Persistent Vegetative State

A person’s inability to satisfy our longing for response does not justify abandonment or imposed death

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Human beings are not “vegetables.” The dehumanizing term “persistent vegetative state” (PVS), crafted in 1972, became more familiar in the 1980s as “right to die” activists, courts, state legislatures, physicians and bioethicists[1] began to use the PVS label as justification for withdrawing food and fluids from persistently unresponsive
patients. PVS is a diagnosis that kills people.

What is a “Persistent Vegetative State?”

Many people have blind faith in medical labeling. Most probably think that PVS is a reliable diagnosis. However, experts disagree about what it is and methods for diagnostic testing are disputed. PVS is grouped in the International Classification of Diseases with “Symptoms, Signs and Ill-Defined Conditions.”

A vegetative state is not a coma. According to the 1994 Multi-Society Task Force (MSTF) on the medical aspects of PVS, a person in a coma is neither awake nor aware; a person in a vegetative state is awake but not aware. The MSTF defined a “persistent vegetative state” as a vegetative state that lasts more than one month.[2]

The person in PVS has sleep-wake cycles, eye movement, and normal respiratory, circulatory and digestive functions. Individuals in PVS are seldom on any life-sustaining equipment other than a feeding tube. Some can swallow, others cannot. Some have random movement, some do not. Some have been physically injured; othersĀ  suffer from stroke or dementia. In some cases, the brain itself appears to change; in others it appears unchanged.

In simple terms, the diagnosis of PVS is based on lack of evidence of awareness of self or environment. However, it is not that simple.

Some patients who are misdiagnosed to be in PVS do exhibit evidence of awareness, but the diagnostician misses (or dismisses) the evidence. These patients may be mute and immobile (“locked-in”), but mentally alert and able to communicate by blinking or through aids such as computers-if someone gives them the opportunity. Other patients retain some measure of awareness even though they do not exhibit any evidence of it. Patients who have recovered from such a state can recall things that were said or done to them while no one knew they were aware.

Kate Adamson was diagnosed as PVS after a brain stem stroke. Actually aware, she underwent surgery with inadequate anesthesia. That pain was nothing compared with the agony of starvation and dehydration. Interviewed by Bill O’Reilly in 2003, Ms. Adamson said, “When the feeding tube was turned off for eight days, I thought I was
going insane. I was screaming out in my mind, ‘Don’t you know I need to eat?’…It was sheer torture.”

The Washington Post, 9/8/2006, reported a case that astounded neurologists. A sophisticated brain scan upon a woman supposedly in a vegetative state indicated that she was clearly aware. The researchers told her to imagine she was playing tennis. They were shocked to see her brain “light up” exactly as an uninjured person’s would. They repeated the test again and again with the same result.

Misdiagnosis of PVS is not uncommon.

— In 2002, a study of mistaken diagnoses of PVS revealed a 15% error rate.[3]
— Data gathered by the MSTF on a group of 434 adult patients who were in PVS as a result of traumatic injury showed that three months after injury, 33% had regained consciousness; by six months, 46% had; and at 12 months, 52% had.[4]
— Out of 40 patients diagnosed as being in PVS, 17 (43%) were later found to be alert, aware, and often able to express a simple wish. The author, London neurologist Dr. Keith Andrews, said, “It is disturbing to think that some patients who were aware had for several years been treated as being vegetative.”[5]
— “Another study shows that around 40% of patients were wrongly diagnosed as in a vegetative state, when they in fact registered the awareness levels of minimal consciousness. Comparing past studies on this issue shows that the level of misdiagnosis has not decreased in the last 15 years.”[6]

Using functional magnetic resonance imaging (MRI), Dr. Haggai Sharon and Dr. Yotam Pasternak of Tel Aviv University’s Functional Brain Center have shown that some patients in PVS emotionally react to photographs of people they know. Their findings offer hope for better care and the development of novel treatments.[7]

What now?

Objections to deliberately ending the lives of patients in PVS often rest on the hope that “they might recover.” Let’s face it: many people with disabilities will not recover. But killing them is not a cure.

It is common for persistently unresponsive patients who are not dispatched by dehydration to wind up warehoused in nursing homes, deprived of rehabilitation and beneficial medical treatment. Their world is far more complex than most of us can imagine. Those who have severe brain damage may still enjoy touch, scent, taste, and
sound; they may also feel pain, loneliness, fear, and despair.

A person’s inability to satisfy our longing for response does not justify abandonment or imposed death. Patients labeled PVS are our brothers and sisters, human beings created in the image and likeness of God. We must treat them with respect and compassion.

NOTE: This article is also a brochure in the Life is Worth Living series produced and distributed by Pro-Life Wisconsin. Other brochures in this series are: Get a Grip on the Grammar, Organ Donation, Advance Directives for Health Care, Feeding and Hydration and The Money Factor. To order these brochures, call Pro-Life Wisconsin at (262) 796-1111.

[1] Bioethicists often determine who should die. The core principle of modern bioethics is “quality of life.” The core principle of traditional medical ethics is “sanctity of life.”

[2] Mappes, Thomas A., “Persistent Vegetative State, Prospective Thinking and Advance Directives,” Kennedy Institute of Ethics Journal, 2003: Vol. 13, No. 2: 119-139
[3] Ibid
[4] Ibid
[5] British Medical Journal, 7/6/96
[6] Quote from http://www.news-medical.net/news/2007/06/20/26672.aspx
[7] http://www.aftau.org/site/News2?page=NewsArticle&id=19561, 12/16/2013