Thursday, January 5, 2012

Vegetative state versus conscious


Vegetative state versus consciousArticle 1 image

Excerpt from "'Vegetative' patients may be fully conscious: Lancet study," LifeSiteNews. November 15, 2011--A study published in one of the most respected medical journals in the world in November 2011 has found that many "vegetative" patients are in fact fully conscious and aware.

Experts at the University of Western Ontario conducted the experiment by applying an electroencephalogram (EEG) machine, a common mechanism for measuring brain waves, to a large group of unresponsive patients suffering from brain injuries. The New York Times reported that, when researchers asked "vegetative" patients to imagine squeezing their hand into a fist or wiggling their toes on cue, they found the brain waves of about 20 percent of such patients responding in precisely the same way as healthy patients.

While one of the researchers of the Lancet study concluded that the experiment was "a strong sign of our inability to correctly diagnose people in the vegetative state," some disability advocates say the diagnosis should be abandoned altogether, arguing that it is a tool routinely used to discriminate against the cognitively disabled. Bioethics commentator Wesley Smith expressed concern that the new testing would likely do little to stop the routine dehydration of minimally conscious patients.

While the test should certainly "become part of the practice of medicine" if it is accurate, Smith said, "we really need to change our values so that all of us are embraced and accepted as moral equals regardless of our cognitive states."


Jeff Fenyves, MD ImageGastroenterologist and CMDA Member Jeff Fenyves, MD:"Two Christmases past, my baby sister of 42 years made the brave decision to not allow her placement on a ventilator after a very painful, decades-long battle with aggressive Syringomyelia. She was tired of hurting, and could no longer use her limbs at all. She made a conscious decision that I will defend to my death.

"Then this Lancet study provides confirmation that AT LEAST 20 PERCENT of our coma decisions are wrong, combined with the illustrative case recently of Sam Schmid, the Arizona student in a coma since he was involved in a five-car accident on Oct. 19. Do you recall the headlines of his miraculous awakening on Dec. 22, just as plans were being contemplated for his removal from life support and organ donation?

"These two cases, my sister and Mr. Schmid, contain a stark contrast we should not dismiss. She made a conscious decision, while we almost made a decision to put a 21-year-old man to death because we ASSUME he is NOT conscious and thinking, an assumption made with very primitive tools at best. Remember, we no longer put any criminal in the United States to death if there is a REASONABLE doubt. Don’t our loved ones in coma deserve at least as much consideration as a death row case?"


Resources

CMDA Ethics Statement - Vegetative State

CMDA Ethics Statement - Withholding Nutrition

2 comments:

  1. Dr. Fenyves underlines the uncertainties that persist in our knowledge of cognitive impairment. The more we learn, the more we realize what we don't know, or we learn that what we "know" is incorrect. In the process, however, we must be careful to not confuse or misinterpret things that we do know. The PVS (Lancet study) and coma (Sam Schmid) are not the same, and the findings from one should not be misapplied to the other.
    Bob Orr, Clinical Ethicist

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