Friday, November 18, 2011

PVS patients are misdiagnosed

Patients in so-called persistent vegetative state are awake, but according to doctors, unaware. (I dislike using the expression vegetative state. No human being is ever a vegetable. Vegetables are things you can throw away.)

According to a study published in the medical journal the Lancet, new research at Addenbrooke's Hospital, Cambridge, and University Hospital in Liege, Belgium, shows that despite rigorous assessment, many patients said to be in PVS are misdiagnosed.

Previous studies have shown that fMRI scans can uncover awareness in apparently vegetative patients, but such scans are not always available and can produce confusing results. The new research used "a considerably cheaper and more portable technique" - an EEG machine, which records brainwaves - on 16 patients diagnosed as being in PVS.

Although they were unable to move their limbs physically, the patients were told to imagine moving their right hand and toes. Three patients produced repeated and reliable brainwave patterns which showed they were aware of the commands and responding to them.

Judges in UK courts have given permission for food and water to be withdrawn from more than 40 PVS patients, causing their lives to be ended.

Here is the question: how many patients dehydrated to death have been aware but unable to respond?

And here is another question: will the knowledge that some patients are awake and aware prevent this happening in the future?

American bioethicist Wesley J. Smith agrees with me about the expression persistent vegetative state, which he says should be changed to "persistent unconscious state." The v-word, he argues, "demeans, diminishes, dehumanises and degrades the moral value of the patient."

And don't think, he says, that learning a patient is conscious will lead many to advocate against their dehydration. Although permission to dehydrate a minimally conscious patient was recently refused in a case in the UK, many have argued that someone being minimally conscious is even more reason to pull the plug because they will be suffering from the potential knowledge of their limitations.

"We really need to change our values," he says, "so that all of us are embraced and accepted as moral equals regardless of our cognitive states."