The Vegetative State: Is it Really Time to Pull the Plug?

           One of the most controversial cases of medicine was that of Terri Schiavo, whose husband was persistent on filing petitions to have her feeding tube removed in order to pass comfortably and whose parents were on the completely opposite side of the spectrum and fought for her right to live. Terri, who suffered massive brain damage resulting from an eating disorder, had been stuck in a vegetative state for eight years with no apparent signs of awareness. Although her husband won the case and Terri passed away after removal of her feeding tube, many still wonder whether “she was still there” and “could there have been a treatment in the near future that could have restored her awareness” (Bor 225). 

           

            Daniel Bor in The Ravenous Brain explains that in order to really understand the vegetative state and the complete loss of awareness, one must distinguish between the permanent vegetative state (PVS) and minimally conscious state. The latter can only be applied when a patient has showed signs of improvement that may include, but are not limited to, tracking an object with his/her eyes or responding to commands (Bor 222). The issue is when outward signs of wakefulness occur; for example, slight, erratic movements. In many cases, these types of responses do not even require consciousness and provide false hope of recovery. The vegetative state is linked to damage to the thalamus and prefrontal cortex (Bor 225).

 

So, the question is can patients in the vegetative state recover and regain normal consciousness? Bor says that many patients do have a chance, although half do not. The longer the time spent in the vegetative state, the less likely the patient is to recover, however. He describes that currently, there are better behavioral assessments becoming available; for example, better-defined rating scales and serve as diagnostic markers placing patients into categories (Bor 226). Bor also talks about communication via brain scanners. These devices are able to detect brain activity, which potentially detects any level of awareness of the brain in vegetative patients. The only disadvantage with this method is that negative results are hard to interpret (Bor 230). Irrelevant or excessive movements are likely to disrupt the results. Bor agrees that these methods are not even close to be considered effective clinical tools, but does state that this will change in the next five years or so.

In the article Study: New Technique Predicts Consciousness of Brain-Damaged Patients by Alexandra Sifferlin, new research has provided evidence that physicians are now able to determine when a patient is likely to recover through a brain imaging technique known as PET (positron emission topography). In this study, researchers found that out of one hundred twenty-six patients with severe brain damage, a small proportion of patients were able to retain brain activity as detected by recorded PET scans. A behavioral test was used in accordance with this diagnosis, but it was found that the PET scan was needed for confirmation. Nonetheless, researchers still claim that this is not an “exact science”. Regardless, it leaves much doubt whether a patient in a vegetative state should be taken off life support.

 

Work Cited:

Bor, Daniel. The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning.  New York: Basic, 2012.  Print.

Sifferlin, A. (2014, April 15). Study: New Technique Predicts Consciousness of Brain-Damaged Patients. Retrieved October 17, 2014, from http://time.com/63928/study-new-technique-predicts-consciousness-of-brain-damaged-patients/