Trauma: September 2008 Archives
The media failed to educate the public about persistent vegetative state (PVS) in its coverage of the Theresa Schiavo case. This is the conclusion of neurologists who reviewed more than 1000 relevant articles published in the NYT, The Washington Post, or 2 local Florida papers during a 15-year time span. The results of their examination were published in this week's Neurology.
The investigators examined 1141 articles, most of which (75%) were journalistic reports, printed from 1990 to 2005 and found statements denying Schiavo's PVS diagnosis in 71 articles. Other articles falsely claimed brain death (12) or minimal consciousness (10), both inconsistent with PVS. Also some descriptions of Schiavo's behavior (typically obtained from Schiavo's parents or sympathetic individuals)—such as responding, reacting, or communicating—are inconsistent with PVS.
Nearly 30% of articles contained statements that Schiavo "might improve" or "might recover," virtually nonexistent possibilities after spending 15 years in a PVS.* A lower percentage of articles (26%) included statements that Schiavo would not improve or recover. The neurologists, overall, found that "explanations of the basic concept of PVS...were rare."
In an accompanying editorial, neurologist James Bernat—who testified before the United States Senate Health, Education, Labor, and Pension Committee on April 6, 2005, to discuss Schiavo's case—chides the media for "squandering the opportunity to educate the public about disorders of consciousness and end-of-life care." He notes that, instead, coverage fixated on the dispute between Schiavo's husband and her parents and the politicization of the case by ultra-right-wing conservatives in a kind of pro-life stance.
Bernat also reproaches TV media for repeatedly showing an edited videotape of Schiavo, provided by her parents, which was likely to suggest consciousness to an uneducated public. Perhaps most important, the media failed to clarify that Schiavo's desire not to have a feeding tube (at the center of the dispute between Schiavo's husband and her parents) was concluded after "exhaustive hearings," which were based on the testimony of numerous friends and relatives.
On March 31, 2005, Schiavo died 13 days after the court-approved removal of her feeding tube and 15 years after sustaining hypoxic-ischemic brain injury during cardiac arrest (presumed to be due to, ironically enough, hypokalemia as a result of an eating disorder).
The American Academy of Neurology provides criteria for the diagnosis of PVS or, more accurately in the case of Theresa Schiavo, permanent vegetative state.
* Recovery from PVS (due to nontraumatic brain injury) after 3 months is rare.
CT image of normal brain (left) and of Schiavo's brain (right) in 2002, showing marked atrophy with hydrocephalus (presumably ex vacuo). Reprinted, from Wikipedia, under fair-use law.
