http://news.bbc.co.uk/1/hi/health/5320234.stm
The stuff of nightmares I reckon.
This stuff always reminds me of Ray Miland in “Premature Burial”. I don’t know how many times the legend of the casket with fingernail marks on the inner side has come up. Same thing here. Is it alive, or is it Memorex? If the brain is partially functioning, but there is no hope of recovery from an otherwise vegetative state, do you keep them alive? What would the patient choose, if they could? What kind of salad dressing would you use?
djm
from the article:
“Despite the woman’s very poor behavioural status, the FMRI findings indicate this existence of a rich mental life.”
For me, personally (and I would in NO WAY insist this has to apply to others) being in a totally vegetative state, even temporarily, wouldn’t be a “rich mental life” - it would be frustrating beyond belief, and I wouldn’t want to exist in it. Honestly, just pull the plug on me and get it over with. Even if I was somewhat aware of what was going on around me, if there was no way to interact with it all, I don’t want to be here. I wouldn’t want to see my family be put through that.
Seriously - pull the plug and take my heart, lungs, kidneys, whatever and give it to someone who needs it. Don’t keep me “functioning” in the hopes that I may someday come out of it.
Being trapped inside myself is one of my worst nightmares to be sure… 
I can’t remember anything
Can’t tell if this is true or dream
Deep down inside I feel to scream
This terrible silence stops me
Now that the war is through with me
I’m waking up, I cannot see
That there is not much left of me
Nothing is real but pain now
Hold my breath as I wish for death
Oh please, God, wake me
Back in the womb it’s much
too real
In pumps life that I must feel
But can’t look forward to reveal
Look to the time when I’ll live
Fed through the tube that sticks in me
Just like a wartime novelty
Tied to machines that make me be
Cut this life off from me
Hold my breath as I wish for death
Oh please, God, wake me
Now the world is gone, I’m just one
Oh God, help me
Hold my breath as I wish for death
Oh please, God, help me
Darkness imprisoning me
All that I see
Absolute horror
I cannot live
I cannot die
Trapped in myself
Body my holding cell
Landmine has taken my sight
Taken my speech
Taken my hearing
Taken my arms
Taken my legs
Taken my soul
Left me with life in hell
Mind you, it sure beats exercise as a means of losing weight …
djm
… ouch.
Did they get the idea for that from “Johnny Got His Gun?”
There’s a horrifying book. I don’t want to see the movie.
Yeah, that’s exactly where they took it from. They had to buy the rights to the whole freaking deal just to make the music video.
Check both links out.
Little is known about vegetative states. However some
things may be worth considering. In trauma cases, there is a
diagnosis of persistent vegetative state after one month, however this is
NOT a diagnosis
of ‘permanent vegetative state’’ which is postponed for one year in trauma cases
(like the one reported in Gary’s link).
The prospect of regaining consciousness, that is, being able
to communicate, talk to people, within one year is 52 percent, 58 percent
if one counts those recovering to ‘consciousness’ after
one year. The number of recoveries to consciousness
AFTER one year may be as high as 17 percent of those
available to recover (that is, those who haven’t died or recovered
already). That’s nearly 1 in 5.
Of those recovering to consciousness, I believe about half
recover to independence in the first year–that is, they recover to the
point where they go home and
resume their lives.
So the prospect of recovering to consciousness if you are diagnosed
in a persistent vegetative state due to trauma is about 6 in 10.
However it’s reasonable to suppose that many of the people diagnosed
in persistent vegetative state are entirely comatose, that is, have
no mental life at all because of irreversible brain damage. People who are internally aware, as was this
woman in the the story, probably have a far greater chance
of recovery to consciousness and independence. So if you were
in her situation, there might be a good reason to wish to
stay alive–the probability of recovery.
In sum: There’s a lot of confusion here–people think the ‘persistent vegetative
state’ diagnosis is the ‘permanent vegetative state’ diagnosis.
These are medically different–the latter is supposed to be justified
only when the prospects of recovery are vanishingly small.
Most people think the prospects of recovery from persistent
vegetative state are very poor when in fact they’re better than
half–and probably better still if you are like the woman in
the story. Also, as mentioned, there is a real possibility of recovering
to independence.
Whatever one thinks, it’s best to make an informed decision
about this sort of thing, knowing the
probabilities. Doubtless some people would still opt for death, but I daresay a good number of people who
do opt for death in advance would not do so
if they were informed.
Living Wills, by the way, are often
badly confused about these matters; especially they often
don’t distinguish ‘persistent’ from ‘permanent’ vegetative state.
People who sign a Living Will commanding the withdrawal of
‘life-sustaining treatment’ if they are diagnosed in PVS, are ordering their death while it’s statistically probable they will recover
to consciousness.
I have a paper forthcoming ‘Pascal’s Wager and the Persistent
Vegetative State’ in the journal Bioethics. If anyone’s interested
I would be glad to e mail you a copy.
Really?
resume things like playing fiddle
and full time job without any limitations?
I’m with Missy on this one.
Even if there is a certain statistical chance of my emerging from the vegetative state, I’m not so attached to life that I’d really want to hang around for who knows how long to find out.
A significant number of those who recover to independence make a virtually complete recovery. A much larger group is called ‘moderately’
disabled–they are able to resume ‘almost all the activities
of independent living.’ Whether that includes fiddle playing
I don’t know–I can’t play the fiddle anyhow. I also don’t
know about the full time job ‘without any limitations.’
I play in an acoustic jam with a seriously disabled
guitarist who is quite good and I’ve seen a severely disabled
woman, triaplegic, run a rehab facility in a major hospital.
Doubtless she has some limitations. We are talking about
people either back to normal or significantly less disabled
than these two.
Your call.
However this isn’t a ‘certain statistical chance,’ Emmie.
If you are diagnosed with PVS due to trauma, it is UNLIKELY
that you will remain in a vegetative state.
And it isn’t a matter of ‘hanging around for
who knows how long to find out.’ You
will probably return to consciousness within a year of
the pvs diagnosis.
Consider this too. The probability of 6 in 10 recovery is
for everybody diagnosed in PVS due to trauma. That
includes a lot of people who are all but brain dead.
They bring down the average recovery rate. The probability of
recovery
for the remainder, especially those who are aware,
is bound to be a good deal better than 6 in 10.
If you wish to die when there is a strong probability of
emerging from PVS within a year, fine. But the fact is
that most people are making decisions on the mistaken
assumption that the chance of recovery is very
remote. The opposite is the case, in fact, and it’s
worth counting in making decisions. A good number
of people who opt for death in these circumstances,
believing there is virtually no chance of recovery,
might make a different decision if they
knew the truth.
My claim isn’t that everyone should opt for life,
but that everyone deserves to know the
facts, so they can make an informed decision.
Also if you are on the line with an injured
family member so diagnosed, it’s worth considering
in your decisions that they will probably emerge
from PVS within a year.
I would think the medical pros would be able to provide those probabilities to the folks who’d be making the decision anyway. I’m thinking more along the lines of long term veg states, as in years.
Based on a report like this one, there are evidently ways of measuring mental activity which must be(I guess?) correlated with the likelihood of emerging. It would be a tough call for the caller. I’m just saying that my philosophy regarding life/death is such that life isn’t something I’d feel a need to grasp tenaciously onto at all costs.
even if someone told me the odds would be I’d be somewhat close to normal in a year or so - I wouldn’t want to live that year or so waiting. Or have my family live that year or so.
As I said, I am ONLY answering this for me, there is no way I would try to force my view on someone else, or dictate their wishes in such a situation.
When my dad was operated on for colon cancer, it had already invaded his lymph glands, and those were removed, too. Afterwards, he was given the options. He could receive chemo - but there was no quarentee it would do anything, and it was pretty much a given that he would be very sick during it (this was 20 years ago - I know things have changed since then). Or he could just take his chances. If the cancer DID reoccur, it would take a year to 2 years, and it would hit him quick.
He chose the later. He was fine for 15 months - was building a huge deck for someone that next summer. On Labor Day weekend, he began to feel bad, the next Tuesday went to the doctor, and the cancer had hit his liver, lungs, and his spine (which then involved a LOT of pain). He died October 8th.
Would he have lived longer with chemo? Who knows. He chose to do what HE wanted to do as far as his quality of life, and I can never fault him for that, no matter how much I wish he had lived.
I’ve seen reports that they’re not really able to provide the probabilities. A lot of care providers have trouble explaining what a living will is, for that matter.
As you can see from what Jim said, most people don’t understand the difference between the two states. Even if a medical pro understood it, which might not be the case, he or she might be unable to explain it in any meaningful way, especially if the recipient has preconceived notions about what it is.
Based on a report like this one, there are evidently ways of measuring mental activity which must be(I guess?) correlated with the likelihood of emerging.
There aren’t any ways in use today. That’s the point of this discovery – it may be a way to determine if mental activity is present. Unfortunately, it’s not something you can use now.
Even if someone told me the odds would be I’d be somewhat close to normal in a year or so - I wouldn’t want to live that year or so waiting. Or have my family live that year or so.
On the second point, Missy, I wrote this:
The job of the young and the strong is to care for the old, the sick and the disabled, not vice versa. A proper function of family, I believe, is to support members who are in desperate trouble. If it’s in my interest to opt for life if I have no family, my family has a good reason to support my opting for life.
So I think you may have the moral order of things reversed.
It isn’t your job to take care of them in this circumstance;
it’s their job to take care of you.
On the first point, waiting the year to recover, first, you may well
recover before a year, e.g. tomorrow. Also I think going on with
life in this circumstance, when there is strong hope of recovery,
is an act of compassion for your family. I wrote this:
My family might badly want me to have my chance at recovery, and be devastated at implementing a directive starving me to death. Consequences may be still worse if they suspect that I chose starvation for their sake.
After all, they love you, and if you are probably going to recover
to normalcy with in a year, they would badly want not to lose you.
That would be a reason to wait out the year.
Right. The ‘persistent’ diagnosis is after you are in VS for a month.
In the case of trauma the PVS is judged ‘permanent’ after one year,
because the prospect of recovery from a persistent vegetative
state BEFORE one year is too high.
I wrote this about Living Wills:
Few who sign directives know the difference between ‘persistent’ and ‘permanent’ VS, nor is there any guarantee that medical personnel are better off. Living wills are usually framed in terms of PVS; some specify a ‘persistent vegetative state from which there is a high degree of medical certainty that I will not recover’. Given the apparent synonomy of ‘persistent’ and ‘permanent’, the added condition seems redundant. As people who write their own directions are likely to do so in terms of PVS, they may order their starvation well before a PVS is ‘permanent’, while there is real hope of regaining independence.
A standard Maryland directive provides a checkoff for refusing ‘life-sustaining procedures’ if “I am in a persistent vegetative state, that is, if I’m not conscious and am not aware of my environment nor able to interact with others and there is no reasonable expectation of my recovery”. This confuses persistence with the absence of ‘reasonable’ expectation of recovery. It invites implementation in a nursing home, say, simply because you’re diagnosed in PVS. A West Virginia form states: “if I am…certified by one physician…to be in a persistent vegetative state, I direct that life-prolonging medical intervention that would serve solely to…maintain me in a persistent vegetative state be withheld or withdrawn.” This confusing and highly interpretable directive invites starvation long before the PVS is ‘permanent’.