Persistent Vegetative State

Two recent stories in the news have brought back to the forefront the condition of persistent vegetative state. PVS is medically diagnosed when someone has been in a coma for three or more years without the ability to communicate or understand what is being said to them. I'm not exactly sure how they've previously determined the last part of that because someone may be able to understand but due to the inability to communicate, may not be able to let anyone know they understand.

In the first story, what was originally thought to be words from a man who has been in a vegetative state for the last 23 years turned out to be false hope when further testing revealed that he was unable to articulate any words to the assistant typist. The man's brain stem still functions normally, allowing him to go through periods of being awake and asleep, but there is still a question as to whether he is "conscious" or not even during the wake cycles.

The second story has the potential to be far more reaching. In one study done in England, doctors instructed a patient who was diagnosed with PVS to imagine either a motor or spatial scene to answer yes/no questions. When the patient was asked questions, he correctly answered five of the six as determined by the fMRI scan, which showed the same areas of the brain lighting up as those in a healthy individual. (Functional magnetic resonance imaging (fMRI) essentially takes snapshots of the brain while a person is thinking.) The implications for those who suffer debilitating brain injuries or are diagnosed with PVS are enormous but I think there are other issues that need to be considered as well.

Imagine how the family of the man in the second story now feels, knowing that for the last 7 years, this man has had a functioning brain trapped in a non-functioning body. What if they didn't visit him very often? How much guilt do they feel over the treatment and care he has been given? What effect will it have on them knowing that their loved one is still self-aware and yet at the same time knowing they're going to have to stay this way for the rest of their life?

What will society do if/when someone who can now communicate asks to die? How will we determine whether that person is "of sound mind"? Will we allow doctor assistance in that dying process or will we simply let that person starve to death or dehydrate? How do we determine "levels" of self-awareness? Will that determine if one has the ability to say they want to die?

In the second story, it is obvious from the images of the brain scan that there is major damage to the brain. We're far from understanding the complex wiring of the brain. What if there's enough "awareness" to trigger activity in certain areas of the brain and it's just a freak coincidence that the "correct" areas were triggered during this study. It was only six questions and he only responded to five of them. That's not a very wide statistical basis for making any kind of determination. And of the 23 patients in the study, only 4 showed "appropriate" responses. Which means that for most people diagnosed with PVS, there really is no hope. What will that do to the families who are holding onto what little hope they have left to find out that there really is none? What will society do when those people now decide they want to let their loved on die? Are we going to have thousands of Terry Shiavo's to deal with in our already strained court system?

I personally wouldn't want to continue to "live" in a PVS. Nor would I want to continue to live even if I were able to minimally communicate if my body was beyond my control. That to me is not living: it's simply existing. It's being trapped in hell on earth and I would choose to leave.