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Understanding the "Persistent Vegetative State"

by Mary Johnson

News accounts about Terri Schiavo have consistently referred to her as being in a "persistent vegetative state." Reporters rely on doctors as experts, and so did FL District Judge George Greer, and so did the two guardians ad litem. Richard Pearse and Jay Wolfson, who filed reports with the court, Pearse in 1998, Wolfson in 2003, about Terri's "condition."

You can read these reports -- they're in PDF form -- at the case timeline obligingly provided by the University of Miami's ethics department at http://www.miami.edu/ethics2/schiavo/timeline.htm -- scroll down to find, first, Pearse's report, and then, later, in Dec., 03, Wolfson's report.

Disability studies scholar Lennard Davis, a professor at the University of Illinois at Chicago in English, disability and human development and medical education, who last month wrote a focused and clear explanation in the Chicago Tribune on Why 'Million Dollar Baby' infuriates the disabled, wrote in a new article in the March 27 Chicago Tribune that

The most common misconception is that Schiavo is brain dead or comatose--that is, completely unconscious without any chance of recovery. In fact, she is not comatose but diagnosed as being in a "persistent vegetative state."

This is a state defined as "wakefulness without awareness," and the expectation is that there will be no recovery. Such patients may display eye movements, laughter, crying, grunting or thrashing.

Yet this diagnosis is not just a simple, cut-and-dried category. Persistent vegetative state is a diagnosis made by external observation that infers a lack of consciousness.

No brain scan or MRI is used to confirm this neurological diagnosis. Family and friends, who spend much more time with the patient, often make a very different assessment, asserting that the patient has some minimal consciousness.

Chris Borthwick's website has a long discussion of the concept of "persistent vegetative state" -- how the diagnosis evolved, what it consists of, and the reasons it remains unreliable and subjective. Persistent Vegetative State: A Syndrome In Search Of a Name, Or a Judgement in Search of a Syndrome may make you wonder -- as it should -- why courts continue to rely on this diagnosis.

Davis continues,

A recent study done by doctors at Columbia Medical Center noted that patients "who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond."

Brain scans reveal that the language centers in these patients' brains react like those of normal people to familiar voices. Recently, one minimally conscious patient who had not talked for 20 years surprised her caregivers by beginning to talk.

Not Dead Yet issued a press release earlier this year urging use of these newer scientific methods. Read their statements, with links to the scientific journals, at http://www.notdeadyet.org/docs/moratoriumPR021405.html

Posted March 29, 2005

Mary Johnson edits Ragged Edge. Her latest book is Make Them Go Away: Clint Eastwood, Christopher Reeve and The Case Against Disability Rights.

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