uhh...actually, you have completely misinterepreted the difference between brain dead and persistent vegetative state. Brain dead means that the brain no longer sends signals to vital organs to function, such as, Lungs and Heart. With PVS, one can exit from a coma can be in a state of "wakefullness" but with no detectable awareness.

You brought up the Schiavo case, and I thought I would elaborate on the medical facts:

While video footage did indicate some level of responsiveness, however, it was debatable as to whether it was conscious and purposeful, 6 physicians (5 neurologists and 1 family physician) had independently determined that Schaivo was, in fact, in a persistent vegetative state. Expert testimony by a 7th neurologist indicated that the records in Schaivo's medical chart was consistent with PVS (15 years after the initial incident). Considering the length of time (15 years) in this state, it was highly unlikely for schiavo to return to a higher level of functioning

At the time of the incident, Schaivo was dead--medically defined as no heartbeat, no breathing: She was not breathing, had no pulse and no heart beat. She was defibrillated numerous times and her heart did restart, she was intubated and then switched to a tracheostomy--and eventually, basic brain functioning was restored so that she could breathe on her own. The technical term for her brain injury was "anoxic-ischemic encephalopathy." Meaning there was a disorder of the brain related to anoxia (lack of oxygen) and ischemia (lack of blood flow).



the image on the left is schiavo's brain, the image on the right is a normal functioning brain. The scan indicates extensive damage throughout all regions of her brain. Schiavo's brain weighed half the weight expected for a female of her age, 70% of cortical cells – critical to the functioning of the cortex – were completely lost.

As far as Schiavo's case was concerned, some of the testimony was based on the finding that americans do not want to live without hope of improvement. So with Schiavo, do we wait another 15-30 years for some type of medical procedure that might allow for a full recovery? She was on medicaid--do you want your tax money going to that? I don't want my tax money funding abortions, nor do i want my tax money to keep someone alive who most likely not recover fully (as in the case of Schiavo).

What this all boils down to is fear of letting go. Terry was just a shell. The Terry that people knew and loved was gone, and not coming back. This is not to say she should or should not have been taken off life support, it was about what her wishes would have been had she been able to make that decision for herself. Unfortunately, she wasn't, and someone else made it for her, much to the chagrin of others who disagreed. It's not a matter of who is right, but rather a matter of what is best. The inevitable will occur, we all just have to prepare for it.

There is a saying and it goes like this: "wants to make it, nobody wants to try. Everybody wants to see heaven, nobody wants to die." Just about sums it all up in a nutshell.

again, the media reports i've read said nothing about "brain dead." She was in a persistent vegetative state...

Show me some sources where they did say she was "brain dead" and i'll believe it.

No pathology reports performed indicated physical abuse--the records from the initial incident indicate this...go back and re-review the case report.

She was a shell of the person she once was--of course she was loved by her family--and of course the videos of her may indicate a level of responsiveness...but it was difficult to determine if they were purposeful responses. Her brain was half the size of a normal brain of someone of her age. She had no ability to communicate or self feed, however basic brain functions such as heartbeat and breathing were present. She could breath on her own, but she couldn't eat, bathe, urinate, or evacuate her bowels, nor did she have purposeful movements. It may also have been debatable on her response to pain.

Really, she was dead when the paramedics arrived at the scene and had severe brain hypoxia. There was no considerable measurement of of improvement beyond what her condition was at the time--she would not have gotten better, nor would she ever be able to go on walks with her husband/family, have and raise children, go to PTA meetings, go to church, go grocery shopping--things we take for granted. In other words, she would always remain 100% dependent, and unfortunately, there was no living will, no advanced directives, and the burden rested on her primary caregiver--her husband. So the lesson is be very clear about what life-saving methods, if any, you want, and at what point would it be futile, if you feel so inclined, to continue.

It all depends on how one does look at it...but what it does boil down to is fear of death. Everybody wants to make it, nobody wants to try, everybody wants to see heaven, nobody wants to die.

Of course, it would have been much easier if she was on a ventilator for for 9 years as was the case with Piergiorgio Welby--death would occur very quickly, but unfortunately she wasn't.

if you re-read what I wrote, I specifically stated life-saving. The Manion article you supplied specifically pointed this out in the very first line: "The feeding tube that has kept Terri Schiavo alive..."

It also goes on to state that the "common conception of someone in a vegetative state is that of a person who is unresponsive and brain dead." Correction: common misconception. Medicine is very clear about the difference between PVS and brain death. It is how the public interpreted it, which is incorrect. This may or may not have been based on their own perceptions

As far as articles are concerned, NYT has an archive of all articles since publication (1851)
http://www.nytimes.com/2005/0...
(states brain damage, not brain death)

http://www.nytimes.com/2003/1...
(again, brain damaged)

http://www.nytimes.com/2003/1...
(brain damaged)

http://www.nytimes.com/2005/0...
(tom delay states terry is not "brain dead"-- possibly a ploy used by certain key people to redirect the fact that she was severely brain damaged with no chance of recovery--also, the aritcle points out after investigation, no crime was committed in the initial incident that left terry in PVS)

http://www.nytimes.com/2003/1...
(headline reads brain dead, but first line of article says "brain damaged"--content from AP purchased for publication in NYT)

so there you have it...your inability to provide some direct source proof is invalid, and the sources you supplied are barely credible.

Extraordinary measures were taken after the initial incident--she was dead and received numerous rounds of meds and multiple defibrillations to restart her heart and was on life support. However, I made no mention that a feeding tube is an extraordinary measure--that was your statement. That said, any invasive measure, which a feeding tube is, to sustain life can be deemed extraordinary. (Note, I said "can be deemed"--meaning possibly--which is different that "is"--which implies factual)

The difference is this: Without a feeding tube, death is imminent. Without high blood pressure medication, it's a gamble as to when an MI and death will occur. Without insulin, it's a gamble as to when the body shuts down and death to occur--however, it may be somewhat easier to predict when DKA will occur, which then, if not treated, death will occur. These are just 2 examples of preventive measures--preventing the progression of disease which ultimately leads to death.

A feeding tube is a life-saving measure; without it, death will ensue with a certain immediacy--7-10 days, if not sooner.

Your sources are secondary, hence considered hearsay. Considering where they are from, it could be deemed that they were using the term "brain dead" as a smokescreen. Of course when some non-thinkers in the public hear "brain damage" and "persistent vegetative state" they may think "brain dead." But this is most certainly not the case, and your sources you provided, based on their, uh, non-neutrality, may have strategically inserted the term "brain dead" to incite their audience.

I checked your profile and under "education" you have "graduate/professional." If graduate means college graduate, that is one thing. If graduate means "graduate student" that is another. If you fall into the latter category, that's really great. That said, one of the key features of an advanced degree is being able to discern research material and understand the power of a primary source and should be able to differentiate between a primary source and a secondary or tertiary source. My cursory search of NYT--a primary source--indicated there was only 1 instance of "brain dead" as a term used--in a headline--however, the very first line, they specifically described Schiavo as "brain damaged." This content, however, was purchased from the Associated Press--many publications often source some of their content. It was your contention that the media continually and mistakenly referred to her as brain dead, yet you only provided sources of hearsay saying she wasn't "brain dead" as the media portrayed her to be. As a medical professional and someone with a couple of advanced degrees, i find your sources insufficient to support your assertions. Therefore, it is not unreasonable to question a questionable source. As I said, if you can substantiate with the primary direct source, not someone else's reporting of it, I will be more apt to believe it...NYT has all their articles digitally archived, so there is no reason for you not to be able to provide it.

As far as viewing the NYT articles, a free account can be set up so you can view them. However, without logging in, I can still view the links. Perhaps the Washington Post does as well, but I haven't checked. Time magazine does have a fairly extensive archive, but am not sure how far back they go.

Open letter to the President of the Republic, Giorgio Napolitano
From Piergiorgio Welby, Co-President of the Luca Coscioni Association
September 21, 2006

Mr President,

I am writing to you, and through you I am addressing also those citizens that will have the opportunity to listen to these words, to this cry of mine, which is not one of desperation, but one full of human and civil hope for our country.

Until two and a half months ago, my life may have been marked by rather serious difficulties, but I was able, at any time of the day, to use my computer and write, read, do research and chat with my friends on the Internet. Today, I seem to have fallen into an abyss from which there is no exit.

The day starts with the alarm of the lung ventilator device, while humidifying filter and the mouth catheter is changed, the day continues with the radio in the background, between frequent aspirations of tracheal secretions, the monitoring of oximetric parameters, personal cleaning, medication, and Pulmocare beverages. I used to get up at ten at the latest, and start writing on my PC. Today, my pathology, muscular dystrophy, is in such advanced state, that I cannot make any movements, and my physical balance has become extremely precarious. I get up at noon with the help of my wife and an assistant, but more and more frequently I find myself sitting without opening my computer, because I feel dead tired. I force myself on the chair to assume, for at least an hour, a position other than lying in bed. When I go back to bed, at times I fall asleep, but wake up in a fright, perspiring and more tired than before. I turn on the radio, but listen to it without paying attention. I cannot concentrate because I am constantly thinking on how to put an end to this life. Around six, I make another effort to sit, with the help of my wife Mina and my nephew Simone. Every day I get worse, weaker and more tired. After about an hour they take me back to bed. I watch TV waiting for the Tavor tablet so that I can fall asleep and not feel anything, hoping that I will not wake in the morning.

I love life, Mr President. Life is the woman who loves you, the wind through your hair, the sun on your face, an evening stroll with a friend. Life is also a woman who leaves you, a rainy day, a friend who deceives you. I am neither melancholic nor manic depressive. I find the idea of dying horrible, but what is left to me is no longer a life… it is only a stubborn and senseless obstinacy of keeping active the biological functions. My body is no longer mine… it is there, spread before doctors, assistants, and relatives. Montanelli would understand me. If I were Swiss, Belgian or Dutch, I could escape from this utter outrage, but I am Italian and there is no pity in Italy.

You are probably thinking, Mr President, that I am appealing for a “dignified death” for myself. But no. That is not it. And I am not talking only about my death.

Death cannot be “dignified;” it is life that should be dignified or decent, especially when it is growing weak because of old age or incurable illness. Death is something else. To define death by “dignified” euthanasia is to deny the tragic dimension of dying. It is tantamount to continuing to conceal and to distort death that, driven from home, hidden by a screen in hospitals, neglected in the loneliness of the homes for the aged, seems to be something that it is not. For what is death? Death is an indispensable condition for life. Aeschylus has written. “It’s hard to struggle. Decay is setting in, like a swelling flood. A blind ocean, a cesspool of pain surrounds me without even a glimmer of hope. There is no landing place. There is no landfall.”

And yet there is a landfall, but euthanasia is not a “dignified death” but an appropriate death, in the words of a man of faith, Jacques Pohier. Appropriate is that which “carries to the port;” for Plutarch, the death of young people is a shipwreck, that of old people a landing at a port, and Leopardi defines it as the only “place” where rest, not bound but secure, is possible.

In Italy, euthanasia is a crime, but this does not mean it does not “exist:” there are calls for euthanasia which are not heeded to because the doctors are afraid of being criminally prosecuted, and conversely, acts of euthanasia may be practiced without the informed consent of patients who are conscious. To grant a request for euthanasia, certain European countries, such as the Netherlands and Belgium, have introduced procedures that enable a “terminally ill” patient to plan with the doctor, the course for “landing” at an appropriate death.

A law on euthanasia is not the incomprehensible request of a few eccentrics either. Even in Italy, there were four or five bills already introduced in the last legislature. The association of anaesthetists, with great circumspection, has asked for a clearer law; the recent decision of the lapsed (and not yet renewed) national bioethics committee on the advance directives for healthcare revealed that it was impossible to exclude any eventuality of euthanasia in the event that the doctor adheres to the advance provisions drawn up by the patients. Even in the Church’s strict position there are certain openings, albeit within the confines of tradition, that allow for a heavy intervention with palliative cures and do not allow for intervention with disproportionate treatments that do not entail concrete benefits for the patient. Public opinion is always more aware of the inherent risks of leaving every decision about treatment up to the doctor. Many have helped a family member, a friend or a relative during an incurable or highly debilitating illness and have come to the decision, that if they were faced with the same predicament, they would not follow the same path. Others have witnessed the tragedy of a person in a persistent vegetative state.

When we face issues connected to the end of life, we are not dealing with a dispute as to who is in favour of life and who of death: all patients want to be cured, not to die. Those who share, with love, the course imposed by the illness on the loved one, want that person to recover. Between wishes and hopes, time passes relentlessly, and with the passage of times, hopes grow weaker and the desire to be cured becomes a desire to shorten the course of desperation before reaching that natural end that the reanimation technicians and machines that support or stimulate the vital function risk posting ever forward in time. As to our technical possibilities of keeping people alive, there will come a day when swarms of living dead will come out of reanimation centres, who will wind up vegetating for years. We will probably all have to learn that death is also a learning process, and merely a matter of falling into a state of unconsciousness.

His Holiness, Pope Benedict XVI, has said that “to the claim often put forward that it is necessary to resort to euthanasia in order to eliminate suffering, we must corroborate the inviolable dignity of human life, from conception to its natural end.” But what is “natural” in a reanimation room? What is natural in a hole in the belly and a pump that fills it with fats and proteins? What is natural about a hole in the windpipe and a pump that blows air into the lungs? What is natural about a body kept biologically functional with the help of artificial respirators, artificial feed, artificial hydration, artificial intestinal emptying, of death artificially postponed? I believe that it is possible to play with words for reasons of power or faith, but I do not believe that it is possible to “play” with the life and pain of someone else for the same reasons.

When a terminally ill patient decides to forego emotions, memories, friendships, and life, and asks to put an end to a survival that is cruelly “biological,” … I believe that his will should be respected and heeded with the compassion represented by the force and consistency of secular thinking.

I am aware, Mr President, that I have spoken to you, through my sick body, also of politics, and of objectives necessarily to be debated freely in Parliament, that do not call for your intervention or decision as to their merits. What I do take the liberty of recommending to you, however, is the defence of the right of each and every citizen to be apprised of the proposals, reasons, stories, wills and lives which, like mine are faced with this conundrum.

Luca Coscioni’s dream was to free research and to give a voice – in every sense of the term – to those who are ill. His dream was interrupted and it became known only after it was interrupted. So it is now up to us to dream for him too.

My dream, also in my capacity as co-president of the association that bears Luca’s name, my will, my request, that I wish to bring before all authorities, starting with the political and judicial bodies, is today clearer and more precise in my mind than ever before: to be able to obtain euthanasia. So that Italian citizens can have the same opportunity that is granted to Swiss, Belgian and Dutch citizens.

Piergiorgio Welby