- Published: November 14, 2012
Vegetative State and Legal Aspects
Permanent vegetative state (PVS) is one of the ethically and legally interesting yet controversial fields, yet not so much is known about it. If anyone has ever watched the movie “Hable con Ella,” a Spanish film, it is very easy to feel how challenging and disheartening this condition can be. Neuroimaging technologies, such as fMRI and PET scans have continuously been proving that patients in PVS actually can respond to stimuli, such as their names or kisses; however, there still lacks sufficient evidence as to how they function, and how to help them get out of PVS.
I thought it would also be very interesting to look at legal systems that deal with PVS patients. Some of the questions that can be asked include: should the caretakers, or family members, have the right to have control over issues such as euthanasia, or to make things even more interesting, their properties? Should medical resources be invested in treating patients in PVS? Interestingly, in the UK, only the doctor can make the decision regarding ‘medical death’ after the discussion with the family members. In the US, if the patient is considered ‘competent’ or able to express their thoughts, they have all the rights to refuse initiation or continuation of treatments. However, if the patient is in PVS, they are not considered competent, and the family members can thus make the decision.
Just to make things a bit more confusing, one factor that definitely plays a role in this legal decision and regulation is whether the recovery from PVS is possible, or probable. There indeed has been a case in New York where a patient in PVS started recovering consciousness (and from the movie Hable con Ella mentioned above). To sum things up, the legal situation is not so clear and satisfactory in terms of clearly determining the ethical and legal aspects of PVS patients. One hopeful direction for this is: what if we can incorporate neuroimaging to see if the patients can actually communicate through these techniques? Theoretically, then they would still be considered ‘competent’ enough to make the decisions. For instance, when some PVS patients were asked to move their toes, the motor cortex responsible for such movement got activated. Would a simple ‘yes’ or ‘no’ question become possible to be answered?
. Jennett, B. (2002) The vegetative state. The definition, diagnosis, prognosis and pathology of this state are discussed, together with the legal implications. Journal of Neurology, Neurosurgery & Psychiatry with Practical Neurology. 73:355-357.
. Steinbock, B. (1989) Recovery from Persistent Vegetative State?: The Case of Carrie Coons. Hastings Center Report. Vol 19, Issue 4, 14-15.