There has been some media buzz about a new test that appears to show some patients, previously diagnosed as unaware (persistent vegetative state), can actually perceive. From the New Scientist story:
Owen and his team used an EEG on 16 people thought to be in a PVS and compared the results with 12 healthy controls while they were asked to imagine performing a series of tasks. Each person was asked to imagine at least four separate actions – either clenching their right fist or wiggling their toes.
In three of the people with PVS, brain regions known to be associated with those tasks lit up with activity, despite physical unresponsiveness. This suggested to the researchers that the subjects were carrying out a complex set of cognitive functions including hearing the command, understanding language, sustaining attention and tapping into working memory. “It isn’t the case that just because somebody doesn’t respond they’re not conscious,” Owen says. “There’s a growing body of data now demonstrating that many of these patients aren’t what they appear.”
“The diagnostic criteria for vegetative state have to change,” he adds. The official diagnosis for PVS was formulated in the 1970s, before neuro-imaging was widely used, says Owen. The last update was made in 1995, but the criteria for declaring someone conscious is still based on whether an outside observer believes the patient is trying to communicate.
This is a good thing, and indeed, the criteria should change. We should also change the name of the diagnosis to “persistent unconscious state,” rather than “vegetative state.” None of us is a carrot or turnip. Calling someone vegetative or the dreaded V-word–which should join the N-word as an unutterable–demeans, diminishes, dehumanizes, and degrades the moral value of the patient.
We’ve known for years that PVS is often misdiagnosed, but don’t expect learning that a patient is conscious to lead many bioethicists to advocate against their dehydration. While a UK court recently refused to dehydrate a conscious patient–good for it–in the USA we crossed that Rubicon long ago. Indeed, we dehydrate conscious patients routinely in this country, not because people can’t assimilate nutrition–a different matter altogether–but because we don’t believe their lives are worth living (and/or paying to support). In fact, many of the same bioethicists who once said removing tube-supplied sustenance should be limited to the unconscious, merely pivoted and argued that if someone is “minimally” conscious, it is even more reason to pull the tube because they will be suffering from potential knowledge of their condition or limitations.
Don’t get me wrong. The test, if accurate, should become part of the practice of medicine in this field. But we really need to change our values so that all of us are embraced and accepted as moral equals regardless of our cognitive states.
November 10th, 2011 | 1:32 pm
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November 11th, 2011 | 8:33 am
Thanks for covering this Wes. Let’s hope this will change attitudes towards the unconcious and the minimally concious. http://www.cbc.ca/video/#/News/TV_Shows/The_National/1233408557/ID=2166173474
November 12th, 2011 | 3:35 am
“In THREE of the [SIXTEEN] people with PVS, brain regions known to be associated with those tasks lit up with activity, despite physical unresponsiveness. This SUGGESTED] to the researchers that the subjects were carrying out a complex set of cognitive functions including hearing the command, understanding language, sustaining attention and tapping into working memory.” [emphasis added].
This sounds more like wishful thinking than a solid scientific platform on which to construct policy changes. Remember, no one has suggested that the individuals in this experiment were actually AWARE of anything that was going on; only that their auditory nerves seem to be conveying impulses to their brain and their brains were responding to them in some way. This is reminiscent of the “Terri Schiavo was responding” observation, when in fact her body was responding to stimuli that her brain had no capacity to process into thought. Some may call that “being alive;” I’d call it “existing.”
HW
November 12th, 2011 | 10:44 pm
Wow HW I did not know you were a neurologist who had examined Terri Schiavo. Can you tell me how my son can blink the correct answer to every yes and no question I write on a white board and put in front of him? Can you tell me my son can now sit up unaided for brief moments and hold his own head up. Can you tell me how a total stranger can sit ask my son yes and no questions (with no one else present)and determine the exact make and model of car my son drove?Watch the link I posted earlier and learn about the technology that real scientists have developed .These people have actual degrees behind their names.
HistoryWriter Reply:
November 13th, 2011 at 9:15 am
@bonnie snaith,
No, I’m not a neurologist. I’m just a knowledgeable individual who read Terri Schiavo’s autopsy protocol. Did YOU read it?
From what you’re saying it’s obvious your son isn’t in a PVS. You aren’t making a comparison between him and Terri Schiavo, are you?
HW
November 13th, 2011 | 5:17 pm
Yes I have read Terri’s autopsy and it says they cannot say for certain if she was in a vegetative state or not. I have also read the affidavits of many doctors who said she wasn’t. Yes I am comparing my son to Terri as he was diagnosed as being in a pvs after his accident. His latest diagnosis is minimally conscious. I have also spoken with Terri’s sister. I also have first hand experience caring for my son. Who are you to say these people have no consciousness? Many have recovered from a diagnosis of pvs and said they heard everything that was said around them. Terri did not deserve to be dehydrated to death.You also have no right to decide the quality of her life ,my son’s life or anyone else’s.
HistoryWriter Reply:
November 13th, 2011 at 8:07 pm
@Bonnie Snaith,
I seriously doubt you read the autopsy protocol. If you did read it you undoubtedly skimmed over it without understanding what it said, or saw only those things in it that you wanted to. Most of Terri Schiavo’s brain, specifically the cerebrum and cerebellum, had deteriorated. She wasn’t even minimally conscious, although people who wanted to believe she was were able to interpret spasms and grimaces as “consciousness.” I don’t recall that Terri’s sister and brother are neurologists either.
HW
Wesley J. Smith Reply:
November 13th, 2011 at 8:51 pm
HW: First, she had been dehydrated for 14 days. Second, the report said her condition was consistent with either PVS or MCS. Third, it also said an autopsy can’t tell for sure becuase it is a clinical determination. Fourth, it doesn’t matter.
HistoryWriter Reply:
November 16th, 2011 at 10:37 pm
@Wesley J. Smith,
Apparently it DOES matter to some people. Some of Terri’s relatives seem to be making a lucrative business out of it.
HW
Wesley J. Smith Reply:
November 16th, 2011 at 11:16 pm
You ignorant and nasty man. You have no idea what you are talking about, what these people have been through. None.
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