This look at PVS comes from an article in Evolution News & Views. It is a lengthy read and a scholarly one.
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This is the first in a series of posts in which I will discuss the medical and ethical aspects of persistent vegetative state (PVS). As I noted in an earlier post, I believe that the emergence of PVS as an accepted medical diagnosis is in part a consequence of the emergence of strict materialistic theories of the mind in the late 20th century, especially the theory called "functionalism," which is the theory that the mind is what the brain does, in the same way that running a program is what a computer does. If the mind is entirely caused by the brain, in a way analogous to the running of a software program on a computer's hardware, it stands to reason that there would be situations in which damage to the brain would cause the "mind program" to irreversibly crash. This leads to rather obvious ethical implications. Ideas have consequences, and the materialist understanding of the mind has had direct and disturbing consequences for the medical treatment of people handicapped by severe brain injuries. I will explore this connection between philosophy of the mind and clinical medicine in a future post.
PVS came to wide public attention with the death in 2005 by dehydration and starvation of Terri Schiavo, a young woman with severe brain damage caused by a cardiac arrest (probably from an electrolyte imbalance) in 1990. She died because her feeding tube was removed by court order at the request of her husband, who claimed that she had told him that she would have wanted to be deprived of nourishment under these circumstances. The deprivation of water and nourishment to a handicapped person, even with the pretext of accommodating that person's wishes, obviously raises ethical issues, and I'll discuss them in future posts. I'll address primarily the medical and neurological issues in this post.
~Snip~
The closer one examines the diagnostic issues involved in PVS, the more clear it is that PVS is in many ways a problematic diagnosis. The diagnosis of PVS relies entirely on the patient's ability to communicate internal mental states to the examining neurologist. Yet severe brain damage intrinsically limits the patient's ability to move and speak. Patients in whom the diagnosis of PVS is made are precisely those people in whom the assessment of mental state is most unreliable.
Furthermore, PVS is the only medical diagnosis that, by denying that the patient has a mind, denies the personhood of the patient. Thankfully, many people in PVS are still treated with respect as persons by their families and caregivers, but that respect is conferred despite, not because of, the diagnosis of PVS.
My interlocutor on this topic, Yale neurologist Steven Novella, has posted several essays in defense of what was done to Terri Schiavo. I'll address the issues he raised, such as the reliability of the diagnosis of PVS as well as Ms. Schiavo's autopsy findings and the ethical implications of the deprivation of food and water to people diagnosed with PVS in my next several posts.
Terri Schiavo and the Persistent Vegetative State
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