Fascinating NEJM article on Persistent Vegetative State--clips

[Bouncy Ball]

In 1994, the New England Journal of Medicine published a two-part study titled "Medical Aspects of the Persistent Vegetative State."

If you go to their website, you can register for free and see the entire text, since it is older than six months (have to be a paid subscriber to see newer articles). I have just read both parts.

I'm glad I did. It only verifies that removing her feeding tube and allowing her to pass on peacefully (she does not and cannot feel pain) is the humane and sensible thing to do in her case. In fact, it probably should have been done as long as five years ago (and would have, were it not for all the legal wrangling, jeb bush, etc). Why do I say that? Just read the quotes I have below from the article (these are single sentences, not paragraphs, but I will be careful not to violate copyright):

"In 1989, the American Academy of Neurology published a position paper that defined persistent vegetative state, classified artificial nutrition and hydration as forms of medical treatment, and stated that patients or their surrogates could decide to terminate treatment and that there were no medical or ethical distinctions between withholding and withdrawing treatment."

"A patient in a persistent vegetative state becomes permanently vegetative when the diagnosis of irreversibility can be established with a high degree of clinical certainty -- that is, when the chance that the patient will regain consciousness is exceedingly small."

(According to what I've read, it's amazing she's even still ALIVE 15 years after this happened, and after one year in a persistent vegetative state, your chances of coming out of it are almost nothing. Since she's been in it 15 years--past the life expectancy for most people in her condition--I think you'd be very safe in saying she is in a PERMANENT vegetative state.)

"Recovery of consciousness after three months is rare in adults and children with nontraumatic injuries."

(Hers was not caused by injury, thus nontraumatic.)

"Despite the preservation of hypothalamic and brain-stem function, the severe neurologic injury necessary to produce the vegetative state in adults and children reduces the average life expectancy to approximately two to five years. Survival beyond 10 years is unusual."

(This one is a whole paragraph--)

"A very small number of well-described patients in a persistent vegetative state have survived for more than 15 years (data available from the task force), including three patients who survived for more than 17, 37, and 41 years. Considering the small total number of patients in a persistent vegetative state, the probability that an individual patient will have such a prolonged survival (i.e., over 15 years) is exceedingly low, probably less than 1 in 15,000 to 75,000 (calculations available from the task force)."

The shortened life expectancy of those in a PVS are due to respiratory and urinary tract infections (they are incontinent and have no bowel control), and generalized systemic failure. (This is my paraphrase, not a quote.)

Do they feel pain?

"As noted in the first part of this article, extensive clinical experience, the results of positron-emission tomographic (PET) studies, and neuropathologic examination support the belief that patients in a persistent vegetative state are unaware and insensate and therefore lack the cerebral cortical capacity to be conscious of pain. Almost all such patients have some degree of motor activity and eye movement that would be capable of signaling conscious perception of pain or suffering if such existed."

In other words, no. They are insensate.

"Therapy aimed at reversing the persistent vegetative state has not been successful."

And lastly:

"When artificial nutrition and hydration are withdrawn, patients in a persistent vegetative state usually die within 10 to 14 days. The immediate cause of death is dehydration and electrolyte imbalance rather than malnutrition; patients in a persistent vegetative state cannot experience thirst or hunger. Except for dryness of the skin and mucous membranes, it is not readily apparent to family or health care professionals that a patient in a vegetative state is dying of acute dehydration. Such patients also do not manifest the characteristic signs of malnutrition after depletion of nutrients over a prolonged period."

The article also discusses maintaining the dignity of the patient.

Here is the link to the abstract:

http://content.nejm.org/cgi/content/short/330/21/1499

[rodeodance]

1. pass this onto Sen Frist--and Delay!!

[Bouncy Ball]

2. Like they'd read it.

:eyes:

[blondeatlast]

Excellent summation. While it is wrong to call Ms. Schiavo a "vegetable,"

or to assume there is absolutely no brain activiity whatsoever, the woman should be allowed to do as Nature or her God intends.

I have worked with those in this state, and can see how some of their actions can be interpreted as signes of emotion, but it just isn't the case.

Let this woman go to her rest and reward.

[Bouncy Ball]

11. Agreed.

I read some of your posts on other threads. And you are right, it is VERY easy, apparently, to mistake the involunatary, reflexive motions/actions of someone in a PVS as conscious, voluntary actions.

[ohio_liberal]

3. So the rumor

that Terri Schiavo's eyes are going to sink in her head and her tongue will crack, etc. because of dehydration is pretty much bullshit. Figures.

[Bouncy Ball]

4. VERY much bullshit.

[ohio_liberal]

6. More right wing BS exposed then

Good on you :thumbsup:

[Dave Reynolds]

5. Bouncy, dear lady,

I appreciate all the time you take on this issue. I truly hope that the "keep her alive no matter what" kids can be willing to educate themselves instead of just jerkin their knees (amongst other things).

Keep up the good fight.

[Bouncy Ball]

Thank you

for those kind words. I do find this topic interesting, obviously. And oddly enough, my daughter is doing a unit of study on the brain in her class at school, so we have been reading articles on this together. It's been eye-opening for both of us.

[SidDithers]

7. Good job, Bouncy Ball...

I much prefer to see opinions discussed based on knowledge and research rather than from an entirely emotional point of view.

:toast:

Sid

[Bouncy Ball]

8. You said it.

I do, too. Emotions are fine, we all have them, but there's got to be reason involved, too.

[sonicx]

9. you're the coolest, BB

:D :hi:

[Bouncy Ball]

10. Stop making me blush.

Thanks! :hi:

I was surprised at how "readable" the article was. Thought it would be very dry and "jargon-ey" but it wasn't as bad as I thought.

And to anyone reading, I AM searching for something more recent, as well.

[sonicx]

12. another important highlight...

<<patients in a persistent vegetative state cannot experience thirst or hunger.>>

Fuck you, DeLay!

[Bouncy Ball]

13. I knew that before I read the article

so when I heard DeLay saying all that emotional crap, I thought "YOU are a fucking LIAR."

I mean that is just BLATANTLY untrue. How could they experience thirst or hunger without the brain tissue that perceives such things?

Besides, he doesn't give half a rat's ass about Schiavo. It's all about getting the heat off him and trying to make himself look good.

Too bad all the polls being taken are showing this backfiring on the repukes.

Ha!

[sonicx]

15. new kick

[sonicx]

14. kick