The Terri Schiavo controversy centered on two conflicting observations. Physicians said neurological tests indicated she was in a persistent vegetative state, or PVS, in which the higher functions of her brain had clinically ceased. Opponents argued that video clips of Schiavo smiling at her mother with recognition, clearly proved otherwise. But doctors say even a brain-dead person can exhibit reactions normally associated with sentient people.
A PVS differs from a coma in that a coma is \a profound or deep state of unconsciousness,"" according to the Medical College of Wisconsin website. A coma generally ""results from head trauma or as a complication of an underlying disease."" However, the patient generally wakes up within two to four weeks, though perhaps with compromised brain function.
A patient in a PVS, on the other hand, has virtually no chance of recovery. To say a PVS patient is brain-dead is not completely accurate, since the brainstem, which controls breathing, heartbeat and sleep-wake cycles, can still function. The patient may open her eyes in response to stimuli, or even laugh or cry, but a CAT scan would reveal zero brain function. In other words, primitive parts of the brain might still react to the environment, but the brain is too damaged to register sensory awareness or sentience.
Still, those video clips of a smiling Schiavo are hard to ignore, but one doctor cautions reading too much into those fleeting moments. Leon Prockop is a neurologist at the University of South Florida who actually reviewed Schiavo's CAT scans.
""You can't take these clips out of the context of examining the individual and seeing a long monitoring film,"" he told The Associated Press. ""They don't give you enough information.""
Schiavo's family was intensely polarized by her situation, which doesn't surprise local hospice workers. When a young person is facing death while her parents are still alive, it threatens our view of the natural order of life, said Kathleen Ziemba, a social worker and bereavement counselor at HospiceCare in Madison.
""It's a terrible shock for the parents,"" she said. ""Often they'll say, 'I wish I could trade places.' They don't want to accept it. We try to bring about peaceful closure by helping the family focus on quality of life rather than quantity of life.""
Ziemba echoed the oft-repeated sentiment that the silver lining to the Schiavo case is that more people are signing advanced directives: a living will or a durable power of attorney form. A living will lets a person assert that he does not want life-sustaining treatment in the event of a terminal illness, and a durable power of attorney form enables him to name two agents to make medical decisions on his behalf. Ziemba encouraged people to make their wishes known early.
""The worst time to have the conversation about what the patient wants, is in the emergency room or intensive care unit,"" Ziemba said. ""It makes a world of difference for healthy grieving for the agent to know he did exactly what the patient would have wanted, to have no doubt he did the right thing.""
