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Paper Topic:

Persistent Vegetative State


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Persistent Vegetative State

Nursing is by all means a hands-on job , with a strong emphasis on maintaining a good relationship and association with the patient . Ethics forms a major part of nursing , and this involves taking care of the patient with dedication and commitment . As Carol Gilligan (1982 ) put it nursing involves the Ethic of care , a statement that other nurses and feminists agreed with whole heartedly . Sara Fry (1989 ) was an individual who made out a strong case for

a nursing ethic to be followed by medical practitioners , and she insisted that the basis of the nursing ethic that she was propagating must be feminine (Tschudin , Verena 2003 ) Chris MacDonald , of the Department of Philosophy , Canada , has detailed a set of procedures that would ensure that one is keeping within the boundaries dictated by ethical decisions and dilemmas According to him , one of the first steps a nurse or a caregiver must take would be to recognize that the decision to be taken is one that has a moral and ethical significance . After this has been done , one can start to analyze the individuals involved in the ethical dilemma : who are the people involved , what is their relationship with each other , and who is the individual whose decision must be given top priority in the ethical decision ? After this decision , one must stop and think about the shared values that come into play into the dilemma : is anyone going to be harmed or helped by the decision ? If so , to what extent ? This would bring one automatically to the next step : what are the various benefits or burdens that one would accrue because of the decision to be made ? The benefits may include producing a sense of fairness in the individual for whom the decision matters the most , while burdens may include the financial as well as the emotional , when the decision is taken Macdonald reiterates that one must never hesitate to discuss the ethical dilemma , and the caregiver must make the time to discuss the issue with all the individuals that are involved . However , one must keep in mind issues of confidentiality . The nurse or caregiver must analyze the fact that the decision to be made may not actually be within the legally accepted rules , or within the organizational rules , if any , while keeping in mind the important rule that although rules may be meant to be broken , it would always be a better idea to remain within the laid down rules and regulations . Finally , one must ask oneself this question can I live with this decision , and would I want my children to make this decision ? When one is comfortable with the decision , than one may go ahead with it (MacDonald , Chris 2002

Healthcare ethics is therefore an issue that brings the focus on keeping up truth , human dignity , and in dealing with these issues within the ethical boundaries prescribed , while at the same aware that some of these may deal with life and death issues , and some others with global justice . Take for example a life and death dilemma where a patient may be in a persistent vegetative state . This issue may involve making a decision based on a balanced judgment , after having considered the initial intervention , further intervention for the patient , and whether to continue the intervention and thereby prolong the patient 's life or not (Hunt , Geoffrey , Prof n .d ) One must remember the fact that the Human Rights Act of 1998 , for example , in the United Kingdom states that all Health Authorities will be classified as `public authorities , and this would mean that they must , at all times stay within the guidelines prescribed by the European Convention for Human Rights . Therefore , this would also mean that all NHS Authorities must include the main principles of the convention in their own policies under the heading `risk management strategy , so that all health professionals may remain aware , at any given point , of the rights that their patients have , so that they may stay within the legal conventions and boundaries and successfully avoid potential litigation for the same In short , the NHS must always believe that Everyone 's right to life will be protected by law , and until today the NHS has sought the intervention of the Courts in a few cases that involve `limiting life saving treatment ' to a particular patient . Take for example the case of R v Cambridge Health Authority Ex Parte B ([1995] Vol . 2 129 , in which Jayne Bowen , a child was refused treatment of bone marrow transplant for acute myeloid leukemia because the NHS would not pay for it . The court ruled that it was in no position to pass a verdict or the correctness of such tough decisions involving life and death (Woogara , Jay n .d

Take the ethical dilemma of an individual who has been rendered into a persistent vegetative state . Must this type of patient , who has absolutely no hope of ever waking up again , be allowed to live , or die What would be the approximate costs of keeping this patient alive ? Would the costs of keeping the patient alive justify the ethical dilemma and the decision that would be made as a result ? What would be the responsibilities of the family members and the nurses and primary caregivers of the patient towards the patient in the persistent vegetative state ? Does the government have any decisions to make in this regard ? If so , what may they be ? These are the questions that may surround a patient who is in a vegetative state . One may begin with a of such a patient . The patient in a persistent vegetative state is also referred to incorrectly as being `brain dead . The patient may have regressed into this state after a coma , which may have been caused by a disease or brain injury or any other trauma . This individual would have lost his thinking abilities and also his awareness of his surroundings , but may at the same time retain his non-cognitive functions , as well as his normal sleep patterns . He would breathe on his own , and may at times demonstrate certain spontaneous movements , and open his eyes at external stimuli . He may also be able to cry or laugh or grimace , and may appear relatively normal , but would not be able to respond to any stimuli presented to him by those around him

One must remember that the prognosis for such a patient remaining in the persistent vegetative state may be quite dim , and it may depend upon the cause of the vegetative state , its severity , and the site where the neurological damage has occurred . While some patients may recover gradually over a long period of time , some may never ever recover fully they may acquire a certain level of awareness ( Persistent Vegetative State ' 2007 ) In short , it may be said that for a patient in a persistent vegetative state , the chances of his coming out of the state healthy and well may be slim indeed ( Coma and Persistent Vegetative State ' 2008 ) It can also be defined as a clinical condition of unawareness of self and environment in which the patient breathes spontaneously , has a stable circulation , and shows cycles of eye closure and opening which may simulate sleep and waking ' [Working Group of Royal College Physicians , 1996] At times , these patients may display certain behaviors that could be interpreted by his care givers as being evidence of consciousness , but this may be wrong , because these may be involuntary movements , which have nothing at all to do with the patient 's awareness of his surroundings . However , for an individual to be diagnosed as being in a `persistent vegetative state , he must have been in that state for a period of time lasting longer than a month When a patient continues to remain in the persistent vegetative state for an inordinately long period of time , then he may be termed as being in the `permanent vegetative state ( Persistent Vegetative State 2007 ) In this definition lies the controversy behind the term . It is naturally difficult to define and understand this condition satisfactorily , and this is the reason why there is so much discussion on how these patients must be treated , and whether they must be allowed to continue to live or not (Gustafson , Leif 2000 ) This would bring us back to the ethical decision at stake when dealing with this type of patient : what would be the costs of keeping this patient alive , if the decision to keep him alive were to be made ? This would bring one to the moot point : medical technology has improved so greatly today , and this means that people can be expected to live on for a great many more years than their grandparents could have hoped for , and when it is possible that this same medical technology can be used to keep one 's loved one alive , despite the fact that he may have entered a persistent vegetative state , that must one take advantage of such technology , or not ? Today more and more people are being forced to take this decision of whether they would want to either withhold treatment , or continue it indefinitely , despite the costs involved in the treatment , thereby raising questions on ethical issues such as the appropriate use of available resources , the wishes of the immediate family members , and so on

There can be no doubt that the decision to withdraw fluids and food from a patient who has been in a persistent vegetative state for a period lasting more than a month can be devastating and tragic for the immediate loved ones . One must not forget that the patient would be in a sort of unconscious state , and completely unaware of what is happening around him . This in itself may cause immense trauma to loved ones watching one 's daughter or son or wife or husband languishing in a bed with no hope at all of recovery . Added to this would be the truth that if fluids were to be withdrawn , the patient would die . Therefore , must one be allowed to withdraw fluids from the patient and allow him to pass on , while if he were left to continue , he would live on indefinitely in the same vegetative state ? For some individuals , the question of autonomy may be raised by the issue : if it could be shown that the patient would never want to live on in this condition , then the decision to end his life may be made . Anyway , the quality of the patient 's life may be so poor that there may be no need to keep him alive indefinitely and when one adds the expenses involved , then the decision to end life may be the best one (O 'Mathuna , Donal


There is no doubt that for patients who have been rendered into a persistent vegetative state , the prognosis for recovery remains unfavorable , no matter what , and even if , by sheer chance the patient were to wake up , the chances of his recovering function is close to a zero percent ( Medical Aspects of the persistent Vegetative State 1998 ) According to research , PVS or persistent vegetative state is a major problem in the United States of America today . Statistics show that there are 20 to 25 thousand adults , and 4 to 10 thousand children who live on in this state . The cost of caring for this patient , in 1998 when the research was carried out , was 149 , 200 , and an estimated amount needed for long term day care for a PVS patient would be at an average 350 to 500 per day , everyday until he dies naturally . These costs may be exorbitant and may create a great well in the family resources , especially given the fact that the patient may not ever recover . The family that is forced to make an ethical decision must be accorded counseling , especially when they feel that they lack the resources to take care of their loved one , even if medical technology were to offer them other options (Petrinovich , Lewis 1998

A human being will most definitely need proper `end of life care ' no mater what his illness may be . This is applicable to a patient in the persistent vegetative state as well in fact , it can be termed the `patient 's right , and it is the duty of his caregivers to provide this to him (Kinzbrunner , Barry , Weinrub Neil , Policzer Joel 2001 ) However one must never forget that end of life decisions are always fraught with legal , ethical , moral and religious difficulties

The related issues like `withdrawing ' or `withholding ' treatment would cause severe mental trauma and stress on the loved ones of the patient (Vincent JL 2001 ) Some patients , when they are aware that the end is approaching , may prefer to write on their hospital charts a `Do not Resuscitate , which involves instructing the doctors and other care givers not to perform any life saving procedures on them when they may be required , and to simply allow them to die peacefully . However , in a patient who is in a persistent vegetative state , this may not be possible , unless the patient knew beforehand that he would lapse , one day , into this state ( Do not resuscitate s ' 1998 ) In essence the Do Not Resuscitate states that the health care provider must not `intubate , perform CPR , defibrillate , and administer resuscitation medication ' on the patient ( Do not Resuscitate s ' n .d

A `Living Will ' is another end of life decision , in which an individual thinks of the kind of treatment that he wants or would not want , were he to be struck with a sudden illness that would not allow him to speak for himself . This decision may include a rejection of his feeding tube , artificial airways , and so on (Sadock , Benjamin , Sadock Virginia 2007 ) examples of the `Living Will ' can be found on several websites , and the State of Wisconsin is no exception (Thompson G Tommy n .d ) One may quote the case of Karen Ann Quinlan to illustrate a typical dilemma of an ethical end of life decision . The patient Karen Ann Quinlan , a 17 year old , was not terminally ill , but at the same time she was not `alive ' in the true sense of the word . She had suffered , in 1975 , cardiopulmonary arrest after having consumed alcohol and drugs and she declined into a persistent vegetative state immediately afterwards . The parents of the young girl decided to terminate their daughter 's life , but this decision could not be honored it was taken to the New Jersey Supreme Court . The Harvard Criteria stated that the girl could not be declared legally `dead , while experts stated that she would die if she was to be taken off the respirator . When the father approached the courts for permission to let his child die , he was denied permission , and also warned that the prevailing medical standards and practices could not be violated . The state said that anyone who was willing to terminate the girl 's life support would be stated as having committed `homicide , but finally in 1976 , the Supreme Court ruled that is the hospital ethics committee were to agree that Quinlan would never be able to recover from her vegetative state , then the respirator could be removed , and that all parties would be immune to prosecution . This judgment became the precedent for all right to die cases across the world from that time onwards . The parents continued with fluids and medication , however , and Quinlan continued to breathe on her own until 1985 when she died of multiple infections ( Court and the end of life ' 2008

Another case of an end of life right to die decision and the ethical dilemma that was involved in making the decision to terminate treatment was that of 42 year old Terri Schiavo . When she was 26 , she suffered a cardiac arrest at home , which deprived her of oxygen for a few minutes which left her brain dead and put her in a persistent vegetative state However , she was able to breathe , maintain a heart beat and blood pressure on her own , although she needed a feeding tube for sustenance In this case , the government of Florida allowed for the consideration of end of life wishes , and considered the fact that the patient had stated earlier that she would not wish to be a burden on anybody . Her husband asked to remove her feeding tube and life support systems removed and thus terminate her life , but her parents disagreed , and this became a much publicized moral and ethical dilemma that could not be solved easily . one must note that it was at this time that the US Congress passed legislation at this time allowing federal courts to intervene in such cases , and the most important factor to be considered would be the family 's `ability to pay the hospital bills ' Finally , the plug was pulled by her husband , although her parents never agreed , and Terri died in 2005 (Lynne , Diana 2005

In conclusion , it must be said that ethical dilemmas as seen in the cases detailed above must be protected from the eyes of the public , for one , so that the family may be able to make these traumatic decisions after deliberating amongst themselves and after they are sure that they are doing the right thing . The decision to end life is not an easy one to make , but today , considering all the factors involved in the decision , including the family 's financial status , these and other such decisions have to be taken , so that others may continue to live reasonably well after their loved one has entered a persistent vegetative state , for example , from which there is no hope of recovery . Works Cited

Kinzbrunner , Barry , Weinrub Neil , Policzer Joel 20 Problems in end of life care ' Google Book Search (2001 ) March 24 , 2008

Sadock , Benjamin , Sadock Virginia Kaplan and Sadock 's Synopsis of Psychiatry ' Google Book Search (2007 ) March 24 , 2008

MacDonald , Chris A Guide to Moral Decision Making ' A Guide to Moral Decision Making (2002 ) March 24 , 2008

Lynne , Diana The whole Terri Schiavo story ' World net daily (2005 March 24 , 2008

O 'Mathuna , Donal

Responding to patients in the persistent vegetative state ' Xenos Christian Fellowship (2008 ) March 24 , 2008

Hunt , Geoffrey , Prof Healthcare Ethics , a Global Overview ' University of Surrey (n .d ) March 24 , 2008

Woogara , Jay Human Rights Awareness for Health care Professionals International Association for Nursing Ethics (n .d ) March 24 , 2008

Vincent JL Cultural differences in end of life care ' Critical Care Medicine (2001 ) March 24 , 2008

Gustafson , Leif Persistent Vegetative State ' Persistent Vegetative State (2000 ) March 24 , 2008

Petrinovich , Lewis Living and Dying well ' Google Book Result (1998 March 24 , 2008

Thompson G Tommy State of Wisconsin (n .d ) Department of Health and Family Services March 24 , 2008

Tschudin , Verena Ethics in nursing , the caring relationship ' Google Book Search (2003 ) March 24 , 2008

Coma and Persistent Vegetative State ' Medical College of Wisconsin (2008 ) March 24 , 2008

Court and the end of life ' Library Index (2008 ) March 24 , 2008

Do not resuscitate s ' Ethics in Medicine (1998 ) March 24 , 2008 Do not Resuscitate s ' Shands Healthcare Core Procedure (n .d March 24 , 2008

Medical Aspects of the persistent Vegetative State ' NEJM (1998 March 24 , 2008

Persistent Vegetative State ' National Institute of Neurological Diss and Stroke (2007 ) March 24 , 2008

Persistent Vegetative State ' Ascension Health (2007 ) March 24 , 2008 PAGE

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