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Persistent vegetative state often not so vegetative - Journal of Omnifarious

May. 12th, 2008

05:46 am - Persistent vegetative state often not so vegetative

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Apparently many patients diagnosed as being in a persistent vegetative state are misdiagnosed. Most of the time such patients are not even subjected to well known and understood scans for brain activity.

So, maybe the Republicans were right so long ago, even if for all the wrong reasons. Maybe if even one of the grandstanding politicians from that one case so long ago had mentioned something like this instead of making it into a religion based moral argument things would've gone differently, people would've been educated and lives could've been saved.

Current Mood: [mood icon] contemplative

Comments:

From:rosencrantz319
Date:May 12th, 2008 02:13 pm (UTC)
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From:omnifarious
Date:May 12th, 2008 02:40 pm (UTC)

Yes and no

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I think the article points out that there are other kinds of analysis and observation that could've been done in the Terri Shivo case. Better and more accurate ways to have answered the question it posed. But I don't think the article says in any direct way whether or not Terri Shivo should've been kept on life support or not.

Many were making the argument that basically any attempt to remove life support from someone in a state even remotely like that was just wrong on moral grounds. And I don't really agree. But I do think a very thorough and complete job of diagnosis should be done to determine how much of someone is left in there.

For example, my father had life support removed, and I doubt that was a bad decision. I think most of his brain had been destroyed by the internal hemorrhaging and there was really very little of him left in there. And I think the diagnosis techniques mentioned in this article would've told the same story.



Edited at 2008-05-12 02:40 pm (UTC)
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From:joreth
Date:May 12th, 2008 05:28 pm (UTC)

Re: Yes and no

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Unfortunately, with Terri Shivo, the post-mortem showed that she really was brain dead and there was no hope for recovery.

But a discussion about the scientific and medical options and what our current diagnosis tools mean would be a much better way to make these decisions, rather than a bunch of religious zealots trying to keep alive a vegetable against her stated wishes based on religious principles in the face of evidence.

I do not think moral grounds are the right argument for discussion on whether or not to continue life support. But if we're going to discuss moral grounds, how about the fact that she freakin said not to keep her on? Aren't the wishes of the patient important at all? But a more thorough understanding of the patient's chances will give us a better chance at actually following the patient's wishes, "moral" grounds or no.

Of course, I plan to join Alcor as soon as I have the money for it and have my head frozen when I die to be brought back later :-D I want to be kept on life support indefinately, but those are *my* wishes and not anything I'd even think of imposing on someone else!
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From:omnifarious
Date:May 13th, 2008 04:52 pm (UTC)

Re: Yes and no

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I didn't know that they'd done the autopsy afterward.

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From:joreth
Date:May 13th, 2008 05:50 pm (UTC)

Re: Yes and no

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They had to, to shut everyone up by proving "conclusively" one way or the other. She was totally braindead and was not responding to any stimuli. All appearances as such were coincidental.
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From:catherinew
Date:May 12th, 2008 05:29 pm (UTC)
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After my mother's brain hemorrhaged, they performed the test in which they shut off all oxygen and watched her brainwaves for a full minute to see if she had even the smallest urge to breathe. That's the part of the brain that goes last. She didn't; the line was flat. So in her case, there really was nothing left.

This article describes people who are a lot more alive and responsive than was my mother, and who are not getting the proper diagnosis and care.

For a fascinating article on a related topic, you might want to read "The Checklist" in the December 2007 issue of The New Yorker. The opening story alone -- about truly heroic efforts to save the life of a girl who was submerged in an icy pond for thirty minutes -- is worth the read.
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From:omnifarious
Date:May 13th, 2008 04:56 pm (UTC)

The Checklist

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Now that is a very interesting article.

There is another field I know of in which there is enormous complexity. I wonder if something like that would help there. I bet it would in certain situations where you're performing some well-understood operation like deploying the software.

Of course, seeing all these lists of wrote instructions to be followed causes me to wonder if maybe a machine couldn't do it better. But that brings to mind this story: Manna.



Edited at 2008-05-13 04:56 pm (UTC)
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From:leora
Date:May 13th, 2008 12:01 am (UTC)
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I wish we were allowed to euthanize people. I would not want food denied to me, but I might want to be mercifully killed.

So, the argument seems to be: some of these people are intermittently aware, often suffering horrible pain that isn't being seen to, and unable to communicate.

Now, while I'm all for improving our medical techniques and providing better care and better diagnosis, I think a lot of people wouldn't want to live like that for years.

I had a lesser version of that for a time, and I was terrified. I was also horribly alone. Now, I had people who loved me giving me very good care, but that didn't keep me from being terrified and alone, because I was trapped inside my own body, unable to communicate, and watching my own mental abilities dying - watching my self dying. And not knowing if I would ever get better or whether they'd know or understand what was happening.

Now, I find that worth going through if I can come out of it. I'd want good steps taken to try to treat me. But if odds are good that that is the rest of my existence... I'm not sure I want to live like that for years and years, especially if it's basically all the time and more extreme than what I already went through.

This is why I think living wills are vital. Each person should make that choice for themselves. And if none exists, those close to them should give it their best guesses. But the fact that they are aware and suffering doesn't somehow make it obvious that they shouldn't be let to die. It truly bothers me the way we will humanely kill an animal if its suffering is extreme enough and incurable, but we will force humans to die horribly.
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From:joreth
Date:May 13th, 2008 05:54 pm (UTC)
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I completely concur here. I'm totally opposed to the removal of the feeding tube method. It's really a religious method - if God wills that the patient live, the patient will live. If God doesn't, the patient will die. Meanwhile, I will sit here passively and let God or fate make the decision.

I can't even comprehend the level of inhumanity that thinks this is more "humane" than euthanizing.

I haven't ever been in your situation and my opinion might change if I did, but I'm all for extreme measures of prolonging my life. But, as I said, I want to be an alcor member, so that's about as extreme as it gets :-D
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From:leora
Date:May 13th, 2008 05:58 pm (UTC)
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I don't consider that overly extreme if you can afford it, because it doesn't involve a long period of suffering.

If I could be immortal, I'd take it - so long as I was reasonably okay and reasonably ~me~ during that immortality. I don't want to spend huge amounts of time in horrible agony or with massive brain damage to the point that I'm hurting the people who love me more by existing than I would through death and them being able to mourn me and move on, and I'm not really there much anymore anyway.

The question to me is how well can we tell if the person is still themselves and whether they are horribly suffering. That's really hard to tell. But I doubt most people would want to spend years in agony, even if they'd very much like to spend years alive.
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