Wednesday, August 21, 2013

Patients in Vegetative States should not be presumed unaware

The following article was the editorial in the Calgary Herald on August 19, 2013.

Editorial: Calgary Herald - August 19, 2013

Canadians might recall the end-of-life case of Terri Schiavo, in which Schiavo's husband wanted to remove her from life support given her presumed constant vegetative state. It was a famous battle in Florida between her husband and her parents - a legal struggle that ended with her death by starvation.

Researchers at Western University in London, Ont., Ontario have discovered that at least some ostensibly unaware patients are, in fact, conscious of the world around them. This discovery will rightly raise new objections to allowing family or governments to "pull the plug" or remove the feeding tubes of patients who seem unresponsive but who can understand and respond.

Adrian Owen
The Ontario researchers, led by Adrian Owen at the Brain and Research Institute at the university, were able to elicit "yes" or "no" responses using magnetic resonance imaging. Researchers asked three vegetative patients questions about whether they were in a hospital, and if they recognized their names - questions that could provoke a simple yes or no, and which spurred brain activity the scientists could map.

As one Toronto newspaper reported, one patient, 38-year-old Scott Routley, was even able to let researchers know he was not in pain by responding to yes or no questions, with resulting brain activity captured by the MRI machine. This happened 12 years after the automobile accident that left him in a vegetative state.

This discovery casts into doubt the wisdom of past decisions by some family members and the courts who agreed with them, to end people's lives.

Terri Schiavo
In Schiavo's case, the argument over whether she was in a persistent vegetative state lasted 15 years. It started with her collapse due to cardiac arrest in 1990, and her husband's initial court attempt to have her feeding tubes removed in 1998. That was followed by court battles between the husband and Schiavo's parents, who opposed removing the feeding tube.

Her feeding tube was removed several times and then reinserted after more court orders. It was removed for the last time in March 2005 after one last successful court petition by the husband. Schiavo was literally starved and dehydrated to death and died 13 days later.

Routley is in a similar state as Schiavo was, but fortunately for him, the new research backs up what many families have always claimed: their loved ones are not necessarily unaware and in some twilight zone. Until now, they have simply been unable to communicate with those around them.

Plenty of people, including Schiavo's husband, insisted she was not self-aware. The new research shows that such forced starvation was a mistake, and wrong.

Such patients have every right to live and to die peacefully and naturally later, rather than have their lives prematurely ended by removing a feeding tube.

At least in some cases, they may be fully aware of others' decisions to end their lives, and subjected to a death by starvation inflicted on them - something that can hardly be defended as either necessary or compassionate.

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