Column No. 61 By Steven Jonas, MD, MPH - May 18, 2005

This column is the last; some of you may be pleased to know, of my five part series on the Schiavo case.  As I noted previously, I believe that history will come to see it as the Dred Scott case of this era, whether or not there is in fact a Second Civil War.  Why Dred Scott, you might ask?  That case made the nation face the reality of what was in the Constitution about slaves and the nature of slavery.  It also made the nation face the reality that the South wanted to expand slavery into the Territories without limit.  Schiavo will, I believe, eventually make the nation face the true nature of Georgitism and the RRR, a major feature of which is their goal to force the expansion of their religious belief system into the mind of every American using the force of the criminal law.

A major part of the belief system of the Republican Religious Right is that science and the scientific method are the enemies of what it calls “faith.”  (I illustrated what “faith” means to them in my column last week.)  In addition, precisely because science attempts to explain the unknown in terms of the known while religion attempts to explain the unknown in terms of the unknown, science is an enemy of what the RRR calls “faith.”

Of course, the concept of “God,” theism, and science are not necessarily mutually exclusive.  After all, there is no reason to think that it was none other than God that endowed humankind with the ability to reason and, therefore, with the potential for eventually discovering the scientific method and its many positive uses.  But that is not how the avatars of the RRR think.  To them science, which uses observation, analysis, reason, and experimentation -- rather than simply “I say so” or “the Book says so,” or “I say the Book says so” – science is anathema to them.  For they want the rules to be set entirely by them.  These rules are based entirely on what they claim that particular book called the Bible (in, by the way, for the Old Testament a particular English translation of a Latin translation of a Greek translation of a Hebrew translation of an Aramaic text) says, and that part of it they reference, backed up by the use of the criminal law.

The Schiavo case provided the RRR with several different convenient avenues of attack on science.  Dr. William Frist himself, Republican Senate Majority leader and a former cardiac surgeon (and through his family holdings, a current medical businessman in, among other things, medical malpractice insurance), presumed to make a diagnosis for Terry Schiavo based solely on a two-year old video tape which had been severely edited.  The RRR also brings into the case a neurologist, who happens to be active in the My Right to Control Your Life movement, who looks at the same tape and pronounces that Ms. Schiavo was not in a persistent vegetative state.

Forget that neither physician saw the patient and were doing their “examining” from a video tape, an old and doctored one at that.  What is really going on here is an attack on medical science.  Both physicians chose to ignore the scientific test results that showed that Schiavo had no brain activity on repeated electroencephalograms (EEGs, measures of electrical activity of the brain that science has shown for decades occurs when one is thinking—and that thinking does not occur in the absence of such activity).  Test results also showed that she could not have had such activity, because that part of the brain that responsible for it had unfortunately disintegrated (shown by Computerized Axial Tomography, CAT, Scan).

Frist, the neurologist, and a few other right-wing physicians, chose to substitute for science what in our profession is called “clinical impression.”  Clinical impression was the best diagnostic tool available to medicine – in the 19th century, before testing and other instrumentation became available.  It is still essential in helping to decide what scientific evaluative processes to use, and then, given their results, to round out the picture of what is going on with a given patient.  However, clinical impressions alone can and do differ widely among various observers (just as interpretations of the Bible differ)

Frist’s clinical impression, even if it had not rested on the terribly shaky grounds that it did, was only that: his clinical impression, without reference to the science of laboratory testing.  Doing what he did as a physician in this case served exquisitely the political needs of the RRR: to continue their assault on science and science-based knowledge, to get away from the use of reason, which they hate with a passion, so that they may substitute the “word of God,” as of course they interpret it and tell us what it “truly” is.  In essence, this doctor (Frist) was saying “forget testing, forget science, just take my word for it; this is what this patient has or hasn’t.”  It is the medical version of how the Republican Religious Right wants from everyone in the country: obedience, on their say-so, concerning the conduct of their private lives and thought.  No reason, no science, and of course no freedom, just obedience – because the RRR says so.

Too easily overlooked, also, was that as a physician (forgetting his political motivation for doing what he did) Dr. Frist came with serious limitations in getting seriously involved with this case.  He is a former cardiac surgeon, not known for any expertise either in neurology or end-of-life care.  He made his pronouncements on Terri Schiavo’s condition based on those video tapes.  And he did make a diagnosis.  Aside from everything else, one has to wonder:  A) Does he have a license to practice medicine either in Florida or the District of Columbia?  B) The next time he needs some medical attention, will he have it done by a doc who is not a specialist in the matter afflicting him at the time and who is looking at a two-year old doctored video tape of him, not directly at him, and who totally ignores any laboratory test results?  One useful outcome of this whole episode is that we now indeed know what the term “doctored tapes” really means to make a current diagnosis, given that Dr. Frist was in on their use.

In making their rulings, in coming to their findings, in handing down their decisions, and over a very long period of time, the Florida courts relied on science.  They relied on a science-based definition of life, that in the presence of a non-functioning brain incapable of ever functioning again, simply having active cardio-respiratory, digestive, and excretory systems occupying a body did not constitute life.  They relied on science-based medical testing, EEG and CAT scan, not clinical impression, to come to the conclusion that Terri Schiavo was clearly brain-dead.  And so the virulent attack on the courts was not only an attack on the whole concept of an independent judiciary.  It was also part of the attack on science that is at the center of such RRR campaigns as their efforts to exclude the teaching of evolution in the public schools to their denial of the fact of global warming.

This is an issue to which we shall return from time to time.