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'Vegetative State' Patients Often Do Recover Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men Reports of comatose patients on life-support systems waking up continue to amaze us. Recent headlines such as "Doctors Say Electric Pulses Aided Brain-Damaged Man," "Boy in So-Called Persistent Vegetative State for Two Years Awakens," and "Vegetative patient shows signs of conscious thought" should both inspire hope and present a warning to those who would terminate such life. A news-medical.net report from the June meeting of the European Neurological Society in Rhodes, Greece, entitled "High rate of misdiagnosis in patients in an acute vegetative state" states, "the level of misdiagnosis has not decreased in the last 15 years." About half of these "vegetative state" diagnoses were proven false when patients regained some level of consciousness. Dr. Steven Laureys, a neurologist at the University of Liège in Belgium, studied more than 600 patients with some degree of impaired consciousness on admission to an intensive care unit at the university hospital. Two-thirds of those suffering from head trauma recovered at least some degree of consciousness, refuting the initial diagnosis of "vegetative state." About one-third of people with non-traumatic injuries, such as oxygen deprivation, did so. Dr. Laureys said the initial vegetative state "may be transient . . . the prognosis for patients with impaired consciousness depends to a great extent on the nature of the brain damage."
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He also underlined "the importance of extreme caution in any decision to limit the life chances of patients during the acute phase of a vegetative state." The decision to terminate life astounds us because we often give too much credence to the diagnostic and prognostic powers of modern medicine. Medical practitioners are as human and flawed as any other group of human beings.
So we shouldn't be so surprised when our arrogance is taken down a peg. One problem is that the distinction between sound medical judgment and arrogance can be very difficult to detect, especially for non-medical people, such as most patients and their family members. Although we commonly refer to our lesser-witted (formerly dim-witted) friends or political opponents as "brain dead," we should be very careful when applying such terms to people suffering acute brain damage.
Very often, brain damage is temporary, not permanent. Despite this, we continue to read macabre-sounding reports, such as from the AAPS News of the Day report of (March 19, 2007): "Once decisions are made to terminate life support and to donate organs, the donor is moved to an operating room, where a transplant team waits for the heart to stop. Five minutes later (or three, or two, or 75 seconds in infants), surgeons remove the heart. "Donors may receive morphine, diazepam, or other drugs to make sure they do not suffer as life support is withdrawn." "Brain dead" has come to mean "almost all dead," "not quite dead enough," or "not worth keeping alive." Attorney and Discovery Institute colleague Wesley J. Smith aptly states, "when family members claim that they detect signs of consciousness in their 'unconscious' loved ones, doctors should be less quick to assert that they are merely seeing what they want to see." People ought to consider this problem "when determining in an advance medical directive to have themselves dehydrated to death if they become permanently incapacitated." There are some patients who just don't want to, or cannot at the time, play a stimulus-response game when faced with a barrage of questions from medical personnel to determine mental status. Who's to say? What should we do then? Maybe we should present them with a legal-sounding warning, such as suggested by Larry Huntoon, M.D., Ph.D., editor of the Journal of the Association of American Physicians and Surgeons. It might read something like "You have the right to remain silent and not respond, but if you choose not to respond or are unable to respond, your food and water may be taken away by a court of law."
Related Articles: http://www.newsmax.com/archives/articles/2007/1/2/132834.shtml http://www.newsmax.com/archives/articles/2005/3/29/214824.shtml
Editor's Note: Robert J. Cihak wrote this week's column.
* * * Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in economics and citizenship at the International Trade Education Foundation of the Washington International Trade Council.
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