Coming Home

Presidential candidate, Dr. Ben Carson, was recently quoted in the Washington Post  regarding the starvation death undergone by the severely brain injured (and NOT brain dead) Teri Schiavo,

“We face those kinds of issues all the time and while I don’t believe in euthanasia, you have to recognize that people that are in that condition do have a series of medical problems that occur that will take them out,” he said. “Your job [as a doctor] is to keep them comfortable throughout that process and not to treat everything that comes up.”

When the reporter asked whether Carson thought it was necessary for Congress to intervene, he said: “I don’t think it needed to get to that level. I think it was much ado about nothing.”

 

While this has occasioned all manner of denunciations in pro-life quarters, Carson’s comments as a pediatric neurosurgeon are particularly potent, and merit a measured analysis and response.

Recalling that time, many news outlets carried the news that Schiavo was brain dead. If that was what was in Carson’s mind when he made his statement to WaPo, then his comments would appear to make clinical sense, though lacking in any warmth or sensitivity toward the family she left behind. Further, Catholic bioethics would agree that in the case of an active dying process, one would try to keep the individual comfortable, while not treating everything that comes up. But Terri Schiavo existed in a steady state for years. She wasn’t dying, nor was she dead.

There are many of us in science and medicine who contend that what is called, “brain death,” is so broad in its criteria that the majority so labeled are not actually dead yet. It has become a convenient set of criteria to help facilitate the organ transplant industry. The fact that many of these “cadavers” are administered anesthetics during the harvesting should be a rather obvious indication that something is terribly, terribly wrong with our diagnostic criteria for death, especially brain death.

It has always been the contention of Terri Schiavo’s family that they had physicians who challenged the diagnosis of brain death, and that these voices were largely ignored by the media and the courts.

What next becomes troubling about Carson’s comments is the notion that a “brain dead” person could have existed in an intact, dynamic physiological state for years. Dead people don’t track visual stimuli, something that Schiavo did and had captured on video. Doctors for her husband called it a “reflex,” though there is not balloon-tracking reflex that I have ever seen in medicine. In fact, one of the criteria for brain death is the absence of deep reflexes. So how a “dead” brain would be capable of processing visual stimuli and formulating commands to the motor neurons to move the head and eyes along with the side-to-side motion of the balloons, Carson did not say or care to opine.

Dead brains don’t see, don’t process what they can’t see, and don’t issue commands to follow what they can’t see.

They’re dead.

A world-renowned pediatric neurosurgeon certainly knows these things. He should also know that a brain alive enough to have brainwave activity, track visual stimuli, and maintain dynamic, integrated systems functioning is a brain that can’t be, “kept comfortable,” while it is being starved and dehydrated to death.

Carson knows this. He also knows that severely brain damaged people are not the same as people who are dead.

Perhaps the question for Carson in the next debate would be whether he thinks severely brain damaged people such as Terri Schiavo aren’t worth the expenditure of medical and financial resources. If so, then perhaps Dr. Carson might define for us the functionality and worthiness criteria he would have a national healthcare system use in determining when enough is enough.

When is it much ado about nothing, and when does the finality of a single human life degenerate into much ado about nothing?

This scientist would dearly love to know.