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Vegetative state: Frequently Asked Questions

What is "persistent vegetative state"?

Persistent vegetative state means a permanent and irreversible condition in which a person makes no voluntary actions and demonstrates no evidence of having thoughts, is unable to communicate and is unaware of his or her own existence.
The term refers to a condition caused by a brain injury. The victim is unable to respond to his or her surroundings and is not aware of anything, even though the eyes may be open periodically. It is similar to a coma in that the person is unresponsive, but it is a permanent condition. A head injury, stroke or other events may result in this condition and a person may be kept alive indefinitely in this condition by artificial means.

How do doctors diagnose a vegetative state?

Once the patient emerges from a coma, doctors conduct a neurological examination that starts with attempts to get the patient to interact. They speak to the patient, touch the patient, and see whether there is any consistent response verbally or nonverbally. They typically ask the patient to squeeze their hand and blink a certain number of times, for example, testing to see whether they can meaningfully respond. ...

What is persistent vegetative state (PVS)?

PVS is a type of coma. A PVS patient is not dead according to American law or Israeli law. PVS describes severe brain damage where the patient is unconscious and does not respond significantly to most stimulation. The unconscious patient sometimes responds to some pain and has some reflexes, but does not respond to voice and does not communicate. Most often PVS patients are breathing on their own. The diagnosis of PVS is given only after this medical situation has persisted for a period of months. ...
PVS is a form of "Eyes open unconsciousness" which manifests as an apparent lack of awareness while awake. It results from trauma, disease, or injury causing oxygen deprivation to the brain. This was the condition of Karen Anne Quinlan, Nancy Cruzan, and Terri Schiavo. Sleep-wake cycles exist with a putative lack of awareness of self or others while awake. These patients also lack comprehension or expression of language, and they exhibit no reproducible voluntary responses to external stimuli. ...

Was Terri in a Persistent Vegetative State?

Despite Judge Greer's ruling, and in keeping with the 40 medical affidavits submitted to the court by doctors, all evidence proves that Terri was not in a PVS. Terri's behavior and ability to interact with her surroundings did not meet the medical or statutory definition of persistent vegetative state.

Is there another mental state between vegetative and fully conscious?

Some doctors distinguish a condition called minimally conscious, but the diagnosis is still controversial. These patients show intermittent awareness of themselves and others and may occasionally be able to follow a command or meaningfully track an object with their eyes. They may also occasionally communicate with gestures or with a simple yes or no. ...

Can patients in a persistent vegetative state regain consciousness?

Yes, in some cases. Chances for recovery are better early in the condition and diminish over time. Medical literature documents rare cases of at least partial recovery after many years, and medical science remains generally unable to predict with certainty which PVS patients will recover. Some medical authorities, such as the British Medical Association, deny the possibility for recovery from the PVS and attribute the appearance of recovery to an original misdiagnosis.

Are PVS patients in a persistent vegetative state completely unresponsive to their environment?

The answer to this question is controversial, and the situation is complex. It has been widely assumed that PVS patients cannot consciously respond to their environment, but recent studies using brains scanning techniques indicate that some PVS patients exhibit the same cerebral responses to verbal commands as healthy adults. This phenomenon suggests that some PVS patients may in fact have conscious awareness, despite an inability to act upon it or manifest it outwardly.

Did the autopsy prove that Terri was in a Persistent Vegetative State?

The autopsy was unable to determine whether or not Terri was actually in a persistent vegetative state. In fact, on three separate occasions, the report stated that an autopsy is unable to determine if a person is in a persistent vegetative state because the person must be alive in order to make such a diagnosis. The autopsy did prove that that, prior to Terri's death, she was physically healthy and would have lived a long life had she not been dehydrated over a period of two weeks.

Can a patient in a persistent vegetative state recover or gain some higher-level functioning?

They may make small gains early on, with the help of medications and rehabilitative therapy, but after a few months, they have almost no chance of regaining consciousness, according to Dr. Douglas Katz, associate professor of neurology at Boston University School of Medicine. The more time that elapses, the dimmer the prognosis. Schiavo has been unconscious for 15 years. Tests of Schiavo's brain show that her cerebral cortex, which controls thinking, has softened and decayed, according to a document filed by the guardian. ...

When the doctors declared David to be in a "persistent vegetative state," how did you and your family repond?

We were devastated, but we were determined to see for ourselves what state David would remain in. We have learned so much about head injury these past years, especially how many times PVS is misdiagnosed. A British study has estimated they are wrong about 43% of the time. Some other studies have even estimated it to be even higher at 40 to 60% of the time. Traumatic Brain Injury is a wait and see situation. The brain takes time to refocus and reorganize! Some longer than others. ...

What is coma? And how is it like other states of altered consciousness, such as vegetative state, delirium, stupour, or advanced dementia?

In Western medicine coma is understood as a state like sleep, in which individuals are completely unarousable, and unresponsive to external stimulation and to their own inner needs. So called “true coma” of this nature generally persists for two weeks to a month after traumatic brain injury (TBI). Patients that survive pass into a “vegetative state”, also known as, vigil coma or semi coma. In this state patients usually open and close their eyes and have sleep/ wake cycles. ...

Doctors have determined that Terri Schiavo is in a persistent vegetative state. What does that mean?

The diagnosis of a vegetative state means a patient is physically awake but remains mentally unconscious. She has lost her ability to think and awareness of her surroundings. Although she opens her eyes, breathes on her own, and moves reflexively, patients in a vegetative state typically are incontinent and cannot feed themselves or communicate. The condition is considered ''persistent" if it lasts more than one month in patients like Schiavo whose brains were damaged from lack of oxygen.

I don't want to be kept alive if I am in a 'vegetative' condition or with irreversible brain damage. Can I use a living will to state my desires?

Yes. But despite its popular name, a Living Will is not actually a Will at all. A Living Will is a document spelling out what kind of medical care a person wants in the event of terminal illness and incapacity to communicate one's wishes. A Living Will can also spell out the kinds of treatment a person does want or does not want in any circumstances. Any competent adult can make a Living Will. The requirements for Living Wills vary from state-to-state. ...
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