- The first step in any bioethical dilemma is to collect the facts and to understand the medical reality of the situation. Nowhere is this more necessary than in treatment decisions concerning patients with serious neurologic impairments. Modern medicine's half-way technologies have produced new neuro- logic creatures and required new terminology to describe syndromes both more complex and more common than anticipated a few decades ago.
- Unfortunately, enormous conceptual and scientific confusion persists concerning the characteristics of these new syndromes, which include brain death1 (whole brain death)2, persistent vegetative state3 (PVS), permanent unconsciousness, coma, dementia, irreversible coma, chronic and irreversible coma, neocortical death, and locked-in syndrome.
- For example, many over the last ten years mistakenly believed that Karen Quinlan was brain dead. Others, including neurological specialists, continue to consider the persistent vegetative state4 a form of coma. Many, including physicians, still believe that permanently unconscious patients, such as those in a persistent vegetative state5, can experience pain and suffering.
- In addition, there is little consensus about the appropriate terminology to describe such syndromes. In its 1986 statement on fluids and nutrition, the American Medical Association's Council on Ethical and Judicial Affairs used the misleading term "irreversible coma." British physicians to apply broadly the phrase "brain stem death," a medical syndrome that simply does not exist except in extremely rare situations. Many physicians, especially in Europe, use imprecise and antiquated language such as "coma vigile," "akinetic mutism," and "apallic state" to describe some syndromes. The term "chronically and irreversibly comatose" as used in the Child Abuse Amendments of 1984 will be an endless source of confusion.
- If the medical profession persists in failing to understand these syndromes and continues using inconsistent and incorrect terminology, how can the rest of society begin to unravel the complexities of neurology and lay the foundation for a moral and legal analysis of the issues emanating from these neurologic conditions? A full understanding of the medical facts about persistent vegetative state6, including an examination of the significant similarities and differences between it and several other syndromes, is essential before we can begin to apply appropriate moral and legal principles to individual cases and to develop meaningful social policies.
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- Blue: Text by me; © Theo Todman, 2019
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