The Powers That Blog

While we keep track of politics at a certain level, this is not a poliblog, nor a warblog. Maybe "eclectiblog" is a good description, as we note thoughts on topics from art to parenting to whatever comes to mind.

Tuesday, April 04, 2006

What's in a Diagnosis?

Bobby Schindler, Terri's brother, has some interesting thoughts on the diagnosis of Permanent Vegetative State (PVS). His basic premise is that the PVS diagnosis was deliberately invented so that society in general will grow more accepting of euthanising (read: killing) people suffering from brain damage at various levels. He points out that even people opposed to Terri's murder tended to argue the point of whether or not she was PVS as if we'd already bought the assumption that it's somehow OK to starve and dehydrate people who have been given that label.

Two questions come to my mind that Bobby doesn't raise, at least not in a direct sense. 1. If the PVS diagnosis was indeed invented by the pro-euthanasia movement as he claims, how is it that so many doctors have come to accept it as a legitimate diagnosis? 2. Just because doctors have accepted PVS as a legitimate diagnosis, why has society at large also accepted it?

It would take some fact checking to determine if indeed there was a conspiracy concerning the PVS diagnosis as Bobby claims, which I'm not going to do now because it really doesn't matter. What we do have now is a large number of doctors who regularly diagnose patients as being PVS. This somehow has given people charged with those patients' care permission to withhold food and water so as to bring about their deaths. It doesn't seem to matter that half the time a PVS diagnosis is handed down, it turns out to be wrong by the way PVS is defined. Patients who go for a time without responding at all to any stimulus have been known to one day wake up and begin responding to their surroundings in various ways, causing any honest physician to update the diagnosis of PVS. This calls into question the validity of the diagnosis in the first place. Maybe it wasn't exactly invented (as in a bunch of people held a meeting and came up with it), but it's not what you'd call scientifically or medically sound either. So why do doctors accept and use it?

To answer this question, we need to first consider the assumption that doctors only accept what has been scientifically and medically validated. A quick survey of medical history shows that doctors accept ideas and procedures for a variety of reasons besides rigorous scientific inquiry. The most recent example I learned about came from a childbirth class my husband and I are currently attending. As most of you know, the standard position for giving birth in an American hospital is the supine position, or flat on the back with feet up in stirrups. Yet anyone who knows about the mechanics of childbirth will say that is the absolute worst position for a woman to be in. It constricts important blood vessels which feed the uterus and the baby, and it compresses the pelvis making it very difficult for the baby to pass through the birth canal. This can lead to all sorts of birthing complications. The appropriate birthing position which women in all cultures throughout the centuries use most often is a squatting or standing position. The only position that could possibly be worse on a mother-to-be than the supine position would be to have the mother tied by her ankles and hanging upside down. Yet obstetricians in hospitals all across this great country continue to have their clients in that position.

And where did such a ridiculous way of handling birth come from? Well, there was this one French King, Louis XIV, the most self-absorbed and pompous king I've ever heard about. He had something like 14 palaces and spent most of his time lounging around in the lap of luxury. I have no doubt he was the stereotype of worthless nobility that the French revolutionaries had in mind as they brutally beheaded many subsequent French nobles. Louis XIV had a number of mistresses who bore him children. He wanted to watch them giving birth from behind a curtain and he wanted the best view possible, so he commanded them to lie on their backs while giving birth and made sure their caretakers enforced his wishes. Because noblewomen were birthing in the supine position, other women got the impression that was the way to do it and the supine position spread in popularity and remains so to this day. The reasons obstetricians like this position are not too dissimilar from Louis XIV's reasons: they want a good view of the proceedings. The main difference is they do not hide behind a curtain.

If doctors can accept and enforce an insane birthing position that started not from scientific research but from the voyeurism of a pompous French king, they are also vulnerable to accept ridiculous ideas on the other end of life as well. What I am saying is that their acceptance of PVS has nothing to do with the legitimacy of that diagnosis. It may be a brilliant diagnosis or a figment of some Kevorkian-wanna-be's demented imagination and it can be accepted by doctors either way. In other words, acceptance of a procedure or diagnosis or theory by the medical community means nothing.

So why is it that we as a society place so much trust in doctors? Why are we so ready to accept their word as law on so many things that affect our health? Why are we so willing to overlook atrocities committed by doctors in the past and assume that what they are doing now is right?Why is it that pro-lifers who firmly believe it is morally reprehensible for physicians to have anything to do with abortion or euthanasia are so willing to trust them on other issues? Why is it that when a doctor tells us to jump our only question is how high?

I honestly do not know how it is we came to place so much trust in the medical community. I do find that blind trust to be highly disturbing. If we hope to make any headway in reversing the culture of death as it is propagated by the medical community, we need to take a good hard look at this trust and ask ourselves whether or not it may be misplaced. We need to be willing to hold medical professionals accountable for how they treat our loved ones in all areas of healthcare. We can not cherry pick a few especially controversial issues to take the medical community to task on and assume innocence on everything else. If doctors can be so horribly wrong about a few medical aspects, we can't assume they are going to be right about everything else medical.


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