We've recently covered some of the more disturbing political aspects of the Terri Schiavo case in articles posted by Gregster and Klep. I won't repeat their points here. I'd like instead to bring up another topic for discussion: why is there so much interest in this case? What fascinates people about it so much?

My personal opinion here is that the nature of Terri's degeneration is what's really captivated people. Terri was once a fully-functioning human being, unmysterious and common. Her body and persona were linked. There was an entity known as Terri present when her body was present.

Those of us of scientific mind know that (very roughly speaking) the functions of our brains are layered. And by layered, I mean like a network protocol stack, not like a cheeseburger (though there's some of that going on too, but I don't mean to digress into a discussion of brain physiology here). The functions necessary to keep the physical vessel of our bodies going are at the bottom of the stack and in the more primitive parts of our brains and spinal cords. Reflexes, breathing, digestion, and so-on can continue on whether we're thinking or not. We know that (at a minimum) a large part of what makes us self-aware and what makes us individual entities happens (largely) in the cerebral cortex.

We also know from the case history that Terri's brain was starved of oxygen and her cerebral cortex degenerated, eventually being replaced with spinal fluid. Her brain is now abnormal. The entity formerly known as Terri Schiavo is, effectively, gone.

The set of circumstances sets up a terrible heap of questions for people:

  • Are we nothing more than electrical activity in the cerebral cortex?
  • Terri's body is here; why isn't Terri here?
  • Terri's body is still alive; how can we say that Terri isn't alive?
  • Could this happen to me and my family?
  • Where is Terri's soul?

These are difficult, emotionally-charged questions for anyone. None of us wants to think of ourselves as nothing more than electrical impulses in a cerebral cortex, but the effect of the degeneration of Terri's gives us pause. These questions force us to confront our own ideas about our identities. We wonder, "if my cerebral cortex degenerated, where would I go?" Many of us have a strong sense of self, and the idea that self could be destroyed terrifies us. This is what made the Cybermen in Doctor Who (and decades later the Borg in Star Trek) so terrifying.

We have to confront difficult questions like, "what exactly is human life?" Clearly Terri's body is alive. It is functional. She's breathing, respirating, excreting. Her heart is beating. She reflexively responds to stimuli. Yet the personality of Terri is gone. The part of her that made her Terri and different from every other person on earth has been destroyed. For those who don't understand the separation of the body, the lower brain functions and the mind, this is a scary contradiction.

And the short answer to the question, "could this happen to me?" is "yes, absolutely it could." Any number of accidents could cause a permanent shutdown of higher brain functions. But what's permanent? Clearly having no cerebral cortex at all is a permanent condition. (I won't go into weird philosophical questions about injecting stem cells from aborted fetuses here.) What about lesser brain damage that simply inhibits brain function? People have recovered from vegetative states before, although it's rare. What a horrible decision for families to have to make! If you knew that a loved one had a chance, even a minute one, of returning to their normal life, what would you do? How would you make that judgement call on whether to "pull the plug" on someone? Nobody likes to think about these questions. They're scary. We'd hate to stay up nights wondering if we made the right choice or if we'd just sentenced a loved one to death.

In short, I think it's our primal fear of death, our strong sense of "self," our fear of losing ourselves, and a general lack of understanding about what constitutes human life and personality that's led to the great fascination with this case on both sides of the issue (and down the middle for that matter). If it wasn't Terri Schiavo, it would have been someone else. People are taken off life support every day. People drop into persistent vegetative states all the time. Schiavo just happened to be the case with the most drama at this time.

What do you think? What makes people so interested and the case so dramatic? Post your ideas below.

---Nick

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