Monday, June 27, 2005

On Blindness and Ethical Depravity

One more word on the Schiavo case. (I was going to write "one last word", but Jeb seems determined to make that hopeful statement false.)

Last Tuesday's New York Times printed this letter from a professor of neurosurgery at SUNY, Stony Brook regarding the Terri Schiavo autopsy:

     Terri Schiavo's autopsy report claimed that she was probably blind. Supporters of the decision to starve her to death have hailed this finding as bolstering their argument that withdrawal of her feeding tube was ethical.
     Their reasoning is hard to follow.
     If Ms. Schiavo was in a persistent vegetative state, blindness is a meaningless diagnosis. Only sentient people can be blind. And if she were blind, then she was sentient, and the diagnosis of persistent vegetative state was a genuinely fatal mistake.
     The lapses in logic aside, it's chilling to assert that it's more ethical to starve a handicapped person if that person is blind. This is what passes for ethics among advocates for euthanasia.

Let's start with what should be obvious. I don't know of anybody who thinks that "it's more ethical to starve a handicapped person if that person is blind." (Still less do I know of anybody who, holding such an opinion, would express it so baldly, but that's another question.) That the Times's correspondent could blithely assume this level of ethical depravity among what he calls "advocates for euthanasia" shows that he has no real interest in critically examining the issues surrounding Terri Schiavo's death. He knows where he stands, and he's on the side of the angels.

So, discounting the "ethical depravity" explanation, what accounts for the interest in the autopsy results regarding Terri's vision? Simply this: according to the Schindlers and their supporters, Terri couldn't have been in a PVS because she seemed to be able to track objects with her eyes. After the autopsy results were made public, Bill Frist gave a speech on the Senate floor in which he cited the description of PVS in Harrison's Principles of Internal Medicine:

There are always accompanying signs that indicate extensive damage in both cerebral hemisphere, e.g. decerebrate or decorticate limb posturing and absent responses to visual stimuli.

He then went on to point out that "in the video footage . . . she certainly seems to respond to visual stimuli." So Frist himself considered Terri's eye movements to be evidence against the diagnosis of PVS.

Well, it turns out that the operative phrase is "seems to respond". The movements of Terri's eyes in the video Frist refers to (a few brief moments culled from more than four hours of videotape) could not have been under her conscious control—and, therefore, could not have been evidence of sentience—because the feedback from her eyes had nowhere to go. According to the Medical Examiner who performed the autopsy, the "vision centers of her brain were dead."

One key argument against the PVS diagnosis—one reason, possibly, to question the judgment of her doctors that Terri Schiavo was no longer sentient—is thus shown to have been incorrect. Is this reasoning "hard to follow"? Only if you have no interest in actually trying to follow it.

The rest of the good doctor's letter, parsing the word "blind" so as to imply that the finding of blindness contradicts PVS, is just silly. I haven't read the autopsy report itself, so I don't know if it even uses the word "blind", but surely it doesn't matter: the point is that Terri Schiavo lacked the neurological prerequisites for vision.

In fact, a neuropathologist who consulted on the autopsy said that the condition of Terri's brain was "consistent with a persistent vegetative state." I'm betting that he was well aware that this condition included a nonfunctional visual cortex. I'm also betting he'd be pretty surprised to hear the argument that the death of her vision centers could be construed as evidence against PVS.

This is apparently what passes for logic at SUNY, Stony Brook.