What’s in a Name?

Ronald Cranford, M.D.

Remember the name if you haven’t previously heard it. My money says you’ll hear it again.

If you have heard of him, it’s probably because you’ve either seen him on television pontificating in recent days about Terri Schiavo’s diagnosis and prognosis, or you’ve read about him in one of the thousands of news articles written about Terri.

Once again, Cranford has advocated for the death of a disabled individual.

That’s not a new development for Cranford. You’ll find his fingerprints on the pages of every major case involving end of life decision-making in this country, including those of Christine Busilacchi, Nancy Cruzan, and Michael Martin. (Note that I did not refer to any of those as “right to die” cases.)Indeed, when I cross-examined Cranford during the Wendland trial, he had to admit that he had never once, while serving as an “expert” witness, advocated on the side of life.

Not once.

Cranford is a well-known advocate of euthanasia. Specifically, he wrote some years back that people who are in persistent vegetative states lack “personhood.” Since they are unable to independently exercise their Fourteenth Amendment rights, Cranford believes that they should not be deemed to have any. In other words, they are completely expendable.

He also has a way to “solve” the “Alzheimer’s problem” in this country: Legalized euthanasia.

Belittling life

Unlike in Terri’s case, Cranford never testified that Robert was in a persistent vegetative state. There was overwhelming, uncontroverted evidence that Robert was conscious and interactive. At trial, even Cranford was forced to admit that when Robert emerged from his 16 month coma, he “achieved cognitive life.”

Robert’s abilities included:

• Operating a manual wheelchair (using his left hand or foot) or an electric wheelchair with the use of a joystick (Cranford testified that he was surprised when he came to California to examine Robert and found that he really could operate the wheelchair);
• Throwing and catching a ball with his hand;
• Kicking and stopping a ball with his foot;
• Working in a standing frame during which time he viewed himself in a mirror and was able to balance and right himself (with cues) for short periods of time;
• Reaching for/grabbing thera-putty in response to cueing;
• Operating an augmentative communication device to give “yes” or “no” responses to questions (the California Supreme Court was particularly interested in the fact that Robert did not respond when his treating physician asked Robert if he wanted to die — the doctor never bother to ask if Robert wanted to live);
• Blinking with his eyes to respond to questions such as those listed above;
• Picking brightly colored pegs or blocks and replaced them in a tray or handed them to a therapy assistant;
• Picking specific numbers and handed them to a therapy assistant;
• Turning the pages of books and magazines;
• Drawing circles and writing the letter “R” with his left (nondominant) hand, sometimes without assistance;
• Responding to verbal requests that he open his mouth and hold it open to allow oral care and hygiene; and
• Responding to verbal commands directed toward behavior management.

Robert interacted with his mother when she visited him. For instance, he picked up her hand and kissed it when she asked him to. It was not just “wishful thinking” on the part of a desperate mother, as Cranford always suggests when family members who are not persuaded that dehydration is appropriate report their observations about the patient’s responsiveness.

How am I so sure that Robert’s mother was not just seeing what she wanted to see? I saw him respond to Florence and kiss her hand with my own eyes. I also saw him hold his hand up to Florence’s mouth, asking her to kiss his hand in return.

Nonetheless, Cranford shamefully testified that it would be medically and ethically appropriate to remove Robert’s feeding tube and allow him to die the same way that Terri Schiavo is dying today.

In their quest for legal authority to kill Robert, Cranford, the other experts called to testify, the attorney representing Robert’s wife, and even Robert’s own court-appointed attorney (who advocated for Robert’s death in both the trial and appellate courts) dehumanized Robert and belittled his abilities. For instance, Robert’s own attorney wrote: Robert can “respond to simple stimuli somewhat in the manner that an animal might.” Cranford said that Robert was, during his therapy sessions at Lodi Memorial Hospital, being “trained like an animal” and “being used like a trained animal . . .” One bioethicist, Laurie Zoloth-Dorfman, testifying in favor of dehydrating Robert, described herself as an Orthodox Jew, but dehumanized Robert when she said that he interacted with his environment less than “some animals that I have a close friendship with.”

A new medical term devised to move the line between life and death

So how, from a medical perspective, could Cranford and the others opine with a straight face that a man who was indisputably not in a persistent vegetative state should have his feeding tube removed? He and the other experts tried to coin a new phrase to describe him: “Minimally conscious.” Then they lobbied to have that new term, as well as a protocol for dehydrating such patients, accepted within the medical community during the pendency of the Wendland case.

The real motive

The following exchange took place when I cross-examined Cranford. I believe that it reveals Cranford’s true motivation:

Q. Why in your opinion as a clinical ethicist should . . .the error not be on the side of caution. . . and just let Robert live?
. . .

A. The harm to continuing treatment . . . there wouldn’t be a lot of harm to Robert per say as he is now. . .

So — you can go on and on about the psychologic harm to the family. I think the family should be allowed to go through the grieving process. And four years is enough.

And so I think for people to start functioning again — because it’s really harmful to families when you get into a situation like this — that the family should be allowed to live their lives.

They can still love Robert and remember Robert, but Robert should be allowed to die so the family can grieve and go through the normal process of grieving and knowing that Robert’s wishes are respected. . .

I think there’s a lot of harm that’s done by erring on the side of caution. I think it’s ridiculous to err on the side of caution when there’s [no] doubt in my mind and any reputable person will say he’s never going to recover. He’s beyond that point.

“Robert should be allowed to die so the family can grieve.” I’ll never forget the stunned silence in the courtroom when Cranford uttered those words.

Robert Wendland died, ostensibly of pneumonia, in July 2001. The LA Times described the press conference his wife and daughters held the day after his death: “Rose Wendland praised Dr. Ronald Cranford, a Minnesota neurologist and bioethicist, for providing her with medical and moral advice during Robert’s final days. Cranford, a consultant in several high-profile right-to-die cases, did not personally treat Wendland but advised doctors on his care. His presence at the hospital enraged some pro-life activists, who fired off a statement Tuesday denouncing his involvement.” I have videotape of a local news story that ran the night Robert died. The reporter is shown going to Rose Wendland’s house seeking comment from her — Cranford opens the door, talks with the reporter and is identified as a family spokesperson.

Ronald Cranford, M.D.

Remember the name. Remember the agenda. Remember the testimony. Remember the real motivation.

Your life or the life of one of your loved ones might depend upon your memory.