Amongst all else that we cannot separate completely, this is yet another topic that falls into the not-so black and white model. Living cadavers, as referred to by medical authorities, seems to be a paradox in itself. A cadaver is associated with a biologically dead body so how is it possible that it could be living? In the case of brain death, that is exactly what the patient is: a living cadaver. Brain death is determined when an individual cannot sustain life without the support of an artificial ventilator, lacks of consciousness, and the end of brain activity in general. The situation of brain death is very similar to that of Persistent Vegetative State (PVS), although there is minimal consciousness in the patient.
Many people are familiar with the case of Terri Schiavo, a woman who suffered from a collapse due to cardiac arrest and ended up in PVS. She was placed on a feeding tube which brought about a load of legal controversy after her husband Michael Schiavo decided to take the feeding tube out despite three years of endless trials of rehabilitation with no progress. Terri's parents on the other hand were against the removal of the feeding tube. After reading Eric Krakauer's "To Be Freed from the Infirmity of (the) Age" and Margaret Lock's "Living Cadavers and the Calculation of Death", I saw some similarities between the two articles and the case of Terri Schiavo. It is difficult to determine who was right in her defense; her husband and his will to end her suffering or her parents and their faith and hope in the rehabilitation of their daughter. Granted, it was a very difficult situation for both husband and parents because of that human connection. A CT scan of her brain was shown in comparison to a healthy brain. In the image, Terri's brain showed a loss of significant brain tissue and liquid in the center of the brain, indicating hydrocephalus. Dr. Timothy Quill, a professor of medicine at the University of Rochester Medical Center states, "Computed tomographic scans [CT scans] of her brain eventually showed severe atrophy of her cerebral hemispheres, and her electroencephalograms were flat, indicating no functional activity of the cerebral cortex." (N Engl J Med, 2005) In order to be kept alive, Shiavo was sustaining life through a feeding tube. The topic is a very sensitive one and from where I stand, I do believe that Michael Schiavo made the right choice in removing her feeding tube, especially after the unsuccessful rehabilitation and stimulation of the brain stem procedures. With life-sustaining technologies, such as feeding tubes in this example, Krakauer mentions that, "... experience showed that life-sustaining technologies not only had an obvious potential benefits for patients but could also be very burdensome... the great gift of this technology brought with it the unforseen danger of exacerbating suffering." (Krakauer, pg. 382) However, Dr. Quill also goes on to explain that Schiavo was not suffering only because, "... the usual definition of [suffering] requires conscious awareness that is impossible in the absence of cortical activity." Personally speaking, the feeding tube itself was a burden to Schiavo. Though she had no conscious suffering, Schiavo was essentially on her way to becoming a living cadaver, especially due to the continuous death of brain tissue which would lead to her lose function of respiration.
Image Source: http://www.msnbc.msn.com/id/7328639/ns/msnbc_tv-the_abrams_report/
Michael Schiavo may have understood the concept that his wife suffered from an irreversible loss of brain function and that 15 years of being placed on a feeding tube was only prolonging her suffering. He may have realized that his wife was no longer is wife but just a body in which the loss of brain function was just reducing her down to a vessel, because what made her her was gone. "... the absence of the person is evident because of the a diagnosis or irreversible brain function, thus ensuring a permanent lack of consciousness, no awareness and no sensation of pain. In other words, a sensate, suffering, individual has ceased to exist because their mind no longer function." (Lock, pg. 141) As Lock continues on in her article, she interviews another doctor who finds consolation in his claim that, "... to remain in a severely vegetative state is much worse than to be dead." (Lock, pg. 142)
Dr. Quill is also the director of the Center for Palliative Care and Clinical Ethics at the University of Rochester Medical Center, so clearly he is educated in the field of the use of life-sustaining technology. He believes that the right choice was made for the removal of the feeding tube because it allowed her body to do what it needed to do: to die. "[Terri Schiavo's] family and the public should be reassured and educated that dying in this way can be a natural, humane process (humans died in this way for thousands of years before the advent of feeding tubes)." (N Engl J Med, 2005) Palliative medicine places a great significance on allowing death to happen. It is a response to suffering and determines if life-sustaining technologies will exacerbate it. In the case of Terri Schiavo, there technically was no suffering involved due to her lack of cognitive function. Palliative medicine would view this case with the feeding tube as prolonging a life that is not meaningful anymore, and therefore, "... acknowledges the inevitability of death and to let dying be."
Terri Schiavo had her feeding tube removed on March 18th, 2005 and died of dehydration (under palliative care) on March 31st, 2005. Although her case was muddled in legal issues and a tug-of-war between two families who wanted the best for her, it was obvious that her cognitive functions were not going to improve. Pinellas-Pasco Medical Examiner Jon Thogmartin, in charge of her autopsy, said, “The brain weighed 615 grams, roughly half of the expected weight of a human brain... this damage was irreversible, and no amount of therapy or treatment would have regenerated the massive loss of neurons.” (Associated Press, 2005)
Sources:
"Terri Schiavo — A Tragedy Compounded". The New England Journal of Medicine. Dr. Timothy Quill, 2005
http://www.nejm.org/doi/full/10.1056/NEJMp058062
"Schiavo Autopsy Shows Irreversible Damage". MSNBC.com, Associated Press, June 18th, 2005.
http://www.msnbc.msn.com/id/8225637/ns/us_news/
"Living Cadavers and the Calculation of Death". Margaret Lock, 2004
"To be Freed from the Infirmity of (the) Age". Eric L. Krakauer, 2007
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