Talk:Terri Schiavo case/Archive 51

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Recent anecdotal developments in patients with severely atrophied brain tissue

With reference to the persistent vegetative state diagnosis (not the ruling), I believe some creative author should incorporate the recent letter to the _Lancet_ (http://www.sciencedaily.com/releases/2007/07/070722203858.htm) to demonstrate how little we really know about the condition. It may well be that some form of therapy could have restored a measure of consciousness to her. 67.163.7.98 06:02, 24 July 2007 (UTC)

I agree. However, my edit was reverted, as explained in the next section.Ferrylodge 02:47, 26 July 2007 (UTC)

This article has had no shortage of "creative" editors. But aside from the clear policy violation discussed below (based on the fact that no reliable source has drawn such a connection), the two conditions are different. The French gentleman had a congential malformation which resulted in obstructive hydrocephalus. The brain atrophy was a result of the hydrocephalus. Terri Schiavo had hydrocephalus ex vacuo, in which the brain atrophy is the cause of hydrocephalus. No reasonable medically savvy person would conclude that one case has any bearing on the other. MastCell ^Talk 20:00, 27 July 2007 (UTC)

A reasonable, medically savvy person would not take such an extremely narrow view. The French gentleman's case demonstrates the unexpected capacity of a small remnant of brain tissue to support normal human functioning. Obviously there are differences between the French gentleman's case and Chiavo's case. For example, he is male and she was female. He is alive and she is dead. Obsessing about such differences is not medically savvy. A medically savvy person might conclude from the French gentleman's case that, "the brain is very plastic and can adapt to some brain damage occurring in the pre- and postnatal period when treated appropriately." A medically savvy person might find it "amazing" that "the brain can deal with something which you think should not be compatible with life." Those comments about the French gentleman's case are from Max Muenke of the National Human Genome Research Institute in Bethesda, Maryland, US.[1]Ferrylodge 20:18, 27 July 2007 (UTC)

Obviously, the male/female difference is largely irrelevant, but then you're raising it to obscure my point. A medically savvy person would "obsess" about the medical differences between the two situations. Did Dr. Muenke make any comment about Terri Schiavo, PVS, hydrocephalus ex vacuo, or hypoxic-ischemic encephalopathy? I mean, beyond a vague and general statement about the wonders of the human brain? If not, do his comments have any relevance to this talk page, or are you citing them in the interest of continuing an off-topic argument? MastCell ^Talk 20:38, 27 July 2007 (UTC)

The New Scientist article discusses "hydrocephalus." It does not narrowly focus on hydrocephalus ex vacuo, or on Dandy Walker Syndrome, or on any other particular kind of hydrocephalus. This is because the French gentlemen's case has broader ramifications for hydrocephalus generally, rather than just his particular circumstances. Scientific inquiry often examines particular cases to draw more general conclusions. Schiavo had massive hydrocephalus, which is a condition that rarely occurs in normally functioning people, and there is no reason why this article on Schiavo should not say so.Ferrylodge 21:22, 27 July 2007 (UTC)

The problem, in this case, is that the "more general conclusions" are not being drawn by scientists, but by you, a Wikipedia editor, in service of a POV which you've amply expressed above and in your earlier edits. I'm not really sure why I'm continuing this discussion, which is well enough off-topic and WP:OR-ish to violate the talk page guidelines, but I notice you selectively quoted the New Scientist paper here and below. Here are two things you left out:

• The Frenchman's CT is shown next to a normal head CT for comparison, just like Schiavo's in this article (blatant POV-pushing on the part of the New Scientist?)
• You rather snarkily quoted Dr. Muenke at length below, but left out his concluding remarks for some reason: "If something happens very slowly over quite some time, maybe over decades, the different parts of the brain take up functions that would normally be done by the part that is pushed to the side." (emphasis mine). Schiavo's brain injury happened in a matter of minutes, as a result of a cardiac arrest, and is very different from brain changes developing over decades. And her brain was not "pushed to the side" as in obstructing hydrocephalus; the fluid simply accumulated in the space left behind as her brain atrophied (hydrocephalus ex vacuo). MastCell ^Talk 00:12, 28 July 2007 (UTC)

Mastcell, you have carefully avoided saying whether you agree that massive hydrocephalus is a condition that rarely occurs in normally functioning people. That is all I wanted this article to mention, and that is not some sinister general conclusion that I wish to express in service of a POV. It is a very simple and relevant fact. Do you deny it?

I do not see where I "quoted Dr. Muenke at length below" --- much less where I did so "snarkily". If you're going to make assertions, please try to be accurate.

And, no, the New Scientist was not POV-pushing by showing a scan of a normal person. Quite the opposite; the New Scientist's contrasting scans of a normal person and the Frenchman illustrate correctly how massive the hydrocephulus can be in a normally functioning person. In this Schiavo article, the contrasting scans convey quite a different and incorrect message: that Schiavo's brain appeared to be very different from those of normally functioning people.

People reading this article should not be kept completely in the dark (and misled) about the fact that normal human functioning can rarely be supported by very little brain tissue; that is a scientific fact, and it is absurd to assert that it is irrelevant to Schiavo's predicament or personhood. I completely agree with you that Schiavo's brain was not "pushed to the side" as in obstructing hydrocephalus; the fluid simply accumulated in the space left behind as her brain atrophied (hydrocephalus ex vacuo). The fact still remains that she had an amount of remaining brain tissue comparable to that of the Frenchman, and it is simply unknown how the potential capabilities of that remaining brain tissue differed from that of the Frenchman.

In any event, instead of preventing readers of this article from becoming aware of the indisputable and relevant fact that massive hydrocephalus rarely occurs in normally functioning people, perhaps you ought to consider the possibility of elaborating instead of censoring. For example, the footnote could say: "'Man with tiny brain shocks doctors', New Scientist (2007-07-20). Gradual rather than sudden loss of brain tissue can have less profound symptoms."

As for what my POV may be, I would suggest that you not jump to conclusions.Ferrylodge 01:17, 28 July 2007 (UTC)

As to accuracy, you're right: you quoted Muenke at length above, not below, my comment. Apologies. As to the rest, we're going in circles and I'm not in the mood for more philosophical debate, so as there remains no source for the original synthesis you propose, I'll leave it there. MastCell ^Talk 04:01, 28 July 2007 (UTC)

You seem to be wikilawyering. I am not proposing any synthesis. I am proposing that the image caption include a statement that "massive hydrocephalus rarely occurs in normally functioning people, and gradual onset may have fewer symptoms than sudden onset." These are straightforward and relevant medical facts.[2]Ferrylodge 06:03, 28 July 2007 (UTC)

I'm here also to offer a third opinion. Ferrylodge, you're being a real dick. Jgro is right. You're being really immature. Instead of a stupid philosophical debate, lets make this simple. 1. There is no source, hence original research. 2. The article isn't about hydrocephalus. 3. That French guy had a different kind of hydrocephalus than Schiavo. And even with a generalization of a condition, the subsets of it are very different things. Is brain cancer the same thing as testicular cancer? Obviously not. Are they treated in the same way? Not necessarily. 4. The template says "This is NOT a forum to discuss the article's subject." You're talking about the possibility of recovery in hydrocephalus patients. Not hydrocephalus ex vacuo patients. The hydrocephalus happened AFTER she had brain damage. The Frenchman's brain damage happened BECAUSE of the hydrocephalus. They are two completely different things. 5. You are continuing an off topic argument, therefore, breaking talk page guidelines. 6. I've looked up what wikilawyering is. MastCell has done none of those things. Hence my assertion before: Ferrylodge, you're being a dick. Drop it. —Preceding unsigned comment added by ForestAngel (talk • contribs) 12:52, 20 December 2007 (UTC)

I really only came to this page to check out the proper spelling of Terri's name, but I saw the cleanup tag and thought I'd check out what that was about and then when I saw literally 50 edits back and forth by two people, I thought I'd offer a Third Opinion. I think the statement that massive hydrocephalus is a condition that rarely occurs in normally functioning people is a misleading digression with respect to Terri Schiavo. No one considered Terri, at the time of the CT scan, to be a normally functioning person. The dispute was fairly limited to whether she was in a persistent vegetative state or a minimally conscious state, or, in other words, how badly her brain was damaged, not whether or not it was damaged. The article does not discuss hydrocephalus but rather cerebral atrophy, which nevertheless was just one piece of supporting evidence for what was going on. The definitive tests were behavioral tests and the expert witnesses are not quoted as saying how they arrived at their diagnoses and what part (if any) the CT scan played in their determination. The proper place for a discussion of hydrocephalus and relevant medical facts is on the hydrocephalus page, to which the CT image caption provides a link. Jgro 08:28, 31 July 2007 (UTC)

Dandy Walker

This recent edit deleted a photo of a scan of a person with Dandy Walker syndrome. Currently, the scan of Terri Schiavo is only contrasted with a scan of a completely healthy person, and the dramatic difference is obviously meant to push the POV that Schiavo could not possibly have had any capacity to think. Why should only a scan of a healthy person be shown? Why not a scan of a brain similar to Schiavo's, but of a person who functions normally with a 75 IQ? Contrasting only with a completely healthy brain is POV pushing, IMHO.Ferrylodge 02:19, 26 July 2007 (UTC)

P.S. Using the Dandy Walker photo is not a case of improper synthesis. It's true that Dandy-Walker and hypoxic encephalopathy are different, but a healthy brain and hypoxic encephalopathy are also different. Moreover, merely displaying a photo of Dandy Walker syndrome does not advance a position, but merely allows readers to compare for themselves. I will restore the photo if there are no objections.Ferrylodge 02:41, 26 July 2007 (UTC)

All medical tests are interpreted with reference to what is normal. I would assume that's why the normal scan is there, since most readers will not be familiar with the normal appearance of the brain on a head CT, rather than ascribing it to POV-pushing and retaliating in kind. A comparison with Dandy-Walker makes no sense medically: saying that someone with a congential hydrocephalic disorder like Dandy-Walker can grow up to have an IQ of 75 is one thing. Saying a normal woman who suffers hypoxic-ischemic encephalopathy and resulting cerebral atrophy can regain an IQ of 75 because her brain scan looks like a Dandy-Walker patient's is absurd, but that's exactly what you're trying to imply. Saying you're not trying to advance a position by juxtaposing the two is disingenuous, given your edit summaries. Now, I don't feel especially strongly about the "normal" scan; I suppose it could be removed, though I think the image makes more sense with it there for comparison. But is there some reliable medical authority indicating that, because Schiavo's brain scan looked like that of a Dandy-Walker patient, she had a chance of regaining a functional IQ of 75? If not, it's improper synthesis. MastCell ^Talk 03:16, 26 July 2007 (UTC)

Even if the image of the normal brain were removed, the image of Schiavo's brain would still cause an untrained person (such as a Wikipedia reader) to say, "Gosh, she hasn't got a brain, therefore she must not be able to think." The image of the normal brain only magnifies this problem. I personally do not believe that, as Mastcell said, "Schiavo had a chance of regaining a functional IQ of 75". I don't think anyone believes that, and I don't think the image of the Dandy Walker case implies that. It simply illustrates that having a skull full of water doesn't necessarily determine whether a person can think or have consciousness or sentience. What's wrong with mentioning that?Ferrylodge 04:14, 26 July 2007 (UTC)

P.S. I have edited the caption of the existing scan accordingly.Ferrylodge 05:45, 26 July 2007 (UTC)

What's wrong with it? It's original research, as I don't see any reliable sources making the argument you're advancing. It also sets up a strawman - obviously, Schiavo's diagnosis and prognosis were not based on the CT in isolation, but juxtaposing the Dandy-Walker scan is an attempt to cast doubt on individual pieces of her diagnosis. Again, a person whose brain develops under conditions of congenital hydrocephalus has a very different outlook and prognosis that someone with a normally developed brain which is then destroyed by hypoxic-ischemic encephalopathy, though their scans might look similar. If you want to include content, then the onus is on you to demonstrate that a reliable source has somehow indicated it's relevant to Terri Schiavo's case. You haven't done that; hence it's OR, and what you're doing is not subtle. MastCell ^Talk 15:00, 26 July 2007 (UTC)

I should add that the "IQ of 75" apparently refers to this case, which as you are obviously well aware was considered utterly extraordinary and exceptional, so much so that it was published as a case report in Lancet. Implying, as you are, that this case is somehow relevant to Terri Schiavo, when it is well outside the norm even for people with Dandy-Walker, seems a huge stretch. MastCell ^Talk 19:51, 26 July 2007 (UTC)

Mastcell, this is very simple. Having a skull full of water doesn't necessarily determine whether a person can think or have consciousness or sentience. The unusual Dandy Walker syndrome case proves that fact beyond a shadow of a doubt. Instead, our article now gives the exact opposite impression. I regret that you don't acknowledge the misimpression that is currently promoted by our article.

The way our article now stands, it might as well say: "Most of her brain had been replaced with fluid. Not all people whose quality of life may be deemed 'too low to be worth living' have such clear medical diagnosis." That is the current implication of our article, and it is a wrong implication. Incidentally, I didn't make that quote up. See Toufe, Zeynep. "You Too Can Lose Weight and Keep it Off: The Terri Schiavo Success Story", CommonDreams.org (2005-04-01). Would you be willing to let me add anything into this article that mentions that replacing most of a person's brain with fluid can, in exceptional cases, still allow a normal life?Ferrylodge 20:08, 26 July 2007 (UTC)

Of course. Would you be willing to comply with Wikipedia's policies by providing a reliable source that makes such a connection in Terri Schiavo's case, so that it does not violate WP:SYN? You're currently connecting source A (head CT from guy with Dandy-Walker and an IQ of 75) and source B (Schiavo's head CT) to advance novel position C (that Schiavo's diagnosis or prognosis were incorrect). That's textbook original synthesis. Nonetheless, even if you want to go down that road, you're setting up strawmen. Schiavo's diagnosis was not based primarily on her CT. The scan was a piece of data, along with her clinical condition, EEG, etc. Schiavo's situation is not comparable to that of someone with Dandy-Walker just because you believe their head CT's look similar. MastCell ^Talk 22:31, 26 July 2007 (UTC)

The two different edits that I suggested did not advance any novel position C that Schiavo's diagnosis or prognosis were incorrect. They simply showed that people should not jump to conclusions based on the different-looking scans that are now in our article.Ferrylodge 22:43, 26 July 2007 (UTC)

Ah, so you were advancing a different novel position C: that people should not jump to conclusions based on the CT scan, because a gentleman in France with an completely different condition has an IQ of 75 and, to your eye, their head CT's look comparable. It still sounds like WP:SYN. MastCell ^Talk 22:57, 26 July 2007 (UTC)

The caption currently says:

Left: CT scan of normal brain; Right: Schiavo's 2002 CT scan, showing loss of brain tissue. The black area is liquid, indicating hydrocephalus.[1]

[1]Fins, Joseph and Schiff, Nicholas. “In Brief: The Afterlife of Terri Schiavo”, The Hastings Center Report (2005-09-01): “She had developed hydrocephalus ex vacuo, a condition marked by enlarged ventricles filled with cerebrospinal fluid, because of this profound loss of cortical volume.”

I would like to modify this as follows:

Left: CT scan of normal brain; Right: Schiavo's 2002 CT scan, showing loss of brain tissue. The black area is liquid, indicating massive hydrocephalus,[1] which rarely occurs in normally functioning people.[2]

[1]Fins, Joseph and Schiff, Nicholas. “In Brief: The Afterlife of Terri Schiavo”, The Hastings Center Report (2005-09-01): “She had developed hydrocephalus ex vacuo, a condition marked by enlarged ventricles filled with cerebrospinal fluid, because of this profound loss of cortical volume.”

[2]"Man with tiny brain shocks doctors", New Scientist (2007-07-20).

These two footnotes make clear that the Schiavo photo shows hydrocephulus, and that people with hydrocephalus rarely function normally. Any objection?Ferrylodge 02:39, 27 July 2007 (UTC)

Yes, the same one I made in the very first post: Dandy-Walker has nothing to do with Terri Schiavo's situation. The second footnote is out of place. If you feel it's absolutely necessary to discuss hydrocephalus ex vacuo in depth, then cite a medical article or text. MastCell ^Talk 05:29, 27 July 2007 (UTC)

Schiavo had profound hydrocephalus (fact A), according to a published reliable source. The fact that profound hydrocephalus rarely occurs in normally functioning people (B) is published by another reliable source. That's it. There is no attempt to join A and B together in this article to advance any position C. Readers are allowed to form their own conclusions based on a fuller set of facts, instead of based on a blatantly POV comparison of Schiavo's head to that of a completely healthy person. I am done for the time being with this matter, because I do not see any prospect of consensus.Ferrylodge 07:42, 27 July 2007 (UTC)

So you're saying that using a normal head CT as a reference for interpreting abnormal findings is "blatantly POV"? Have you brought this up with the American College of Radiology? Seriously, though, if your goal is to get the word out about hydrocephalus, then I question its relevance here, but you could at least cite a medical article or text on it rather than a sensational case report. MastCell ^Talk 17:44, 27 July 2007 (UTC)

The New Scientist article is not "sensational" nor is the Lancet article it cites; neither exaggerates or contains lurid details. If you think they're inaccurate, why not just come out and say why? Wikipedia is not a technical medical publication, and therefore citing an accurate synopsis for laymen is perfectly appropriate here. Right now, this Wikipedia article reads like a sensational case report, by inter alia inaccurately giving the impression (to a layman) that Terry Schiavo's hydrocephalic head appeared vastly different from the head of any normally functioning person. That impression is false, and that false impression is all I was trying to alleviate. Untrained readers here will be making an assessment about whether a human person potentially resided in Schiavo's head --- and we're deliberately making that look impossible, which is POV.Ferrylodge 18:37, 27 July 2007 (UTC)

No, neither Lancet nor New Scientist are sensationalistic (with rare exceptions in the latter case). The case is sensational, as are most individual cases which generate mainstream news coverage, and hence not even representative of people with Dandy-Walker, much less of anything relevant to Terri Schiavo. There is nothing "sensational", "false", or POV about indicating that Terri Schiavo's CT differed markedly from normal. Anyone who cares to make a judgement about Terri Schiavo's level of consciousness has by now long since done so; thus, your goal of using this article to help guide readers through that process, aside from being outside of the encyclopedic mission, is unecessary. MastCell ^Talk 18:44, 27 July 2007 (UTC)

There is nothing "sensational", "false", or POV about indicating that Terri Schiavo's CT did not differ markedly from that of a normally functioning person in a rare case; in contrast, it is POV to only indicate that Terri Schiavo's CT differed markedly from that of most normally functioning people. You are incorrectly omitting info about a rare and relevant case of hydrocephalus as if it were a "minority view" within the meaning of WP:Undue Weight. If you were correct that it's now "unnecessary" to guide readers by giving them a balanced set of information, then you may as well blank this article and write "what's done is done."Ferrylodge 19:16, 27 July 2007 (UTC)

As we seem to have entered the Twilight Zone here, I'm not going to respond or argue with you further, other than to reiterate my conviction that the edits and image you propose are entirely unsourced original synthesis in service of a POV. MastCell ^Talk 19:48, 27 July 2007 (UTC)

I agree that we have entered the Twilight Zone. Saying in this article that massive hydrocephulus "rarely occurs in normally functioning people" is a plainly correct and very relevant statement. There is nothing orginal about it.Ferrylodge 20:22, 27 July 2007 (UTC)

As I stated above in Talk:Terri_Schiavo#Recent_anecdotal_developments_in_patients_with_severely_atrophied_brain_tissue, I really only came to this page to check out the proper spelling of Terri's name, but since I'm here I'll offer a Third Opinion. I think having a CT image of a Dandy-Walker brain would be an irrelevant digression, as would be a footnote citing a man with a tiny brain. I disagree that the two CT images "push the POV that Schiavo could not possibly have had any capacity to think." They objectively document the difference between her CT scan and a normal one. No one disputed she had massive brain damage and nowhere in the article is the CT scan cited as evidence that she was not minimally conscious, which was the alternate diagnosis being pushed by Terri's parents. (It is stated that the CT scans were reviewed by the experts, but not what they derived from it. Obviously Drs. Maxfield and Hammesfahr looked at it and concluded it was not inconsistent with Terri being in a minimally conscious state.) If you want to add more weight to the argument that the PVS diagnosis was wrong, you could start by expanding the section recounting the expert testimony, giving the experts' reasoning and providing links to the research they referenced. Adding Dandy-Walker images is providing a counter-example to an argument that the article doesn't make, namely that one look at the CT scan should have settled this debate immediately. Jgro 08:59, 31 July 2007 (UTC)

Thanks for the third opinion here, and in the previous section. I have not suggested that the PVS diagnosis was wrong, as you indicated. Even if her PVS diagnosis was 100% accurate, it is still important to understand the ramifications of PVS. Does it completely preclude personhood, thought, and/or sentience? These questions straddle the line between morality and medicine. You say that the article doesn't make the argument that one look at the CT scan should have settled this debate immediately. Nevertheless, when a layman compares the scans, what does he conclude? That no one with such a brain scan could possibly have the barest hope of any meaningful existence, much less a normal life. And that conclusion from the images presented is 100% wrong... the proof being here. This link does not prove that Schiavo could have recovered, or that she didn't have PVS, but it does prove that people should not jump to conclusions about the valuelessness of her life based on her brain scan.Ferrylodge 09:14, 31 July 2007 (UTC)

Ferrylodge, you are arguing how a layman would interpret the CT scan without evidence. You certainly didn't conclude what you say the layman would. Are you an expert? I'm a layman and I didn't make that conclusion. The scan still shows a lot of brain left. If the PVS diagnosis was accurate, that would by definition mean she had no hope of a life of even minimal sentience. Whether or not such a life is a meaningful one is well beyond the scope of a CT scan. It's clear from the article that Terri's parents thought such a life was meaningful and I'm sure the CT scan didn't change Terri's parents' minds.

In other words, there's already plenty of material in the article to give people a reason to avoid jumping to conclusions. If readers are going to skip what on my computer is 19 pages of text to decide such a complex case based on 2 medical images, there's really not much hope that adding still more information is going to sway them. On the other hand, by rebutting an argument that is at most implied and which MastCell and I don't see in the images, you are asking the editors to make the implied argument (CT scan proves Terri could not possibly have the barest hope of any meaningful existence) explicit so they can both be weighed by the reader. But again, that argument didn't exist in the popular debate or, as far as I know, the medical testimony, so I don't think it belongs in the article. I agree that Terri's case raises questions that straddle the line between morality and medicine. I just think that a lay person who wants to resolve such a deep question by only looking at two medical images is so obviously uninterested as to be beyond the reach of a neutral forum such as Wikipedia. Jgro 10:48, 31 July 2007 (UTC)

Jgro, images are very powerful (hence the expression that they're worth a thousand words). When the Schiavo controversy was at its peak, those particular images were plastered everywhere: on the news, in the magazines, everywhere. And what were people saying about those images? Stuff like this: "Most of her brain had been replaced with fluid. Not all people whose quality of life may be deemed 'too low to be worth living' have such clear medical diagnosis."[3] I could find you lots of other quotes just like that one. Heck, when I first saw those images, I felt the same way. I thought, mistakenly, that no one could possibly have a meaningful life with so much of their brain missing. And I was wrong to jump to that conclusion. It still may well be that Schiavo did not have any hope of a meaningful life, but the big black areas in those images don't prove it, contrary to what LOTS of people said at the time, and contrary to what I myself assumed. I really feel uncomfortable having to write all these paragraphs about a matter that seems quite straightforward: adding a sentence and footnote to the caption would add material that is relevant, in the sense that it is both notable and interesting. Do you really think it's not notable or not interesting? Ferrylodge 11:18, 31 July 2007 (UTC)

Ferrylodge, I do really think it is not notable or interesting that Terri Schiavo's CT scan, to the casual observer, resembles someone else's who is alive and functioning with an IQ of 75. That is to say, it's really nothing to do with the subject of this article. I was serious when I suggested you add it to the article on hydrocephalus, because it may be interesting and notable in that context. I'd also point out that the quote you cited notes "most of her brain had been replaced with fluid" while the other articles/cases you want to cite as counter-evidence show cases where the brain either didn't grow in the first place or was compressed and/or displaced by fluid, which is very different than being replaced by fluid. Jgro 07:03, 6 August 2007 (UTC)

Image caption

I would like to add the following sentence to the caption of the brain scan image: "A massive degree of hydrocephalus rarely exists in normally functioning people, and such rarity has occurred if onset is gradual rather than sudden."

This is a factual statement, supported by this source: "Man with tiny brain shocks doctors", New Scientist (2007-07-20). It therefore is not unsourced. As for original synthesis, there is no joining of A and B together to advance any position C.

I would like to know what other people think. Mastcell already commented above about the caption, and I've adjusted the sentence in response to his comments.

As it stands, the brain scan images are misleading to a lay reader, who should be informed that the images --- in and of themselves --- are just as consistent with normal functioning as with complete and total disability. That is a major reason why I would like to add this sentence: "A massive degree of hydrocephalus rarely exists in normally functioning people, and such rarity has occured if onset is gradual rather than sudden."Ferrylodge 19:31, 28 July 2007 (UTC)

The scans are not misleading. They are not presented "in and of themselves." The text of the article indicates that they were used as one piece of data in a determination about Schiavo's status. Your statement that her scan is "just as consistent with normal functioning as with complete and total disability" is false; you've found one case in which someone with a totally different condition and a scan which only you believe to be similar to Schiavo's functioned normally. That instance was so remarkable that it was written up in medical journals and the popular press. All the necessary context is already in the article, no reliable source has discussed this point in relation to Schiavo, it is original synthesis, it lends undue weight to an unsourced argument about the relevance of her CT, and it is an attempt to insert POV into a very straightforward image caption. I welcome the opinion of other editors, since ours have been expressed at such length above. MastCell ^Talk 20:51, 28 July 2007 (UTC)

Of course, we should exclude any "remarkable" factual information that might not be politically correct.Ferrylodge 21:00, 28 July 2007 (UTC)

... or irrelevant. Sigh. Anybody else? MastCell ^Talk 21:08, 28 July 2007 (UTC)

As I stated above in Talk:Terri_Schiavo#Recent_anecdotal_developments_in_patients_with_severely_atrophied_brain_tissue, I think discussion of the consequences of hydrocephalus belongs on the hydrocephalus page which the caption already references. (Why is this one issue being discussed in 3 separate threads?) The purpose of a Wikipedia article is to provide a short and readable summary of the most relevant details of the topic. It has to exclude the vast majority of relevant factual information in order to achieve this goal. For example, virtually all of the actual text of the court rulings and briefs filed and transcripts of testimony are excluded from the article. No one argued that the CT scan was all the proof they needed to diagnose Terri and no one in the article argued that hydrocephalus was inconsistent with Terri being in a minimally conscious state. Every expert who viewed the CT scan and rendered an expert opinion also examined Terri in person. If Terri had reliably looked in the direction of people calling her name, no one claims they would have still made the diagnosis of PVS based on the CT scan. So beyond noting that the CT scan showed hydrocephalus and providing a link for more information on what that means, this article shouldn't go into it. It is an irrelevant digression.

As for the statement that Terri's CT scan is "just as consistent with normal functioning as with complete and total disability," that is simply untrue. While her scan might not be inconsistent with normal functioning (and I doubt an expert would make a determination based on the single image shown), it is far more likely that someone with such a scan is disabled rather than completely normal, as Ferrylodge acknowledges by use of the word "rarely" in the proposed caption. Jgro 09:55, 31 July 2007 (UTC)

Jgro, in long talk page discussions, it's common to break it up into separate sections. The usual practice is to go to the last section unless there's something particular in the previous sections that you want to comment about.

As I said above, images are very powerful (hence the expression that they're worth a thousand words). When the Schiavo controversy was at its peak, those particular images were plastered everywhere: on the news, in the magazines, everywhere. And what were people saying about those images? Stuff like this: "Most of her brain had been replaced with fluid. Not all people whose quality of life may be deemed 'too low to be worth living' have such clear medical diagnosis."[4] I could find you lots of other quotes just like that one. Heck, when I first saw those images, I felt the same way. I thought, mistakenly, that no one could possibly have a meaningful life with so much of their brain missing. And I was wrong to jump to that conclusion. It still may well be that Schiavo did not have any hope of a meaningful life, but the big black areas in those images don't prove it, contrary to what LOTS of people said at the time, and contrary to what I myself assumed. Those images were Exhibit A in front of the American public supporting pulling the plug on that woman. And maybe the plug should have been pulled. But those images need to be put in proper context.

As for my remark that Terri's CT scan is "just as consistent with normal functioning as with complete and total disability," you say that is simply untrue. And then in the very next sentence you say that "her scan might not be inconsistent with normal functioning." I don't understand why it's true when you say it but not when I say it.Ferrylodge 11:24, 31 July 2007 (UTC)

Ferrylodge, saying A is just as consistent with B as with C is very different from saying that A might not be inconsistent with B. "Just as consistent" means (or at least strongly implies) "just as likely." "Not inconsistent with" just means it's not impossible. A person having 10 fingers is not just as consistent with having 1 hand as with having 2 hands, although it is also not inconsistent with that person having only one hand (some birth defects result in arm stubs that have stubby fingers at the end).

As for the CT scans being "Exhibit A" in the campaign for pulling the plug at the time of the controversy, that wasn't my experience while I was following the case, but even setting that aside for the sake of argument, it's not here in this article put forth with any statement suggesting that it be interpreted for or against pulling the plug. And as I said in the previous topic, the quote you cite indicates that most of Terri Schiavo's brain was replaced with fluid, while the counter-examples you want to reference only show brains that were stunted in their growth or displaced by fluid, so they're not truly counter-examples anyway. Jgro 07:30, 6 August 2007 (UTC)

Just wanted to offer a fourth opinion here. I largely agree with MastCell here. It is original research (synthesis) to put a Dandy Walker syndrome picture here. Unless and until a reliable source is found indicating it is meaningful (for some reason) to compare the two then any comparisons should not be done. It sounds to me like a lot of unnecessary arguments are being done on this talk page (I admit I'm often also guilty of that). If you wish to debate whether the comparisons are meaningful, there are a lot of place you can do that, but this isn't one of them. If you are convinced your medical knowledge is sufficient that you understand why there is a meaningful comparison, then I suggest you write an article and try to get a reliable source interested in your article. In any case, it might be helpful to read WP:OR. It's quite clear last time I checked that putting an irrelevant point into the article, to lead the reader to put the two together even tho no reliable source does so is OR. Nil Einne 08:59, 8 October 2007 (UTC)

Also, my only personal OT comment is this. I agree as well that there is no reason to presume the images are going to sway the debate one way or another. I would suspect that the vast majority of people (definitely I was) were swayed by the experts who analysed her who concluded that she was in a PVS with no likelihood of improvement (experts who we hope understand her condition a lot better and have a lot more experience with these things then you and I). And also the recognisation that the removal of the feeding tubes was something that would have wanted had she been able to make the decision and supported by her husband, the person who she entrusted to make such decisions for her (a husband who had initially fully stood by and attempted to rehabilitate his wife until her accepted the diagnosis of her doctors). Arguments about 'personhood' etc are IMHO mostly irrelevant and offensive. Nil Einne 09:17, 8 October 2007 (UTC)

This article is too big

72KB. Too big. Where is there room for compression. That whole "Five years of family conflict" section looks like a good place to start. The pace of the whole article really bogs down there.--SallyForth123 11:19, 2 August 2007 (UTC)

Agreed. —Viriditas | Talk 02:08, 24 October 2007 (UTC)

Do not delete other peoples' comments. Instead, you should archive the older comments.Ferrylodge 17:53, 21 August 2007 (UTC)