October 26, 2009
With all of the current debate in the United States over President Obama's proposed health care legislation, people seem to have firmly chosen sides—based on their political leanings and not necessarily the actual content of the bill, HR 3200.
In a nation that professes a profound reverence for the lives and wellness of its citizens, it is no argument that our system of healthcare delivery fails many patients and that insurance companies and health maintenance organizations have long dodged the bullet of responsibility when they've rationed care or denied coverage for certain types of treatments and therapies. That rationing and denial of coverage is most rampant among our most vulnerable citizens—when such treatments and therapies are essential for daily living. And now the government wants in.
Though our current system is in serious need of repair, many fear that a government-run system could open the doors for bureaucrats to make decisions in life and death for patients whose diagnoses are less than promising. This becomes most alarming when certain diagnoses can equal a death sentence for someone who is helpless to save themselves.
On September 20, 2009, Scientific American published a report titled "Conditional Consciousness: Patients in Vegetative States Can Learn, Predicting Recovery." Citing a study published by Nature Neuroscience, the report states that patients who were previously diagnosed as being in a vegetative state were able to relearn behaviors—suggesting cognition in people who had failed more traditional tests for cognitive function and awareness.
Perhaps the most important piece of Scientific American's article is the following, attributed to the study's senior author and the director of the Integrative Neurosciences Laboratory at the University of Buenos Aires, Mariano Sigman:
… current designation of either vegetative or minimally conscious did not determine how well patients learned. Some of those who were minimally conscious didn't learn as well as some who were classified as vegetative and vice versa. "I think there's some consensus that there is a [need for] revision in the way these patients are classified," Sigman says.
Since the high-profile cases of Karen Ann Quinlan, Nancy Cruzan and my own sister, Terri Schiavo, the public has been encouraged to accept the definition of persistent vegetative state (PVS) as an accurate and reliable one. However, evidence is growing that the diagnosis fails in many cases.
PVS is an oft-used term describe a patient who has lost all awareness of surroundings and self, displays no purposeful behaviors or intentional movements and has no capacity in higher brain functions such as decision making or problem solving.
Because the diagnosis itself has been used as justification for the removal of ordinary care from incapacitated patients (thereby causing death or dehydration and starvation in otherwise healthy patients), it merits strict scrutiny by the public and the medical community.
Instead, we've been conditioned to believe the accuracy of this diagnosis, out of hand, and have been told that removing the basic provision of medically-assisted food and fluids (causing the patient's death) is kinder than continuing to care for and love the disabled person.
A study published in BioMed Central Neurology indicates that doctors do not have the tools to diagnose the condition with certainty. A new tool, the JFK Coma Recovery Scale, is a barrage of more than 20 clinical tests that is designed to give doctors better insight into the cognitive abilities of their patients. Yet, over 40 percent of patients diagnosed PVS are not, in fact, in a persistent vegetative state, according to the Royal Hospital for Neurodisability in London.
Most patients, however, do not receive the full battery of this type of testing and are, instead, subjected to a bedside diagnosis—with the opinion of the doctor bearing the ultimate weight.
