Human Exceptionalism

New Diagnostic Techniques to Reduce Forty Percent PVS Misdiagnosis

The Times of London reports that scientists hope to be able to reduce the 40% misdiagnosis of PVS. From the story:

Ten years ago, Kate went into a deep coma and was on a ventilator for several weeks. She had suffered severe brain inflammation after contracting a viral infection. When she came out of the coma, she opened her eyes and could breathe naturally, but she was unresponsive to speech and visual stimuli, and appeared to lack all conscious awareness. She was still in this condition four months after falling ill, and was later diagnosed to be in a persistent vegetative state, or PVS: in other words, persistently unaware. But the diagnosis was wrong.

Although Kate could not speak, or hear properly, or make any kind of signal, or take in sustenance except through a tube into the stomach, she was sometimes aware of herself and her surroundings. She had a raging thirst that was not alleviated by the ward staff. She was racked with pain. Sometimes she’d cry out, but the ward staff thought it was just a reflex action. Kate suffered so much pain and despair that she tried to take her own life by holding her breath.

Then a Cambridge neuroscientist called Dr Adrian Owen put her in a special kind of scanner and performed an unprecedented experiment. It revealed evidence of fluctuating levels of brain activation when she was presented with pictures of her parents. From that point, she started her long journey back into the world.

It’s always “just a reflex.” When families or nurses report signs of cognizance, it is often, “They are only seeing what they want to see.”

But that may change:

The team is now experimenting with drawing parallels between scanners and EEG machines, which measure brainwaves. It is possible that EEG “markers” can be created that are identical to crucial brain locations found only by scanning techniques. The plan is to be able to make functional brain tests at the patient’s bedside that preclude the high cost and massive bulk involved in Pet and MRI scans. This should lead to “tailor-made” rehabilitation based on highly refined external observations in combination with precise interior knowledge of an impaired brain.

The story also discusses the problem of putting the disabled person out of our misery:

“Imagine the case of this family who, after several years, want to finally grieve and get their lives back. Mr K has a new partner, their son plans to go to Australia, and their daughter has moved to Scotland. Their hospital visits have dwindled to once every three months. They’ve made their decision to apply for withdrawal of feeding and allow Mrs K to die. What if a scan now finds a trace of minimal awareness? The withdrawal will obviously be halted, there will be new feelings of guilt to be dealt with, and the family’s life is back on hold.

Decisions about patients’ deaths should not be made on the basis of family impact. Besides, in the US at least, conscious patients are dehydrated all the time.

I strongly believe that it should not matter whether a patient is in a PVS or not in the sense of their right to life, and care, and moral worth. Barring an advance directive in writing, their food and water should not be removed on the decision of others based on quality of life judgments. But using these tests to determine the extent of the brain insult can lead to better treatment and improved conditions. The question will be raised, of course about the price tag. But are we really willing to abandon these patients because we don’t think their lives are worth living?