Science Forums 2

[CraigD]

This tread examines a very important subject which many readers may need to understand well at some point in their lives.

Originally Posted by paigetheoracle

All of these cases seem to indicate that our methods of deciding who is dead and who is not are nowhere as foolproof as we thought - likewise that paralysis and brain damage means A) patients will never recover and B) that coma means brain dead. On top of this perhaps what we assume is vegetative, is in fact a kind of tension, rather than irreversible brain damage and drug induced relaxation techniques 'might' work across the spectrum on those seemingly paralysed or brain damaged, through illness or injury.

The modern definition of death – ”brain death” - is, I think, very reliable, so much so that no person has incorrectly been declared dead by a physician in a modern hospital in over a decade.

I think what Paige, and the articles and films he mentions, are emphasizing, is the much more difficult determination of whether a person in a coma or persistent vegetative state, will recover to have some sort of normal life, or die without showing signs of consciousness, sometimes after years of life maintaining care that can be financially and emotionally hurtful to their family and friends. In this area, medical technology that allows successful long-term life maintenance, necessitates the difficult ethical decision to continue of stop such treatment, while sometimes providing only an uncertain estimate of the patient’s likelihood of eventual recovery.

A couple of details

• The patients in Awakenings suffered from catatonia, a condition less medically severe that PVS, and meeting none of the criteria for brain death. Such people typically show occasional awareness, have enough voluntary movement that they don’t develop ”bed sore” ulcers, and can usually be fed orally, without an NG tube. In none but the most radically euthanasia-promoting societies would anyone suggest that these people could be denied care to the extent that they died, or euthanized.
• Determining likelihood of recovery is not difficult in all cases of coma/PVS. For example, the recent (2005) case of Terry Schiavo is one in which no competent, ethical diagnosis of her condition was uncertain in determining that she could not recover. Imaging (CT scan), confirmed by her 2005 autopsy, revealed gross loss of brain tissue – about 50% of its normal mass. There is no theoretical or empirical evidence that a brain so damaged can heal.
• ”Mild” coma is not uncommon, and the majority of patients recover from it fully. By modern definitions such as the GCS, normal conditions such as sleep and conditions such as general anesthesia, with very high (99.9995%) expectation of full recovery, qualify as slight coma.