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The ethics of PVS

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William Crawley | 17:27 UK time, Wednesday, 5 May 2010

BlandDM1305_468x360.jpgI heard a fascinating documentary on Radio 4 yesterday which examined the clinical and ethical issues attending the diagnosis of a "persistent vegetative state". When I first learned about PVS, while studying medical ethics twenty years ago, I was assured that a PVS patient was "beyond consciousness". New science has questioned that previous understanding of the condition, and raises moral questions for both clinicians and a patient's loved-ones. The new research, also challenges us to explain perhaps the most complex phenomenon of all -- consciousness itself. What does it mean to be conscious in the world and of the world? While thinking that one through, you can listen "PVS: The Search for Consciousness" on the Ö÷²¥´óÐã iPlayer.

Picture: Tony Bland, who was diagnosed PVS after he was crushed during the Hillsborough Stadium tragedy in 1989. A High Court ruling, upheld by the House of Lords, permitted doctors at the Airedale Hospital trust to remove his feeding tube. He died nine days after the tube was removed.

Comments

  • Comment number 1.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 2.

    This is a sad story but now new reports tell us that many named as Persistent Vegetative State were conscious and some of them were aware too. We now discovered that some of them are conscious and now improved as fully/conscious and aware but lost their motor function due to 'brain shock'. Now we have further gone to see that they still have muscular power and can assist in moves but can not initiate.Hope some day we will find some way to get them back.

  • Comment number 3.

    PVS is a very tragic scenario, and things have been made much worse by the Belgian fiasco (?con) with "facilitated communication". It is time society wised up ethically in relation to this and other issues. If we value human life, we need to recognise that it is by its very nature a time-limited process. We are *very* good at prolonging biological life beyond the stage where it is reasonable to continue, and the notion that we should preserve it at all costs, and never act to take control of that end-point is frankly untenable. The bottom line is this: I *know* I am going to die some day; if I end up in a PVS, or severely demented, I *do* trust my relatives to make the right decision for me, and in discussion with my doctors, ease me off into that good night with a hefty dose of diamorphine.

    And it is not that I am just saying that now - death holds absolutely no fear for me - the only concerns I have are to make sure that the people I care about are looked after best.

  • Comment number 4.

    Life is a gift of God and there is no choice to reject it.At the moment when I am writing this my Persistent Vegetative son is lying beside me and I have lost another son.kidnapped for ransom and killed beside receiving the ransom . I am really thankful to God for all which he granted me and it is his choice to take anything back. Our duty is to struggle how can we forget our duty in this matter.

  • Comment number 5.

    Anwer, I'm very sorry about your personal circumstances - that must be dreadful. But I would very *very* strongly refute the notion that decisions around how people's lives end constitute a *rejection* of life, regardless of whether it is viewed as a "gift" of some god or other. I and several other people who comment on this blog have dedicated our lives to *preventing* deaths that would otherwise occur, if nature is allowed to take its course (you could regard this as us fighting against god/gods to prevent their capricious snuffing out of human life; how you rationalise that is not really my business).

    The issue for me and many others is that we value life *extremely* highly, whether that life is ours or anyone else's. We recognise, however, that it is a *process* - death is not a disaster, but a life poorly-lived certainly is (as Will has been pointing out on other threads about certain clergymen).

    If you make the argument that it is for the gods to decide how life ends, then the corollary is that it is hardly up to us to decide how life is maintained. We can pack up our hospitals and ambulances, dispense with our surgery and our antibiotics and seatbelts and crash helmets, and put our trust in the babble of charlatans. Hardly progress. If we are to have a mature debate, we need to be able to discuss the very real issues, and move to viewing life as a process, not as some sort of spooky vital force.

    Cheers,
    -H

  • Comment number 6.

    I have not had a chance to listen yet to the doc but will do so....just to say that to my understanding there is always a much bigger picture at play than we can see from 'first look' or a snapshot of a situation or life event.....we tend to look at things in a very black and white, good and bad sort of way ....that perhaps does not reflect what is going on in the bigger picture. For me, God is love and is healing and all life events can be viewed from a healing perspective....as endeavouring to heal our apparent separation from God and love....although i appreciate that this is not the usual way we see things and does require a shift in world view/understanding. Illness and disease can be healing ....again something that goes against the grain of our current thinking and medical understanding....and requires us to understand those processes in a different way. We tend to see death as a tragedy ....when in fact it might be the best blessing and healing for an individual and I know this from personal experience not just in theory... (not my own death of course!! yet...). There is in my view nothing to fear from death....(Helio - we agree!).... our suffering is in my view brought about as a consequence of our own choices that are made in separation to God/love over aeons (choices of previous past lives have consequences that can play out in this life) ....and the soul/God/love is always 'working' in the direction of healing that separation.

  • Comment number 7.

    Eunice, don't panic - we don't agree *too* much :-)
    It's not that the "soul" is working towards "healing" or any cabbage like that - the shift in viewpoint you require is to realise that we're here, and we are exposed. As mature people we can choose to deal with what circumstance throws at us, or be paralysed into the sort of unhelpful catatonia induced by religious belief in its multifarious forms. Daily I have to make decisions. Sometimes I make mistakes. I learn from them and move on.

  • Comment number 8.

    Helio - agree - we do make decisions every day and mistakes and learn from them ... however ....which of the following do you prefer ......
    1) being a victim of *circumstances* that are *thrown at us* and over which we have no control - being a recipient of whatever life happens to dish at you.
    2) being a creator of life......where you know that all your choices past and present are influencing what is thrown at you .......but which is not really thrown at you as you had a big hand in the creation of it ......even if it seems like the last thing you would want to create.....
    For me, 1) is disempowering and I can do nothing to influence it and 2) is empowering .......in the latter I can realise that if my choices influence what happens in my life .....then how can I make choices that lead to more love, joy harmony and wellbeing etc I do not advocate catatonia /paralysis in any way - but very much being an active participant in the creation of one's life and experiences.....
    Your exposure is your choice :-)

  • Comment number 9.

    Apparently, pointing out that a person from whom all sustenance is removed dies of starvation, is in breach of house rules. Truth, what is that?

  • Comment number 10.

    There is no evidence so support any claims that there is any cognition or communication happening. The claims are fantasy.

    Truly bad science:


    If a person in this state had any consciousness it would be as if existing in torment.

    Write and sign a living will and make sure that you nominate a power of attorney should this situation happen. It is gross.

    The movie about Jack Kavorkian was on HBO last week and quite informative.

    You don't know Jack:


    Kovorakian blames religious fanatics for causing the suffering of so many dying people for not allowing them to die with dignity. Staving a person to death is cruel.

  • Comment number 11.

    You have to starve them so you can pretend you're simply withdrawing a burdensome medical procedure. Reality is the person isn't dying so if you want rid you have to actually kill them. They often turn the heat off and open the windows to induce hypothermia as well.

  • Comment number 12.

    This comment was removed because the moderators found it broke the house rules. Explain.

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