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Thursday, April 14, 2005
THE OFFICIAL TERRI SCHIAVO LIST OF FACTS THAT ONCE AND FOR ALL DISPELS THE LIES AND MISINFORMATION PROVIDED TO YOU BY THOSE WHO CLAIM TO PRESENT THE TRUTH TO YOU . . . AND A WORD ON THE POPE
Dear Lionel Acolyte, Sycophant, Detractor, Lickspittle, Toady, Bootlick, Excoriant and Newsletter Subscriber:
And now, a few words on the Pontiff's passing. The Pope is now gone. He was simply nonpareil in his influence and effect on the world. He was a great man. He will be missed. And now, the Terri Schiavo mess. (What?! I promised a few words. What more can be said?)
I only rejoice in one thing - the fact that the Terri Schiavo case is over, the Schindlers have retreated and we, as a country, are free from the yoke of the media-addicted Schindler family, trying in a desperate and poetic vain to re-capsulize and re-package the same thought(s) that are announced by the impuissant and feckless chuffs of TV and radio talk. If there's one good thing about the Pope's death, it's that the media-frenzied Schindlers were bounced from the airwaves. There is a God!
As promised, this is the final word on Terri Schiavo, a case with no winners and certainly a voluminous list of losers. Let me explain in greater detail. As anyone who's listened to me knows, my greatest disgust with this case centered around the plethora of misinformation, manufactured facts, lies, distortions, misrepresentations and the patently biased statements advanced primarily by the bumper sticker, playbook, sound bite conservative (BSPSBC hereinafter) media hacks who advanced their own agenda in a not-so-thinly-veiled attempt to cater to their core base. Despicable, they are!
Let's look at the facts of the case and the sins committed by the usual suspects in the Schiavo media scrum - O'Reilly, Hannity, Savage, Rush, Glenn Beck (perhaps the most horrid) and, oh, yes, Joe Scarborough, the quintessential anti-intellectual bumpkin, who is the titular viceroy of that Potemkin village, "Scarborough Country." Let me be specific.
Contained infra is the operative statute that none of the aforementioned rubes ever read or understood. (Please note the emphases supplied denoted by [e.s.].) I also took the liberty of providing a number of associated links that you might find of interest - or not. This is THE law in Florida that was controlling at the time of Terri's case and is still the law there. Did I mention that none of the armchair legal scholars listed read the law? Oh, yes, forgive me; I in fact did.
There are some salient points to notice here anent the statute and the facts themselves.
There are no mentions of heroic or extraordinary measures; the operative language here is "life prolonging procedures." Got that, guys? Now this may be subject to further debate as to what such connotes. But Florida law clearly envisioned feeding and hydration tubes as such. This is clear law, bolstered by precedent. Can you say stare decisis? LIFE PROLONGING PROCEDURES. Why didn't O'Reilly and the like mention that? Gee, perhaps they never read or heard of the statute? No spin, my ass! No spin, no read, no truth.
N.B. The order of priority as to who has standing, both superior and subordinate, in deciding for an incapacitated patient. Note further that parents are fourth in line. Sorry about that, O'Reilly. Did you hear that, Sean? Hey, Joe Scarborough, get that?
The legislature envisaged not only those in a persistent vegetative state (PVS) but those who are "incapacitated or developmentally disabled," a far more plenary inclusion than any of our talkmeisters cared or bothered to notice.
There is no legally-recognized means for Michael Schiavo to have "given back" his wife to the Schindlers. She's not a loaf of bread. An order was entered by the 6th Circuit Court of Florida through Judge George Greer, an adjudication was had and therefore the role of the guardian and any subsequent guardian(s) is to enforce the judgment, viz. to see that the feeding and hydration tube is removed. That's it, plain and simple. I don't have to tell you how many times this case was appealed at both the state and federal levels. Even the U.S. Supreme Court rejected an appeal and denied review. By the by, Florida Circuit Court judges are not appointed by U.S. Presidents, including Bill Clinton. They are either elected or appointed by Florida Governors.
Terri suffered from a persistent, that is PERSISTENT, vegetative state (PVS). Simply put to all the neurologist wannabes (Hello, Hannity!), this is not a coma. Terri was gone; her cerebral cortex atrophied to the extent that spinal fluid replaced the contours of what was. What of this FACT didn't the Randall Terrys understand? What part of PVS didn't they get? Terri never tracked a balloon with her eyes as they claimed the FOUR year-old videotape may have suggested. Terri responded to stimulus and reflex, much like a patellar reflex. Her paralytic rictus never denoted or evinced smiling or the like. Her mouth was fused in a perpetual maw, susceptible to the neurologically-unenlightened as a smile.
Her brain stem was intact which accounted for respiration, heart beat and sleep cycles. Duh! This did not permit cognition, mentation or the like. This is axiomatic and requires a basic understanding of rudimentary medical knowledge.
What should be the most disturbing and frightening to all guardians of the Constitution and self-styled patriots who advocate the very hijacking of such were the grandstanding antics of House Majority Leader Tom DeLay in his futile attempt to divert attention from his own ethics investigation. DeLay pledged to "look at an arrogant, out-of-control, unaccountable judiciary that thumbed their nose at the Congress and president when given jurisdiction to hear this case anew." He further added that "the time will come for the men responsible for this to answer for their behavior." No words can adequately explicate the hubris this man possesses and the ostensible contempt he has for the Constitution and the doctrine of separation of powers that he swore to uphold.
When Karl Rove realized the political fallout of these statements and moves and after seeing firsthand the polling that indicated an overwhelming disagreement with DeLay et al. that the public had, GW, Jeb, Presidential wannabe Bill Frist and a host of the politically astute backed off, thus leaving DeLay alone in his attack on the judiciary. In fact the BSPSBC's also blew this call in failing to have a clue as to vox populi. This goes to the notion of the "playbook." You see, these conservative pundits never review an issue in a fact by fact, case by case analysis. Instead, they dust off the conservative playbook, turn to the issue at hand and spout and spew that which has been dictated. It's consistent with their "the sky is falling" mantra - that the "culture of life" is being subverted by a host of anti-American, godless heathens. Boy, did they miss this one.
In my conversations with callers, friends, pub associates and the like, I have not met anyone who would desire to be kept like a turnip indefinitely even though their wishes were not memorialized in an advance directive or living will. Not a soul! And who would? During the entire discussion, not one of these members of the conservative brain guild ever asked themselves or addressed the real question as to who would ever want this as a means of life. In fact most had executed living wills, thus indicating that they wouldn't want to end up like Terri. Ironic?
And here are the facts that aren't contained supra or infra - the controlling statute.
THE STATUTE NOBODY READ
Florida Statute 765.401 The proxy.--
(1) If an incapacitated or developmentally disabled patient [e.s.] has not executed an advance directive, or designated a surrogate to execute an advance directive, or the designated or alternate surrogate is no longer available to make health care decisions, health care decisions may be made for the patient by any of the following individuals, in the following order of priority, if no individual in a prior class is reasonably available, willing, or competent to act:
(a) The judicially appointed guardian of the patient or the guardian advocate of the person having a developmental disability as defined in s. 393.063, who has been authorized to consent to medical treatment, if such guardian has previously been appointed; however, this paragraph shall not be construed to require such appointment before a treatment decision can be made under this subsection;
(b) The patient's spouse;
(c) An adult child of the patient, or if the patient has more than one adult child, a majority of the adult children who are reasonably available for consultation;
(d) A parent of the patient;
(e) The adult sibling of the patient or, if the patient has more than one sibling, a majority of the adult siblings who are reasonably available for consultation;
(f) An adult relative of the patient who has exhibited special care and concern for the patient and who has maintained regular contact with the patient and who is familiar with the patient's activities, health, and religious or moral beliefs; or
(g) A close friend of the patient.
(h) A clinical social worker licensed pursuant to chapter 491, or who is a graduate of a court-approved guardianship program. Such a proxy must be selected by the provider's bioethics committee and must not be employed by the provider. If the provider does not have a bioethics committee, then such a proxy may be chosen through an arrangement with the bioethics committee of another provider. The proxy will be notified that, upon request, the provider shall make available a second physician, not involved in the patient's care to assist the proxy in evaluating treatment. Decisions to withhold or withdraw life-prolonging procedures will be reviewed by the facility's bioethics committee. Documentation of efforts to locate proxies from prior classes must be recorded in the patient record.
(2) Any health care decision made under this part must be based on the proxy's informed consent and on the decision the proxy reasonably believes the patient would have made under the circumstances. If there is no indication of what the patient would have chosen, the proxy may consider the patient's best interest in deciding that proposed treatments are to be withheld or that treatments currently in effect are to be withdrawn. [e.s.]
(3) Before exercising the incapacitated patient's rights to select or decline health care, the proxy must comply with the provisions of ss. 765.205 and 765.305, except that a proxy's decision to withhold or withdraw life-prolonging procedures [e.s.] must be supported by clear and convincing evidence that the decision would have been the one the patient would have chosen had the patient been competent or, if there is no indication of what the patient would have chosen, that the decision is in the patient's best interest.
(4) Nothing in this section shall be construed to preempt the designation of persons who may consent to the medical care or treatment of minors established pursuant to s. 743.0645.
History.--s. 5, ch. 92-199; s. 12, ch. 94-183; s. 32, ch. 99-331; s. 15, ch. 2000-295; s. 7, ch. 2001-250; s. 136, ch. 2001-277; s. 13, ch. 2002-195; s. 5, ch. 2003-57.
IF YOU'RE NOT TOTALLY BORED AND INSIST ON MORE INFORMATION,
PLEASE READ THE FOLLOWING.
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC305.HTM&Title=->2004->Ch0765- >Section%20305#0765.305
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC401.HTM&Title=->2004->Ch0765- >Section%20401#0765.401
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC401.HTM&Title=->2004->Ch0765- >Section%20401#0765.401
AND JUST WHEN YOU THOUGHT YOU'VE READ EVERYTHING ON PVS, SURPRISE!
Schiavo videotape misleading, experts say...
Last Updated: 2005-03-24 10:00:18 -0400 (Reuters Health)
WASHINGTON (Reuters) - The videotape that runs endlessly on television stations around the world shows an apparently smiling Terri Schiavo being caressed by her mother's loving hand. She seems to look deeply, even lovingly, into the off-camera eyes of her mother. Schiavo's parents and their supporters, including doctors in Congress, have used the tape as evidence the 41-year-old brain-damaged woman is at least occasionally aware of her surroundings and might even be revived from her condition. They are fighting to get her feeding tube reinserted against the wishes of her husband and legal guardian who says Schiavo would not want to be kept alive in that condition. But many experts agree the tape is a cruelly misleading trick of biology. "Pictures do lie," said Dr. Lawrence Schneiderman, a physician and bioethicist at the University of California, San Diego. "Every time they have done a videotaped neurological examination, the courts have reviewed them and said, 'Yes this woman is unconscious.' Those movements of her eyeballs are reflexive and have nothing to do with recognition." Studies of people whose cerebral cortices are damaged in the way Schiavo's is show that their eyes will respond to stimuli such as movement or a human face, but there is no way for them to be conscious of what they are seeing. Florida Gov. Jeb Bush, who has been part of the fight to prolong Schiavo's life, said on Wednesday a review of Schiavo's medical records by a neurologist for Florida's Adult Protective Services indicated she may have been misdiagnosed and was more likely in a state of minimal consciousness rather than in a persistent vegetative state. Such a condition, in which a patient slips in and out of consciousness, was sometimes mistaken for a persistent vegetative state, said Dr. Joseph Fins of New York Presbyterian Hospital/Weill Cornell Medical Center. But Schiavo was not in that state, Fins said. "I think now it can be argued that with the advent of minimally conscious state (as a diagnosis), that permanent vegetative state as a diagnosis becomes much more certain," Fins said in a telephone interview. It is almost certain that when someone suffers brain damage from a lack of oxygen, they are permanently vegetative, Fins said. Schiavo's brain was starved of oxygen after her heart stopped 15 years ago and most doctors who have examined her say there is no chance of recovery.
'UNNERVING PHENOMENON'
Dr. Ronald Cranford, a neurologist and bioethicist at the University of Minnesota Medical School, said reflexes can fool nonspecialists. "To the families and loved ones, and to inexperienced health care professionals, PVS (permanent vegetative state) patients often look fairly 'normal,'" Cranford said in a statement. "Their eyes are open and moving about during the periods of wakefulness that alternate with periods of sleep; there may be spontaneous movements of the arms and legs, and at times these patients appear to smile, grimace, laugh, utter guttural sounds, groan and moan, and manifest other facial expressions and sounds that appear to reflect cognitive functions and emotions, especially in the eyes of the family."
Dr. Timothy Quill of the Center for Palliative Care and Clinical Ethics at the University of Rochester in New York, said reporting about the case had confused people. "Distortion by interest groups, media hyperbole, and manipulative use of videotape have characterized this case and demonstrate what can happen when a patient becomes more a precedent-setting symbol than a unique human being," Quill wrote in a commentary published on Wednesday in the New England Journal of Medicine. "Anybody who has been around patients in a persistent vegetative state knows that it is an unnerving phenomenon because they alternate between sleep and wakefulness but that have no ability to interact," Quill said in a telephone interview. "It is difficult for families because it is very difficult to discern that."
Persistent Vegetative State vs. Minimally Conscious
Diagnosing a Patient's Level of Awareness Involves Complex Analysis, Tests
By AMANDA ONION
Mar. 23, 2005 - Whether a person is conscious or not may seem like a simple question, but neurologists say that determining a person's level of awareness can be a complex diagnosis based on signs that aren't always apparent to untrained eyes. It can even be a complicated call for trained eyes. "There is obviously no way to get inside another person's mind and know firsthand if they are awake," said James Bernat, a professor of neurology at Dartmouth Medical School in Hanover, N.H. "All we can do is introduce stimuli to the patient, do tests and reach a reasoned judgment." The American Academy of Neurology has a set of guidelines when it comes to determining the conscious state of a patient. The disputed case of Florida patient Terri Schiavo has thrown these medical gradations into public light -- where, researchers argue, the complexity of the diagnosis is sometimes lost. "The key point is this is a clinical judgment," said Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital, "and medical diagnosis is not an ideological activity."
Vegetative State Defined
Doctors have determined that Schiavo is in a persistent vegetative state. Bernat explains this is when "you have wakefulness, your eyes are open, but you are unaware. It can appear as if you are aware, but it's a state of unconsciousness." How can a patient be awake but unaware? Bernat says extensive damage to key parts of the brain -- namely, the cerebral cortex, the thalamus and/or connections between them -- can strip a person of his or her sense of awareness, while an undamaged brain stem keeps automatic activities, such as breathing, sleep and wake cycles and eye movement, going. "The cerebral cortex and thalamus are the most important regions of the brain in terms of personality and consciousness," said Bernat. "They're what differentiate us from lower animals in terms of our ability to have language and communicate." In the mid-1990s, a group of medical societies, including the American Academy of Neurology, published guidelines defining a vegetative state as "persistent" after a month. In this condition, patients show:
No evidence of awareness of self or environment and an inability to interact with others.
No evidence of sustained, reproducible, purposeful or voluntary behavioral responses to visual, auditory, tactile or noxious stimuli.
No evidence of language comprehension or expression.
Intermittent wakefulness manifested by the presence of sleep-wake cycles.
Sufficiently preserved brainstem function to permit survival (i.e. ,breathing) with medical and nursing care.
Bowel and bladder incontinence.
Variably preserved cranial nerve function and spinal reflexes; that is, the person may blink or smile.
The AAN considers those who have been in this condition for a year or longer to have "almost no probability of recovery." Ronald Cranford, a neurology professor at the University of Minnesota Medical School who has examined Schiavo, says there are a number of signs showing that her cerebral cortex has severe damage from the six-minute period in 1990 when her heart stopped and her brain was without oxygen. He said electroencephalograms, also known as EEGs or brain wave tests, of Schiavo's brain have revealed no activity. He has also reported that areas of her brain have shown shrinkage -- a sign of irreversible damage. Despite such findings, Bernat says it's easy to still believe a patient is aware. "It's common for family members to feel that their loved ones are aware. Part of it is motivated by the love they have for the person -- they want to interpret any indication as a sign that they are aware," he said.
'Minimally Conscious': Aware, but Compromised
David Gibbs, the attorney for Schiavo's parents, who wish to keep her on life support, has argued that Schiavo may be in a semiconscious state known as a minimally conscious state. This state of consciousness was first defined in 1996 as a transitional state indicating either improvement in consciousness or deterioration in the level of consciousness. In this condition, patients show occasional moments of awareness, such as attempting to communicate through speaking, writing or using yes/no signals (other than eye blinks). A recent study in the journal Neuroscience revealed that people in this state may be quite aware, although trapped in a body that is largely nonfunctioning. The researchers from New York Presbyterian Hospital used brain imaging technology to show that, when played audiotapes of their loved ones' voices, people in this state have brain activity similar to that of a fully conscious person. However, when no recording was played to the patients, their brain activity was less than half that of healthy people. "These are patients who show episodic consciousness," said Fins. "They may be saying a word or smile, but it is intermittent." An estimated 100,000 to 300,000 Americans have been diagnosed with being in this transitional state and some patients have emerged from the condition to reach a fuller consciousness. But neurologists are quick to point out that there are important distinctions between those in a semiconscious state and those in a persistent vegetative state. "The difference is between autonomic activity and episodic conscious activity," said Fins. "It's something that can be observed by a neurologist or detected on a brain scan. It's not a diagnosis that legislators can make after viewing videotapes."
Copyright (c) 2005 ABC News Internet Ventures
Dear Lionel Acolyte, Sycophant, Detractor, Lickspittle, Toady, Bootlick, Excoriant and Newsletter Subscriber:
And now, a few words on the Pontiff's passing. The Pope is now gone. He was simply nonpareil in his influence and effect on the world. He was a great man. He will be missed. And now, the Terri Schiavo mess. (What?! I promised a few words. What more can be said?)
I only rejoice in one thing - the fact that the Terri Schiavo case is over, the Schindlers have retreated and we, as a country, are free from the yoke of the media-addicted Schindler family, trying in a desperate and poetic vain to re-capsulize and re-package the same thought(s) that are announced by the impuissant and feckless chuffs of TV and radio talk. If there's one good thing about the Pope's death, it's that the media-frenzied Schindlers were bounced from the airwaves. There is a God!
As promised, this is the final word on Terri Schiavo, a case with no winners and certainly a voluminous list of losers. Let me explain in greater detail. As anyone who's listened to me knows, my greatest disgust with this case centered around the plethora of misinformation, manufactured facts, lies, distortions, misrepresentations and the patently biased statements advanced primarily by the bumper sticker, playbook, sound bite conservative (BSPSBC hereinafter) media hacks who advanced their own agenda in a not-so-thinly-veiled attempt to cater to their core base. Despicable, they are!
Let's look at the facts of the case and the sins committed by the usual suspects in the Schiavo media scrum - O'Reilly, Hannity, Savage, Rush, Glenn Beck (perhaps the most horrid) and, oh, yes, Joe Scarborough, the quintessential anti-intellectual bumpkin, who is the titular viceroy of that Potemkin village, "Scarborough Country." Let me be specific.
Contained infra is the operative statute that none of the aforementioned rubes ever read or understood. (Please note the emphases supplied denoted by [e.s.].) I also took the liberty of providing a number of associated links that you might find of interest - or not. This is THE law in Florida that was controlling at the time of Terri's case and is still the law there. Did I mention that none of the armchair legal scholars listed read the law? Oh, yes, forgive me; I in fact did.
There are some salient points to notice here anent the statute and the facts themselves.
There are no mentions of heroic or extraordinary measures; the operative language here is "life prolonging procedures." Got that, guys? Now this may be subject to further debate as to what such connotes. But Florida law clearly envisioned feeding and hydration tubes as such. This is clear law, bolstered by precedent. Can you say stare decisis? LIFE PROLONGING PROCEDURES. Why didn't O'Reilly and the like mention that? Gee, perhaps they never read or heard of the statute? No spin, my ass! No spin, no read, no truth.
N.B. The order of priority as to who has standing, both superior and subordinate, in deciding for an incapacitated patient. Note further that parents are fourth in line. Sorry about that, O'Reilly. Did you hear that, Sean? Hey, Joe Scarborough, get that?
The legislature envisaged not only those in a persistent vegetative state (PVS) but those who are "incapacitated or developmentally disabled," a far more plenary inclusion than any of our talkmeisters cared or bothered to notice.
There is no legally-recognized means for Michael Schiavo to have "given back" his wife to the Schindlers. She's not a loaf of bread. An order was entered by the 6th Circuit Court of Florida through Judge George Greer, an adjudication was had and therefore the role of the guardian and any subsequent guardian(s) is to enforce the judgment, viz. to see that the feeding and hydration tube is removed. That's it, plain and simple. I don't have to tell you how many times this case was appealed at both the state and federal levels. Even the U.S. Supreme Court rejected an appeal and denied review. By the by, Florida Circuit Court judges are not appointed by U.S. Presidents, including Bill Clinton. They are either elected or appointed by Florida Governors.
Terri suffered from a persistent, that is PERSISTENT, vegetative state (PVS). Simply put to all the neurologist wannabes (Hello, Hannity!), this is not a coma. Terri was gone; her cerebral cortex atrophied to the extent that spinal fluid replaced the contours of what was. What of this FACT didn't the Randall Terrys understand? What part of PVS didn't they get? Terri never tracked a balloon with her eyes as they claimed the FOUR year-old videotape may have suggested. Terri responded to stimulus and reflex, much like a patellar reflex. Her paralytic rictus never denoted or evinced smiling or the like. Her mouth was fused in a perpetual maw, susceptible to the neurologically-unenlightened as a smile.
Her brain stem was intact which accounted for respiration, heart beat and sleep cycles. Duh! This did not permit cognition, mentation or the like. This is axiomatic and requires a basic understanding of rudimentary medical knowledge.
What should be the most disturbing and frightening to all guardians of the Constitution and self-styled patriots who advocate the very hijacking of such were the grandstanding antics of House Majority Leader Tom DeLay in his futile attempt to divert attention from his own ethics investigation. DeLay pledged to "look at an arrogant, out-of-control, unaccountable judiciary that thumbed their nose at the Congress and president when given jurisdiction to hear this case anew." He further added that "the time will come for the men responsible for this to answer for their behavior." No words can adequately explicate the hubris this man possesses and the ostensible contempt he has for the Constitution and the doctrine of separation of powers that he swore to uphold.
When Karl Rove realized the political fallout of these statements and moves and after seeing firsthand the polling that indicated an overwhelming disagreement with DeLay et al. that the public had, GW, Jeb, Presidential wannabe Bill Frist and a host of the politically astute backed off, thus leaving DeLay alone in his attack on the judiciary. In fact the BSPSBC's also blew this call in failing to have a clue as to vox populi. This goes to the notion of the "playbook." You see, these conservative pundits never review an issue in a fact by fact, case by case analysis. Instead, they dust off the conservative playbook, turn to the issue at hand and spout and spew that which has been dictated. It's consistent with their "the sky is falling" mantra - that the "culture of life" is being subverted by a host of anti-American, godless heathens. Boy, did they miss this one.
In my conversations with callers, friends, pub associates and the like, I have not met anyone who would desire to be kept like a turnip indefinitely even though their wishes were not memorialized in an advance directive or living will. Not a soul! And who would? During the entire discussion, not one of these members of the conservative brain guild ever asked themselves or addressed the real question as to who would ever want this as a means of life. In fact most had executed living wills, thus indicating that they wouldn't want to end up like Terri. Ironic?
And here are the facts that aren't contained supra or infra - the controlling statute.
THE STATUTE NOBODY READ
Florida Statute 765.401 The proxy.--
(1) If an incapacitated or developmentally disabled patient [e.s.] has not executed an advance directive, or designated a surrogate to execute an advance directive, or the designated or alternate surrogate is no longer available to make health care decisions, health care decisions may be made for the patient by any of the following individuals, in the following order of priority, if no individual in a prior class is reasonably available, willing, or competent to act:
(a) The judicially appointed guardian of the patient or the guardian advocate of the person having a developmental disability as defined in s. 393.063, who has been authorized to consent to medical treatment, if such guardian has previously been appointed; however, this paragraph shall not be construed to require such appointment before a treatment decision can be made under this subsection;
(b) The patient's spouse;
(c) An adult child of the patient, or if the patient has more than one adult child, a majority of the adult children who are reasonably available for consultation;
(d) A parent of the patient;
(e) The adult sibling of the patient or, if the patient has more than one sibling, a majority of the adult siblings who are reasonably available for consultation;
(f) An adult relative of the patient who has exhibited special care and concern for the patient and who has maintained regular contact with the patient and who is familiar with the patient's activities, health, and religious or moral beliefs; or
(g) A close friend of the patient.
(h) A clinical social worker licensed pursuant to chapter 491, or who is a graduate of a court-approved guardianship program. Such a proxy must be selected by the provider's bioethics committee and must not be employed by the provider. If the provider does not have a bioethics committee, then such a proxy may be chosen through an arrangement with the bioethics committee of another provider. The proxy will be notified that, upon request, the provider shall make available a second physician, not involved in the patient's care to assist the proxy in evaluating treatment. Decisions to withhold or withdraw life-prolonging procedures will be reviewed by the facility's bioethics committee. Documentation of efforts to locate proxies from prior classes must be recorded in the patient record.
(2) Any health care decision made under this part must be based on the proxy's informed consent and on the decision the proxy reasonably believes the patient would have made under the circumstances. If there is no indication of what the patient would have chosen, the proxy may consider the patient's best interest in deciding that proposed treatments are to be withheld or that treatments currently in effect are to be withdrawn. [e.s.]
(3) Before exercising the incapacitated patient's rights to select or decline health care, the proxy must comply with the provisions of ss. 765.205 and 765.305, except that a proxy's decision to withhold or withdraw life-prolonging procedures [e.s.] must be supported by clear and convincing evidence that the decision would have been the one the patient would have chosen had the patient been competent or, if there is no indication of what the patient would have chosen, that the decision is in the patient's best interest.
(4) Nothing in this section shall be construed to preempt the designation of persons who may consent to the medical care or treatment of minors established pursuant to s. 743.0645.
History.--s. 5, ch. 92-199; s. 12, ch. 94-183; s. 32, ch. 99-331; s. 15, ch. 2000-295; s. 7, ch. 2001-250; s. 136, ch. 2001-277; s. 13, ch. 2002-195; s. 5, ch. 2003-57.
IF YOU'RE NOT TOTALLY BORED AND INSIST ON MORE INFORMATION,
PLEASE READ THE FOLLOWING.
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC305.HTM&Title=->2004->Ch0765- >Section%20305#0765.305
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC401.HTM&Title=->2004->Ch0765- >Section%20401#0765.401
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statu te&Search_String=&URL=Ch0765/SEC401.HTM&Title=->2004->Ch0765- >Section%20401#0765.401
AND JUST WHEN YOU THOUGHT YOU'VE READ EVERYTHING ON PVS, SURPRISE!
Schiavo videotape misleading, experts say...
Last Updated: 2005-03-24 10:00:18 -0400 (Reuters Health)
WASHINGTON (Reuters) - The videotape that runs endlessly on television stations around the world shows an apparently smiling Terri Schiavo being caressed by her mother's loving hand. She seems to look deeply, even lovingly, into the off-camera eyes of her mother. Schiavo's parents and their supporters, including doctors in Congress, have used the tape as evidence the 41-year-old brain-damaged woman is at least occasionally aware of her surroundings and might even be revived from her condition. They are fighting to get her feeding tube reinserted against the wishes of her husband and legal guardian who says Schiavo would not want to be kept alive in that condition. But many experts agree the tape is a cruelly misleading trick of biology. "Pictures do lie," said Dr. Lawrence Schneiderman, a physician and bioethicist at the University of California, San Diego. "Every time they have done a videotaped neurological examination, the courts have reviewed them and said, 'Yes this woman is unconscious.' Those movements of her eyeballs are reflexive and have nothing to do with recognition." Studies of people whose cerebral cortices are damaged in the way Schiavo's is show that their eyes will respond to stimuli such as movement or a human face, but there is no way for them to be conscious of what they are seeing. Florida Gov. Jeb Bush, who has been part of the fight to prolong Schiavo's life, said on Wednesday a review of Schiavo's medical records by a neurologist for Florida's Adult Protective Services indicated she may have been misdiagnosed and was more likely in a state of minimal consciousness rather than in a persistent vegetative state. Such a condition, in which a patient slips in and out of consciousness, was sometimes mistaken for a persistent vegetative state, said Dr. Joseph Fins of New York Presbyterian Hospital/Weill Cornell Medical Center. But Schiavo was not in that state, Fins said. "I think now it can be argued that with the advent of minimally conscious state (as a diagnosis), that permanent vegetative state as a diagnosis becomes much more certain," Fins said in a telephone interview. It is almost certain that when someone suffers brain damage from a lack of oxygen, they are permanently vegetative, Fins said. Schiavo's brain was starved of oxygen after her heart stopped 15 years ago and most doctors who have examined her say there is no chance of recovery.
'UNNERVING PHENOMENON'
Dr. Ronald Cranford, a neurologist and bioethicist at the University of Minnesota Medical School, said reflexes can fool nonspecialists. "To the families and loved ones, and to inexperienced health care professionals, PVS (permanent vegetative state) patients often look fairly 'normal,'" Cranford said in a statement. "Their eyes are open and moving about during the periods of wakefulness that alternate with periods of sleep; there may be spontaneous movements of the arms and legs, and at times these patients appear to smile, grimace, laugh, utter guttural sounds, groan and moan, and manifest other facial expressions and sounds that appear to reflect cognitive functions and emotions, especially in the eyes of the family."
Dr. Timothy Quill of the Center for Palliative Care and Clinical Ethics at the University of Rochester in New York, said reporting about the case had confused people. "Distortion by interest groups, media hyperbole, and manipulative use of videotape have characterized this case and demonstrate what can happen when a patient becomes more a precedent-setting symbol than a unique human being," Quill wrote in a commentary published on Wednesday in the New England Journal of Medicine. "Anybody who has been around patients in a persistent vegetative state knows that it is an unnerving phenomenon because they alternate between sleep and wakefulness but that have no ability to interact," Quill said in a telephone interview. "It is difficult for families because it is very difficult to discern that."
Persistent Vegetative State vs. Minimally Conscious
Diagnosing a Patient's Level of Awareness Involves Complex Analysis, Tests
By AMANDA ONION
Mar. 23, 2005 - Whether a person is conscious or not may seem like a simple question, but neurologists say that determining a person's level of awareness can be a complex diagnosis based on signs that aren't always apparent to untrained eyes. It can even be a complicated call for trained eyes. "There is obviously no way to get inside another person's mind and know firsthand if they are awake," said James Bernat, a professor of neurology at Dartmouth Medical School in Hanover, N.H. "All we can do is introduce stimuli to the patient, do tests and reach a reasoned judgment." The American Academy of Neurology has a set of guidelines when it comes to determining the conscious state of a patient. The disputed case of Florida patient Terri Schiavo has thrown these medical gradations into public light -- where, researchers argue, the complexity of the diagnosis is sometimes lost. "The key point is this is a clinical judgment," said Joseph Fins, chief of the medical ethics division of New York Presbyterian Hospital, "and medical diagnosis is not an ideological activity."
Vegetative State Defined
Doctors have determined that Schiavo is in a persistent vegetative state. Bernat explains this is when "you have wakefulness, your eyes are open, but you are unaware. It can appear as if you are aware, but it's a state of unconsciousness." How can a patient be awake but unaware? Bernat says extensive damage to key parts of the brain -- namely, the cerebral cortex, the thalamus and/or connections between them -- can strip a person of his or her sense of awareness, while an undamaged brain stem keeps automatic activities, such as breathing, sleep and wake cycles and eye movement, going. "The cerebral cortex and thalamus are the most important regions of the brain in terms of personality and consciousness," said Bernat. "They're what differentiate us from lower animals in terms of our ability to have language and communicate." In the mid-1990s, a group of medical societies, including the American Academy of Neurology, published guidelines defining a vegetative state as "persistent" after a month. In this condition, patients show:
No evidence of awareness of self or environment and an inability to interact with others.
No evidence of sustained, reproducible, purposeful or voluntary behavioral responses to visual, auditory, tactile or noxious stimuli.
No evidence of language comprehension or expression.
Intermittent wakefulness manifested by the presence of sleep-wake cycles.
Sufficiently preserved brainstem function to permit survival (i.e. ,breathing) with medical and nursing care.
Bowel and bladder incontinence.
Variably preserved cranial nerve function and spinal reflexes; that is, the person may blink or smile.
The AAN considers those who have been in this condition for a year or longer to have "almost no probability of recovery." Ronald Cranford, a neurology professor at the University of Minnesota Medical School who has examined Schiavo, says there are a number of signs showing that her cerebral cortex has severe damage from the six-minute period in 1990 when her heart stopped and her brain was without oxygen. He said electroencephalograms, also known as EEGs or brain wave tests, of Schiavo's brain have revealed no activity. He has also reported that areas of her brain have shown shrinkage -- a sign of irreversible damage. Despite such findings, Bernat says it's easy to still believe a patient is aware. "It's common for family members to feel that their loved ones are aware. Part of it is motivated by the love they have for the person -- they want to interpret any indication as a sign that they are aware," he said.
'Minimally Conscious': Aware, but Compromised
David Gibbs, the attorney for Schiavo's parents, who wish to keep her on life support, has argued that Schiavo may be in a semiconscious state known as a minimally conscious state. This state of consciousness was first defined in 1996 as a transitional state indicating either improvement in consciousness or deterioration in the level of consciousness. In this condition, patients show occasional moments of awareness, such as attempting to communicate through speaking, writing or using yes/no signals (other than eye blinks). A recent study in the journal Neuroscience revealed that people in this state may be quite aware, although trapped in a body that is largely nonfunctioning. The researchers from New York Presbyterian Hospital used brain imaging technology to show that, when played audiotapes of their loved ones' voices, people in this state have brain activity similar to that of a fully conscious person. However, when no recording was played to the patients, their brain activity was less than half that of healthy people. "These are patients who show episodic consciousness," said Fins. "They may be saying a word or smile, but it is intermittent." An estimated 100,000 to 300,000 Americans have been diagnosed with being in this transitional state and some patients have emerged from the condition to reach a fuller consciousness. But neurologists are quick to point out that there are important distinctions between those in a semiconscious state and those in a persistent vegetative state. "The difference is between autonomic activity and episodic conscious activity," said Fins. "It's something that can be observed by a neurologist or detected on a brain scan. It's not a diagnosis that legislators can make after viewing videotapes."
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