Doctors debate level of awareness

At the request of the state of Florida, a doctor observed Schiavo at her bedside.
By MALCOLM RITTER
AP SCIENCE WRITER
Is there any doubt that Terri Schiavo is in a persistent vegetative state? Yes, argue those fighting to keep her alive, including Gov. Jeb Bush. Doctors have sparred about this before in court, and the most recent ruling upheld the diagnosis.
The issue arose again this week when a neurologist, Dr. William Cheshire of the Mayo Clinic in Jacksonville, Fla., said in a court document that he believed it's more likely that Schiavo is in a "minimally conscious state" than a persistent vegetative one.
In a persistent vegetative state, a person is awake but not aware of oneself or the environment, and making only reflex movements. In a minimally conscious state, a person's behavior shows inconsistent but reproducible signs of consciousness. For example, a patient can occasionally follow simple commands, scratch the nose if it itches, or try to use an object like a comb for its correct use.
Dr. Cheshire was not available for an interview, the Mayo Clinic in Jacksonville said in a statement. It said that at the request of the state of Florida he observed Schiavo at her bedside and reviewed her medical history but did not conduct an extensive examination of her.
Responses
In his affidavit, Dr. Cheshire said Schiavo showed several behaviors "that I believe cast a reasonable doubt on the prior diagnosis" of persistent vegetative state. For example, he said, her face brightens and she smiles in response to the voice of familiar people such as her parents. Her eyes don't track moving objects consistently, but "she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time," he said.
"Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her," Dr. Cheshire said in the affidavit.
Bias
But the first part of that sentence, in fact, "starts to meet the criteria for vegetative state," said Dr. Gene Sung, director of the neurocritical care and stroke section of the University of Southern California.
Dr. Sung, who has not been involved with the case, said of Dr. Cheshire that "unfortunately his feelings, and possibly his religious beliefs, are affecting his medical decision." The Center for Bioethics and Human Dignity, which notes on its Web site that it was founded by Christian bioethicists, lists Dr. Cheshire as its director of biotech ethics.
Dr. Sung said the original diagnosis was based on repeated examinations by "very distinguished neurologists" and he called himself as comfortable with that diagnosis as he can be without examining Schiavo himself.
Dr. Roger Albin, a professor of neurology at the University of Michigan who also was not involved in the Schiavo case, agreed. "I don't think there's any reason to doubt the diagnosis... I don't think her evaluation could have been done better."
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