Sorry, for the too many bold words. You have to take Post No. 56 as the better version of the two, though it got the commands the other way round.

    Yi-Ling (b075b6)

  56. Philly: …. there is often not a commitment to intellectual honesty and a commitment to finding “the truth” of a matter, but rather finding a way to justify what one prefers or wants to believe. I think this is a universal part of human nature, but perhaps some cultures and individuals practice it to a higher degree than others.

    In so far as the comment relates to Terri, and the ascertainment of her either PVS or NOT state, the reason why I think it is essential that we try to uncover the truth of her medical condition, is to avoid lingering wrong thoughts, which are then the foundation and basis for other wrong thoughts.

    One example is if one is convinced that Terri is not in a PVS, then one could legitimately argue that, the conduct of not calling for an fMRI is criminal neglect. On the other hand, B. Proud has hinted and Dusky has expressly made clear that the proxy need only show he is satisfied based on good faith standard that the Terri is in a PVS. The question arises whether failure to call for an fMRI when at least one doctor has asked for it, though it was not his position to ask for it [ in that court did not direct him to investigate that point], amounts to criminal neglect. That’s besides the point that DCA said it is clear and convincing standard of in a PVS.

    Taking this a step further, if one thinks there is criminal neglect, then anger arises in one’s heart. From this anger, stems, other thoughts, ranging from impeachment of judges [ which Paterrico has said is wrongly based] to threatening life of Greer so that he is said to be in hiding, to lesser wrong thoughts.

    I think we owe it to ourselves and our loved ones to know what is the truth that we can dispel wrongly founded thoughts, if there are as some say http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?14@235.EfGRbHIs1tf^4@.ef272cd/15608 . Righteous anger has a place, but if based on wrong facts, wrongful anger can be unhelpful to the individual and country.

    If it is righteous anger, then at least, measures can be taken to address it to prevent another such similar situation. If it is wrongful anger, then the consequential thoughts and measures that follow from that are wrongly based, and should never have happened in the first place, if we cared to know the truth.

    We are not counsels nor doctors nor judges nor Schiavos nor Schindlers, involved in the case. The case is over and she is dead. We and our loved ones are part of the people who are affected either by this version http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?14@235.EfGRbHIs1tf^6@.ef272cd/15601
    or that version http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?14@235.EfGRbHIs1tf^4@.ef272cd/15608 , or some other version (this is used a catch all phrase to cover all situations) and accordingly we and our loved ones form our /their opinion & take action accordingly.

    Right action can only stem from right thoughts. Right thoughts can only be formed from right facts.

    Philly: …. there is often not a commitment to intellectual honesty and a commitment to finding “the truth” of a matter, but rather finding a way to justify what one prefers or wants to believe. I think this is a universal part of human nature, but perhaps some cultures and individuals practice it to a higher degree than others.

    Thus, Philly, the need to commit to intellectual honesty and find the truth of the matter, for ourselves, our loved ones and the country. Not to win the case, because it is over. Not to rescue Terri because she is dead. But to avoid overspill of wrongful anger if based on wrong facts.

    Yi-Ling (b075b6)

  57. It sounds like somebody is mixing up Cheshire with Hammesfahr. Hammesfahr is the (probably) fake Nobel Prize guy who the Schindlers originally relied on. Cheshire is a respected neurologist from Mayo Clinic (are there any non-respected ones there?) who got involved much later in the game. AFAIK, Cheshire has never claimed to have been nominated for a Nobel Prize, to have invented/created the Internet, or to have done anything else he hasn’t really done.

    Xrlq (c51d0d)

  58. It sounds like somebody is mixing up Cheshire with Hammesfahr.

    Appears so, as one cannot remember all their names on first reading.

    Hammesfahr is the (probably) fake Nobel Prize guy who the Schindlers originally relied on.

    Hmmmm….. Given that the other is a radiologist, then, one can understand how the 2 doctors called by Schindlers did not really advance Schindlers case that she is not in a PVS.

    Cheshire is a respected neurologist from Mayo Clinic (are there any non-respected ones there?) who got involved much later in the game.

    Cheshire’s affidavit is dated March 23rd 2005. Fr Rob’s article is dated March 16, 2005 and thus did not and could not have mentioned Cheshire’s affidavit.

    AFAIK, Cheshire has never claimed to have been nominated for a Nobel Prize, to have invented/created the Internet, or to have done anything else he hasn’t really done.

    What’s AFAIK? So kinda naughty of the writer of the article that Philly linked at http://majikthise.typepad.com/majikthise_/2005/03/dr_william_ches.html to have it entitled as, “Dr. William Cheshire not nominated for Nobel Prize, either” and have the heading at the top as “Hammesfahr not nominated for Nobel Prize | Main | The Left and Terri Schiavo »”

    The question is never answered why Hammesfahr is said to be a nominee for the Nobel Prize.

    Maybe all the good medical witnesses do not show up till too late, if they did.

    The point is not noted that Cheshire came into on request of Fla. Adult Protection Services, of which he is a volunteer to provide a medical review on allegations of abuse on Terri, and his views on whether she is in a PVS was not in his scope of appointment.

    The legal question then is what weight, if any, can such an affidavit carry on the whether PVS issue, when the scope of appointment is to investigate allegations of abuse on her, and that’s besides the point, that, this issue of abuse, is more or less, said to be not present now.

    Hmmmm…. where is the legal case for the medical evidence that she is not in a PVS?

    Yi-Ling (ed13b9)

  59. Xrlq,

    Xrlq: Hammesfahr is the (probably) fake Nobel Prize guy who the Schindlers originally relied on.

    Does that mean you agree with the court order dated Nov. 22, 2002 http://www.geocities.com/purple_kangaroo_angela/schiavo2002trial/trialctorder11-02greerverdict.html where evidence of Hammesfahr was taken?

    Dr. Hammesfahr feels his vasodilatation therapy will have a positive affect on Terry Schiavo. Drs. Greer, Bambakidis and Cranford do not feel it will have such an affect. It is clear that this therapy is not recognized in the medical community. Dr. Hammesfahr operates his clinic on a cash basis in advance which made the discussion regarding Medicare eligibility quite irrelevant. A lot of the time also was spent regarding his nominations for a Nobel Prize. While he certainly is a self-promoter and should have had for the court’s review a copy of the letter from the Nobel committee in Stockholm, Sweden, the truth of the matter is that he is
    probably the only person involved in these proceedings who had a United States Congressman recommend him for such an award. Whether the committee “accepted” the nomination, “received” the nomination or whatever, it is not that significant. What is significant, however, and what undemises his creditability is that he did not present to this court any evidence other than his generalized statements as to the efficacy of his therapy on brain damaged individuals like Terry Schiavo. He testified that he has treated about 50 patients in the same or worse condition than Terry Schiavo since 1994 but he offered no names, no case studies, no videos and no tests results to support his claim that he had success in all but one of them. If his therapy is as effective as he would lead this court to believe, it is
    inconceivable that he would not produce clinical results of these patients he has
    treated. And surely the medical literature would be replete with this new, now
    patented, procedure. Yet, he has only published one article and that was in 1995
    involving some 63 patients, 60% of whom were suffering from whiplash. None of these
    patients were in a persistent vegetative state and all were conversant.

    Yi-Ling (b6bca8)

  60. FYI,

    To: Philly & Xrlq,

    Yi-Ling – 02:08am Apr 18, 2005 [ findlaw]
    To: Dusky (1) wish (2) PVS

    Dusky, I think I am wrong on Terri’s wish after reading the order that Greer made when it was pointed out to him his error as to date of death of Karen Quinlin. However pending your reply on the CT Scan and MRI or PET scan, I think you are wrong to play down, the issue that a MRI or PET scan is not needed to meet the standard of proof of a finding of in a PVS, whether by your submitted “good faith” standard or by Greer/DCA’s “clear and convincing” standard. Xrlq has elsewhere pointed out a link on the MRI versus CT scan. http://codeblueblog.blogs.com/codeblueblog/2005/03/codeblueblog_is.html

    Now regarding my earlier view, this is my revised view of Karen’s date of death. Before that…However, as I view that, the conflicting the medical testimony, makes it uncertain whether Terri is in a PVS, I stand by what I said that, there should have been a rehearing on whether she is in a PVS. As a non medical person, I somehow innocently expect greater precision from medicine and this inability to have a heightened consensus on whether is in a PVS or not, bothers me.
    Now regarding my earlier view, this is my revised view of Karen’s date of death.

    • The kind of examples that are commonly touted are more like, even if she did say, she does not want to be on a machine, but, feeding tube is not a ventilator and thus not a machine. But Florida law says I think, feeding tube like hers is life support. Its a statutory definition.
    • What puzzles me is the way Greer gleaned her intent as the “machine”. Primarily there were 5 witnesses and maybe some lesser ones, with 2 from Schindlers and 3 from Schiavos.
    • The Schindlers evidence that of her mother Mary Schindler and Diane Meyer her good friend, were more or less considered unreliable because Greer seemed to think they were making up the testimony. Both witnesses referred to events of Karen’s father waging a court battle to remove Karen’s ventilator. The court allowed it but Karen surprisingly lived even without the ventilator for another 9 years, though Karen was also on feeding tube. Her father did not remove her feeding tube.
    • Greer was taken in by the use of the present tense, when Diane Meyer referred to college day incidents of discussion on Karen with Terri. That would make Terri 19 , a good age to make her mind on such issues. Meyer evidence suggests Terri did not agree with Karen’s father to remove life support.
    • Because Mary Schindler went first before Meyer [ I think its in that order] she also said at first Terri was 19 but when opposing counsel showed newpsapers that showed the date of the court battle, Mary Schindler admitted and agreed that Terri would be 12 then.
    • Based on this, Greer also formed the idea that Meyer would also be referring to discussion with Terri when Meyer was having summer holiday with Schindlers family when Terri was 12.
    • This error on date of death of Karen was realised 5 years after the order by Greer of 2000. Greer had chance to reverse his order by accepting testimony of Meyer, but he explained that it made no difference. The error was just the date of Karen’s death, there was in other words, no error as to his view that Meyer did not discuss this issue with Terri when they were 19 in college, but that they discussed it when they were in early teens , age 12, on summer holiday together when the Karen case was waged in court room.
    • Some have said the error is fatal, but reading Greer’s explanation in his new order, it seems the error is not fatal.
    • I back track to add, that Greer also deduced Meyer is not reliable witness because during her deposition her memory was bad but at trial it was too excellent. So if we keep this in mind, then, the error as to date of death itself is not fatal, if Greer still did not think that Meyer could have discussed this Karen case in present tense with Terri when they are 19, as discussion at age 19, would not allow the discussion to be discussed in present tense. It would be talking of the case in past tense.
    • It also seems that Karen died 3 years after the purported Meyer’s 19 years old discussion, which means that it cannot also be a discussion in the present tense, on Karen’s death.
    • But more importantly if the discussion and Terri’s dismay was Karen’s father wanting to remove Karen’s ventilator, that discussion in the present tense can only take place when Terri is 12, when the court room events were in the newspaper.

    I know there will be others who think the error was fatal as I first did, and I would be pleased to have my above views challenged since I already think there is no clear and convincing evidence that Terri is in a PVS or at least there should be a rehearing to try that or further tests should be conducted, either MRI & PET scan or longer period of observation as Philly once mentioned.

    Yi-Ling (e0c28a)

  61. No news is good news : no reply to Xrlq’s:

    “Dusky, I don’t know where you got the idea the Terri Schiavo had two MRIs, but it is factually incorrect. Your claim that “they” wouldn’t be satisfied with a 1997 MRI is presumptuous in the extreme.

    You are entitled to your probable belief that Terri is better off dead than in her last present state, whatever we call it- as it is in dispute- but you are not entitled to make up facts (2 MRIs rather than 1) or to speculate idly as to what other people’s beliefs are- example: my belief that “If any MRI between 1990 and 2005 had shown that Terri Schiavo had no cerebral cortex, I for one would be satisfied under Florida law, that she was as good as brain dead.”

    Further, the difference between half a cortex and no cortex is the difference between having cognitive thoughts and not having them. If it were so insignificant, as you suggest, then why did so many anti-tubists make a big deal of the “fact” that Terri Schiavo’s cerebral cortex was gone completely in 1996, and not merely damaged as we all knew it was in 1990? By relying on an inherently fuzzy CT scan and refusing to order a much more reliable MRI or PET scan, Michael Schiavo and Judge Greer acted as if they didn’t really want to know.”

    http://boards.lp.findlaw.com/cgi-bin/WebX.fcgi?14@125.yviEb6IK11f^1@.ef272cd/15622

    Conclusion: Unheated reply aims and hits the opponent’s target better and delivers better result, with probable doubt cast in mind of worthy opponent, that maybe there is no clear and convincing evidence that she is in a PVS . Cheerio :-)

    Yi-Ling (010ca0)

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