"Vegetative" Patient May Have Awareness

From Wesley Smith Blog:

Sophisticated brain scans of a woman diagnosed to be in a persistent vegetative state has revealed startling levels of activity. Indeed, it may indicate that she is aware.

The description of the patient in question is startlingly similar to Terri Schiavo: “Scientists don’t even agree on whether the woman had some real awareness–she seemed to follow, mentally, certain commands–or if her brain was responding more automatically to speech.”

And here is some more important information from the story: “First, they checked that she could process speech. Upon being told ‘there was milk and sugar in the coffee,’ the fMRI showed brain regions reacting the same in the woman and in healthy volunteers.

“Then came the big test. Owen told the woman to perform a mental task–to imagine herself playing tennis and walking through her house. Motor-control regions of her brain lit up like they did in the healthy people he compared with her.”

These were the very kinds of tests that the Schindlers begged Judge Greer to permit to be given to Terri Schiavo, in the hope that a scan that measured function, would demonstrate more activity than tests that had been done measuring brain structure. Even though the tests would have caused her no possible harm, and might have found she had more awareness than most of the experts thought, Greer refused. And Terri was dehydrated to death.

Caveat: We must be very careful here. One apparently aware vegetative patient does not mean that other or all such patients are similarly cognitive. But it seems to me that this case provides a very urgent reason to find out, and find out fast. People are being dehydrated to death as you read these words because they are deemed non persons due to perceived permanent loss of any awareness. If that isn’t so, if many or most of these people are aware, we had better find out.

Postscript: Oh, and here’s a small prediction: If we do find out that many PVS patients are actually aware, look for dehydration advocates to claim that such a finding is even a more compelling reason to make sure the patients die. If they are aware, they will be suffering due to their profound cognitive disability, they will argue, making these patients’ life even less worth living than if they were truly unconscious.

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Father and Michael B: What will bloggers on OrthodoxyToday will be debating ten years from now? I predict, that as our population ages and health care inflation consumes and even larger portion of our GDP (16 percent today), we will be discussing the ethics and morality of rationing health care. An ethical perspective and moral awareness will become even more necessary as health care decisions grow more difficult

Harvard economist David Cutler, author of “Your Money or Your Life“, is fairly optimistic. According to Cutler, while we are are spending more in health care, the additional years of life and improved quality of life obtained from advancements in health care have enabled us to more than recoup the investment. To prove his point, Cutler presents a methodology for assigning a dollar value to an additional year of life, which he then compares with the cost of the medical care required to sustain that additional year of life. Based on this analysis Cutler argues that we are getting are a positive return.

There are two problems with Cutler’s analysis. First, his methodology assigns a different value to a year of life based on a person’s age and work status. In Cutler’s cost/benefit analysis, the dollar value of a year of life from a working person in his or her prime is assumed to be worth more to society than that of a retired or disabled person. While the retired or disabled have less dollar value to society their cost of care is greater.

Second, Cutler is getting a lot of heat for assuming that the money to pay for health care is unlimited. Critics have responded:

Cutler’s is a generous vision. But will the wealthiest among us really be kind enough to finance health care for all at a level that equals 30 percent of GDP? Not if they realize that other countries have made similar strides in lengthening life expectancy while spending far less. Indeed, many have done better. Worldwide, the United States ranks 31st in longevity, behind such countries as Australia, Canada, and Malta. And it ranks 40th in the probability that a child will die before age 5, with nations such as Estonia, Portugal, and Slovenia doing better.

I think all this points to the urgent need to wring inefficiency out of our health care system, and bring costs under control. Otherwise we might reach the limits of what society is willing to pay for health care. This will lead to calls for rationing and the strictly financial cost/benefit analysis that would put the hypothetical person in a vegetative state at an extreme disadvantage.

1 thought on ““Vegetative” Patient May Have Awareness”

Dean Scourtes

September 8, 2006 at 2:01 pm

Father and Michael B: What will bloggers on OrthodoxyToday will be debating ten years from now? I predict, that as our population ages and health care inflation consumes and even larger portion of our GDP (16 percent today), we will be discussing the ethics and morality of rationing health care. An ethical perspective and moral awareness will become even more necessary as health care decisions grow more difficult

Harvard economist David Cutler, author of “Your Money or Your Life“, is fairly optimistic. According to Cutler, while we are are spending more in health care, the additional years of life and improved quality of life obtained from advancements in health care have enabled us to more than recoup the investment. To prove his point, Cutler presents a methodology for assigning a dollar value to an additional year of life, which he then compares with the cost of the medical care required to sustain that additional year of life. Based on this analysis Cutler argues that we are getting are a positive return.

There are two problems with Cutler’s analysis. First, his methodology assigns a different value to a year of life based on a person’s age and work status. In Cutler’s cost/benefit analysis, the dollar value of a year of life from a working person in his or her prime is assumed to be worth more to society than that of a retired or disabled person. While the retired or disabled have less dollar value to society their cost of care is greater.

Second, Cutler is getting a lot of heat for assuming that the money to pay for health care is unlimited. Critics have responded:

Cutler’s is a generous vision. But will the wealthiest among us really be kind enough to finance health care for all at a level that equals 30 percent of GDP? Not if they realize that other countries have made similar strides in lengthening life expectancy while spending far less. Indeed, many have done better. Worldwide, the United States ranks 31st in longevity, behind such countries as Australia, Canada, and Malta. And it ranks 40th in the probability that a child will die before age 5, with nations such as Estonia, Portugal, and Slovenia doing better.

I think all this points to the urgent need to wring inefficiency out of our health care system, and bring costs under control. Otherwise we might reach the limits of what society is willing to pay for health care. This will lead to calls for rationing and the strictly financial cost/benefit analysis that would put the hypothetical person in a vegetative state at an extreme disadvantage.

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