- Published: November 7, 2012
Many legal and ethical issues surround the treatment of people in vegetative states. A prominent example of such a situation was that of Terri Schiavo. These situations lie in legal gray areas; the patients aren’t entirely regarded as dead, but termination of life support is an option. Many questions concerning the treatment of those in vegetative states are unanswered: When is there no hope for recovery? Should we allow these people to die? Who gets to decide to terminate life support? These questions get at the heart of this issue: the vegetative state is not well understood biologically. A vegetative state is defined as a patient being in a partial state of arousal and wakefulness (for example, the patient has normal sleep cycles) but lacking awareness. It is essentially a wakeful, unconscious state. Currently, its diagnosis is based on a lack of behavioral responses to any sort of stimuli (visual, auditory, olfactory, etc.). However, this means of diagnosis may be problematic, as people could possibly be conscious, but unable to respond to external stimuli (they may have retained their cognitive abilities), and would still be diagnosed as in a vegetative state.
The advent of neuroimaging has helped us consider this possibility. In 2006, Owen et al. demonstrated that such patients may exist. They used fMRI technology on a woman diagnosed as being in a vegetative state due to head trauma to show that she could generate brain activity to external stimuli, suggesting that she could understand external stimuli. The possibility that some patients in apparent vegetative states actually have cognitive ability is very useful to the legal system. These patients should be treated differently by the law, as they are further from being “brain dead” than those who do not generate such brain activity.
Owen AM, Coleman MR. “Detecting awareness in the vegetative state.” Ann N Y Acad Sci. 2008;1129:130-8.
The Multi-Society Task Force on PVS “Medical aspects of the persistent vegetative state”. N Engl J Med. 1994;330(21):1499-508.