Deader than dead?


How do we understand PVS, persistent vegetative state? One researcher finds that people in these states are deader than dead

Deader than dead: people in vegetative states are viewed as deader than corpses

From DiscoverMagazine blog

In 1990, Terri Schiavo suffered a heart attack that left her in a persistent vegetative state. She came out of her coma but severe brain damage left her unresponsive with no detectable brain activity. Trapped in a state of “wakeful unconsciousness”, her condition triggered a lengthy legal battle between her husband, who wanted to end her life support, and her parents, who wanted to keep her alive. The debate over Schiavo’s moral rights raged for the better part of a decade, and the arguments were filled with people who claimed that her condition was a “fate worse than death”.

The phrase reflects a curious tendency to view people in a persistent vegetative state (PVS) as being deader than dead. Kurt Gray from the University of Maryland has found that people, especially religious ones, tend to think of PVS patients as having less mental capacity than a corpse.

. . .

Gray argues that while people tend to see dead people as disembodied minds, they see people in a PVS as mindless corpses. As he writes, “These results suggest that for vegetative patients, life or death may depend more upon the mind of person making the decision than the mind of the patient.”

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3 Responses to "Deader than dead?"
  1. Regarding this topic a friend of mine once used a phrase that has stuck in my mind ever since: "A soul trapped inside a body." The autopsy performed on Terri Schiavo indicated that she couldn't possibly have had any consciousness during the time spent in a PVS. Thank God!

    -Cullin R. Schooley

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  2. On reading the article linked in this post. I found some of what was there a bit confusing. As a neurologist, I have pretty clear definitions in mind when I say things like brain death, persistent vegetative state (PVS), permanent vegetative state and minimally conscious state. For the general public, these distinctions are harder to appreciate.

    When they gave the PVS scenario, they said, “David’s entire brain was destroyed, except for the one part that keeps him breathing,”... “So while his body is still technically alive, he will never wake up again.’’

    They have, unfortunately, blended elements of brain death and PVS together in a confusing mix. Persistent vegetative state typically follows a period of "eyes-closed" coma. In the PVS, eyes may open and close and do so in a manner consistent with sleep-wake cycles, so that they are "awake" in a rudimentary sense. They may make crude and reflex movements of the limbs, non-verbal vocalizations and, even, briefly, direct eyes to stimuli ("look at" someone/thing). They show, however, no ability to follow commands or interact with others or the environment. Inferentially, they have no awareness of self or surroundings (we say inferentially, as it is impossible in any state to directly experience the consciousness of another). Crudely, the PVS state is rather like "the lights are on but nobody is home." So when they say "David will never wake up again," they actually make it sound like brain death, where no evolution to "eyes open" occurs.

    The other side that is less clear is that they made an absolute prediction that David will "never wake up again" presumably intending that he will never return to self awareness. While it is unlikely that someone in a PVS will return to consciousness, it is not theoretically or statistically impossible. A small percentage will "improve" but usually to severe disability such as a "minimally conscious" state.

    In the American Academy of Neurology's review of PVS published in 1994, for a person in a PVS at six months after a traumatic brain injury the prognosis at one year was for death in 32%, continued PVS in 50%, severe disability in 12% and moderate disability to good recovery in only 4%. I find, therefore, the "will never wake up again" to be an overly simplistic and potentially mis-leading way of putting things.

    The issues of brain death, persistent vegetative state and minimally conscious state medically and ethically are complex, but a "simplistic" and somewhat "misleading" scenario may not be telling us very much. GIGO?

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