This Is Your Brain On Jeb

March 23, 2005 10:30 PM

Blogger analysis of Terri Schiavo's CAT Scan. Healthy brain. Terri Schiavo's brain.
posted by fandango_matt (105 comments total)

Sounds skeptical, but in the comments he mentions his qualifications, which are impressive if true:

Out of curiosity, what are your qualifications for assessing brain imagery, Cerebrocrat?

Robert: a perfectly fair question. Here’s what I’m not - I am not a medical doctor, and I do not evaluate human brain images as part of my daily work. I AM a recent behavioral neuroscience PhD, a research fellow in a neurophysiology lab at a major institution, and I took clinical neuroanatomy in the medical school of my graduate institution as part of my coursework; neurology rounds and clinical evaluations of CAT and MRI scans were part of the curriculum. In addition, the jewel in the crown of my graduate program was a research-dedicated MRI, which meant that many of my peers did imaging work and I had to sit through countless (zzzzzzz) departmental colloquia featuring functional brain imaging. So, no argument from me - I am not the most qualified person to evaluate Terri Schiavo’s status from one small CAT picture on the web; that would be someone who evaluates scans professionally (or at least, regularly). But part of the point of my post was that I don’t have to be - I know how brains work (I mean, up to a point, obviously), I know what healthy ones and sick ones look like, and I know what I’m looking at when I look at a brain image. Schiavo’s damage is so severe that it doesn’t take an *expert’s* eye, but merely an *educated* eye, to understand the basics of her status.
posted by null terminated at 10:44 PM on March 23, 2005

*I was skeptical, I should say.
posted by null terminated at 10:46 PM on March 23, 2005

In all the fuss, has anyone mentioned this previous thread. IANAD, and it seems that the parents, Bush, the courts, etc, should butt out. - however, there do seem to be quite a few cases of severe hydrocephalus in relatively normally functioning people. In one case I believe actual brain volume was measured at 108 cc , about a tenth of normal, and the person was normally functioning. Probably not the case here of course but the brain may be more flexible than we give it credit for. Where's Ikkuyu2 when we need him/her?
posted by Rumple at 11:43 PM on March 23, 2005

Here's an argument from an expert who disagrees (I found the links from the comments in the FPP-linked blog)

He's got a few educated posts on his blog about the case, and he's an actual doctor. And I apologize if this has been linked on Metafilter before, but it seemed worth mentioning.
posted by onalark at 11:45 PM on March 23, 2005

I'm not qualified to interpret those scans, And neither is the president or his brother.
posted by Balisong at 11:56 PM on March 23, 2005

I'm not qualified to interpret those scans, And neither is the president or his brother.

Neither is Frist, for that matter, and he's an MD. Nor are either of the experts on this thread, either.

Personal diagnosis is critical. On that front, not a single doctor has dissented. We absolutely have to rely on them. We have to rely on the 16 judges that have seen all the evidence. Again, every time, a ruling in favor of the husband.

You just can't get any more certain about such a tough issue.
posted by teece at 12:13 AM on March 24, 2005

I'm not qualified to interpret those scans, And neither is the president or his brother.

Which seems to be a pretty sound argument for establishing a procedure for an impartial decision-maker (like a federal judge) to decide these things instead of the husband (who has no more qualifications than you, I, or President Bush). After all, the status quo here will basically allow the husband to kill his wife by starving her to death. You can argue if she's alive or dead, but why is he the one that gets to make the call. Might he want her dead for other reasons (he's dating a new woman, etc)?

I'm not qualified to interpret the scans, but I know for sure that if I were alive and my wife were living with another man and she tried to starve me to death then I would be one pissed-off mofo.

Interesting quote: "We didn't know what Terri wanted, but this is what we want" (Larry King interview with Michael)
posted by thedevildancedlightly at 12:14 AM on March 24, 2005

It really surprises me that we're spending so much time and money essentially degrading this poor woman by plastering her face all over the TV all day. Talk about consent eh. When you think about all the starving people out there who aren't brain dead and all the sick people who'd rather commit suicide and can't, this all becomes rather silly.
posted by twjordan at 12:20 AM on March 24, 2005

there do seem to be quite a few cases of severe hydrocephalus in relatively normally functioning people.

There's a huge difference between Schiavo's brain and hydrocephalus. She doesn't just have an increased amount of cerebrospinal fluid (which would cause pressure on the brain), she is missing brain matter; a bunch of brain matter.
posted by vevaphon at 12:25 AM on March 24, 2005

Bleah. Where to start.

1) Releasing or distributing confidential medical records - like this scan - without the patient's permission is a serious breach of medical ethics, not to mention Federal law. It's probably not appropriate for me even to be commenting on them, but what the hell. They're out there.

2) Neurologists look at these scans all the time. We don't use them in a vacuum - ever. We use them in conjunction with a clinical history, a careful neurological exam, and other tests. The use we make of them is to diagnose (What's wrong), to prognose (What's going to happen), and to treat (What can be done to make things better.) This can't be handwaved away. You can't diagnose, prognose, or treat with only a scan. You need the rest of the information.

Neuroradiologists read these scans, but they do not diagnose, prognose, or treat. They limit themselves to describing the findings. In this case the findings are severe cortical and subcortical atrophy with enlarged ventricles and a shunt in the patient's right lateral ventricle (if, as it appears, the image is reversed.) There are a number of things that can make a brain look this way.

c) There's no reason to believe this is Ms Schiavo's scan. It could be someone else's scan.

iv.) Is this a bad brain? Sure. Would I be surprised to learn it was the brain of someone in a persistent vegetative state? Nope.

Have I seen people walking and talking in a (superficially) normal fashion with scans like this, as the expert linked by onalark states? Yep. It's always hard to believe when it happens - but it happens. I've seen people whose brains looked worse who seemed to have average level of function for their age.

I don't call for a CT scan to discover what the patient's current level of mental function is. I do call for a CT scan if there's some question about what's causing a current impairment, or if there's a question about the correct way to proceed with treatment. Sometimes the CT helps answer these questions. Almost certainly this CT scan was done for one of those reasons - whether it's Ms Schiavo's scan or not.

Fifth.) Does it have any bearing on the case at hand, the whole legal fight? Maybe it'll surprise you to learn that I don't think so. From all accounts, Ms. Schiavo seems to be in what we call a persistent vegetative state. Maybe she's in a "minimally aware state" - a new set of criteria to reflect the presence of certain vegetative functions that are no longer felt to be present in what we're now supposed to call a vegetative state. That's a definitional issue, and to my mind one of very little importance. Is she going to get up, look around, listen to things, walk, talk, act like a healthy person again? Nope, and it doesn't seem like any of the reasonable parties involved disagree about that. If she's fed and hydrated, her body will remain in that bed without ever evidencing any of the traits that make you want to spend time interacting with a person.

The real issue is: what's to be done with people in vegetative states? How does it make sense to treat them? Should they be fed, or not? It's similar to questions like "why should grain be allowed to rot in a silo while kids are starving in Africa" - interesting, important questions, but really completely outside the jurisidiction of medicine. They are religious questions, or philosophical ones.

Part the last: To be clear: what a neurologist thinks of this patient's scan doesn't have any bearing on the current debate - at all.
posted by ikkyu2 at 12:28 AM on March 24, 2005

I do know how to spell 'jurisdiction' - I am not , a crack pot !!!
posted by ikkyu2 at 12:31 AM on March 24, 2005

You know, TDDL, that kind of attempt at character assassination is wholly and completely despicable. This man has taken his case before SIXTEEN judges, and not one has found any grounds to question his motives.

The case is tragic enough without you and others trying to drag the man's name through the mud. The woman has been dead for 15 years for all intents and purposes -- it is not even mildly surprising that he is with someone else.

Hell, if he just wanted to be rid of her, all he would have to do is divorce Terri, and she'd be the parents problem. That he hasn't ought to tell you that he actually gives a shit.

(And it is a doctor that makes the call on whether or not she is in the persistent vegetative state, not the husband.)
posted by teece at 12:32 AM on March 24, 2005

This man has taken his case before SIXTEEN judges, and not one has found any grounds to question his motives.

To be honest, a number of those judges made procedural decisions, not substantive ones. There's a huge distincition between saying "I'm going to decide this case on the merits" and "I'm not in a position to say one way or the other so go ahead and do whatever you want."

As for his name, I don't doubt his motives in this particular case. He does seem to be extremely loyal. There are rumors of domestic violence back in the 80's, but let's let sleeping dogs lie. However, the precedent here is a little questionable - a husband, abusive or not, can choose to kill his wife by slow starvation if she's in a vegetative state? Michael might be an absolute saint - I can't telly you that from here - but there are plenty of people out there who aren't.
posted by thedevildancedlightly at 12:37 AM on March 24, 2005

all he would have to do is divorce Terri

Serious question: How would one go about getting a divorce of somebody in a PVS? It seems like it'd be tough to get her to sign on the dotted line for an uncontested divorce, but a contested one wouldn't really work either since there's nobody to represent her interests.

Also, I think ikkyu2 has presented a good analysis. I defer to him for what the real issue is.
posted by thedevildancedlightly at 12:42 AM on March 24, 2005

Thanks, ikkyu2. Great info and analysis for an already thought-provoking post from fandango_matt.
posted by sninky-chan at 12:44 AM on March 24, 2005

Which seems to be a pretty sound argument for establishing a procedure for an impartial decision-maker (like a federal judge) to decide these things instead of the husband (who has no more qualifications than you, I, or President Bush).

Um...isn't that what just happened over the last 15 years?
posted by BackwardsCity at 12:53 AM on March 24, 2005

The grounds for divorce in Florida are:

*The irretrievable breakdown of the marriage; or
*The mental incapacity of either the husband or the wife
From here.

And I gotta agree with BackwardsCity.
posted by teece at 1:02 AM on March 24, 2005

Terry Shavio reminds me in more ways than one of Fred and his fate.
posted by hortense at 1:21 AM on March 24, 2005

This isn't about science, this is about faith.
posted by inpHilltr8r at 1:22 AM on March 24, 2005

It didn't take a brain scan for me to know this has more to do with politics than science. Anyone else see the seething anger of the news anchors on Fox news? It was almost like watching a TV show.
posted by Dean Keaton at 1:24 AM on March 24, 2005

ikkyu2 writes " Part the last: To be clear: what a neurologist thinks of this patient's scan doesn't have any bearing on the current debate - at all."

Nicely reasoned. In both senses of the word "nicely". Thanks.
posted by orthogonality at 2:43 AM on March 24, 2005

It's a pity about all those people who need medical care they can't afford, in order to live, but who aren't brain-dead. I guess you've got to be someone the Shrub can relate to, to get anything out of his administration.
posted by aeschenkarnos at 2:46 AM on March 24, 2005

Interesting quote: "We didn't know what Terri wanted, but this is what we want" (Larry King interview with Michael)

I don't know if you're taking this out of context because of agenda thrashing or ignorance, but I'll give you the benefit of the doubt. Here is the context:

KING: Do you understand how they [her parents] feel?

M. SCHIAVO: Yes, I do. But this is not about them, it's about Terri. And I've also said that in court. We didn't know what Terri wanted, but this is what we want...

Even most of the freepers admitted this was Michael speaking in the voice of the parents, not some smoking gun.
posted by TungstenChef at 3:03 AM on March 24, 2005

will basically allow the husband to kill his wife by starving her to death

Ignoring the ugly phrasing there - the husband gets as much, if not more, of my sympathy, than the parents - that aspect of this case does trouble me. I'm not completely familiar with the history, since it's only recently been getting a lot of coverage over here, but it seems particularly horrific that while the legal wranglings continue, she's being starved. Not that she knows about it, by the sound of it, but it's still pretty repulsive.

Is this the usual method of ending the life of someone in this sort of near-dead state in the US? I believe that in the UK, for conscious patients, or at the request of relatives, it's usually the 'enough painkillers to kill without the explicit intention of killing' or witholding of treatement method that's used, rather than starvation. (Totally illegal, but not uncommon).
posted by jack_mo at 3:41 AM on March 24, 2005

jack_mo writes "Is this the usual method of ending the life of someone in this sort of near-dead state in the US?"

Yes, because otherwise the doctor might be prosecuted for assisting a suicide or for inappropriate use of medication (a number of doctors have gone to prison for sentences of several years for too freely prescribing pain medication to ambulatory, non-terminal patients).

As it happens, Schiavo is probably quite incapable of experiencing pain at this point, but that's not the case for many cancer patients or other terminal patients, who are routinely given the choice of dying slowly and in pain, or secretly hoarding their painkillers until they have a stash large enough to kill themselves with.

This is yet another consequence of the so-called "Culture of Life" and theological opposition to euthanasia and other forms of suicide.
posted by orthogonality at 4:11 AM on March 24, 2005

thedevildancedlightly: You can argue if she's alive or dead, but why is he the one that gets to make the call.

Well, he's arguably the closest relative, for starters. Also, I didn't follow the case too closely, but I dimly remember him saying that he and Terri had discussed a similar situation, back when she was still "alive", and she apparently had expressed the desire to be kept alive by artificial means. That is basically believable, I think; people talk about this stuff, and I have people very close to me say the same thing.

But even if we can establish that it was Terri's own wish not to be kept alive artificialy, that still leaves the important ethical question whether we, as society, should comply with this or whether we should keep her alive out of principle, i.e. out of respect for human life itself --- A suicidal person may wish to end his/her life, but we will still try to keep them from going through with it.

Now, we could argue that Terri is not really human anymore, which I believe is basically the point of the cerebrocrat (the linked blogger). However, this may open the floodgates to declaring all kinds of people "not human", such as people with genetic defects or maybe even people of different ethniticities, like the Nazis did.

What is slightly disturbing about all this is that the same people crying the loudest now about saving one of God's creatures are the same ones that are the fastest on the flipping the switch on the likes of Karla Faye Tucker.
posted by sour cream at 4:27 AM on March 24, 2005

I wrote: ... she apparently had expressed the desire to be kept alive by artificial means...

*not* to be kept alive, of course.
posted by sour cream at 4:29 AM on March 24, 2005

Here's a silver lining. :-)
Don't remember where I stole found this but thanks!

Brain Dead

Washington D.C. (AP) -- In the largest legal action of its kind to date, nearly 300 doctors in the Washington D.C. area have asked a federal court for permission to withdraw food, water and other forms of life support from their patients -- all of them members of the House and Senate Republican caucuses.

In their brief, the doctors contend their patients have lapsed into a "persistent vegetative state," and have shown "absolutely no signs of cognitive brain function" since September of 2001. All hopes for recovery are gone, they added.

Lawyers for family members of the afflicted Senators and Representatives asked the judge to reject the petition, saying the standard for withdrawing life support proposed by the doctors would permit the involuntary euthanization of almost 51% of the voting-age American population.

However, after reviewing the evidence -- House and Senate voting records for the past four years -- the judge agreed to take the matter under advisement.

Associated Press
Doctors Seek "Mercy Deaths" for GOP Senators, Reps
April 1, 2005
posted by nofundy at 4:43 AM on March 24, 2005

Not just slightly disturbing, sour cream. By now we've been reminded (but not enough) that while governor, GW Bush signed a bill permitting hospitals to withdraw life-sustaining medical care if the patient could not pay--over the wishes of the next of kin. That law was invoked to allow a day-old child to die a couple of weeks ago, against the mother's wishes. (As usual, Molly Ivins has the goods--Star-Telegram link, reg. required.)

George W. Bush is neither a neurologist nor a medical ethicist. What is he doing?

In 1999, while he was governor of Texas, Bush signed the Advanced Directives Act, which gives hospitals the right to remove life support in cases where there is no possibility of revival, when the family cannot pay, no matter what the family's wishes are. . . .

The very Republicans who pushed for this arrogant, interfering bill, which if used across the board would take away everyone's right to make their own decisions in these awful cases, are the same people who voted to cut Medicaid, which pays for the care of people like Schiavo.
posted by palancik at 4:50 AM on March 24, 2005

Rivka has a post making the case that this case is fundamentally different from assisted suicide; it consists in the withholding of medical treatment, which is something everyone has the choice to make. You can't force someone to have chemotherapy against their will. So you also can't force someone to stay on a feeding tube if it was determined not to be their will.
posted by Jeanne at 4:53 AM on March 24, 2005

No reputable doctor has said there's any hope at all for recovery or improvement (i type this as the father is on CNN again, saying she talks and laughs, and doctors told him that she could improve and join society).

You can't regrow a brain.
posted by amberglow at 5:11 AM on March 24, 2005

However, the precedent here is a little questionable - a husband, abusive or not, can choose to kill his wife by slow starvation if she's in a vegetative state?

This isn't a precedent setting case by any means. Thousands of feeding tubes get pulled every day in the US, probably tens of thousands of ventilators get switched off. If you have parents or grandparents this is most likely a decision you are going to have to make yourself in the future. Ask around, almost everyone I know has. The spouse or closest relative has the right under state law and, basically, tradition to make this decision. If they didn't have money no-one would have given a damn what the parents wanted. (How are they paying for this anyway?).

It would only be precedent setting if Congress forced every hospital to keep every similar case on life support indefinitely and that's not going to happen.
posted by fshgrl at 5:41 AM on March 24, 2005

Which seems to be a pretty sound argument for establishing a procedure for an impartial decision-maker (like a federal judge) to decide these things instead of the husband (who has no more qualifications than you, I, or President Bush).

It's amazing to me that so many people continue to claim that Michael Schiavo made the decision to remove the feeding tube. Does anyone read a newspaper anymore?

Michael Schiavo didn't decide anything; the removal of her feeding tube was a court order. He petititioned a judge to decide, and the Florida courts heard testimony from Schiavo, Terri Schiavo's parents, other friends and family, and numerous medical experts. The judge ruled that she would not choose to live in this condition. The legal basis of his decision has been affirmed time after time in appellate courts.

What you're hoping for has already happened.
posted by rcade at 5:58 AM on March 24, 2005

Jeb Bush's M.D.: On a mission from God--In his last-ditch, desperation attempt to save Terri Schiavo, Florida governor Jeb Bush is relying upon the medical opinion of a Jacksonville neurologist who once published a poem that bitterly attacks the "right-to-die" and doctor-assisted suicide, concluding that "the one firm reference point of truth" is "the cross of Jesus Christ the Lord."
posted by amberglow at 6:19 AM on March 24, 2005

You can't regrow a brain.

Still, I think they should try (in the case of the president).
posted by Doohickie at 6:23 AM on March 24, 2005

I can't escape the sense that, from the GOP's standpoint, this is less about Schiavo and more about the upcoming judicial nominations.

Given that the decision to uphold Michael Schiavo's custodial rights has been made in the federal judiciary, and since that decision was made against the express intentions of the Congress and the President, I think the stage is set now for a series of references to a judiciary out of step with American values. It'll be a lot easier to try to change the Senate's procedural rules on filibustering if people have the complex emotions associated with the Schiavo case near at hand.

I think the Republicans are using this poor woman as a chess piece in a bigger game. And that's unconscionable. Michael Schiavo should move his wife to Texas and declare bankruptcy.
posted by felix betachat at 6:34 AM on March 24, 2005

The mention of hydrocephalus caught my attention... that's a good point about the difference between enlarged ventricles and missing brain matter. How easy is it to distinguish between a scan showing enlarged ventricles and a scan showing missing brain matter? I've only seen the former, not the latter. Seems like both would show big, open spaces where grey matter and thin ventricles would be.

It's been about seven years since I last had any major problems, but there were times when a CT scan of my brain looked similar to the one reported to be Schiavo's.
posted by emelenjr at 6:59 AM on March 24, 2005

In one case I believe actual brain volume was measured at 108 cc , about a tenth of normal, and the person was normally functioning.

Some of them appear to be working in high-level posts in the Bush Administration, in fact!

I'll believe this "culture of life" stuff when Bush abolishes the death penalty in the US, stops warmongering, puts pressure on the current Governor of Texas to repeal the Texas Futile Care law, and stops trying to effect deep cuts to Medicare, which is often relied on in cases catastrophic illness. Until then this whole brouhaha is nothing but political opportunism of the lowest sort.

Most sadly ironic is Tom DeLay's pushing the "culture of life"... the guy's a fucking exterminator, for chrissakes. He sold death for money before Texas rubes sent him to Washington.
posted by clevershark at 7:12 AM on March 24, 2005

Oops, that should be "cuts to Medicaid", not "cuts to Medicare".
posted by clevershark at 7:12 AM on March 24, 2005

One piece on the funding sources for the continued appeals.
"In the Schiavo case, the money leads to a consortium of conservative foundations, with $2 billion in total assets, that are funding a legal and public relations war of attrition intended to prolong Terri's life indefinitely in order to further their own faith-based cultural agendas."
posted by mania at 7:13 AM on March 24, 2005

This kind of activism is counter to true conservatism -- as are many of the current administration's big-government polices. Evangelicals have made great headway in destroying the conservative movement. Whenever I hear "conservative, faith-based cultural agendas" I turn to my friends who are true conservatives and watch their eyes roll...
posted by mania at 7:24 AM on March 24, 2005

What gets me in all this is that people claim to vote for GOP candidates because they don't want the government to interfere in their lives. I don't know how government can be more intrusive to one's life than it is in this case.
posted by clevershark at 7:26 AM on March 24, 2005

Felix betachat has IMO the best long term evaulation of this otherwise slightly inexplicable rigamarole.

This is further evidence of Activist Judges, Taking the Law into their Own Hands, Out of Step with Americans on so many Moral Values.

Scalia to the Rescue!
posted by anthill at 7:31 AM on March 24, 2005

tdd: You can argue if she's alive or dead, but why is he the one that gets to make the call.

I was really surprised by this question. I'm married, and it's a very easy question for me - my wife makes my medical decisions if I am unable to. No matter how well meaning my parents or other relatives may be, my wife is the one I've chosen as my guardian if I am unable to be my own, and she gets the choice if my wishes are unclear.

This is pretty well established - it's one of the reasons why gay marriage (actual marriage) is important, so your partner, who you have chosen, can make these decisions. Certainly barring the existance of a husband or wife, your closest relative can make the call. But certainly not your parents over your husband/wife, and not Congress or the President. Right? I don't know anyone who is married who would rather have their parents be the default choice - especially if their parent's wishes differ with their spouse's wishes. And if your wishes differ from what your spouse might choose, that's a good reason to have a living will. If a living will doesn't exist, you have to let the spouse choose, in my opinion.
posted by drstupid at 7:51 AM on March 24, 2005

I move that we cast her in bronze and crucify her on the front lawn of the White House. Then everybody's happy.

/sorry, just tired of this shit
posted by fungible at 7:57 AM on March 24, 2005

SCOTUS denies appeal hearing
posted by XQUZYPHYR at 7:58 AM on March 24, 2005

Before going off and quoting every opinion and feeling of medical quacks and political opportunists, I think everyone should read this little piece:
A REPORT TO GOVERNOR JEB BUSH AND THE 6TH JUDICIAL CIRCUIT IN THE MATTER OF THERESA MARIE SCHIAVO
It is written by Jay Wolfson, DrPH, JD, Guardian Ad Litem for Theresa Marie Schiavo on 1 December 2003.
He details the case, the court proceedings, the various legal opinions, and more. Mr Wolfson helps put this case into a context, which the news media seems incapable of doing.
posted by mooncrow at 8:08 AM on March 24, 2005

The mention of hydrocephalus caught my attention... that's a good point about the difference between enlarged ventricles and missing brain matter. How easy is it to distinguish between a scan showing enlarged ventricles and a scan showing missing brain matter? I've only seen the former, not the latter. Seems like both would show big, open spaces where grey matter and thin ventricles would be.

There is sometimes overlap in radiographic findings in subtle cases of either, however most cases are easily differentiated. Any (neuro)radiologist should be able to tell. While IANAR, IAAD, and I can usually tell. For me it's largely gestault, but if you're really interested, here are a few hallmarks I borrowed from the interweb that are true:

HYDROCEPHALUS vs. ATROPHY (CT)

Hydrocephalus (ventricles >> sulci)
- Ballooned and tight frontal horns - Dilated temporal horns
- Dilated 3rd (hourglass shape) with flow void on MR
- decreased mammillopontine measurement (expanded 3rd pushes mammillary bodies post./inf.
- Dilated 4th ventricle
- Periventricular abnormal signal/density

Atrophy (sulci and ventricles dilate proportionately)
- Large cortical sulci
- Less 3rd ventricular dilatation (with parallel sides NOT hourglass shape)
- Increased with age


Of course, the test of greater value in this case would probably be her EEG. CTs have nothing to do with brain death criteria.
posted by drpynchon at 8:10 AM on March 24, 2005

i'm surprised by the Supremes not taking this.

The longer this stays in the news, the worse it is for the GOP.
posted by amberglow at 8:13 AM on March 24, 2005

I've got a huge battery of feelings about this, and it won't fit well into the comments here. If you like, have a look at my blog post instead...
posted by chinese_fashion at 8:23 AM on March 24, 2005

i'm surprised by the Supremes not taking this.

*visualizes Diana Ross singing "You Keep Me Hanging On"*
posted by felix betachat at 8:25 AM on March 24, 2005

permitting hospitals to withdraw life-sustaining medical care if the patient could not pay--over the wishes of the next of kin. That law was invoked to allow a day-old child to die a couple of weeks ago, against the mother's wishes.

palancik, you seem to be buying into the lefty knee-jerk over Texas' Futile Care law a little too much. Kevin Keith at Lean Left has a great post that thoroughly explains why futile care laws - even those that allow decisions "over the wishes of the next of kin" - are not only acceptable, but sometimes absolutely necessary:

In some cases, caregivers agree to provide futile treatments simply to avoid the impression of cutting the family off without hope, or to give the family time to come to terms with the reality of the case. But there are other times when that’s not a reasonable option...When a family demands scarce resources, such as access to a necessary piece of equipment that other patients also need and can benefit from, a conflict arises and caregivers try to manage that in favor of the patient who can benefit - but for the family in denial or clinging to unrealistic hope, that solution is not satisfactory...

Another conflict may arise when a patient needs very expensive ongoing treatments - such as intensive life-support - but has no hope of recovery. When a family is willing to pay for this treatment and no conflicting need on the part of other patients exists, most institutions will agree to continue providing the treatment. When the family cannot pay, and the treatment cannot benefit the patient, institutions are much less willing to continue to pay out of their own pockets for intensive care that serves no purpose other than to show the family that something is being done...

We ought to demand a lot from our healthcare institutions, but that they provide extremely expensive care to the physical bodies of long-gone non-persons, simply becaused the former patient’s family will not come to terms with the situation or harbors some unrealistic religious belief, is too much to ask. Aside from the question of profit, that money can be spent providing resources and services to other patients. And so, in these cases of clear futility where a family demands ongoing expensive treatment that they cannot pay for, something has to be done.
posted by mediareport at 8:27 AM on March 24, 2005

No matter how well meaning my parents or other relatives may be, my wife is the one I've chosen as my guardian if I am unable to be my own, and she gets the choice if my wishes are unclear.

To me, that's the most fundamental and important right bestowed by marraige, and the one that most demonstrates why gay marraige should be a constitutional guarantee.

I love my extended family, but the idea that any of them could fight with my wife over my life or death in a situation like Terri Schiavo's is horrifying.

I think the prospect of an entire family being in agreement on removing a feeding tube is next to impossible. The decision's hard enough to contemplate singly -- Michael Schiavo pursued eight years of aggressive rehabilitation before reaching that point.

Death brings up a lot of deep-seated and intractable beliefs. It seems to me that this entire conflict is grounded in the absolute refusal by Terri Schiavo's parents to accept the prospect of her death, no matter how degraded her existence could become. (They even said in court, in a hypothetical, that if necrosis affected her limbs, they'd favor amputating all four of them over ending her feeding.)

I can sympathize with them (sort of -- who could fully contemplate their agonizing plight?), but I don't see why their beliefs should be considered equally to her husband's.

When my grandfather died, he willed his body to medical science, and it became an unfortunate source of disagreement. Some family members were very uncomfortable with the idea, and it got a little ugly during an already sorrowful time.

I can't imagine that involving Tom DeLay and Operation Rescue in our disagreement would have improved things.
posted by rcade at 8:28 AM on March 24, 2005

I'm sorry but starving this woman to death is just brutal. If her husband is convinced she would not want to live like this well... he should have been a man about it and smothered her with a fucking pillow or something (or at least found a doctor willing to O.D. her with morphine). I love my wife enough to risk going to trial for a "mercy killing" to ease her suffering and I would hope she feels the same way about me.
posted by MikeMc at 8:32 AM on March 24, 2005

well said, chinese.

(and that snake thing is unbelievable)
posted by amberglow at 8:40 AM on March 24, 2005

posted by quonsar at 8:51 AM on March 24, 2005

when are we going to get back to talking about stereoid use? you know, something that actually has some bearing on our everyday lives?
posted by mcsweetie at 9:06 AM on March 24, 2005

Brain and brain! What is brain?!
posted by fandango_matt at 9:07 AM on March 24, 2005

Yikes, quonsar... yikes.
posted by BobFrapples at 9:21 AM on March 24, 2005

i'm surprised by the Supremes not taking this.

*visualizes Diana Ross singing "You Keep Me Hanging On"*

I am sooo going to hell for laughing at that.
posted by deborah at 9:27 AM on March 24, 2005

Thanks Ikkuyu2 - informative and well put. And thanks drpynchon. I realize she doesnt have hydrocephalus, but it struck me that superficial comments on her CT scan and apparent "hole in the brain" in and of themselves don't tell us anything. It is outrageous that scan is available on the internet, if it is hers, and in any case it is almost 10 years out of date.
(very eloquent, quonsar)
posted by Rumple at 9:34 AM on March 24, 2005

Per MSNBC:
Moby says he doesn’t want to be drawn into the Terri Schiavo case, but writes on his Web site: “My note to the far-right would be: you can’t have it both ways. If you genuinely believe in the sanctity of life then you cannot support the death penalty and you cannot allow people to buy automatic assault weapons and you cannot support wars that result in the deaths of hundreds of thousands of innocent people. And if you genuinely believe in states rights then you can’t pass intrusive federal legislation when the states do things that you arbitrarily disagree with.”
posted by Diamornte at 9:44 AM on March 24, 2005

I don't know. I'm sad this case got so politicised -- people are hijacking a woman's plight to toss mud balls across the aisle.

And I can't help feeling for her parents that a husband who already has a new family of his own (doesn't that kinda make him an ex-husband =P) gets a *complete* say over their wishes. How would you feel if it was your life and blood being starved to death.

Nevertheless, I do understand why the laws were designed that way. So R.I.P Terri.
posted by slf at 9:51 AM on March 24, 2005

Brain and brain! What is brain?!
posted by fandango_matt

Nothing like the real thing. Warning: it makes teh noise.
posted by Devils Rancher at 9:56 AM on March 24, 2005

I thought this discussion of coma patients and their recovery was quite valuable. Schiavo is below coma-level, though, as someone in the thread mentions.
posted by schroedinger at 9:59 AM on March 24, 2005

I feel for her parents, especially because they seem unable to let go of a daughter who has, realistically, been gone from them for years and years. Her death, finally, will allow them to (hopefully) move ON with their lives. And the husband, as well, who is trying to move on but is being held hostage by the situation, and now being vilified.

Let the woman die. She's not feeling any pain. She's not really alive anyway.
posted by papercake at 9:59 AM on March 24, 2005

She wouldn't starve to death (although starving herself got her to this point), her organs would give up due to lack of water, if the mouth is kept moist this isn't a painful way to go; terminally ill patients often choose this method.
posted by zeoslap at 10:04 AM on March 24, 2005

So, in other words, normal people have brains in black and white, but Terry's is in color.

So it's like the difference between I Love Lucy and The Lucy Show.

Yeah, we should all form opinions about this. The only ethical choice is I Love Lucy.

It's what Jesus would want.
posted by nyxxxx at 10:07 AM on March 24, 2005

mediareport, the problem with that quote--and the whole system--is that if the person in the next bed in a hospital is getting treatments simply because of their ability to pay for them, and not because of their medical utility, and their roommate with the same condition isn't, you can't justify that in any way. Why shouldn't all patients in the same medical circumstances get the same care? It's fucked--excuse my french.
posted by amberglow at 10:16 AM on March 24, 2005

A year ago last fall Dahlia Lithwick wrote a very interesting article for Slate about why spouses trump parents in cases like Terri Schiavo's. In many ways it echoes the points already made by people here.

On another note, I continue to find all the images of Terri Schiavo that have been plastered on news sites recently to be very disturbing. I keep thinking that I wouldn't want the whole world to see me in that state.

Further, the degree to which her parents have infantilized Ms. Schiavo is rather disturbing, but probably plays a role in why they are unwilling to let her go.
posted by HiddenInput at 10:23 AM on March 24, 2005

I am so tired of this line "she's starving to death". When people say that it makes you think that she's laying there begging for a steak. She hasn't eaten or drank anything for 15 years. She has been hydrated and given nutrients directly to her stomach. As I type this I know that it sounds cruel but the hard cold truth is that removing the feeding tube is like not watering a plant. Mrs. Shiavo died along time ago and it's time for her parents to release her body.

There are some things that are truly worse than death, and being kept alive in this manner is one of them, IMO.
posted by bas67 at 10:30 AM on March 24, 2005

I still can't get over the tremendous (and sad) irony of the situation: a former bulimic dying from starvation. Maybe part of the "culture of life" should be mandating insurance companies to cover treatment for eating disorders. Or universal health insurance, wouldn't that be nice...
posted by greatgefilte at 10:32 AM on March 24, 2005

Given Bush's recurring disdain for science, it is completely expected that he would resort to this drivel about "Culture of Life" in his attempt to override the findings of numerous court-appointed Neurologists and their fuzzy "science". They're probably *just* scientists, and bureaucratic ones at that .

Therefore, I'm surprised how quickly and boldly he has acted on this...I would have expected him to commission a 10-year study on the existence of a "so-called" "Permanent Vegetative State." Sure, Terri would be dead by the time they came up with their inconclusive preliminary findings, but that seems to be the administration's MO on Global Climate Change, Abu Ghraib, Valerie Plame leak, or hey, just about anything that conflicts with Rove et al's master plan. Next up, a presidential commission to study "so-called" Evolution?
posted by MrSoyBoy at 11:14 AM on March 24, 2005

Supposedly she became vegetative when her brain didn't have enough oxygen because of heart failure from anorexia.
And now . . . they're starving her to death . . .

o_O
posted by cinderful at 11:19 AM on March 24, 2005

latest legal bid failed, guess we see if ole Jeb goes nuclear.

They talk about trying to prove neglect/abuse/exploitation, which is pretty funny, as the ones trying to prove exploitation are in fact, exploiting her.
posted by edgeways at 11:31 AM on March 24, 2005

er, it may be a fine distinction, but not anorexia, bulimia. Related, not quite the same
posted by edgeways at 11:32 AM on March 24, 2005

They knocked Jeb down too.-- After the U.S. Supreme Court rejected an appeal by Bob and Mary Schindler to intervene in the case, a Florida judge denied three other legal requests, including a petition by a state agency to take custody of Schiavo.

Schiavo has been without food or water since Pinellas-Pasco Circuit Judge George Greer ordered her feeding tube removed Friday.

Thursday, Greer denied a petition of the state Department of Children and Families and Gov. Jeb Bush to take Schiavo into state custody.

He also denied a petition from the DCF to investigate allegations that Terri Schiavo's husband, Michael, abused her.
posted by amberglow at 12:59 PM on March 24, 2005

Oh man. It's gonna be ugly if/when she dies. People are getting particularly emotionally involved in this story, for some reason.
posted by sonofsamiam at 1:01 PM on March 24, 2005

The brain is, for all intents and purposes, dead and the body is being kept alive artifically.

What seems missing from all the fundie arguments is ANYTHING about the soul!
Why torture the poor woman's soul with a brain dead body? What's a matter?
Don't believe in heaven or something?
Would not that be immensely better than the hellish suffering and torment her sould must be enduring?

F*cking hypocrits! It's about the politics and power, not about this person. They don't give a flying f*ck about anyone who isn't greasing their palms with Benjamins. (pardon the rant but sometimes you gotta get it out)
posted by nofundy at 1:05 PM on March 24, 2005

Senator Frist kills cats.
posted by monju_bosatsu at 1:07 PM on March 24, 2005

Would not that be immensely better than the hellish suffering and torment her soul must be enduring?

Silly rabbit: everyone knows suffering is good for the soul.
posted by PinkStainlessTail at 1:07 PM on March 24, 2005

Oh man. It's gonna be ugly if/when she dies. People are getting particularly emotionally involved in this story, for some reason.


the picture on the home page of CN of a girl with a taped mouth has a sign behind her--America's Law has failed. God's Law will Prevail.
posted by amberglow at 1:11 PM on March 24, 2005

(oop-CNN)
posted by amberglow at 1:27 PM on March 24, 2005

Their (CNN) main page has two fellows, one who looks like he is about to have a conniption, wonder what the sign behind them says... #1 Man Smack?

(Amberglow, I think you may be looking at the International edition).
posted by edgeways at 1:37 PM on March 24, 2005

It's been 15 years, and I gather she has not been lying there all alone with no professional help. 15 years. If she were going to wake up wouldn't she have done it already?

I have downloaded a Living Will thing. I'm going to take care of that pronto. I'm also thinking of having "DO NOT REVIVE" tattooed on my chest.

And by the way, I've seen veterinarians give cancerous ferrets pentothal injections; it's a nice easy death, they literally go to sleep forever. I say that doctors ought to be able to do that for us in such cases, instead of withdrawing the feeding tube and waiting. That's got to be easier on the people around you at least. Why save lethal injection for people we don't like?
posted by davy at 2:21 PM on March 24, 2005

It's gonna be ugly
Been watching this case seeing how many fences could be created. Thier


Parent's rights – her parents brought her into this world.
Husband's rights – husband wants her wishes fulfilled.
{these two can be linked to why gay marriage is wanted as a right}

Women's Rights - Gloria Fienstien (guessing why she is involved as she’s on the west coast)0

Pro Life right’s - Bush
Right’s to die – Kavorkian backers.

State’s rights
Federal rights

Court’s rights
Appeal’s rights

Citizen’s rights

Still to figure if the fences should be colored. One thing you see, not enough fence for all these sides, yet they have been low enough to see over.
posted by thomcatspike at 2:57 PM on March 24, 2005

Her death, finally, will allow them to (hopefully) move ON with their lives.

Her eventual death would probably have had that effect, but her death as a legal choice is only going to make them more stuck on this moment, and it's only going polarize the debate over right-to-die stuff... I expressed my ideas on this in the other thread, so won't repeat it all here, except to note that there seem to be two different defenses going on, which have slightly different connotations. One is that the husband should have the right to make this choice, and one is that her condition is such that she personally wouldn't want to be kept alive. If we go with the first defense, would the husband be able to stop the parents from feeding her if it didn't require an artificial tube (ie, if she were in a coma rather than a PVS)? If we go with the second, is hearsay a strong enough basis for such a decision?

As I said on the other thread, I agree that she's probably gone, and that the real tragedy happened 15 years ago, and that the congressional actions are overstepping bounds, but at the same time I am interested in the precedents this could set. I suppose ultimately it's important not to marry someone you wouldn't trust with this sort of decision! Unfortunately, plenty of people marry the wrong person... but I guess that's kind of their own fault.
posted by mdn at 2:58 PM on March 24, 2005

Ayup, marry someone who you trust to make decisions for you in your absence, or state in writing what you want is even better. Do it, do it now.
posted by edgeways at 3:27 PM on March 24, 2005

I'm hoping projects that everyone but management think should be killed are referred to as "Schiavoware."
posted by fandango_matt at 3:51 PM on March 24, 2005

Easter is coming... wait for the inevitable connections... visions/Virgin Mary spottings/bright lights... sigh.

On preview: fandango_matt, that amused me.
posted by mania at 3:55 PM on March 24, 2005

Faith in what?
posted by Smedleyman at 4:37 PM on March 24, 2005

is hearsay a strong enough basis for such a decision?

Just as an aside, I am so fucking tired of people throwing around the word "hearsay" as if they know what it means.

hearsay: Statements by a witness who did not see or hear the incident in question but heard about it from someone else. Hearsay is usually not admissible as evidence in court.

When M. Schaivo told the court(s) about a conversation he had with his wife, he was there, he heard what she said and testified to that. That's not hearsay. If you want to call the guy a liar, then do it, but don't hide suspicion behind a misunderstood word.
posted by Wulfgar! at 5:09 PM on March 24, 2005

there seem to be two different defenses going on, which have slightly different connotations. One is that the husband should have the right to make this choice, and one is that her condition is such that she personally wouldn't want to be kept alive

Please read Abstract Appeal's Terri Schiavo Information Page and acquaint yourself with the facts of the case. I don't mean to be rude, but I've seen lots of people ask questions that have already been answered.

From Abstract Appeal's Q&A (my emphasis):

Michael Schiavo did not make the decision to discontinue life-prolonging measures for Terri.

As Terri's husband, Michael has been her guardian and her surrogate decision-maker. By 1998, though -- eight years after the trauma that produced Terri's situation -- Michael and Terri's parents disagreed over the proper course for her.

Rather than make the decision himself, Michael followed a procedure permitted by Florida courts by which a surrogate such as Michael can petition a court, asking the court to act as the ward's surrogate and determine what the ward would decide to do. Michael did this, and based on statements Terri made to him and others, he took the position that Terri would not wish to continue life-prolonging measures. The Schindlers took the position that Terri would continue life-prolonging measures. Under this procedure, the trial court becomes the surrogate decision-maker, and that is what happened in this case.

The trial court in this case held a trial on the dispute. Both sides were given opportunities to present their views and the evidence supporting those views. Afterwards, the trial court determined that, even applying the "clear and convincing evidence" standard -- the highest burden of proof used in civil cases -- the evidence showed that Terri would not wish to continue life-prolonging measures.

This decision was upheld by Florida's Second District Court of Appeal, and the Florida Supreme Court declined to review the case.
posted by kirkaracha at 5:51 PM on March 24, 2005

Why shouldn't all patients in the same medical circumstances get the same care?

You're missing Kevin's point, amberglow, which focuses on cases of "clear medical futility" in which any treatment "serves no purpose other than to show the family that something is being done." I'd be surprised if socialized medical systems don't address (or begin to address) the issue in a similar way.

Sure, in America, if the family is rich hospitals may decide not to push the matter if "no conflicting need on the part of other patients exists," but that doesn't mean it's the right thing to do, or is something citizens should insist be provided to all.

Hospitals simply asked for the right to stop humoring misguided relatives who can't or won't accept medical reality. In the real world of scarce and expensive equipment, I don't see how you can argue that hospitals are morally obligated to provide that kind of "treatment," even if the rich can buy themselves a few more deluded months. Or years.
posted by mediareport at 7:09 PM on March 24, 2005

When M. Schaivo told the court(s) about a conversation he had with his wife, he was there, he heard what she said and testified to that. That's not hearsay.

But the person who made the actual choice (the judge) is responding to what someone else said she said. I just mean that it is one step removed. If we had a tape of terri schiavo saying she would want a feeding tube removed if she could not swallow on her own, we would have direct testimony, but as it is, we have what someone says she said.

Maybe the difference is, the definition says the witness has to be present at the "incident", but when the incident is someone saying something, that seems different from, for example, seeing a murder...

kirkaracha, a lot of supporters of the decision continue to bring up the argument that the husband should have the right to make decisions for her, so that is why I was responding to those claims.
posted by mdn at 7:31 PM on March 24, 2005

mdn, from what I've read the decision of the court was not based just on testimony of Mr. Schiavo, but also the testimony of others including Terri's mother which validated his testimony. I am sure all this was taken into account by the court when they made their decision(s).
posted by Eekacat at 10:48 PM on March 24, 2005

media, that's not what he said. He said that if the family could pay, the hospital would spend extra effort, even if futile. And they wouldn't do that for patients that couldn't pay.
posted by amberglow at 12:08 AM on March 25, 2005

You're wrong, amberglow; Keith posted a followup that makes his emphasis even more clear:

Patients, or the families of unconscious patients, often demand futile treatments - they cling to unrealistic hopes, or they want to “hold out for a miracle,” or they have heard of some exotic treatment or machine that they think will help them, and they insist on having it even when there is no known medical reason for doing so, and no factually-grounded expectation that it will help. One can certainly sympathize with the families in these cases, but that does not mean we must agree that there is any tangible benefit to the patient from the futile treatment.

Providing futile treatments is a problem...

It is unrealistic and unfair to allow a family to demand extensive resources that cannot realistically make a tangible difference in the patient’s clinical condition, simply because they choose to. When the family cannot pay for those resources, or is demanding resources that other patients need, the problem becomes more acute, but it is a problem even under the best of circumstances. Hospitals usually go to great lengths to accomodate families’ wishes, but there must be a limit, and when families will not constrain their own demands in the interests of fairness or simple realism, there must be a mechanism to make such decisions even against their objections. [emphasis mine]

It's also worth noting that extremely similar issues have arisen in recent years in Canada, home of a socialist, single-payer health care system many lefties (like me) would like to see in the U.S.:

In Canada today, physicians sometimes refuse to provide or threaten to withdraw life-sustaining treatment against the wishes of patients and their families. One such case has recently attracted national media attention. Andrew Sawatsky, a 79-year-old man with Parkinson's disease, was admitted to a long-term care facility after suffering a series of strokes. Because he was no longer able to speak for himself, his wife of 43 years urged physicians to "use all ... means to keep him alive if his medical condition deteriorates."1 Physicians and the hospital unleashed a two-punch response. Helene Sawatsky was, as the Globe and Mail reported, deemed "not competent to act for him since she disagrees with the medical experts," and the Public Trustee assumed legal supervision of the case. A do-not-resuscitate (DNR) order was unilaterally written on the patient's chart on the grounds that cardiopulmonary resuscitation (CPR) would be medically futile...

[F]utilitarianism — the belief that physicians may unilaterally refuse to provide treatment they believe to be useless — has gained considerable support among Canadian physicians. Bioethicists George Webster and Pat Murphy recently observed: "On any number of occasions ... clinicians have said to us that they no longer have to have the permission of patients to write a DNR order, if they think [CPR] would be 'futile.'"

Get it yet? It's overly simplistic to blame U.S.-style, profit-driven capitalism for Futile Care laws that attempt to deal rationally with the wrenching social and emotional issues surrounding the end of life.
posted by mediareport at 12:43 AM on March 25, 2005

I was originally worried that discussion of this law - which provides for medical care facilities to terminate treatment that is clearly “medically futile” (offers no tangible benefit to the patient)...
And, finally, there is of course the question of money: insurance companies may not pay for futile treatment, and patients’ families may not be able to pay, leaving hospitals with sometimes very large costs for intensive treatment that is justified by nothing more than wishful thinking. ...
When the family cannot pay for those resources, or is demanding resources that other patients need, the problem becomes more acute, but it is a problem even under the best of circumstances. Hospitals usually go to great lengths to accomodate families’ wishes,...
It’s certainly true that money is a factor in these cases - how could it not be? - but many other resource-availability questions are also factors, such as the need for staff services for other patients, the demand among multiple patients for scarce equipment or medication, and the availability of intensive-care beds and other facilities. ...
I also wanted to emphasize that the financial aspect of futile cases - that patients’ families may demand futile treatment that they themselves cannot pay for, and this is both unfair and detrimental to other patients if there is no way to deny their demands - is both relevant and only one of many determining factors in such decisions...

Throughout his followup it's all there. What am i missing? What he doesn't explicitly say is that that very expensive futile treatment IS being provided to others, but that's clear. We wouldn't hear anything about what they do for the Bushes, for instance, or Rockefellers, or Texas oil millionaires. No treatment would be denied them--futile or not. It's not even worth mentioning, apparently--in the news or in this guy's arguments.
posted by amberglow at 6:07 AM on March 25, 2005

Some people buy yachts with their bazillions, some keep Mom on a machine for thirty years...
posted by beth at 7:01 AM on March 25, 2005

What he doesn't explicitly say is that that very expensive futile treatment IS being provided to others

He addresses that point directly in both posts, amberglow; from the 2nd: "It is unrealistic and unfair to allow a family to demand extensive resources that cannot realistically make a tangible difference in the patient’s clinical condition, simply because they choose to."

He shares your disgust that some people can afford absurd luxuries, and wishes it would stop. His point here, though, is that medically useful treatments are not at issue in either of the case cited by lefties under the Texas law, and that many of them are overreacting by claiming the hospitals are killing patients simply because they don't have any money. Those lefties are ignoring the complexity of futile care issues, and in many cases simply assuming there'd be no need to address them under a non-U.S.-style system.

That's nonsense. The problem is acute even under socialist systems like the one in Canada. I'd love to see you address that point.
posted by mediareport at 10:09 AM on March 25, 2005

But the futility doesn't matter at all--if they're providing care for some and not others. This law does nothing to stop that, and in fact makes it easier for them to deny treatment--futile or not--to those without resources, and shove them off to a public hospital, or just let them die. If that little kid in Texas had been a millionaire's kid, they would have provided the futile care with no problem, and that's the problem (it's a sin, really).

In Canada, the rich go out of the system and fly to the US for some treatments and surgeries and stuff--which actually helps take the load off that system. They may have waits for surgeries and things, but the system doesn't depend on ability to pay--at all. Nor does it treat the poor person in one bed differently from the rich person in another.
posted by amberglow at 10:26 AM on March 25, 2005

makes it easier for them to deny treatment--futile or not--to those without resources

Whoa. These laws cover only futile care. I don't think anyone is dreaming of expanding them to cover care that actually has a chance of improving the patient.

People would (rightly) howl at that.
posted by beth at 10:45 AM on March 25, 2005

Who would know? They make the decision, and private hospitals are profit-making enterprises (Ask Frist about that part).

President Bush's Proposed 2006 Budget Cuts Funding for Traumatic Brain Injury Programs
posted by amberglow at 7:31 PM on March 25, 2005

In case anyone is still reading and confused by some of the terms:

Hydrocephalus simply means "water on the head." When it comes to CT scans it means that the amount of intracranial space seen to be occupied by cerebro-spinal fluid (CSF) is greater than normal.

This can be caused by increased volume AND pressure of the CSF, squashing the brain matter against the inside walls of the cranial cavity. This has a characteristic appearance.

Or, if brain matter is lost, something has to replace it. This something is CSF. As the neurons in the grey matter die, the white matter tracts connecting them to other neurons also die, and since this is what surrounds the ventricles, the ventricles become larger, occupying the space formerly occupied by white matter. We variously call this "volume loss" or "global atrophy." It has been called "hydrocephalus ex vacuo" (the ex vacuo to distinguish it from high-pressure hydrocephalus), but for obvious reasons this is a confusing term and many of us feel it should be done away with.

Don't even get me started about the separate entity, so-called "normal-pressure hydrocephalus," which is probably a combination of focal atrophy and abnormal, pulsatile fluid dynamics in the CSF. NPH is possibly the most confusingly-named thing I have ever run across and bedevils my medical students and residents to no end.
posted by ikkyu2 at 1:38 PM on March 26, 2005