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Palliative Care
Published in Kathleen Benton, Renzo Pegoraro, Finding Dignity at the End of Life, 2020
The previously cited Jahi McMath situation, which was the source of some controversy, is one example in which a patient was maintained nutritionally even after being declared brain dead. The medical decision-making becomes quite a bit murkier when dealing with chronic neurologic conditions that are not terminal. In the Pennsylvania bishops’ statement, distinctions were made between the conditions of coma, psychiatric pseudocoma, the locked-in state, and the persistent vegetative state. All of these conditions are generally felt to be reversible with the exception of the last one. Patients in a persistent vegetative state have an almost zero percent chance of meaningful recovery after persisting in that condition for more than a year (Plum & Posner, 2007). The bishops made the statement that if the supplying of nutrition and hydration is of benefit to the patient and causes no undue burden of pain or suffering or excessive expenditure of resources, then it is our duty to provide that nutrition and hydration. If the burdens have surpassed the benefits, then our obligation has ceased. That being said, the bishops stated that, in times of uncertainty about the nature of a patient’s clinical situation, it is desirable that the benefit of the doubt be given to the continued sustenance of the life of the unconscious person (Nutrition and Hydration, 1999).
The Redefinition Issue
Published in David Lamb, Organ Transplants and Ethics, 2020
The respective prognoses of brainstem death and persistent vegetative states are only similar in the initial period. Brainstem death can be determined with absolute precision within at most a few hours, or days. But with the persistent vegetative state the prognosis for non-recovery of cognition or other intellectual functions cannot be determined with any degree of certitude until much later in the course of the patient’s illness. After the initial ischemic insult to the brain there is usually a temporary depression of brainstem functions, where the patient may need a ventilator. After a few days, maybe weeks, recovery of the brainstem occurs with a resumption of a normal level of arousal, where ventilation is no longer required. This is often interpreted by relatives as signs of recovery, but frequently it is only an evolution into the persistent vegetative state. Nevertheless a certain diagnosis of the persistent vegetative state involves observations over a considerable length of time. It may take weeks or months before a physician is ‘reasonably confident of the severe, irreversible destruction of the cerebral cortex, as judged by the behavioural responses of the patient’ (Cranford and Smith, 1979:205).
Religion, Culture and End-of-Life Issues
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
Nevertheless, there are basic values shared by most Buddhists. The primary point is that there is no mandate or moral obligation to preserve life at all costs in Buddhism – this would be a denial of human mortality. There are no specific Buddhist teachings on patients in a persistent vegetative state, but maintaining artificial nutrition is a way to keep the patient alive artificially – which is not mandatory in Buddhism. Alleviation of pain, and the principle of double effect (McIntyre 2009), is accepted, but Buddhists strive to meet death with mental clarity. Therefore, some may abstain from analgesia or sedation. Hence, it is extremely important to inquire about specific attitudes that may be deeply held by a Buddhist patient and family who come from a particular culture.
Conflict Over Death by Neurologic Criteria: Caution, Consent, and Nursing Considerations
Published in The American Journal of Bioethics, 2023
Brenda Barnum, Sabrina F. Derrington
There are many reasons that Maddie’s family may be refusing brain death testing. Research demonstrates that the public holds inconsistent definitions of DNC and has difficulty differentiating between brain death, coma, and persistent vegetative state (Zheng et al. 2022). While cessation of cardiac activity is quickly followed by visible, irreversible changes in the body (e.g., discoloration, loss of warmth, rigor mortis) widely recognized as death, there are no obvious changes to distinguish a ventilated comatose patient from one diagnosed with DNC, especially in the eyes of their family members. Public media has highlighted controversial cases like Jahi McMath’s as well as stories of patients who were misdiagnosed with DNC, further perpetuating public confusion and distrust. In a country where many patients experience substandard care and poor health outcomes as the result of structural and interpersonal racism, and given the historical connection of DNC with organ procurement, some families may worry that care is being unfairly withheld or that an evaluation for DNC is motivated by discriminatory perceptions (Goodwin 2018). Within this context, requesting informed consent is a powerful mechanism for demonstrating respect and restoring trust (Johnson 2020).
Neural reactivity parameters of awareness predetermine one-year survival in patients with disorders of consciousness
Published in Brain Injury, 2021
Oded Meiron, Jeremy Barron, Jonathan David, Efraim Jaul
Disorders of consciousness (DOC) patients included in the study were 10 adult residents of a chronic hospital unit (i.e. Complex Nursing unit) in Jerusalem, Israel, with a diagnosis of persistent vegetative state (VS) or minimal conscious state (MCS) according to their baseline JFK Coma Recovery Scale-Revised (CRS-R) scores (6). Clinical and demographic characteristics of DOC sample can be viewed in Table 1. Baseline event-related EEG was also collected from 10 demographically matched healthy controls (HC) recruited from the hospital’s immediate surrounding community (see Table 1 for HC demographic characteristics). HC participants were excluded if they had neurological or psychiatric disorders. Across all patients with DOC, vital signs, electrolytes, and blood counts were checked and were confirmed to be stable and reasonable before any study procedures were initiated. All patients with DOC had a history of mechanical ventilation and had all been weaned successfully from ventilator support before the study. All of the participants with DOC received enteral tube feeding. All patients with DOC were medically stable without active infection at the time of baseline assessments.
Reversible conductive hearing impediments among patients with severe brain injury
Published in Disability and Rehabilitation, 2020
Udi Cinamon, Dov Albukrek, David Dvir, Tal Marom
The patients included in the study were unconscious adult patients (>18 years) who were hospitalized in the central rehabilitation hospital due to a severe brain injury, classified as a “persistent vegetative state.” This institution is a multidisciplinary rehabilitative care center that treats patients whose motor and/or cognitive functions have been severely impaired by injury, illness or disease (http://www.reuth.org). The most common primary etiologies of injury in this cohort were traumatic brain injury, severe anoxic brain damage after cardiopulmonary resuscitations and cerebrovascular accidents. All the patients included were ventilator-dependent and required tube feeding, therefore, tracheotomy and a feeding gastrostomy were placed. None of the patients had a known previous otogenic (hearing) disorder. Patients who did not meet the eligibility criteria were excluded.