An article in the July 2011 issue of Discover magazine, and the November release of the study that the author investigated, prompted Bobby Schindler to comment on his blog that misdiagnosis was used to “deliberately kill my sister.”
He was referring to the 2005 court ruling that enabled Terri Schiavo’s husband to have hydration and nourishment removed, causing her death several weeks later. The Florida woman had been diagnosed as being in a persistent vegetative state (PVS) since 1991, although her family insisted that they could detect awareness and responses.
They may have been right, considering the results of the study that was published in the online edition of the medical journal, The Lancet.
According to the summary, researchers from the University of Western Ontario in Canada found that three of 16 patients with PVS diagnoses were aware of their surroundings and could respond to instructions. (See sidebar for details.)
Previous but smaller studies at New York University School of Medicine and Weill Cornell Medical College, both in New York City, also detected meaningful brain activity in people diagnosed with PVS.
The latest investigation is the largest and has generated new comments and concerns in secular, medical and religious circles.
Matter of respect
The issue of consciousness — or lack of — is relevant to Church teachings on the dignity of life.
“These kinds of studies are refreshing, because they remind us that we are dealing with another human being and it gives us new insight into a new world,” said Father Tad Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia, who has a doctorate in neuroscience from Yale University. He also did post-doctoral work at Harvard University.
Recognizing awareness can impact decisions on potential treatment options that can facilitate a degree of recovery or gain. Recognizing awareness also can affect basic care, for instance, acknowledging that a patient can hear and see, and therefore speaking and acting accordingly. Or even not keeping a television on day and night, which, Father Pacholczyk said, could be “a form of torture.”
But the deeper question, he said, is not what is done with and for the people who are responsive, but rather, what about the ones who really don’t appear to be responsive?
“Does that mean that we can write them off?” Father Pacholczyk said.
“No. We need to always start from the point of view of response toward a fellow human being who is injured and treat them with the full respect and dignity as we would any brother or sister who wasn’t in an injured state. If they are unresponsive, that doesn’t cut us any slack to ignore them.”
Author, speaker and advocate Wesley J. Smith began fighting assisted suicide after a dear friend was influenced by Hemlock Society literature to commit suicide.
His interest evolved into bioethics and “the importance of being human.” He is now a senior fellow at Discovery Institute’s Center on Human Exceptionalism in Seattle, Wash., and a consultant for the Patients Rights Council in Steubenville, Ohio.
Smith told OSV that bioethics should not differentiate among cognitively devastated patients regarding whether or not they are diagnosed as being conscious or unconscious.
“As living human beings, all such patients retain their intrinsic human dignity and equal moral worth,” he said. “I think it is a grave error for anyone to have their value or humanity judged or denigrated based on the subjective criteria such as level of awareness which we are now learning is not as easy to determine as once thought.”
He additionally objects to the “vegetative” terminology in PVS and the common parlance of calling such persons “vegetables.”
“The ‘V’ word is dehumanizing and should not be used,” he said. “No human being is a turnip, and it’s very hurtful for a family to hear their loved one being described as a carrot. The preferred word would be ‘persistent unconsciousness.’”
What’s learned from these studies is good, he added, providing that the results are used properly to apply or devise techniques to help patients improve.
“There is another dimension here,” Father Pacholczyk said. “Sometimes when we are taking care of people who can’t really respond to us, they can never say thank you and it all seems so futile that they are just lying there and not doing anything.
“But when we take care of someone like that, we are changed. When you are not actually looking for anything in return, that is to truly love somebody in an unconditional way. Caring for someone with such brain injuries may be the highest manifestation of human love, knowing that you will never receive even a word of thanks from the injured person or anything in reply.”
Maryann Gogniat Eidemiller writes from Pennsylvania.