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Would More Brain Scans Have Helped Schiavo?

Neurologist Tells Congress High-Tech Brain Scans Can't Diagnose Mental Status
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April 6, 2005 -- Lawmakers criticized Florida doctors' care of Terri Schiavo Wednesday, suggesting that they did not use brain scan technology that might have helped determine whether the woman was in a true vegetative state.

But would it have helped?

At a Capitol Hill hearing, Sen. Richard Burr, a first-term Republican from North Carolina, complained that doctors "didn't exhaust every diagnostic tool" in determining the extent of Schiavo's brain damage before removing a feeding tube that was preserving her life.

Burr criticized doctors for failing to examine Schiavo with a PET scan, a sophisticated brain imaging machine capable of showing whether parts of the brain are active. He argued that the scan, known also as positron emission tomography, could have determined whether Schiavo was in a permanent vegetative state or was able to respond to her environment, as her parents claimed.

"It disappoints me that we didn't go to that length," said Burr.

Not Ready for Prime Time

Sen. Mike Enzi (R-Wyo.), chairman of the Health, Education, Labor, and Pensions Committee, questioned James L. Bernat, MD, an expert testifying on behalf of the American Academy of Neurology, on whether doctors should have used a PET scan in Schiavo's case.

Bernat told lawmakers that PET scans and similar diagnostic tests including functional magnetic resonance imaging (fMRI) are not yet well enough understood to diagnose a patient's mental status.

"They have not yet developed the necessary standardization to be used clinically," said Bernat, a professor of medicine at Dartmouth Medical School. "Right now they're not quite ready for prime time."

Advance Directives Message

The Schiavo case has left open the possibility of action from Congress on advance directives, including living wills.living wills.

Lawmakers have proposed changes including improving access to advance directives through the Medicare program or permanently giving federal courts jurisdiction over disputes similar to Schiavo's.

"Americans need to know how to prepare themselves for the unthinkable,prepare themselves for the unthinkable," Enzi said. "This hearing is about more than Terri Schiavo," he told Wednesday's panel.

Donald J. Schumacher, president of the National Hospice and Palliative Care Association, said his organization recently fielded more than 900 phone calls and 2,000 emails in a single day requesting advance directive forms.

"This may be the only good that has come out of the situation we've seen play out in Florida," he noted.

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