Persistent Vegetative State

The term 'persistent vegetative state' was first used in 1972 and came into common usage in the 80's. PVS is not a simple diagnosis and is disputed by some medical professionals.
  • Patients in PVS can breathe on their own and all their vital organs function normally, they also respond to pain with reflex movements.
  • Opponents to EAS reject the term persistent vegetative state, saying it is dehumanising.
  • More than half of all patients diagnosed as PVS eventually regain consciousness.
  • In New Zealand doctors may make a decision to withdraw a particular treatment if the patient has an Advance Directive allowing such withdrawal.
The label 'persistent vegetative state' (PVS) was first coined in 1972 and became more often used by neurologists in the 1980s. It is frequently used as justification for withdrawing food and water from living patients.

PVS patients can live for more than fifteen years, however the longer a patient is in PVS the less likely they are of recovering from it.

A Multi-Society Task Force defined diagnostic criteria for PVS in 1994. These criteria include the lack of awareness of self or environment and the inability to interact with others. The lack of sustained, reproducible, purposeful or voluntary behavioral responses to visual auditory, tactile or noxious stimuli, and a lack of evidence of language comprehension or expression.

There is intermittent wakefulness manifested by the presence of sleep-wake cycles, a sufficient hypothalamic and brain-stem autonomic function for survival with medical and nursing care, bowel and bladder incontinence, and finally there are variably preserved cranial-nerve reflexes and spinal reflexes.

In short, a wakeful unconscious state that lasts longer that a few weeks is referred to as a persistent vegetative state.This state can last for more than fifteen years, however the longer a patient is in PVS the less likely they are of recovering from it.

Patients in PVS can breathe on their own and all their vital organs function normally, they also respond to pain with reflex movements.

Although the terms 'persistent vegetative state' (PVS) and 'brain death' are often used interchangeably, they differ greatly in meaning. Sometimes the term PVS is incorrectly given to someone who is in a coma.

'Dehumanising' label
Opponents to Euthanasia and Assisted Suicide (EAS) reject the term persistent vegetative state, saying it is dehumanising.
"People are never "vegetables" at any time between the fertilization to natural death, and so others should never refer to them as such. We must recognize that all human beings must be afforded dignity and care as basic rights, regardless of the seriousness of their condition." 1
They suggest a more dignified term would be simply "comatose."

Terri Schindler Schiavo
EAS opponents claim that PVS is too broad a term and allows doctors to use the diagnosis to justify killing patients by dehydration and starvation. They use the case of Terri Schindler Schiavo in Florida to illustrate their point. Terri Schiavo had her food and fluids withdrawn in March 2005 and died nearly two weeks later.

Michael Schiavo's doctor, Dr. Ron Cranford, who is a "right to die" activist, examined her for 48 minutes and stated unequivocally that Terri was PVS. He and other doctors testified on behalf of Michael Schiavo saying that Terri was in a persistent vegetative state, with no hope of recovery.

Terri's parents, brother, sister, and numerous other family members and friends who visited her regularly disagreed. Numerous doctors also testified denying that Terri was not in a PVS state.

Dr. Joseph Fins of New York Presbyterian Hospital/Weill Cornell Medical Center reviewed Schiavo's medical records for the Florida Department of Children and Familes.

Dr. Fins indicated Terri's condition amy have been misdiagnosed and that she was more likely in a state of minimal consciousness rather than a PVS patient as courts and many media outlets have alleged. 2

Terri was also examined by neurologist Dr. William Hammesfahr - whose specialties include advancements in diagnosis and treatment of severe brain injured/damaged people.

He noted in his official report in the Terri Schiavo case that she is not in a vegetative state. That's his expert medical diagnosis speaking there.

He examined Terri personally for more than 10 hours, examined her medical records and videotapes for more than 300 hours in total. 3

Denial or withdrawal of food and water
"It is ironic that the only reason that tube feeding has been identified as 'treatment' is so that it can be withdrawn" 4

Dr. Peter McCullagh, of the John Curtin School of Medical Research (Division of Molecular Medicine) in Canberra, Australia, wrote in a letter to The Times on 16 May 1996:

"'Vegetative state' patients cannot describe thirst. However, an extensive body of published evidence, derived from both animal studies and from patients with specific loss of thirst sensation alone, indicates that this sensation is influenced by parts of the brain that can continue to function despite the 'vegetative state'.

"Animal research has also shown that keeping the mouth moist has no more influence on thirst sensation than an oasis mirage has for a traveller lost in the desert." 5

Recovery from PVS
It is largely unknown outside of medical circles that more than half of all patients diagnosed as PVS eventually regain consciousness.

A study of 84 people to those who the doctors considered to be in a "persistent vegetative state" threw that 41% of them had recovered the conscience within the 6 subsequent months and 58% within the 3 years. A second study of 26 children in comma state, state that lasted more than 12 weeks, threw that 75% recovered the conscience. Another study threw that 33% of 370 patients in "persistent vegetative state" of until a year of duration recovered the sufficient thing like returning to the work. 6

Medical Council of New Zealand & PVS
Following the Tony Bland case in the UK, the New Zealand Medical Council endorsed, a report written by the Otago Bio Ethics Centre recommending that where a patients wishes are known and documented in an advance directive, then this is persuasive evidence that a decision to withdraw a particular treatment is acceptable and in accord with the patients wishes and "good medical practice" in such situations. 7

See also: Brain Death
Coma Recoveries

References:
  1. Brian Clowes, The Facts of Life Ch 5 # 61. p.112
  2. www.worldnetdaily.com
  3. Complete report of Dr. William Hammesfahr, a world-reknowned neurologist
  4. Do No Harm Briefing 2002
  5. Ibid
  6. Keith Andrews, "Managing the Persistent Vegetative State:Early Skilled Treatment Offers the Best Hope for Optimal Recovery."British Medical Journal, August 1992, pp304-305
  7. www.fmlaw.co.nz