Tuesday, November 15, 2005

Terri Schiavo: A look back

I had the pleasure of hearing Mary Labyak, MSSW, LCSW of The Hospice of the Florida Suncoast speak at the Missouri Hospice and Palliative Care Association meeting this week. She spoke about her experiences as President of the hospice agency that was charged with caring for Mrs. Schiavo. Ms. Labyak's talk fit very well with a recent article in the Annals of Internal Medicine reviewing Mrs. Schiavo's case from three different perspectives. A firm knowledge of the legal, ethical, and medical perspectives of this case from fellow professionals and not the media is essential for anyone willing to call themselves a palliative medicine professional.

Regardless of your discipline in end-of-life care, the issues surrounding the case of Mrs. Schiavo are frequently recalled by patients, families and health care staff. One of my main functions is to overcome misconceptions about end-of-life care that are pervasive. By having a clear handle on the facts of this important case, we do a better service.

A quick review of the American Academy of Neurology’s requirements for persistent vegetative state is followed by a few important facts that discount the likelihood of improved functional status of a prolonged vegetative state:

Of the patients in the persistent vegetative state for more than 3 months after nontraumatic injuries, the probability of moderate disability or good recovery was 1% (99% CI, 0% to 4%), but for patients still in the persistent vegetative state at 6 months, this probability was 0%. No patient, even those with traumatic brain injury, has been reported to recover after a full year of being in the persistent vegetative state.
The authors are a lawyer, an ethicist, and a neurologist from Nashville. (Which reminds me of a good joke...) They do a concise and competent job reviewing this case for the health care professionals interested in end-of-life, palliative medicine and ethics.

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