Australian Lefty on Politics, Governance, Science and Info Management

Persistent Vegetative State: Decisions getting harder

Posted by Dave Bath on 2007-07-12

I’ve taken a few days to reflect on a New Scientist article Persistent vegetative state: A medical minefield (actually entitled Impossible awakenings in the hardcopy version), which unsettled my previous near-certainties about matters like the Terry Schiavo controversy, (which post mortem investigation thankfully indicates to have had a reasonable conclusion).

The article describes various "awakenings" of people classified as being in a PVS (Persistent Vegetative State) when given a number of drugs, or hints emerging from sophisticated scans.

The science is still sketchy, and there is no real pattern to the drugs that may or not work with a particular patient, the effects might only last a few hours each time, and the long-term efficacy of treatment may be as tragic as that depicted in the Robert de Niro / Robin Williams film "Awakenings" inspired by the work of neurologist Oliver Sacks (home page and wikipedia entry).

I think this has a profound impact on the way right-to-die cases are managed, by both medical and legal experts.

In my view, the response of a UK judge in 2006 was correct when ordering a test with one of these drugs to a woman classified as being in a PVS for three years, going against family wishes in a right-to-die case.

With advances in this field, and the stream of right-to-die cases for PVS cases coming before courts and confronting medical staff, it seems reasonable to establish a standing expert body that meets once a year to review scientific journals and case histories, with the objective of issuing guidelines on what tests are appropriate in such cases, and the range of reasonable test results that support either cessation or continuation of medical treatment, if a "living will" is unavailable.

I believe such a panel would be cost-effective to society at large, cutting down court time, but also and more importantly decrease the distress of many families affected by such cases.

Perhaps there is a good reason to establish standing expert panels for other similar situations, or a single panel with a broad remit.  The composition of such a panel should not be determined by politicians, but nominated by the college of neurologists for the country concerned, with legal advisors nominated by something like a bar association.

Sci Am Report Deep-brain stimulation “jump-starts” a man’s brain six years after he suffered a severe head trauma

Declaration of interest: Despite the chance of Ruddock coming down on me for using the internet to make such a statement, I support the efforts of various "Death with dignity" groups, and consider that the Dutch have got balanced legislation on such matters.


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