Ok, Maybe We Were Wrong About that Whole "Vegetative" Thing
In what could be a complicating factor in the Schiavo case, a report in The New York Times today, called "Signs of Awareness Seen in Brain-Injured Patients," claims that brain imaging suggests that some patients with severe brain injuries still have some awareness of their surroundings. They seem to respond differently to familiar stimuli. The open questions are, first, whether such information might predict the potential for some additional recovery, and second, whether minimal awareness is enough to suggest that such patients be kept alive. -- Paul Root Wolpecontribute a comment
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The study was performed on two patients who had clinically "minimally conscious state", a state of brain trauma already defined as
" Patients in minimally conscious states posses sleep-wake cycles and limited, inconsistent but definite awareness of self and environment (e.g., avoiding unpleasant stimuli, uttering intelligible sounds or reaching for objects in a way that adjusts for their size and location)"
I am not sure what dramatic addition to the already known clinical picture definition this study contributed.
The study was not done on a persistent vegetative state patient such as Schiavo. The only complication this study may add to the already complex and unfortunate legal mess of Schiavo may be that the family members will find and use some unrealistic and illogical hope from the study as a basis for supporting further legal battles. I hope not. ..Maurice.
- by Maurice Bernstein, M.D. on Feb 8, 2005 at 11:04 PM | link
Isn't the question for all of us--no matter the level of awareness--whether we should be kept alive? Let's not pretend that the minimally conscious are at greater risk from our whims than anyone else.
- by Thomas on Feb 10, 2005 at 1:28 AM | link
Thomas, if you put it that way, certainly the minimally conscious is definitely at greater risk from"our whims" compared to an alert, normal patient. The minimally conscious patient cannot say directly to the physician whether he or she wants to be kept alive and can't provide defense for whatever act the physician takes. ..Maurice.
- by Maurice Bernstein, M.D. on Feb 10, 2005 at 4:45 PM | link
Dr. Bernstein, we consider the patient's communications only at our whim. We always reserve the right to decide that they should die.
- by Thomas on Feb 11, 2005 at 11:00 AM | link
We have the right to hold an opinion but I don't think we have, "at our whim", the ethical nor legal rilght to turn off life support or to administer a deadly dose of something to kill off the patient. If we are responsible for patient care and we fail to treat when the standard of care is to treat and the patient dies, we will have to answer to that inaction morally and legally. Sure, if a patient desires a medically futile treatment, we are under no obligation to provide it. ..Maurice.
- by Maurice Bernstein, M.D. on Feb 11, 2005 at 7:03 PM | link