Persistent Vegetative State Sometimes Misdiagnosed

From the Times of London:

Ten years ago, Kate [Bainbridge] went into a deep coma and was on a ventilator for several weeks. She had suffered severe brain inflammation after contracting a viral infection. When she came out of the coma, she opened her eyes and could breathe naturally, but she was unresponsive to speech and visual stimuli, and appeared to lack all conscious awareness. She was still in this condition four months after falling ill, and was later diagnosed to be in a persistent vegetative state, or PVS: in other words, persistently unaware. But the diagnosis was wrong.

Although Kate could not speak, or hear properly, or make any kind of signal, or take in sustenance except through a tube into the stomach, she was sometimes aware of herself and her surroundings. She had a raging thirst that was not alleviated by the ward staff. She was racked with pain. Sometimes she’d cry out, but the ward staff thought it was just a reflex action. Kate suffered so much pain and despair that she tried to take her own life by holding her breath.

Then a Cambridge neuroscientist called Dr Adrian Owen put her in a special kind of scanner and performed an unprecedented experiment. It revealed evidence of fluctuating levels of brain activation when she was presented with pictures of her parents.

British doctors are leading the effort to correct what some consider a widespread problem.  Some experts estimate that up to 40% of PVS patients are misdiagnosed.  This is why the intrinsic value of human beings should always be our guiding principle in making life and death decisions for coma patients.  The hubris in the confidence that some "death with dignity" proponents speak with about the state of "these vegetables" when someone wants to "pull the plug" doesn't respect the life of these poor individuals, many of whom apparently could be misdiagnosed.

Comments

[Aaron]

I almost thought this post was going to make a valid point until I read:

She had a raging thirst that was not alleviated by the ward staff. She was racked with pain. Sometimes she’d cry out, but the ward staff thought it was just a reflex action. Kate suffered so much pain and despair that she tried to take her own life by holding her breath.

[Mo]

This poor woman. How awful to be trapped in your own body, unable to communicate what you are feeling!

And how sad that the only remedy this world gives (so often) is to kill these people.

[Gabriel]

Aaron,

I am confused... I thought you were going to make an argument, until I read you were just repeating part of the article.

Why does this post not make a valid point? What is it about misdiagnosing people who are aware and reactive, but cannot show this because of health reasons you do not take as valid? Since there is so much controversy over whether or not we should pull the plug I would like to know anything new I can.

Also, I would like to point out this controversy is not about whether we should kill a human being. No one thinks it is OK to kill a human being. Instead the debate is similar to the abortion controversy in that it is about what constitutes a human being.

Even Peter Singer inadvertently admits humans are special when he he writes his books. They are written for humans to read, because humans are the only "animals" capable of fighting for the rights of themselves and other species. They are the only ones who understand the arguments.

Terrorists do not think it is OK to arbitrarily kill any human, instead they make an excuse about why the humans they kill have forfeited their right to life... "they are infidels."

The capital punishment debate is similar... for one reason or another the person has forfeited their right to life. This is shaky to me.

But I am rambling now. Just wanted to be clear on some things. This post makes a very valid point... An intrinsically worthwhile individual might be misdiagnosed by doctors, this should make us very squeamish about "pulling the plug."

[Aaron]

Hi Gabriel,

Would you like to take a guess at what I meant? I'll explain it to you if you want but I'm sure you could catch my point if you put a little effort into it.

[Amy Hall]

Aaron, are you dismissing the article because you think the author is exaggerating his idea of what it could have been like for her? If that's the case, then you should read the rest of the article. They didn't guess about this, Kate has communicated to them that this was her experience.

Two excerpts:

"Kate is a happy and healthy woman with a lovely mop of wavy hair and highly intelligent eyes, who is full of life even if challenged physically. She has reshaped and reasserted her highly imaginative personality through, and despite, her brain injury. It is hard to imagine the devastation of her mind and body 10 years ago."

and

"After my first meeting with Kate, she handed me a print-out from her laptop that declared: “Other scans show doctors what is wrong with your brain, but Dr Owen’s show what is working. It gave them a reason to carry on with my recovery. It really scares me to think where I would be if I hadn’t had it.”"

[Amy Hall]

And here's a more specific quote (from the first paragraph of the article) to explain how she communicates:

"She sits in a wheelchair “speaking” with the aid of a letter-board, using her left forefinger to spell out words individually."

Does that respond to your criticism, or was it something else?

[alan.powers]

Aaron, you will be better served by communicating in a straightforward manner. Your attempts at obfuscation are not winsome. Put simply, if your goal is to simply irritate, then you achieved it. If your goal is truly to change opinions, you failed miserably. Hopefully your goal is higher than irritation.

[Sam]

Alright, I'll tell y'all what Aaron meant, and if Aaron thinks I've got it wrong, he won't be able to resist the urge to correct me by letting us all know what he meant.

The point Melinda was making was that since people we thought were vegetables really weren't, we shouldn't so glibly let people "die with dignity." Aaron thinks the point is not valid because Kate WANTED to die.

There ye have it!

[Gabriel]

Sam,

Even if she wanted to die does not change the point of the article. If this is what Aaron wanted to show he has completely missed the point.

People all the time "want" to die, but we do not grant this to them.

What about people who are in a vegetative state, but cannot communicate the want to LIVE? How are we to differentiate between the two kinds of cases?

[Sam]

Gabriel, I completely agree with your last point about people wanting to live.

But I also disagree with Aaron's point for another reason. Melinda is responding to the notion that people ought to be allowed to "die with dignity" BECAUSE they are in a vegetative state. Since we have discovered that people we once thought were in a vegetative state really weren't, that removes the particular justification for "dying with dignity" that Melinda was addressing.

Aaron has not invalidated that point. All he's done is raise ANOTHER reason for why people should be able to "die with dignity"--because sometimes they WANT to die. Since Melinda didn't even address that argument, the quote doesn't invalidate the point Melinda made.

[Dennis]

Aaron,

Your point is actually the one completely invalid. Kate only tried to kill herself because the nursing staff wasn't tending to her needs- due to the misdiagnosis. Had, instead, they understood that the lights were on and someone was, in fact, home, they would have attempted to help, and the pain would have ultimately been relieved.
Point being that we need to try harder for the patients in this sort of condition, not that now it's okay to kill them whenever we decide (quite fallibly) that they are no longer a "person".
You're going to actually have to read and understand posts if you're going to respond intelligently.

[Amy Hall]

Hold on there, Dennis! We don't know Aaron's point for sure yet. We only have guesses so far.

Aaron?

[Gabriel]

Sam,

Well said, I agree completely.

[Jack]

The issue of her contemplating suicide is secondary. I have treated hundreds of people over the years (frequently against their will) who were suicidal, as every state has a law addressing this. The state has no problem asserting its right to STOP this action.

The irony is that she could have been killed by medical personnel for being in a PVS, but would NOT have been allowed to kill herself if she were to express the desire to do so!

[William Wilcox]

It seeems that there may be an implication being made that if a person is genuinely in a PVS that it is then morally appropriate to "pull the plug".

I don't think that Melinda actually holds that position but the language on that point seemed vague to me.

[Claire]

Why do so many comments assume that letting die= killing. There's a big difference between ending treatment and killing. Everyone should have the right to do one, but not the other. Cancer patients and people who have been on dialysis for a while routinely choose to stop treatment, but that doesn't mean that they are killing themselves.
It is very sad that PVS is so often falsely diagnosed, but that doesn't mean that a person who asks not to receive treatment if she goes into one is asking to be killed. Nor does it mean she thinks that if she goes into one, she won't be a real person anymore. (Just like people who refuse chemotherapy still recognize themselves as the persons they are). Incidentally, the loved ones who sit by and honor their wishes also still view them as persons.

[Amy Hall]

>>Why do so many comments assume that letting die= killing.

Claire, here's a question that I think will clarify that claim for you:

Imagine your wheelchair-bound mother is under your care, and you keep the food on the top shelf out of her reach. If you decide one day not to take the food from the top shelf and give it to her any more, are you letting her die, or are you killing her?

Feeding is not "treatment," but something that everyone requires.

[Claire]

I wasn't referring to the feeding tube issue (though I think it's a sticky subject--and not one I have a settled view on--whether or not feeding tubes are forms of treatment, given the medical advances required both to develop and insert them).

I was referring to the "pulling the plug" lines, including Gabriel's post about the issue being not one of whether killing humans is ok but of what constitutes a human.

[Claire]

Also, in this case, Kate was on a ventilator. So, this isn't just a feeding tube issue.

[Claire]

Wait, I misread. It looks like she came off of the ventilator-dependence. My mistake!