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medpundit |
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Sunday, November 16, 2003Comparing a patient with locked-in syndrome where a small area of injury in the pons or brainstem leads to complete paralysis with a patient in a persistent vegetative state (PVS) like Terri Schiavo who's entire cerebral cortex is irreversibly destroyed by anoxia is what I call comparing "apples to oranges". The locked-in patient has a cortex is still intact and hence the conscious mind is assumed to still be intact as well. The premise is further bolstered by the fact that these patients can still communicate via eye movements and blinking and it is in this way that Dr. Smith's literary hero Jean-Dominique Bauby (who suffers locked-in syndrome from a stroke to the brainstem) is able to "write" his introspective book "The Diving-Bell & The Butterfly ". Persistant vegetative state is, in fact, not the easy diagnosis that Rangel makes it seem. Jean-Dominique Bauby (who by the way died shortly after his book was published), was only able to move one of his eyes. By Rangel's logic, if he had been deprived of the use of both his eyes, he would have been dead. He certainly would have fit the criteria for being in a persistent vegetative state. There is no other objective means to identify the difference between the two states. Rangel, in fact, makes many more assumptions than I do. (In fact, I make no assumptions. I acknowledge the limitations of science in this case.) He assumes that PSV is an easy diagnosis. He assumes that anoxic damage to the brain obliterates all consciousness. He assumes that the MRI and CT scans tell us how well a brain functions. Even functional MRI and PET scans which measure the activity of brain areas haven't been perfected enough to do that. In such a state of uncertainty, in a situation as uncertain as Terri Schiavo's it's better to err on the side of life. Now, obviously, Rangel disagrees with that. But our differences lie in our philosophies, not in science. He's fooling himself if he thinks otherwise. But the most jarring, and baseless, of his accusations (and some of the email I've gotten) is that my stance is politically motivated. Yeah, that's right. I'm angling for the Republican presidential nomination. posted by Sydney on 11/16/2003 02:07:00 PM 0 comments 0 Comments: |
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