Persistent Vegetative State/Permanent Vegetative State
Chris Borthwick may be contacted on cborthwick@vicnet.net.au
. He would be very interested to hear from anybody else
studying the socioethics of PVS.
Almost all medical ethicists discussing post-coma
survival have been guilty of pernicious oversimplification of the
medical background to their ideas. This oversimplification emerges
clearly from any close reading of work on this topic. I have examined
different aspects of this issue in articles for a number of journals in
this area.
ABSTRACT
It is now over twenty years since Jennett and Plum in 1972 coined the
name "persistent vegetative state" to describe a state that is "neither
unconscious<ness> nor coma in the usual sense of these terms...
<but rather> wakefulness without awareness".1 It is a term that
has been widely used since, and the mantraps and spring guns that were
built into the definition at the outset are still dangerous. Definitions
decided on at the outset have channelled the debate ever since, and are
still influential. It is important to re-examine the first steps in this
area to see why that course was adopted then and why it is still
directing us now.
This paper is reprinted with thanks to the Monash Bioethics
Review, where it first appeared (1995, April, 14, 2, 20-26)
ABSTRACT
Patients with ‘persistent vegetative state’ (PVS) are often cited in
discussions of ethicists as examples of human beings who are unconscious
and do not experience life, and a number of theoretical and practical
recommendations have been made on that basis. This article examines the
evidence and the theoretical rationale for the belief that people with
PVS are unconscious and finds them wanting. This conclusion is related
to the discipline of ethics.
This paper is reprinted with thanks to the Journal of Medical
Ethics , where it first appeared (1995, August - 21 (4), 205-8)
.
ABSTRACT
In 1994 a Multi-Society Task Force made up of representatives of the
American Academy of Neurology, the Child Neurology Society, the American
Neurological Association, the American Association of Neurological
Surgeons, and the American Academy of Pediatrics produced a Consensus
Statement on the Medical Aspects of the Persistent Vegetative State
(PVS). This Statement presents a picture of the degree of diagnostic
certainty achievable in this area that is in many respects misleading.
Its attempt to propose a condition called Permanent Vegetative State,
which would be based on a high degree of medical certainty either that
there is no further hope for recovery of consciousness or that, if
consciousness were recovered, the patient would be left severely
disabled, confuses two different issues.
This paper is reprinted with thanks to Issues in Law and Medicine
, where it first appeared.
Cite as Borthwick C The permanent vegetative state: ethical crux,
medical fiction? Issues Law Med.
1996 Fall;12(2):167-85.
Borthwick CJ, Crossley R., Permanent
vegetative state: usefulness and limits of a prognostic definition. NeuroRehabilitation.
2004;19(4):381-9.
Abstract
Jennett and Plum’s 1972 naming of post-coma unresponsiveness as
“persistent vegetative state (PVS)” characterised the condition as
essentially irrecoverable and insentient. The evidence for these
propositions was always weak, and they have been largely disproved by
more recent research. Nonetheless, the definition and the attitudes it
embodies remain generally accepted, resting as they do on a firm
foundation of medical attitudes to disability and a public willingness
to evade uncomfortable facts. The first step in altering our approach to
people with this form of communication impairment must be to rectify
our understanding of the terminology.
This paper is reprinted with thanks to NeuroRehabilitation
, where it first appeared.
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