- The Washington Times - Wednesday, March 23, 2005

Terri Schiavo’s medical condition is not particularly rare — an estimated 30,000 to 45,000 patients in the United States are being kept alive in persistent vegetative states through feeding tubes.

What is unprecedented in the 41-year-old Florida woman’s case is the long unresolved legal battle between members of her own family “” her husband and her parents”” as to whether she should live or die.

“Ninety-nine percent of these cases are resolved privately as a result of agreement between a patient’s family members and doctors. Court cases are a rarity,” said Dr. Scott Miller, a medical ethicist and internist at Allegheny General Hospital in Pittsburgh.

Dr. Miller said it’s a “common scenario” to have relatives who initially disagree as to whether a severely brain-damaged patient’s feeding tube should be removed to reconcile differences in a matter of months or a year or two and then withdraw the tube.

“Fifteen years later, it’s amazing that these two sides [in the Schiavo case] still can’t agree,” he said in a telephone interview.

No official figures are available as to the number of Americans who exist in persistent vegetative states. But the Brain Injury Association of America estimates the number between 30,000 and 45,000.

The group further says that it is most likely the number is in the “upper ranges” of that estimate.

At its Web site, the National Institute of Neurological Disorders and Stroke explains that persons in a persistent vegetative state “have lost their thinking abilities and awareness of their surroundings, but retain noncognitive function and normal sleep patterns” and can breathe on their own.

Mrs. Schiavo needs a feeding tube because she cannot swallow. Her parents and siblings say she responds to them and that her condition can improve with treatment. Mrs. Schiavo has been in her present condition since February 1990, when she collapsed in cardiac arrest at her Florida home, and her brain was without oxygen for approximately 10 minutes.

Her husband, Michael Schiavo, says he initially believed she would recover. But in 1997, he said that Mrs. Schiavo had told him before her illness that she would not want to be kept alive with feeding tubes. Since 1998, he has sought legal permission to withdraw her tube, and his wife’s parents have fought him every step of the way.

“In 15 years, there has been no other case like this one,” said Dr. Miller.

The American Medical Association’s policy on such cases since 1991 says that “advance directives (living wills and durable powers of attorney for health care) are the best insurance for individuals that their interests will be promoted in the event they become incompetent.” It recommends that patients designate a “surrogate decision maker.”

Without a designated proxy, a “patient’s family should become the surrogate decision maker,” the AMA says. When family members disagree, the policy recommends that institutional ethics committees make the decisions.

“Judicial review should be a last resort,” the AMA says.

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