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Ellen Goodman: Horror or Hope in Vegetative Patient Study?Posted on Sep 13, 2006British researchers reported that a totally unresponsive 23-year-old woman showed signs of awareness on a brain-imaging test. What we can’t know, however, is whether someone actually wants to keep living like that.
BOSTON—Of all the headlines on the story, this one took the prize for provocation: “Woman in Vegetative State Plays Tennis in Her Head.’’ I suppose this is what happens when science throws up a startling piece of new research and the media slams it into the court of public opinion. In Britain, researchers have reported that a totally unresponsive 23-year-old woman showed signs of awareness on a brain-imaging test. When asked to imagine playing tennis, her brain lit up the same neural pathways as a healthy brain. When asked to imagine walking through her house, the MRI revealed changes in specific brain regions that mimicked those of healthy people. The exuberant lead researcher, Adrian Owen, said the results “confirmed beyond any doubt that she was consciously aware of herself and her surroundings.’’ A colleague even raised the possibility that some vegetative patients have “a rich and complex internal life.’’ Tennis in her head. What are we to make of this? An editorial in Science magazine where the research was published was quick to warn that this case is nothing like that of Terri Schiavo. The British woman has something Terri did not have: a cortex. She suffered an injury, not a lack of oxygen. She was in her unresponsive condition for five months, not 15 years. She was not in a persistent vegetative state. Nevertheless, those who play politics in their heads have found this research useful. The pathways to the pro-life blogs describing Terri’s death as murder also lit up. Terri’s father, Robert Schindler, declared game, set, match in the controversy: “This new case is not surprising to our family.’’ But what about the rest of us who were fully aware that Terri had no inner life, rich or poor? What about those of us who believed all along that Terri was, ironically, one of the easy cases. Surely, as one bioethicist said, this research creates another shade of gray in the understanding of gray matter. And in decisions that revolve around life and death. We don’t know if similar patients will show the same level of awareness. Indeed there are some who believe that the British researchers overinterpreted what they saw. But an estimated 6,000 Americans are in vegetative states and 100,000 more Americans exist in some state of partial consciousness. We know there is a bell curve of consciousness, a range of symptoms and prospects for recovery among such patients. A 23-year-old accident victim has a different prognosis than an 88-year-old stroke victim. But we do not know if the researchers who suggest that vegetative patients may be “aware’’ of themselves and their surroundings have given us a hopeful story line or a horror story. As University of Pennsylvania bioethicist Art Caplan says, “It’s not necessarily good news that someone might have some form of consciousness but not be able to interact emotionally, socially or communicate in any way shape or form. To spend your life dimly aware but unable to let anyone know you are in there is more the subject of Stephen King or Edgar Allan Poe than some sort of medical hope.’’ For families who already are left with the hard choices about life and death, about treatment and nontreatment, this research, says Caplan, “will generate more guilt than light.” How often science drives ethics into a ditch. Brain imaging may eventually help to answer the most poignant family question about a profoundly injured member: Does she understand me? If doctors can eventually determine which people can “come back’’ and how far, the technology may be worth the emotional and financial price. But they are unlikely to make hard decisions any easier. No MRI can say whether that “rich, inner life” is a tapestry of hope or a nightmare. Which cliche fits a locked-up awareness? “While there’s life there’s hope”? Or “a fate worse than death”? The researchers, in all their enthusiasm, cannot answer the fundamental question that was indeed raised by the Schiavo case: Would you want to live like this? Nor can technology with all its power tell us what is right and wrong, humane and inhumane. Nearly a year after the accident, the British patient had advanced into a state of minimal consciousness. She could follow a mirror with her eyes. But no machine can tell her family or doctors whether she wanted to live “like this.” The deep family conversations that were prompted by Terri Schiavo’s fate are not simplified by this science, but, rather, expanded. Woman in Vegetative State Plays Tennis in Her Head. But is it a game or a trap? Previous item: Joe Conason: Bush Spurned Greatness for Partisan Gain Next item: Molly Ivins: Remembering Ann Richards Elsewhere: . CommentsAre you a Truthdig member yet? Login now, or register with Truthdig. Add Your Comment |
By Hondo, September 22, 2006 at 6:24 pm #
(Unregistered commenter)
I am amazed at how almost everybody who has posted a comment here has misstated what happened in the Schiavo case. The doctors didn’t “let Terri die.” They killed her by starvation and dehydration. This was not a “refusal of medical treatment.” Food and water are not medicine and they are not medical treatment. To call this a “refusal of medical treatment case” is dishonest. Schiavo was starved to death, and she didn’t ask for that happen to her. Terri’s husband said she did, but he offered no proof. Terri’s parents said she didn’t, but they offered no proof either. Since her wishes were not clear, the error should have been on the side of life, but that would be a clear violation of the tenents of liberalism, wouldn’t it? Liberalism demands that inconvenient life be terminated, and all opposition to their policy of death is met with name calling, temper tantrums, and hysteria. Where was Terri Schiavo’s “choice” in all of this?
Report thisBy alaman1952, September 20, 2006 at 7:36 am #
(Unregistered commenter)
This liberal-conservative debate obscures the real issue: the right of self autonomy. The Patient Self Determination act reiterated that we have the right to refuse medical treatment. Now, the liberals and the conservatives don’t always get that.
As to the Terri Schiavo case, the courts ruled that Michael Schiavo was the legal surrogate. He stated that Terri did not want to be kept alive in that type of state. The autopsy confirmed that her brain had indeed atrophied and there was nothing that could be done. It was not a reversible condition. During the first few years of that case, Michael Schiavo and the Schindlers (Terri’s parents) were in agreement. Only after two years, did reality set in. The Schindlers wanted to spend the money on rehab, Michael Schiavo wanted to spend it on long term care.
Withdrawing feeding tube and hydration is the same as refusal of medical treatment. We still have the right to refuse that. (There are some things worst than death- being left in a PVS state like Terri Schiavo. I certainly would not want that for myself or my loved one.)
Both sides, liberals and conservatives, used the Shiavo case to promote their agendas.
As far as the diatribe against physicians, it is ridiculous. There are good and bad individuals within every profession. However, by and large, many physicians practice medicine out of a sense of making a difference in the lives of others.
Report thisBy Gloria, September 20, 2006 at 5:49 am #
(Unregistered commenter)
Since the Schiavo case came to the public in 1993 I have had a comprehensive living will. I always carried an Illinois Declaration in my purse because the living will is ten pages long. Since the circus outside the nursing home where Teri was imprisoned & the completely illegal intervention by Bush et al I have carred the whole magilla on me at all times; an entire ten page living will, the Illinois Declaration, and a power of attorney. Everyone of my friends & family knows that under no circumstance whatsoever am I to be kept on life support. Gunk in a (feeding) tube is life support.
Report thisFunniest thing to me is that the very people who think they know G-d so well and that they are doing His work are so terrified of death. That’s very faithful, isn’t it.
Bottom line is you do it your way & I will do it mine. You have no say so what I do. You jump around with your Holy Bible until doomsday. And what will you do when it (doomsday) comes? Look as if you are a bunch of hysterical fools for minding everyone else’s business but your own.
By blues, September 18, 2006 at 1:27 am #
(Unregistered commenter)
Matters of life and death ultimately cannot be entrusted to doctors. Only about 50% of medical doctors have much real compassion, and few have any serious comprehension of the ultimate nature of science. We have to remember that, ordinarily, doctors are systematically trained to devalue human life in the ‘intern’ portion of their training, in which they work insane hours, with inadequate sleep on poor (never wealthy!) patients. They have their ‘Hypocritical Oath’, but they are the ones who really, if covertly, conduct the executions and tortures that out political fiends demand. They are the ones who insist on unequal levels of care for the non-wealthy, who decry ‘socialized medicine’, etc.
They know virtually nothing about people who experience unusual mental states, yet the murder people who the think are unlikely to recover from vegetative states. And they also ‘let’ many other sorts of ‘useless eaters’ die too, when they can, since 50% are fascists of one kind or other. Victims of the Hospice System who have no socialized medicine are only given pain medicine after they renounce all treatment for their presumed-fatal illnesses. And they effectively are forced to agree to ‘die on schedule.’ A huge federal hospice facility administration funnels billions of dollars to hospice doctors and often Scientology-run facilities (the original faith-based initiative) to ensure that they die on time, saving much money, but killing many who would otherwise recover, or be valuable citizens.
The decision of when to let a patient die should never be left to family members who may feel remorse over having cause that patient’s condition, or by doctors who are well paid by federal hospice funds to eliminate useless eaters. In should be decided by independent randomly chosen jurors who are the patient’s peers.
Report thisBy rachelle, September 17, 2006 at 2:02 pm #
(Unregistered commenter)
Hear, hear!!! Dave Summers. There is a difference indeed between those of us who “know” medicine, and most of us who just wade about hoping for the better. Whereas one is always entitled to question the ethics or even *knowledge* of the medical profession, it seems we have to trust you to provide us with an honorable and just response to a difficult loss.
Hence the Hippocratic Oath. Hope you all take it as seriously as we wish you do…
Report thisBy Dave Summers, M.D., September 17, 2006 at 11:08 am #
(Unregistered commenter)
Thanks, Sam, for sharing with me Goodman’s highly pertinent
Report thisresponse to the report claiming conscious awareness of a 23-year-old, comatose female; my first observation after reading the report by the British researchers was that more complex, confusing, exploitative data (reliable or not) would be added for the public to ponder. The Goodman query, “Is it a game or a trap?” should be answered by thoughtful & objective thinkers who honor facts, especially pragmatic consequences of permitting a single anecdotal report to influence daily decisions on life & death issues. Almost always they are not the “coerced death”, which Nat Hentoff has so nonsensibly imposed on this issue (see Free Inquiry, Aug/Sept 2006) but, instead, practical & fact-based decisions by physicians “who know & know that they know” that functional, truly conscious, normal quality of life will not return or that “brain death”, by all historical, procedural & neurological criteria, is certain & irreversilble. The American Academy of Neurology emphasizes “self-determination by patients or their surrogates” but apparently fails to provide proper guidelines for handling, not only a patient’s wishes but also obvious instances of irreversible coma, which may, as in the Schiavo diagnosis of PVS (permanent vegetative state), be supported 15+ years! Thus “medical futility”, when allowed by experienced clinicians or by the courts or both (while a grieving family awaits the false hope of both a Lazarus-phenomenon on Earth & a fable of delusional supernaturalism) may lead, as I have witnessed, to decomposing corpses still being “ventilated” when death’s finality (a decision often neurologically-based) is ignored! Meanwhile, legal fiascos still are imposed, in Oregon, where a majority of voters favor “death with dignity” & in Lousiana, where a physician & two nurses have been charged with “murder”, having sedated & minimized the misery of four ventilation-supported patients when Katrina’s flooding interrupted electricty—not a mere few minutes but days & weeks! Neither religion’s unreason nor the “no hope at all” of terminally-ill patients nor anecdotal, possibly exaggerated research should be imposed on the compassionate & combined expertise of the medical, scientific & technoligical care of the 21st century nor any future century.
By rachelle, September 17, 2006 at 4:25 am #
(Unregistered commenter)
I don’t care to discuss with morally superior commentators…
Report thisOnly wished to write that I agree with the author, Ellen Goodman, which totally explains my position.
By Liberal, September 16, 2006 at 8:31 pm #
(Unregistered commenter)
I am weary of being defined by conservatives. Yes, I am liberal, but no, I am not “dedicated to the cause of terminating ‘inconvenient’ life.” Please, conservatives, define yourselves and tell us what you believe in, but stop, already, telling me what a liberal is, does, thinks. I know what I think and believe; remember, I am the liberal. And I guarantee, I am not any of the things you say a liberal is.
Report thisBy blues, September 15, 2006 at 8:38 pm #
(Unregistered commenter)
Look, this is stupid. I am totally liberal, yet was not in favor of letting Schaivo die. She did have some of her cortex, from what I’ve heard. There have been cases of ‘persistently vegetative’ folks regenerating their brain tissue. The whole ‘cruel liberal’ idea seems to emanate from the apparent grip that certain wacko Scientology extremists have on the academic dunderheads.
That narrative doesn’t cut it for all of us.
Report thisBy Hondo, September 15, 2006 at 7:55 pm #
(Unregistered commenter)
Jonickle, you will get none of the compassion I showed to Diane. Your comment was mindless liberal drivel, and there wasn’t any truth to it. I get very angry any time I hear a liberal attempt to lecture conservatives about compassion for the poor and the under-privileged. Christian Conservatives believe that charity means that we should reach into our own pockets and give from what we have to those in need. Christian Conservatives believe that charity means that we must give of our own time, talents, and treasure to help all those in need. Liberals believe that charity means that the government confiscates money from other people and redistributes it to the appropriate “victim groups.” Don’t lecture me about charity, you ammoral simpleton!
Report thisBy Hondo, September 15, 2006 at 7:48 pm #
(Unregistered commenter)
Diane, my thoughts and prayers are with you. I have 3 children, and I can’t even imagine the anguish I would feel if I went through what you and your husband went through. My youngest had some health issues during his first month (insignificant compared to what you went through) and I know how that felt. God bless you. I promise you that I will pray for you and your husband.
Report thisHaving said that, surely you understand, don’t you, that your situation is not the type of situation I was referring to? You and your husband made the unbelievably courageous decision to let God take your baby home, rather than to artificially keep the baby on life support. That is a very different thing from an abortion. There is no comparison and no moral equivilency whatsoever. The same goes with the Terri Schiavo situation. She was living comfortably, pain free, when her husband and her doctors decided to murder her via starvation and dehydration. Again--no comparison, no moral equivilency. Liberals do that with inconvenient life--they want to terminate it. I guess my point is that the Christian conservative is able to see the difference between your situation and the others. The liberal is not.
By jonickle, September 15, 2006 at 6:29 am #
(Unregistered commenter)
The unborn and the unconscious are certainly deserving of our care and compassion, but conservatives make more of a loud commotion in their favor than they are willing to provide in real support and aid. The rhetoric of conservatism doesn’t address the real societal issues. There have been so many financial cuts in social programs in the last 6 years, our collective heads are spinning. We can’t help but wonder what programs will be next to be shut down or crippled as we see endless billions of dollars poured down the Middle Eastern black hole.
Who are the unwanted anybodies anyway?
Are they the babies born to mothers who can get no child support from the father? How about the babies born addicted to crack and heroin? Babies with fetal alcohol syndrome? Babies born into hopelessness and poverty? Hungry children living in squalor? Children from dysfunctional families shuffled from one foster home after another?
Could they be the chronically mentally ill, left to survive alone and “free” on the street, unmedicated, unsupervised, homeless?
Are they the 4.5 million American citizens trying to cope without health insurance? Maybe they are our elderly citizens who must make a choice between buying food or life-saving medication. Mothers who can’t afford to go to work but can’t afford not to because of the cost of childcare? Bright young students who find that college is financially out of reach; our elderly scraping by with part-time jobs lacking pensions or savings.
High school drop-outs turning to street drugs, crime, prostitution, gangs and guns to survive? What about the victims of crime, domestic violence, pedophilia, child abuse?
Not everyone comes from a “Solid Middle-Class” family, the conservative bastion. It’s time to stop believing that myth and start dealing with the true situation. As a society, we do not do a good job of protecting and caring for our children; the helpless victims of violence; our elderly; our sick; our lonely, our poor and disadvantaged. Ours is not a Norman Rockwell society. We must recognize that there are huge social problems to be addressed and so doing, we will strengthen our country and the morale of our people.
Report thisBy Diane, September 15, 2006 at 5:33 am #
(Unregistered commenter)
“Inconvenient Life”
Report thisConservatives are so sure of how Liberals think and has no problem making strong, inflammatory statements.
Perhaps this person has not been faced with an unwanted/rape/medical problem pregnancy.
I hope so. I believe that most people believe abortion should be an alternative RARELY USED.
Or perhaps you have not had a premature baby who has had numerous brain bleeds so that his brain was mostly destroyed.
That he had seizures so constantly that his body needed to be paralyzed and was kept alive by being vented. And then his kidneys failed and his skin started to ooz. There was nothing to be done.
So yes his father and I removed him form life support and held him while he died. He weiged less then 2 lbs.
The next time you make a callous remark about liberals and an unwanted life, please remember my story. I did the best I could for my child.
God wanted him home.
By Hondo, September 14, 2006 at 4:13 pm #
(Unregistered commenter)
Ellen Goodman asks the question, “What are we to make of this?” Well, if you happen to be a Christian conservative, the findings represent progress in the treatment of comotose patients. This is cause for celebration. If you are a liberal, the story represents nothing but bad news. Liberals are absolutely dedicated to the cause of terminating “inconvenient” life--unwanted babies, unwanted comotose wives, unwanted anybody. These findings mean that liberal activist judges will have to be more creative in fabricating constitutional reasons why inconvenient lives must be snuffed out.
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