Schiavo's condition difficult to evaluate

To answer life-and-death questions about Terri Schiavo, one first must decide who Terri Schiavo is today. Not who she was before she suffered oxygen deprivation and brain damage 15 years ago. And not who various family members with different viewpoints wish she was, Utah experts on end-of-life issues agree.

A Florida federal judge on Tuesday refused to order Schiavo's feeding tube reinserted and even as the 11th U.S. Circuit Court of Appeals in Atlanta deliberated into the evening Tuesday on whether to issue the order, two very different portraits are being painted of the Florida woman.

The parents and siblings of Schiavo, now 41, say she is responsive and loving, smiling and acknowledging them. They believe that medicine may in the near future provide solutions that would restore her at least partially to her former health.

Her husband and most medical experts say she now exists on a more primitive plane, her brain stem activity on automatic pilot to keep her breathing and her heart beating. Her brain, they say, has physically changed. She is no longer capable of thought or pain, living instead in what has been called a "persistent vegetative state." Most health experts believe it is very unlikely, if not actually impossible, that her prognosis will change.

Were she brain-dead, it would be simpler, because there are concrete objective tests to determine that. A persistent vegetative state relies on some tests, not conclusive, and a thorough clinical evaluation, said Dr. Sharon Weinstein, neurologist and palliative care expert at the Huntsman Cancer Institute and the University of Utah.

The 2nd District Court referred to a 1996 CAT scan of Schiavo in its determination, later cited by the Supreme Court of Florida: "The evidence is overwhelming that Theresa is in a permanent or persistent vegetative state. . . . She has cycles of apparent wakefulness and apparent sleep without any cognition or awareness. . . .

"By mid-1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition."

Utah medical experts, who point out that they have not personally examined Schiavo, doubt meaningful recovery is possible.

"It's highly unlikely, if not extremely unlikely that at this point she would ever recover what you and I would consider to be meaningful brain function," Weinstein said.