NRL News

The Lancet Study and Terri Schiavo

by | Nov 11, 2011

By Dave Andrusko

  Late last night the prestigious British medical journal “The Lancet” published a very important study online that further demonstrated that patients diagnosed to be in a persistent vegetative state have either often been misdiagnosed or are sometimes consciously aware even if they are in a PVS. Several of you wrote back in response to our analysis ( which is one important reason for this follow-up.

I spent about an hour and a half today reading how media outlets covered the conclusions drawn by “Bedside detection of awareness in the vegetative state: a cohort study.” The New York Times’ two lead paragraphs are absolutely brilliant, touching most of the major points succinctly in only 145 words:


Three severely brain-injured people thought to be in an irreversible ‘vegetative’ state showed signs of full consciousness when tested with a relatively inexpensive and commonly used method of measuring brain waves, doctors reported Wednesday. Experts said the findings, if replicated, would change standards in treating such patients.


“Scientists have seen meaningful, responsive brain activity in such patients before, using a high-tech magnetic resonance imagingscanner. But the new study, posted online Wednesday by the journal The Lancet, is the first to demonstrate that clear signs of conscious awareness can be detected on an electroencephalogram machine by using an innovative strategy. The EEG is a portable, widely available unit that picks up electrical brain activity through electrodes positioned on a person’s head. Clinics and homes treating people with severe brain injuries are far more likely to have access to an EEG than to an M.R.I. scanner.”


Very, very impressive. And note that last sentence: EEG is so much easier to use and, by the way, much gentler with patients who are physically fragile.

As helpful as the study is there is an important caveat. While the Lancet study shows that EEGs could detect signs of consciousness in patients who had been diagnosed as “vegetative,” it does not follow that such patients are definitely unconscious if EEGs do not detect these signs.

As the study itself notes, the fact that the EEG did not pick up these signs of consciousness in 25% of the healthy and aware  patients (the “controls”) “shows unequivocally that a null EEG outcome does not necessarily indicate an absence of awareness.”

Burke J. Balch, director of NRLC’s Powell Center for Medical Ethics, commented,  “Many  patients, probably thousands, have had their food and fluids cut off and died, based on what we now know may well have been mistaken assumptions that they had lost all capacity for consciousness.  The Lancet EEG study, together with earlier functional MRI studies, holds out the hope that we may develop ways to communicate with aware patients who have routinely been diagnosed as ‘vegetative,’ much as today eye movements and blinks are used to communicate with some patients with paraplegia.”

Balch added, “Just as what were once generally accepted mental health diagnoses of ‘idiot’ and ‘moron’ have long been dropped from standard medical vocabulary, it is to be hoped that these studies will help lead to abandonment of the dehumanizing and inaccurate term ‘vegetative’ as an acceptable medical diagnostic term.”

This raises and obvious question which the Washington Post’s Rob Stein wrote about today:


“The research inevitably raises questions about patients such asTerri Schiavo, a Florida woman in a persistent vegetative state whose family’s dispute over whether to discontinue her care ignited a national debate over the right-to-die issue and congressional intervention in 2005. Schiavo’s brother, Bobby Schindler, said the new study highlights the limits of medicine in providing an accurate diagnosis.


“’Regrettably, Terri was never afforded these types of exams,’ Schindler wrote in an e-mail to The Washington Post. ‘Such testing could not have hurt Terri but could have helped her.’


“Schindler and others called for a reconsideration of such diagnoses.

“’These findings only reinforce our family’s contention that the PVS diagnosis needs to be eliminated — particularly given the fact that it not only dehumanizes the cognitively disabled, but it is being used in some instances to decide whether or not a person should live or die, as it was used in Terri’s case. None of us deserves to be deprived of food and water,’ he said.”


Two quick concluding points. To be clear the Schindler family adamantly denied that Terri was in a PVS. It was that diagnosis that made intervention to save their sister/daughter almost impossible.

Second, the Schiavo case, properly understood, was NEVER about the “right to die.” There were bogus assurances given by those who wanted her feeding tube removed that she had expressed a wish not to live if ever she was in a situation like that, assurances her family vociferously disputed.

Rather the case was about the duty to treat–to extend to a fellow human being the absolute minimum: food and fluids–and to extend to Terri’s family the right to take Terri home and care for her there.

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