Man in a Vegetative State Responds to Questions

This has been all over the web, but Wesley Smith at his Human Exceptionalism blog on the National Review Online web site has probably the best take on it.

A Canadian man named Scott Routley suffered severe brain damage in a car accident 12 years ago, and since then, he has not provided physicians with any evidence that he is conscious.  Several physical assessments by health care professionals have not indicated that Mr. Routley shows any signs of awareness, or has the ability to communicate.

What types of assessments are given to these patients?  The Royal Hospital for Neuro-disability (RHN) in Putney, London, specializes in the rehabilitation of brain-injured patients.  The RHN invented a complex assessment technique for brain-damaged patients that has been given the clever acronym “SMART.”  SMART tests all five senses, and a SMART assessment asks patients to track objects with their eyes, press switches, look at photographs, and even gives them things to taste and smell.

Patients who uniformly fail to show any signs of sensation in a SMART assessment (and others) are thought to be in a “persistent vegetative state.”  Essentially the brain stem still works to get the heart pumping and the lungs breathing, but these are autonomic functions provided by vital centers in the brain stem.  There cerebral cortex and the so-called “higher brain functions” that many people equate with being a human person, are thought to be gone.

Sometimes, patients in a persistent vegetative state will awaken to a kind of coma, in which their eyes are open, but they do not seem to have any perception of themselves or the outside world.

This view of severely brain-damaged patient will need to be rewritten, according to British neuroscientist Prof Adrian Owen.  Owen directed a neurological research team at the Brain and Mind Institute at the University of Western Ontario that examined Mr Routley’s brain with fMRI (fiunctional magnetic resonance imaging).  Their data, in Owen’s view shows that Mr. Routley is clearly not vegetative.

According the Dr. Owen, “”Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is.”

Dr. Owen continued: “Asking a patient something important to them has been our aim for many years. In future we could ask what we could do to improve their quality of life. It could be simple things like the entertainment we provide or the times of day they are washed and fed.”

Folks, being able to answer questions is not something that patients in persistent vegetative states do.  This chap and probably hundreds or more like him are alive and their brains are functioning.  Their brains however are too damaged to make their bodies move beyond so-called “core reflexes.”

Wesley Smith brings up the poignant point to be taken from all this:  “People such as Routley are dehydrated to death every day in all fifty states and in many countries around the world by having their tube-supplied sustenance withdrawn–supposedly based on their lack of personhood. But don’t expect this to stop the dehydration imperative. Bioethicists will merely say this is even more reason to kill them since they are aware of their profound disabilities and suffering. Indeed, that argument has already started.”

Smith is dead-on.  There are plenty of cases of supposedly brain-dead patients suddenly regaining abilities after being out of it for a long time.  For example, Haleigh Poutre, who was beaten into a coma by her stepfather Jason Strickland and her maternal aunt Holli Strickland.  The Department of Social Services, which had failed to rescue her from an obviously abusive situation in the first place, took custody of her and ordered her to be killed by dehydration and starvation.  However, this order was stayed after Haleigh began to breathe on her own and follow simple commands.  There are many other cases like this and do not get me started on Terry Schiavo (no I am not going to let that one go).

We are putting people down as though they were our pets just because they do sit up a bark when we say so.  Our original moral instincts were correct in the first place – that people are people regardless of whether or not they can follow our instructions.  May God forgive us for what we have done to the most disabled among us.  Hopefully, brain scans such as these will become mandatory before a patient is starved to death in the name of “mercy killing,” which is just simple murder.

British Medical Association (Again) Urges Doctors To Abdicate Their Professional Duty

Wesley Smith blogs on the British Medical Journal article that argues that British physicians should end their opposition to physician-assisted suicide. Instead, the Journal argues, this is a question for society and doctors should be neutral about it.

Smith rightly notes that this is preposterous, since doctors are a part of society and have a sworn duty to the well-being of their patients. Shame on the British Medical Association for pulling a stunt like this and shame on the Journal of being complicit in the promotion of doctor-based murder.

Read Smith’s post here.

Palliative Sedation is Not the Same as Euthanasia

Palliative sedation is a medical technique for terminally ill patients who cannot receive adequate pain relief while they are awake. Palliative sedation uses sedative medications to make the patient unaware and unconscious while the disease takes its course. This relieves extreme suffering by placing the patient in a kind of sleep. The sedative medication is gradually increased until the patient is comfortable and able to relax. Palliative sedation is not intended to cause death or shorten life (Erin Brender, MD; Alison Burke, MA; Richard M. Glass, MD. JAMA. 2005;294(14):1850.)

This has not stopped euthanasia advocates from asserting that palliative sedation is euthanasia. The inimitable Wesley Smith has a blog post on this and he refers to an article in the Journal of Pain & Palliative Care Pharmacotherapy that takes this deliberate conflation of these two very different things to the woodshed.  It’s a great read.  Check it out here.