Persistent Vegetative State

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mypsychoticself
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Persistent Vegetative State

Postby mypsychoticself » Fri Apr 24, 2009 12:51 am UTC

I am currently writing an Ethics paper about whether people in a persistent vegetative state should remain on life support. I, personally, don't think so. People in a persistent vegetative state are unlikely to recover (assuming that they were diagnosed correctly).
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Re: Persistent Vegetative State

Postby philly13 » Sat Apr 25, 2009 6:22 pm UTC

If I were ever in a persistent vegetative state, I would want to be taken off life support. The way I see it, it's an unnecessary burden to the family and friends who have to pay for it, and it never lets them let you go. It just delays the inevitable (I understand that death is always inevitable, but being in a persistent vegetative state is different) and is essentially just an open casket for as long as you're on life support. I wouldn't want my family to have to worry about me if there was a near 0 chance that I would ever even move again, I would rather see them move on and just keep me in their memories.

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Re: Persistent Vegetative State

Postby rath358 » Sun Apr 26, 2009 6:57 pm UTC

I can understand doing this long enough to let my organs be donated, but anything longer is repulsive.


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Re: Persistent Vegetative State

Postby el_loco_avs » Mon Apr 27, 2009 10:02 am UTC

I've always failed to see a (non-religious) reason to keep someone in a vegetative state on life-support for any extended time. If there is anyone here, I'm genuinely curious.

Personally, I actually support euthanasia for anyone that has made that decision before becoming vegetative. No need to wait for the body to just...well... die of hunger?
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Re: Persistent Vegetative State

Postby Seraph » Mon Apr 27, 2009 9:20 pm UTC

I've always failed to see a (non-religious) reason to keep someone in a vegetative state on life-support for any extended time. If there is anyone here, I'm genuinely curious.

How about the fact that a lot of people recover from them?

EDIT: There is a nice article in the New England Journal of Medicine about this:
http://content.nejm.org/cgi/content/full/330/22/1572
It gives a recovery rate of 52-62% within one year depending on age.

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Re: Persistent Vegetative State

Postby Princess Marzipan » Mon Apr 27, 2009 10:27 pm UTC

I think there's a terminology issue here.

There are situations from which the body and mind can recover, and I think they're classified differently from ones where no, that person will never recover.

I'm not sure what's called what and can't be assed to look into myself right now, but I do know there are different names for the different conditions and that intelligent discourse requires clarifying what's what.

Why don't we use brain death, coma and vegetative state. Conveniently listed in least to most brain function.

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Re: Persistent Vegetative State

Postby mypsychoticself » Tue Apr 28, 2009 3:22 am UTC

Three months after injury, 33 percent of the patients had recovered consciousness; 67 percent had died or remained in a vegetative state. Recovery had occurred in 46 percent of the patients at 6 months and in 52 percent at 12 months. Recovery after 12 months was reported in only 7 of the 434 patients47,49. One patient recovered consciousness 30 months after injury and remained severely disabled47,111. The Traumatic Coma Data Bank study reported that 6 of 93 adult patients in a vegetative state recovered consciousness one to three years after injury49. Four of these six patients had severe disability, and one had moderate disability; the status of the sixth patient could not be determined. Five of the six patients were under 30 years of age. There have been no other well-documented reports of recovery of consciousness in patients in a persistent vegetative state more than 12 months after a traumatic injury.


I don't think that any of us are talking about pulling the plug immediately after an injury; however, if I had not regained consciousness within one year, I'm not sure that I would want to. But that's not the only question to consider. Keeping people alive takes a lot of resources--resources that could be used to help people with better prognoses.
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Re: Persistent Vegetative State

Postby el_loco_avs » Tue Apr 28, 2009 10:18 am UTC

Seraph wrote:
I've always failed to see a (non-religious) reason to keep someone in a vegetative state on life-support for any extended time. If there is anyone here, I'm genuinely curious.

How about the fact that a lot of people recover from them?

EDIT: There is a nice article in the New England Journal of Medicine about this:
http://content.nejm.org/cgi/content/full/330/22/1572
It gives a recovery rate of 52-62% within one year depending on age.



I should ofcourse have been clearer. With "for any extended time" i meant beyond the period where recovery is expected.

Reading up a little (via wiki) it seems PVS is often misdiagnosed (it mentions a study where 43% of patients were misdiagnosed). This changes my view a bit. You'd have to wait a long time to be sure that the person in question has only a negligible chance of recovery (ie, those with non-traumatic brain injury after 3 months, as from your article).
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Re: Persistent Vegetative State

Postby GraphiteGirl » Fri May 01, 2009 4:56 am UTC

el_loco_avs wrote:
Seraph wrote:
I've always failed to see a (non-religious) reason to keep someone in a vegetative state on life-support for any extended time. If there is anyone here, I'm genuinely curious.

How about the fact that a lot of people recover from them?

EDIT: There is a nice article in the New England Journal of Medicine about this:
http://content.nejm.org/cgi/content/full/330/22/1572
It gives a recovery rate of 52-62% within one year depending on age.



I should ofcourse have been clearer. With "for any extended time" i meant beyond the period where recovery is expected.

Reading up a little (via wiki) it seems PVS is often misdiagnosed (it mentions a study where 43% of patients were misdiagnosed). This changes my view a bit. You'd have to wait a long time to be sure that the person in question has only a negligible chance of recovery (ie, those with non-traumatic brain injury after 3 months, as from your article).


Following a heart attack, my grandfather recovered from a long coma (several weeks). Doctors had given him a 10% survival rate, and suggested that even if he did wake up, he would have difficulty with basic speech and would probably never walk again. My mother (a sociologist specialising in sociomedical issues) and grandmother refused to switch off the life support despite this. Ten years later, he's alive, has only the degree of frailty you'd expect in any octegenarian, is incredibly articulate and still entirely mentally present. This has substantially shaped my view on comas/persistent vegetative states.
If there was some way to prove conclusively that recovery was impossible, I'd want someone to switch off my life support (although I'd still be hesitant about switching off someone else's). But science hasn't quite progressed to the point where such certainty is possible.
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Re: Persistent Vegetative State

Postby VannA » Fri May 01, 2009 5:53 am UTC

I don't beleive this is an area that should be legislated, or at least, not with out a lot of fiddlyness.

I, personally, would be reasonably comfortable if the missing-persons-declared-deceased rules were applied to those in a coma. (IE, you're in a coma for 5 years, 10 years, 15 years, whatever is applicable, you are declared legally dead.)
Once you're legally dead, I would imagine the reality would follow.

I would also like to see provision in the laws regarding pre-death wills to have provisions for self-directed termination of life support in such a state.

I'm generally opposed to family or general people being able to turn if off, without a substantial amount of time.

PVS, I'm less comfortable with. Too many misdiagnoses, apparently, and recoveries that are too often for me to be comfortable with effective execution orders.

Brain Death is different, again. I'm not personally aware of recoveries from 'Brain Death' that extended longer than 6 or 7 minutes.
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Re: Persistent Vegetative State

Postby KevorkianKat » Fri May 01, 2009 2:15 pm UTC

I am of the opinion that unless a vegetative state can be confirmed in some future medical discovery to be a permanent and completely disabling (complete destruction of the brain) effect on a person that there should be no reason why they can't (or their family) choose to continue life support. It is unfortunate that we cannot currently reconstruct brain matter to restore personality and functionality, but we can also not often look inside a person to tell if they are able to ever restore that ability themselves.

If a person has even a small chance to recover, even if that chance is unknown by current medical science, then they could possibly in the future continue to contribute to society and there is every reason to keep them on life support until such a time as they can no longer be supported. If a person wishes to be killed during such a state and has stated so, there is also no reason to not do so, as the person is unlikely to continue to contribute to society if they have made such desires evident.

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Re: Persistent Vegetative State

Postby el_loco_avs » Sat May 02, 2009 8:56 am UTC

Well... I think there should be difference between PVS caused by head-injuries and those caused by things like cancer. If the tumor is inoperable then that person isn't coming out of that PVS no matter what (I assume). I would support active euthanasia at that point (though with many legal hoops to jump through first).

Head injuries are a different thing. With no solid way to make predictions all (especially with diagnosis being... untrustworthy) you can only wait. But that would involve waiting months or years until you "give up" on the chance of recovery. But where would the line be?
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Re: Persistent Vegetative State

Postby Kain » Sun May 03, 2009 1:45 am UTC

I tend to think that the ultimate decision on whether or not someone should be kept on life support should rest with the patient. Since we obviously cannot ask them while they are in the vegatative state, I tend to think governments have a responsibilty to know the intents of their citizens while said citizens are still in good health. Ideally, this information would be gathered in an inobtrusive way. I tend to think of a slightly more complicated version of the question on my driver's licence application that asked wheter or not I wish to be an organ donor. Ideally a question would be added to the application of such government identification cards, which would allow the person applying to add a brief description of their intention should anything force them into a persistant vegitative state. Of course, they would not have to respond to that question, as I am sure most people aren't sure of what they would want in that scenareo, but I am sure a number of people would state their intentions who might otherwise not think of it.

As for the options, I don't have any particular beliefs that make me for or against keeping a person alive. However, I tend to think that unless they specifically asked such, the should not be starved to death if the decision is made to shut down the life support, but rather euthanized in the most humane way possible. That said, I personally would want to be kept alive for about 5 years, after which I would want the life support pulled, without euthanization, just in case through some odd contrivance the life support itself was keeping me comatose (very long odds against that, I know, but probably better than the odds that the euthanasia procedure would spontaneously revive me).
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