Wednesday, March 23, 2005

Why can't there be a better diagnosis?

I haven't written much about the Terri Schiavo case because frankly I don't understand all the complexities nor do I have an extensive knowledge of medicine, bioethics, or law. I don't think that I can say much that is useful in any way. But since this is a place for uninformed bloviation, here goes... .

I saw this article at NRO that makes the argument that a proper diagnosis of Terri Schiavo's condition has not been made. Specifically, that the neurologists consulted by the author believe that Mrs. Schiavo's condition could not be properly determined by depending on a CT scan, and that a PET scan and an MRI scan should have been done on Mrs. Schiavo. Rev. Johansen (the author of the article) reported the view of one of them, Dr. Peter Morin, thus:
Terri’'s diagnosis was arrived at without the benefit of testing that most neurologists would consider standard for diagnosing PVS. One such test is MRI (Magnetic Resonance Imaging). MRI is widely used today, even for ailments as simple as knee injuries — but Terri has never had one. Michael has repeatedly refused to consent to one. The neurologists I have spoken to have reacted with shock upon learning this fact. One such neurologist is Dr. Peter Morin. He is a researcher specializing in degenerative brain diseases, and has both an M.D. and a Ph.D. in biochemistry from Boston University.

In the course of my conversation with Dr. Morin, he made reference to the standard use of MRI and PET (Positron Emission Tomography) scans to diagnose the extent of brain injuries. He seemed to assume that these had been done for Terri. I stopped him and told him that these tests have never been done for her; that Michael had refused them.

There was a moment of dead silence.

“"That’s criminal",” he said, and then asked, in a tone of utter incredulity: “"How can he continue as guardian? People are deliberating over this woman’s life and death and there’s been no MRI or PET?”" He drew a reasonable conclusion: “"These people [Michael Schiavo, George Felos, and Judge Greer] don’t want the information."”

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".”

Now it seems to me that the crux of the problem is a dispute over whether or not Terri Schiavo is in a Persistent Vegetative State (PVS). If PET scans and MRIs really are greatly superior diagnostic tools for understanding her condition, why not use them to develop the best information that can be obtained? Why not have more and better information to use in making what has to be a very difficult, gut-wrenching decision? At this point expense shouldn't be a factor, given that this fight has been going on for over a decade. Not to mention those who want to keep Terri alive undoubtedly would be willing to spring for the tests.

I'm not going to speculate as to why her husband doesn't want the tests. But if I were unfortunate enough to be the judge hearing this case, the first thing I would want is to get the best information possible. Therefore I would order her feeding tube restored pending completion and analysis of a PET scan and MRI on Mrs. Schiavo.

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