20 hours ago · Patients who survive catastrophic brain damage may be left permanently unaware—in the permanent vegetative state. Many doctors are likely to manage these patients at some point in their career. 1 The diagnosis has been the subject of reports prepared by official bodies. 2 – 6 It has been defined as “a clinical condition of unawareness of self and … >> Go To The Portal
The diagnosis of the vegetative state can be made only in a patient shown to be unaware of self and environment Published research varies in relation to prognosis and permanence—currently, the vegetative state is considered permanent by 12 months at the latest
Summary points The diagnosis of the vegetative state can be made only in a patient shown to be unaware of self and environment Published research varies in relation to prognosis and permanence—currently, the vegetative state is considered permanent by 12 months at the latest
It is accepted that in some cases of permanent vegetative state no definitive cause can be discerned.9,16
If you have a loved one who’s in an unaware and unresponsive state, doctors may refer to it as a “vegetative” state. But variations of this term have been used in ways to insult or hurt others. Because of the confusion and pain it may cause loved ones, neurologists are searching for a better term for this state of consciousness.
Diagnosis of Vegetative StateDoctors suspect a vegetative state based on symptoms. ... An imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), is done to check for disorders that may be causing the problem, especially those that can be treated. ... Electroencephalography. ... Functional MRI.
Thus some patients can regain awareness after more than four months in a vegetative state, and, although few reach full independence, most can achieve an improved quality of life within the limitations of their disabilities. The recovery period is prolonged and may continue for several years.
The vegetative state can be diagnosed according to the following criteria: (1) no evidence of awareness of self or environment and an inability to interact with others; (2) no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; (3) no ...
Vegetative state (also known as unresponsive wakefulness syndrome) is when a person is awake, but shows no signs of awareness. This is different to a coma, in which the patient is completely unconscious. You can click the headings below to navigate this article.
Brain death: Irreversible cessation of all functions of the entire brain, including the brain stem. A person who is brain dead is dead, with no chance of revival.
There have been no other well-documented reports of recovery of consciousness in patients in a persistent vegetative state more than 12 months after a traumatic injury. Good recovery of function is also unlikely.
As with 'brain dead' patients, the vegetative and minimally conscious patients started off in intensive care – but, unlike them, they have survived independently of ventilators: they are not 'gone' (that is 'brain dead') and there has been no final 'goodbye'.
To the question "Do you think that patients in a minimally conscious state can feel pain?" nearly all interviewed caregivers answered "yes" (96% of the medical doctors and 97% of the paramedical caregivers). Women and religious caregivers reported more often that minimally conscious patients may experience pain.
Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. Individuals may even occasionally grimace, cry, or laugh.
Other studies have shown that up to 20 percent of patients in various vegetative states can hear and respond on at least some level. But at least some of the responses seen could be dismissed as simple reflexes, or at best akin to someone in a dream state responding to stimuli.
When someone is 'brain dead' they have no reflexes and cannot breathe on their own. They will never regain consciousness or the ability to breathe and are considered legally dead. Usually when someone loses brain stem function they stop breathing, their heart stops and they are clearly dead.
Vegetative state patients who experience consciousness likely endure con-siderable frustration and suffering. They cannot take part in decisions relating to the discontinuation or continuation of their own life support, express when or if they are in pain , request medication or treatment, exert any control over their exterior environment, or communicate with family, friends , or medical staff caring for them.201 Allowing these patients any means of communication, whether fully effective or not, will have a huge impact on their lives and goes straight to the principle at the heart of the ADA and the Rehabilitation Act: put-ting disabled individuals on a more equal footing with everyone else.Unfortunately, if courts hold that health care facilities must provide brain-scanning equipment, the significant costs of the technology may cause undesir-able results. Hospitals may have to lower the quality of treatment they provide to other patients or increase the cost of medical care for all of their patients. These problems might be avoided if courts accurately assess whether any par-ticular health care facility has the resources to supply brain-scanning equipment under an undue burden defense. Even so, it may not be socially advantageous to have hospitals invest in performing brain scans of vegetative state patients when the majority of these patients will remain uncommunicative and there is no definitive proof that those who can communicate are consciously doing so.As this Note illustrates, there are many gaps in the ADA and Rehabilitation Act auxiliary aid requirements that will become increasingly apparent as tech-nological advances create novel prospective auxiliary aids. It will be up to the court system and Congress to fill these gaps by resolving questions such as the following: What threshold of evidence is needed to establish an auxiliary aid’s reliability? How likely does it need to be that an auxiliary aid will enable effec-tive communication before its provision is required? What impact should a lack of alternatives have on a court’s decision to require an auxiliary aid? What do “fundamental alteration” and “undue burden” mean in the context of the auxil-iary aid provisions? And finally, should courts fashion equitable remedies when the use of an auxiliary aid allows for flexibility?
Patients in vegetative states appear to be awake but unconscious. If they have been in a vegetative state for more than one year, they have little chance of ever recovering. Additionally, no one can communicate with them, including phy-sicians, loved ones, and families. However, new scientific evidence has chal-lenged our understanding of this bleak reality. In particular, recent neuroscience research has shown that a substantial number of patients in vegetative states may actually be conscious and able to communicate through the use of brain-scanning technology. This exciting development poses many difficult questions, including the one analyzed here: now that we know neuroimaging may be the only way to communicate with these patients, will health care facilities be required to provide brain-scanning equipment under American disability law? This Note argues that lawsuits seeking neuroimaging technology from hospitals have a significant chance of success. The main challenge for plaintiffs will be convincing judges that existing scientific evidence actually shows that neuroimaging can facilitate communication with patients. Ultimately, if the appropriate legal framework de-velops, brain-scanning technology could permit patients in vegetative states to make decisions regarding their own medical care and allow families to com-municate with their loved ones.
Any disabled individual who is denied the use of an appropriate auxiliary aid by a hospital or health care facility may sue under the ADA and, if the facil-ity is a federal aid recipient, under the Rehabilitation Act as well. Yet health care facility defendants in these cases can still elude ADA and Rehabilitation Act requirements through the safety valve of a “fundamental alteration” or “undue burden” defense.152 A defendant seeking to raise a fundamental altera-tion or undue burden defense has the burden of proof,153 and courts must eval-uate these defenses on a case-by-case basis.154 This Part examines how courts analyze these defenses and discusses the potential for health care facilities to use them in resisting any requirement to provide brain-scanning technology.