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Cohen: Mental states are clearly defined

CNN's Elizabeth Cohen
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The battle lines over Terri Schiavo aren't as clear as they appear.

Appellate ruling is latest setback for Terri Schiavo's parents.

The Schiavo legal saga hits home for a Michigan family.
Timeline: Schiavo case

• Top story:  Court denies requests
• CNN Access:  Alan Dershowitz
• Interactive: The feeding tube
• Interactive: Opinion poll
• FindLaw:  Appellate rulingexternal link
Jeb Bush
Bill Frist

ATLANTA, Georgia (CNN) -- The 11th U.S. Circuit Court of Appeals twice denied requests Wednesday from the parents of Terri Schiavo, who are seeking to have the severely brain-damaged woman's feeding tube reinserted.

Florida Gov. Jeb Bush said Wednesday that state authorities filed a new request in state court to intervene, arguing that new information from a neurologist suggests she is "most likely in a state of minimal consciousness," rather than the persistent vegetative state previous doctors have diagnosed.

CNN's Candy Crowley discussed the distinction with medical correspondent Elizabeth Cohen.

CROWLEY: Minimally conscious state versus a persistent vegetative state -- sounds to a layman as though they're talking about: She does have a thought process, she is thinking things, she is in there.

COHEN: Actually, the way that medicine defines it, Candy, is not what she's thinking, because it's really hard to assess what someone is thinking. Medicine definitely defines these states as being two very different states.

It defines "minimally conscious" as being aware, as definitely being aware of the surroundings around the patient. In other words, does the patient follow simple "yes" or "no" orders? For example: "Lift your arm; can you do this?; Can you not?;" nodding or giving some indication that they're understanding a very simple command.

Or, for example, just being aware of who's around them, being aware when someone enters the room. That would mean minimal consciousness.

That is very different from the persistent vegetative state, where there is no awareness of what's around the person ...

People may come in and leave, and the person is not aware of what's going on around them. And there are different tests that physicians do to determine which the person is in.

Now, doctor after doctor, including, of course, many neurologists, have assessed Terri Schiavo over the years and said that she is in a vegetative state. This doctor, according to Governor Jeb Bush, apparently disagrees and says that she's in a state of minimal consciousness.

CROWLEY: Can you tell the difference between those two states in a patient if there is not a physical exam? Because as we understand it, there was no physical exam of Terri Schiavo by this new neurologist.

If he did, in fact, go in there and was by her bedside, one assumes he could have talked to her. Can you do it without a physical exam?

COHEN: You know, doctors who I've been talking to, who, for example, heard about [Senate Majority Leader] Bill Frist watching videos and giving an opinion after watching videos -- were critical of him.

They said, you know, doctors shouldn't be making diagnoses based on videos. They should be making a diagnosis based on actually being next to the patient and doing a physical exam, and very importantly watching what happens when they say, "Terri," or -- this would just be a hypothetical -- "if you can hear me, lift your left arm, or look to the left or look to the right," [to see whether the patient] can in some way obey commands ...

In order to make what I think most doctors would consider a really good diagnosis, you would have to be there to witness what her responses were to those kinds of simple commands, or to some kind of a simple "yes" or "no" question.

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