Persistent vegetative state: diagnosis with an agenda

Most Americans don't know the difference between a severe concussion, a coma, wakeful coma and brain death. But even those of us who have never been to a day of medical school know the difference between a person and a vegetable. A person walks and talks, eats, puts on clothes, takes a shower, goes to work, and has fun in any spare time. A vegetable just lies there in the supermarket, gets sprayed with water, and is eaten. Or, if it gets old, wrinkly or rotten, it is thrown away.

Of course, common logic will tell us that, no matter what condition a person is in, he or she will never become a vegetable. Is a dead person a vegetable? Taxonomy charts carried around by botanists don't have spaces for dead people or dead animals, for that matter. Humans and animals do not morph into plants.

So, if people are in a wakeful coma (so—called 'persistent vegetative stated or PVS) they don't actually become vegetables. There is not one single instance of people in a wakeful coma finding their toes turning into carrots or their fingers into green beans. Their DNA remains that of homo sapiens, and a surprising number of them regain higher brain function. None of these return from a state of being a turnip back into being a human.

One does not need a PhD in linguistics or a medical degree to conclude that, as a term, persistent vegetative state is not a useful description of a person who is awake but not conscious (otherwise known as a wakeful coma), who has lost the functioning of the portion of the brain which controls consciousness.

A person diagnosed as PVS still has a functioning brain stem, which controls the mechanisms of breathing, digestion, and reflexes, so they are not brain dead. They have partial brain function.

So, if PVS is such a poor term to describe the medical condition of a wakeful coma, why is it a diagnostic term in the first place?

PVS is a very useful term if you are an advocate of euthanasia. If you believe that killing people who (in your opinion) don't have much 'quality of life,' whom you see as 'trapped in their bodies' at the door to eternity, and who (in your judgment) are better off 'released' from a life confined to bed, then the term persistent vegetative state works very well indeed.

Here's how the process of euthanasia starts: you insert a feeding tube because it is just so much trouble to feed the patient. Then, you explain to the parents, husband, courts, press, an d everyone else that Joe or Jane is in a persistent vegetative state. Joe or Jane will never be self—aware. It is time to consider the option of removing the 'artificial therapy' of the feeding tube.

The word 'vegetative' has already dehumanized the patient, so the euthanasia enthusiast can usually kill them without too much opposition from the family, courts, or public. After all, the thing in the bed isn't a person. Right?

For euthanasia advocates, a recovery from PVS can be might embarrassing. A quick review of web—available medical literature on PVS leads the layman to conclude three things:

1) PVS recovery rates go way down a year after diagnosis;
2) Even after a year, a small percentage do recover;
3) Medical science does not understand the mechanism for recovery. (In two reported cases, full—blown PVS patients recovered well after being given Seratonin Reuptake Inhibitors.)

Given the paucity of data available on the prognosis of patients who have been diagnosed PVS and our limited understanding of human consciousness, medicine should have a profound humility when approaching brain damage diagnosis and prognosis. Physicians who favor death as the standard of care are ignoring their own lack of understanding of the small number of patients who recover, and their profound lack of understanding of the mind—body question. If they knew more, they would be able to evaluate the state of human self awareness using assessments of organic brain states or function.

In times before the germ theory was understood, it was hard to get a conscious patient to go to a hospital — their chance of dying was much higher there than anywhere else. The ignorance of doctors was fatal.

Now, the brain damaged may well revert to hospital avoidance. Medical ignorance of the brain, along with the stunning presumption that patients prefer death by starvation to impaired brain function encourages this reversion.

The crossroads are upon us, where men and women in medicine are going to be forced to choose between terminology that accurately communicates a patient's condition, or language that facilitates the killing those patients with disorders of the brain. And the rest of us must learn to parse the science from propaganda in diagnostic language.

Carl Rossini is an advertising instructor, with graduate and undergraduate degrees in history, as well as a MBA. He lives in the Dallas area.

Most Americans don't know the difference between a severe concussion, a coma, wakeful coma and brain death. But even those of us who have never been to a day of medical school know the difference between a person and a vegetable. A person walks and talks, eats, puts on clothes, takes a shower, goes to work, and has fun in any spare time. A vegetable just lies there in the supermarket, gets sprayed with water, and is eaten. Or, if it gets old, wrinkly or rotten, it is thrown away.

Of course, common logic will tell us that, no matter what condition a person is in, he or she will never become a vegetable. Is a dead person a vegetable? Taxonomy charts carried around by botanists don't have spaces for dead people or dead animals, for that matter. Humans and animals do not morph into plants.

So, if people are in a wakeful coma (so—called 'persistent vegetative stated or PVS) they don't actually become vegetables. There is not one single instance of people in a wakeful coma finding their toes turning into carrots or their fingers into green beans. Their DNA remains that of homo sapiens, and a surprising number of them regain higher brain function. None of these return from a state of being a turnip back into being a human.

One does not need a PhD in linguistics or a medical degree to conclude that, as a term, persistent vegetative state is not a useful description of a person who is awake but not conscious (otherwise known as a wakeful coma), who has lost the functioning of the portion of the brain which controls consciousness.

A person diagnosed as PVS still has a functioning brain stem, which controls the mechanisms of breathing, digestion, and reflexes, so they are not brain dead. They have partial brain function.

So, if PVS is such a poor term to describe the medical condition of a wakeful coma, why is it a diagnostic term in the first place?

PVS is a very useful term if you are an advocate of euthanasia. If you believe that killing people who (in your opinion) don't have much 'quality of life,' whom you see as 'trapped in their bodies' at the door to eternity, and who (in your judgment) are better off 'released' from a life confined to bed, then the term persistent vegetative state works very well indeed.

Here's how the process of euthanasia starts: you insert a feeding tube because it is just so much trouble to feed the patient. Then, you explain to the parents, husband, courts, press, an d everyone else that Joe or Jane is in a persistent vegetative state. Joe or Jane will never be self—aware. It is time to consider the option of removing the 'artificial therapy' of the feeding tube.

The word 'vegetative' has already dehumanized the patient, so the euthanasia enthusiast can usually kill them without too much opposition from the family, courts, or public. After all, the thing in the bed isn't a person. Right?

For euthanasia advocates, a recovery from PVS can be might embarrassing. A quick review of web—available medical literature on PVS leads the layman to conclude three things:

1) PVS recovery rates go way down a year after diagnosis;
2) Even after a year, a small percentage do recover;
3) Medical science does not understand the mechanism for recovery. (In two reported cases, full—blown PVS patients recovered well after being given Seratonin Reuptake Inhibitors.)

Given the paucity of data available on the prognosis of patients who have been diagnosed PVS and our limited understanding of human consciousness, medicine should have a profound humility when approaching brain damage diagnosis and prognosis. Physicians who favor death as the standard of care are ignoring their own lack of understanding of the small number of patients who recover, and their profound lack of understanding of the mind—body question. If they knew more, they would be able to evaluate the state of human self awareness using assessments of organic brain states or function.

In times before the germ theory was understood, it was hard to get a conscious patient to go to a hospital — their chance of dying was much higher there than anywhere else. The ignorance of doctors was fatal.

Now, the brain damaged may well revert to hospital avoidance. Medical ignorance of the brain, along with the stunning presumption that patients prefer death by starvation to impaired brain function encourages this reversion.

The crossroads are upon us, where men and women in medicine are going to be forced to choose between terminology that accurately communicates a patient's condition, or language that facilitates the killing those patients with disorders of the brain. And the rest of us must learn to parse the science from propaganda in diagnostic language.

Carl Rossini is an advertising instructor, with graduate and undergraduate degrees in history, as well as a MBA. He lives in the Dallas area.