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3/24/05 A Diagnosis With a Dose of Religion


William P. Cheshire Jr., the Florida doctor cited by Gov. Jeb Bush yesterday in his announcement that he would intervene again in the case of Terri Schiavo, is a neurologist and bioethicist whose life and work have been guided by his religious beliefs.

Dr. Cheshire directs a laboratory at the Mayo Clinic branch in Jacksonville dealing with unconscious reflexes like digestion, and he is director of biotech ethics at the Center for Bioethics and Human Dignity, a nonprofit group founded by "more than a dozen leading Christian bioethicists," in the words of its Web site.

In an article last year in Physician magazine, published by the evangelical group Focus on the Family, Dr. Cheshire, 44, said doctors are too quick to declare that a patient is in a persistent vegetative state.

"I'm not sure the diagnosis is used consistently," he told Physician. "I am sometimes asked if a patient is in P.V.S., but it's only been a few days. By definition, you have to wait at least a month."

Yesterday, in an affidavit supporting a petition by the Florida Department of Children and Families in the case, Dr. Cheshire said it was more likely that Ms. Schiavo was in a "minimally conscious state."

"Although Terri did not demonstrate during our 90-minute visit compelling evidence of verbalization, conscious awareness or volitional behavior," he wrote, "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."

Mr. Bush called Dr. Cheshire a "renowned neurologist," but he is not widely known in the neurology or bioethics fields. Asked about him, Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, replied, "Who?"

Dr. Cheshire, who graduated from Princeton and earned a medical degree at West Virginia University, did not return calls to the Mayo Clinic seeking comment. The clinic said in a statement that his work on the Schiavo case was not related to his work at the clinic and that the state had invited his opinion. "He observed the patient at her bedside and conducted an extensive review of her medical history but did not conduct an examination," the statement said.

Dr. Caplan said that was not good enough. "There is just no excuse for going in and making any pronouncement about the state that Terri Schiavo is in unless you're going to go in and do some form of technologically mediated scanning that would overturn what's on the record already," he said.

Dr. Ronald Cranford, a neurologist and medical ethicist at the University of Minnesota Medical School who has examined Ms. Schiavo on behalf of the Florida courts and declared her to be irredeemably brain-damaged, said, "I have no idea who this Cheshire is," and added: "He has to be bogus, a pro-life fanatic. You'll not find any credible neurologist or neurosurgeon to get involved at this point and say she's not vegetative."

He said there was no doubt that Ms. Schiavo was in a persistent vegetative state. "Her CAT scan shows massive shrinkage of the brain," he said. "Her EEG is flat - flat. There's no electrical activity coming from her brain."

Dr. Cheshire entered the field of bioethics relatively late in his career. A profile of him on the Web site of Trinity International University, where he enrolled in the master's program in bioethics in 2000, states that he was "searching for how he should integrate his faith with his medical career." After getting the degree, he became an adjunct professor of bioethics there.

A search of his publication record in the online medical library PubMed yielded articles in medical journals, with a focus on headache pain, in particular trigeminal neuralgia, a painful disorder originating in a cranial nerve called the trigeminal. None of the papers dealt with persistent vegetative states.

His papers show a fondness for puns, as in the title of a letter to The New England Journal of Medicine about a patient whose fillings caused an electrical current that made her condition worse: "The shocking tooth about trigeminal neuralgia."

He was also the author, with others from the Center for Bioethics and Human Dignity, of a paper opposing stem cell research.

The center's Web site notes that he and his wife and four children are members of the Episcopal Church of the Redeemer in Jacksonville and that he has done medical missionary work in Honduras and Siberia.

He has also written poetry, including "Exit Ramp," a poem about the movement to allow physician-assisted suicide that uses the metaphor of a highway off-ramp to warn of a different kind of slippery slope:

Such killing fast degenerates,
Despite concern for patients' best,
Into a plot that terminates
Without explicit prerequest.

Source: New York Times


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