“I have no doubt, none at all, that we are
in the midst of a global warming, or,
as I prefer to call it, spring.”

- Dick Cheney

The Answer
by Rudyard Kipling

A Rose, in tatters on the garden path,
Cried out to God and murmured 'gainst His Wrath,
Because a sudden wind at twilight's hush
Had snapped her stem alone of all the bush.
And God, Who hears both sun-dried dust and sun,
Had pity, whispering to that luckless one,
"Sister, in that thou sayest We did not well --
What voices heardst thou when thy petals fell?"
And the Rose answered, "In that evil hour
A voice said, 'Father, wherefore falls the flower?
For lo, the very gossamers are still.'
And a voice answered, 'Son, by Allah's will!'"

Then softly as a rain-mist on the sward,
Came to the Rose the Answer of the Lord:
"Sister, before We smote the dark in twain,
Ere yet the stars saw one another plain,
Time, Tide, and Space, We bound unto the task
That thou shouldst fall, and such an one should ask."
Whereat the withered flower, all content,
Died as they die whose days are innocent;
While he who questioned why the flower fell
Caught hold of God and saved his soul from Hell.

(excerpt)
...The Over 35, geez. We used to joke about that, and make fun of those guys at tournaments. We’d bitch about it when they were on a better field or playing at a better time than us as if the good fields and the good playing times should be reserved for the real softball players. “Over 35,” we’d say. “Is that their age or their waist size?” Of course, my own waist size is now closer to 40 than I am, and my double-knits have crossed over that fine line between snug and tight, but the Over 35? A cold, bony finger starts picking at something deep inside me.

I play first base now; the outfield literally and figuratively behind me. The green grass of youth replaced by the dirt and rocks where I now stand, the turf uneven from the footprints of all who have come before me.

In the outfield the other team is always just a distant threat, almost impersonal. You don’t see their faces, you just watch the ball and run it down and throw it back in while they either circle the bases or turn and jog back to their bench. At first base they come close. I see their faces, the fire in their eyes, the flare of their nostrils. I can hear them, smell them as they stand at my back, kicking dirt, waiting for the next play. When the throw and my stretch beat them to the bag they don’t act discouraged. They snort as if it’s only a matter of time. “Next time,” they seem to say. “Next time, old man...”

An international labor union that has launched organizing drives at Wal-Mart is now taking aim at Target Corp.

The United Food and Commercial Workers has been quietly laying the groundwork for a major organizing campaign at Target's store in West St. Paul, which the union hopes will become the first of Target's 1,330 stores to unionize.

Over the past five weeks, the union has distributed hundreds of leaflets to West St. Paul residents claiming that Target pays substandard wages and health benefits to its workers. And Monday, UFCW Local 789 in St. Paul issued a statement protesting the $731,000 in local tax breaks that Target received to redevelop the West St. Paul store.

The goal is to create a groundswell of opposition to Target before the West St. Paul store reopens this fall as a SuperTarget, said Bernie Hesse, a union organizer with Local 789 of St. Paul, which represents 7,500 workers in the Twin Cities area.

"We want to have people in those stores, organizing, on the day it opens and we want the [West St. Paul] community to support us," he said.

Target spokeswoman Paula Thornton-Greear said that the company offers a wage and benefit package that is "among the best in the retail industry" and that workers don't need a union. "We don't believe that a union or any third-party representative would improve anything, not for our team members, guests or the company," Thornton-Greear said.

BEMIDJI, Minnesota (AP) — English teacher Neva Rogers finally had found a place where she felt needed, where she could give opportunities to poverty-stricken children who struggled with teen pregnancies, drugs and alcohol.

That place was Red Lake High School, where she died in a school shooting last week. While students crouched under their desks in a corner, Rogers stood out in the open and began to pray.

"God be with us. God help us," 15-year-old Ashley Lajeunesse heard Rogers say after she told students to hide as gunman Jeff Weise fired through a window and marched into the room.

The teacher spoke up. "God be with us," said Rogers. Provoked, the gunman shot her. He then aimed at another student, Chon'gai'la Morris, and asked, "Do you believe in God?"

"No," came the answer. The gunman turned away and found other targets, shooting and killing Dewayne Lewis, Thurlene Stillday, Chanelle Rosebear and Alicia White as they huddled on the floor. He left the room and exchanged fire with police officers, who were advancing down the hallway. Retreating into Rogers' classroom, he yelled, "I have hostages!" Then he turned a gun on himself and pulled the trigger. Silent throughout the ordeal, the surviving students began to scream.

He also wrote of strange tingly feelings that woke him out of a sound sleep and dark visions of small creatures sitting by his bed that he would reach out to touch before falling unconscious. But whatever demon finally compelled Weise to act also made him plan his assault.

JOHANNESBURG, South Africa (Reuters) — Animal rights groups have begun fresh public campaigns timed for the start of the annual seal hunt off the coast of Canada this week and suggestions that South Africa may kill elephants for population control...

Canada said last week it would allow hunters to kill 320,000 young seals on the ice floes off its Atlantic coast from Tuesday and earlier this month a South African official told Reuters that national parks were leaning towards an elephant cull.

Anti-hunt activists held protests earlier this month in 50 cities around the world. Groups like the Humane Society International (HSI) said they would press ahead with calls for a boycott of Canadian seafood.

"We are joining in a specific boycott of Canadian seafood products, focusing on snow crabs, and starting on Tuesday, the day the first seal is killed," HSI vice-president John Grandy told Reuters by phone from the eastern Canadian province of Prince Edward Island.

Big beasts strike a chord with the public, making them the perfect "poster animals" for conservationists who have branded Canada and South Africa as outposts of wildlife tyranny.

"The things that seem to attract the layman the most is the big animals. I think people... connect to them," said Chris Hails, the Global programs director for WWF International...

...national park authorities say the burgeoning elephant population in the flag-ship Kruger National Park has made culling a necessity. The park has an estimated 12,000 ponderous pachyderms, well above the estimated "carrying capacity" of around 7,000.

Animal rights activists are horrified at the prospect of a return to culling elephants, which involves the herding and shooting of entire family groups.

Based on my review of extensive medical records documenting Terri’s case over the years, on my personal observations of Terri, and on my observations of Terri’s responses in the many hours of videotapes taken in 2002, she demonstrates a number of behaviors that I believe cast a reasonable doubt on the prior diagnosis of PVS. These include:

1. Her behavior is frequently context-specific. For example, her facial expression brightens and she smiles in response to the voice of familiar persons such as her parents or her nurse. Her agitation subsides and her facial demeanor softens when quiet music is played. When jubilant piano music is played, her face brightens, she lifts her eyebrows, smiles, and even laughs. Her lateral gaze toward the tape player is sustained for many minutes. Several times I witnessed Terri briefly, albeit inconsistently, laugh in response to a humorous comment someone in the room had made. I did not see her laugh in the absence of someone else's laughter.

(Read the other six observations:)

2. Although she does not seem to track or follow visual objects consistently or for long periods of time, she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time and occasionally follow with her eyes at least briefly as these objects move from side to side. When I first walked into her room, she immediately turned her head toward me and looked directly at my face. There was a look of curiosity or expectation in her expression, and she maintained eye contact for about half a minute. Later, when she again looked at me, she brought her lips together as if to pronounce the letter "O," and although for a moment it appeared that she might be making an intentional effort to speak, her face then fell blank, and no words came out.

3. Although I did not hear Terri utter distinct words, she demonstrates emotional expressivity by her use of single syllable vocalizations such as "ah," making cooing sounds, or by expressing guttural sounds of annoyance or moaning appropriate to the context of the situation. The context-specific range and variability of her vocalizations suggests at least a reasonable probability of the processing of emotional thought within her brain. There have been reports of Terri rarely using actual words specific to her situational context. The July 25, 2003 affidavit of speech pathologist Sara Green Mele, MS, on page 6, reads, "The records of Mediplex reflect the fact that she has said 'stop' in apparent response to a medical procedure being done to her." The Adult Protective Services team has been unable to retrieve those original medical records in this instance.

4. Although Terri has not consistently followed commands, there appear to be some notable exceptions. In the taped examination by Dr. Hammesfahr from 2002, when asked to close her eyes she began to blink repeatedly. Although it was unclear whether she squeezed her grip when asked, she did appear to raise her right leg four times in succession each time she was asked to do so. Rehabilitation notes form 1991 indicated that she tracked inconsistently, and although did not develop a yes/no communication system, did follow some commands inconsistently and demonstrated good eye contact to family members.

5. There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to go unnoticed at the time. At 2:44 p.m., Dr. Hammesfahr had just turned Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well after he ceased applying the stimulus and had returned Terri to a comfortable position, he says to her parents, "So, we’re going to have to roll her over…" Immediately Terri cries. She vocalizes a crying sound, "Ugh, ha, ha, ha," presses her eyebrows together, and sadly grimaces. It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr's comment and signals her anticipation of pain. This response suggests some degree of language processing and interpretation at the level of the cerebral cortex. It also suggests that she may be aware of pain beyond what could be explained by simple reflex withdrawal.

6. According to the definition of PVS published by the American Academy of Neurology, "persistent vegetative state patients do not have the capacity to experience pain or suffering. Pain and suffering are attributes of consciousness requiring cerebral cortical functioning, and patients who are permanently and completely unconscious cannot experience these symptoms." And yet, in my review of Terri's medical records, pain issues keep surfacing. The nurses at Woodside Hospice told us that she often has pain with menstrual cramps. Menstrual flow is associated with agitation, repeated or sustained moaning, facial grimacing, limb posturing, and facial flushing, all of which subside once she is given ibuprofen. Some of the records document moaning, crying, and other painful behavior in the setting of urinary tract infection.

The neurologic literature has traditionally distinguished between, on one hand, the patterned reflex response resulting form mere activation of spinal and brain stem pain circuits in PVS and, on the other hand, conscious awareness of pain which requires participation by the cerebral cortex, including interpretation, felt emotional awareness, and volitional avoidance behavior that would not be expected to occur in PVS. Recent studies suggest, however, that such a distinction may not be the clear bright line previously imagined. Laureys and colleagues demonstrated, for example, neuronal processing activity in the primary somatosensory area of the cerebral cortex in response to noxious stimuli in patients with PVS.

Regardless of what objective measures may be available, the conscious experience of pain remains a phenomenon directly discernable only trough introspective awareness, which means that one cannot directly know with certainty the pain another person experiences. If, as the authors of a consensus statement on PVS wrote in 1994, there are some cases in which "the absence of a response cannot be taken as proof of the absence of consciousness," then should not the clear presence of pain be given serious consideration as possibly indicating conscious awareness of Terri Schiavo? The fact that Terri's responses to pain have been context-specific, sustained, and in the taped example I cited, in response to a spoken sentence, all suggest the possibility that she may be at some level consciously aware of pain.

Terri has received analgesic medication as treatment for her pain behavior. This seems to be appropriate medical treatment if one cannot know with certainty whether her behavior indicates conscious awareness of pain. If a patient behaves as if in pain, then the clinically prudent and compassionate response, when in doubt, is to treat the pain. If a patient behaves at times as though there may be some remnant of conscious awareness, then the clinically prudent and compassionate response, when in doubt is to treat that patient with respect and care. If Terri is consciously aware of pain, and therefore is capable of suffering, then her diagnosis of PVS may be tragically mistaken.

7. To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead on in some neurological sense no longer there. Although Terri did not demonstrate during our 90-minute visit some compelling evidence of verbalization, conscious awareness, or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her.

As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration. No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others.

The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitively resolve that ambiguity to everyone’s satisfaction. There would be value, I think, in obtaining a functional MRI scan if that is possible.

This situation differs fundamentally from end-of-life scenarios where it is appropriate to withdraw life-sustaining medical interventions that no longer benefit or are burdensome to patients in the terminal stages of illness. Terri's feeding tube is not a burden to her. It is not painful, it is not infected, is not eroding her stomach lining or causing any medical complications. But for the decision to withdraw her feeding tube, Terri cannot be considered medically terminal. But for the removal of food and water, she would not die.

In summary, Terri Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurologic diagnosis of persistent vegetative state. Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurologic consideration, would not be expected in a persistent vegetative state.

Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state. This distinction makes an enormous difference in making ethical decisions on Terri's behalf. If Terri is sufficiently aware of her surroundings that she can feel pleasure and suffer, if she is capable of understanding to some degree how she is being treated, then in my judgment it would be wrong to bring about her death by withdrawing food and water.

(hide)

"What we're offering to the state of California is an even-up trade," said Bob Schindler, Mrs. Schiavo's father. "Scott Peterson, who murdered his wife and son, gets to come to this nursing home where he'll die in a week or two. Our daughter goes to death row in San Quentin, where she'll likely live a long life as Peterson's case is appealed."

Update:

"All the powers of earth seem rapidly combining against him. Mammon is after him; ambition follows, and philosophy follows, and the Theology of the day is fast joining the cry. They have him in his prison house; they have searched his person, and left no prying instrument with him.

One after another they have closed the heavy iron doors upon him, and now they have him, as it were, bolted in with a lock of a hundred keys, which can never be unlocked without the concurrence of every key; the keys in the hands of a hundred different men, and they scattered to a hundred different and distant places; and they stand musing as to what invention, in all the dominions of mind and matter, can be produced to make the impossibility of his escape more complete than it is."

The young mother set her foot on the path of life. "Is this the long way?" she asked. And the guide said "Yes, and the way is hard. And you will be old before you reach the end of it. But the end will be better than the beginning."

But the young mother was happy, and she would not believe that anything could be better than these years. So she played with her children, she fed them and bathed them, and taught them how to tie their shoes and ride a bike and reminded them to feed the dog, and do their homework and brush their teeth. The sun shone on them, and the young Mother cried, "Nothing will ever be lovelier than this."

Then the nights came, and the storms, and the path was sometimes dark,and the children shook with fear and cold, and the mother drew them close and covered them with her arms, and the children said, "Mother, we are not afraid, for you are near, and no harm can come."

And the morning came, and there was a hill ahead, and the children climbed and grew weary, and the mother was weary. But at all times she said to the children, "A little patience and we are there."

So the children climbed, and as they climbed they learned to weather the storms. And with this, she gave them strength to face the world. Year after year, she showed them compassion, understanding, hope, but most of all.....unconditional love. And when they reached the top they said, "Mother, we would not have done it without you."

The days went on, and the weeks and the months and the years, and the mother grew old and she became little and bent. But her children were tall and strong, and walked with courage. And the mother, when she lay down at night, looked up at the stars and said, "This is a better day than the last, for my children have learned so much and are now passing these traits on to their children."

And when the way became rough for her, they lifted her, and gave her their strength, just as she had given them hers. One day they came to a hill, and beyond the hill, they could see a shining road and golden gates flung wide. And mother said: "I have reached the end of my journey. And now I know the end is better than the beginning, for my children can walk with dignity and pride, with their heads held high, and so can their children after them."

And the children said, "You will always walk with us, Mother, even when you have gone through the gates." And they stood and watched her as she went on alone, and the gates closed after her. And they said: "We cannot see her, but she is with us still. A Mother like ours is more than a memory. She is a living presence."

Your Mother is always with you. She's the whisper of the leaves as you walk down the street, she's the smell of certain foods you remember, flowers you pick and perfume that she wore, she's the cool hand on your brow when you're not feeling well, she's your breath in the air on a cold winter's day. She is the sound of the rain that lulls you to sleep, the colors of a rainbow, she is Christmas morning. Your Mother lives inside your laughter. And she's crystallized in every tear drop. A mother shows every emotion ........ happiness, sadness, fear, jealousy, love, hate, anger, helpless-ness, excitement, joy, sorrow.....and all the while, hoping and praying you will only know the good feelings in life.

She's the place you came from, your first home, and she's the map you follow with every step you take. She's your first love, your first friend, even your first enemy, but nothing on earth can separate you. Not time, not space.......not even death!

Update:

Update:
On Wednesday, March 23 the National Review Online posted the following affidavit from William P. Cheshire, Jr., MD. Dr. Cheshire is a neurologist and certified by the American Board of Psychiatry and Neurology and is an appointed volunteer with the Florida statewide Adult Protective Services team, in which capacity he conducted an independent, 90 minute examination of Terri Schiavo on March 1, 2005. To date, the courts have not admitted this affidavit.

The link is to a PDF file of the original document and is somewhat fuzzy. I have retyped an excerpt of seven observations made by Dr. Cheshire below. You can use the link above to read the document in its entirety, including the footnotes to clinical studies in the original that I have omitted in my retyping. These observations, again, are from an expert who has been able to visit Terri Schiavo recently, and may be illuminating to anyone who has the impression that she is little more than a houseplant.

Based on my review of extensive medical records documenting Terri’s case over the years, on my personal observations of Terri, and on my observations of Terri’s responses in the many hours of videotapes taken in 2002, she demonstrates a number of behaviors that I believe cast a reasonable doubt on the prior diagnosis of PVS. These include:

1. Her behavior is frequently context-specific. For example, her facial expression brightens and she smiles in response to the voice of familiar persons such as her parents or her nurse. Her agitation subsides and her facial demeanor softens when quiet music is played. When jubilant piano music is played, her face brightens, she lifts her eyebrows, smiles, and even laughs. Her lateral gaze toward the tape player is sustained for many minutes. Several times I witnessed Terri briefly, albeit inconsistently, laugh in response to a humorous comment someone in the room had made. I did not see her laugh in the absence of someone else's laughter.

(show)

2. Although she does not seem to track or follow visual objects consistently or for long periods of time, she does fixate her gaze on colorful objects or human faces for some 15 seconds at a time and occasionally follow with her eyes at least briefly as these objects move from side to side. When I first walked into her room, she immediately turned her head toward me and looked directly at my face. There was a look of curiosity or expectation in her expression, and she maintained eye contact for about half a minute. Later, when she again looked at me, she brought her lips together as if to pronounce the letter "O," and although for a moment it appeared that she might be making an intentional effort to speak, her face then fell blank, and no words came out.

3. Although I did not hear Terri utter distinct words, she demonstrates emotional expressivity by her use of single syllable vocalizations such as "ah," making cooing sounds, or by expressing guttural sounds of annoyance or moaning appropriate to the context of the situation. The context-specific range and variability of her vocalizations suggests at least a reasonable probability of the processing of emotional thought within her brain. There have been reports of Terri rarely using actual words specific to her situational context. The July 25, 2003 affidavit of speech pathologist Sara Green Mele, MS, on page 6, reads, "The records of Mediplex reflect the fact that she has said 'stop' in apparent response to a medical procedure being done to her." The Adult Protective Services team has been unable to retrieve those original medical records in this instance.

4. Although Terri has not consistently followed commands, there appear to be some notable exceptions. In the taped examination by Dr. Hammesfahr from 2002, when asked to close her eyes she began to blink repeatedly. Although it was unclear whether she squeezed her grip when asked, she did appear to raise her right leg four times in succession each time she was asked to do so. Rehabilitation notes form 1991 indicated that she tracked inconsistently, and although did not develop a yes/no communication system, did follow some commands inconsistently and demonstrated good eye contact to family members.

5. There is a remarkable moment in the videotape of the September 3, 2002 examination by Dr. Hammesfahr that seemed to go unnoticed at the time. At 2:44 p.m., Dr. Hammesfahr had just turned Terri onto her right side to examine her back with a painful sharp stimulus (a sharp piece of wood), to which Terri had responded with signs of discomfort. Well after he ceased applying the stimulus and had returned Terri to a comfortable position, he says to her parents, "So, we’re going to have to roll her over…" Immediately Terri cries. She vocalizes a crying sound, "Ugh, ha, ha, ha," presses her eyebrows together, and sadly grimaces. It is important to note that, at that moment, no one is touching Terri or causing actual pain. Rather, she appears to comprehend the meaning of Dr. Hammesfahr's comment and signals her anticipation of pain. This response suggests some degree of language processing and interpretation at the level of the cerebral cortex. It also suggests that she may be aware of pain beyond what could be explained by simple reflex withdrawal.

6. According to the definition of PVS published by the American Academy of Neurology, "persistent vegetative state patients do not have the capacity to experience pain or suffering. Pain and suffering are attributes of consciousness requiring cerebral cortical functioning, and patients who are permanently and completely unconscious cannot experience these symptoms." And yet, in my review of Terri's medical records, pain issues keep surfacing. The nurses at Woodside Hospice told us that she often has pain with menstrual cramps. Menstrual flow is associated with agitation, repeated or sustained moaning, facial grimacing, limb posturing, and facial flushing, all of which subside once she is given ibuprofen. Some of the records document moaning, crying, and other painful behavior in the setting of urinary tract infection.

The neurologic literature has traditionally distinguished between, on one hand, the patterned reflex response resulting form mere activation of spinal and brain stem pain circuits in PVS and, on the other hand, conscious awareness of pain which requires participation by the cerebral cortex, including interpretation, felt emotional awareness, and volitional avoidance behavior that would not be expected to occur in PVS. Recent studies suggest, however, that such a distinction may not be the clear bright line previously imagined. Laureys and colleagues demonstrated, for example, neuronal processing activity in the primary somatosensory area of the cerebral cortex in response to noxious stimuli in patients with PVS.

Regardless of what objective measures may be available, the conscious experience of pain remains a phenomenon directly discernable only trough introspective awareness, which means that one cannot directly know with certainty the pain another person experiences. If, as the authors of a consensus statement on PVS wrote in 1994, there are some cases in which "the absence of a response cannot be taken as proof of the absence of consciousness," then should not the clear presence of pain be given serious consideration as possibly indicating conscious awareness of Terri Schiavo? The fact that Terri's responses to pain have been context-specific, sustained, and in the taped example I cited, in response to a spoken sentence, all suggest the possibility that she may be at some level consciously aware of pain.

Terri has received analgesic medication as treatment for her pain behavior. This seems to be appropriate medical treatment if one cannot know with certainty whether her behavior indicates conscious awareness of pain. If a patient behaves as if in pain, then the clinically prudent and compassionate response, when in doubt, is to treat the pain. If a patient behaves at times as though there may be some remnant of conscious awareness, then the clinically prudent and compassionate response, when in doubt is to treat that patient with respect and care. If Terri is consciously aware of pain, and therefore is capable of suffering, then her diagnosis of PVS may be tragically mistaken.

7. To enter the room of Terri Schiavo is nothing like entering the room of a patient who is comatose or brain-dead on in some neurological sense no longer there. Although Terri did not demonstrate during our 90-minute visit some compelling evidence of verbalization, conscious awareness, or volitional behavior, yet the visitor has the distinct sense of the presence of a living human being who seems at some level to be aware of some things around her.

As I looked at Terri, and she gazed directly back at me, I asked myself whether, if I were her attending physician, I could in good conscience withdraw her feeding and hydration. No, I could not. I could not withdraw life support if I were asked. I could not withhold life-sustaining nutrition and hydration from this beautiful lady whose face brightens in the presence of others.

The neurologic signs are in many ways ambiguous. There is no guarantee that more sophisticated testing would definitively resolve that ambiguity to everyone’s satisfaction. There would be value, I think, in obtaining a functional MRI scan if that is possible.

This situation differs fundamentally from end-of-life scenarios where it is appropriate to withdraw life-sustaining medical interventions that no longer benefit or are burdensome to patients in the terminal stages of illness. Terri's feeding tube is not a burden to her. It is not painful, it is not infected, is not eroding her stomach lining or causing any medical complications. But for the decision to withdraw her feeding tube, Terri cannot be considered medically terminal. But for the removal of food and water, she would not die.

In summary, Terri Schiavo demonstrates behaviors in a variety of cognitive domains that call into question the previous neurologic diagnosis of persistent vegetative state. Specifically, she has demonstrated behaviors that are context-specific, sustained, and indicative of cerebral cortical processing that, upon careful neurologic consideration, would not be expected in a persistent vegetative state.

Based on this evidence, I believe that, within a reasonable degree of medical certainty, there is a greater likelihood that Terri is in a minimally conscious state than a persistent vegetative state. This distinction makes an enormous difference in making ethical decisions on Terri's behalf. If Terri is sufficiently aware of her surroundings that she can feel pleasure and suffer, if she is capable of understanding to some degree how she is being treated, then in my judgment it would be wrong to bring about her death by withdrawing food and water.