21. Persistent Vegetative State Slide 33 of 36. Go to slide 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 http://www.ces.ncsu.edu/depts/fcs/slide3/slide33.htm

Slide 33 of 36 Go to slide:

22. THE PERSISTENT VEGETATIVE STATE AND THE WITHDRAWAL OF NUTRITION AND HYDRATION THE persistent vegetative state AND THE WITHDRAWAL OF NUTRITION ANDHYDRATION JETS 35/3 (September 1992) 389405 Robert V. Rakestraw http://www.bethel.edu/~rakrob/files/PVS.html

THE PERSISTENT VEGETATIVE STATE AND THE WITHDRAWAL OF NUTRITION AND HYDRATION JETS 35/3 (September 1992) 389-405 Robert V. Rakestraw In recent discussions of euthanasia, coma, and the withdrawal of artificially supplied nutrition and fluids, considerable confusion exists where these topics intersect with the condition known as persistent vegetative state (PVS). For example the terms "PVS" and "coma" are sometimes erroneously used interchangeably, especially by the popular media. Further, regarding the withdrawal of food and water from PVS individuals, some opponents of the practice wrongly allege the intention to kill (aiming at death) on the part of all who allow the practice. Such withdrawal is sometimes incorrectly viewed as euthanasia and is grouped indiscriminately with the deliberate termination of the lives of conscious yet severely disabled persons. The case of Nancy Cruzan—the first "right to die" case to reach the United States Supreme Court—brought the matter of the PVS before the public and the evangelical world with a special urgency. The case of Cruzan v. Director of Missouri Department of Health

23. Persistent Vegetative State And Coma: XtraMSN Health 2003. A to Z Conditions. persistent vegetative state and Coma Health24A coma is a profound or deep state of unconsciousness. Coma http://xtramsn.co.nz/health/0,,8065-1670003,00.html

Advanced Search Home Hotmail Search ... Help navBG = '#336699'; navOverBG = '#6699FF'; casText = '#FFFFFF'; casTextOver = '#FFCC00'; casBG = '#6699FF'; casOverBG = '#336699'; Ask The Expert Beauty Fitness Health Library Natural Health Relationships Parenting SEARCH WEB FOR: BROWSE XTRAMSN: -Select - Academy Awards Auto/Bike/Boat Business Careers Entertainment Games Iraqi War 2003 Kids Money Motoring News Personals Shopping Sport Xtra Super 12 Travel Help SEARCH HEALTH RELATED ITEMS: Xtra Travel XtraMSN Sport Contact Us Health Headlines Now - Sudden Adult Death Syndrome SARS - Latest Advice Lice Therapies Carry Warning Using Herbs To Treat Depression ... Echinacea Pills Had No Echinacea You are here : XtraMSN Health Library A to Z Conditions Mon 31 March 2003 A to Z Conditions Persistent Vegetative State and Coma A coma is a profound or deep state of unconsciousness. Coma may occur as an expected progression or complication of an underlying illness, or as a result of an event such as head trauma. A persistent vegetative state (PVS) sometimes follows a coma. PVS refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment.

24. Coma And Persistent Vegetative State: XtraMSN Health 2003. A to Z Conditions. Coma and persistent vegetative state Health24A coma is a profound or deep state of unconsciousness. Coma http://xtramsn.co.nz/health/0,,8065-1669789,00.html

Advanced Search Home Hotmail Search ... Help navBG = '#336699'; navOverBG = '#6699FF'; casText = '#FFFFFF'; casTextOver = '#FFCC00'; casBG = '#6699FF'; casOverBG = '#336699'; Ask The Expert Beauty Fitness Health Library Natural Health Relationships Parenting SEARCH WEB FOR: BROWSE XTRAMSN: -Select - Academy Awards Auto/Bike/Boat Business Careers Entertainment Games Iraqi War 2003 Kids Money Motoring News Personals Shopping Sport Xtra Super 12 Travel Help SEARCH HEALTH RELATED ITEMS: Xtra Travel XtraMSN Sport Contact Us Health Headlines Now - Sudden Adult Death Syndrome SARS - Latest Advice Lice Therapies Carry Warning Using Herbs To Treat Depression ... Echinacea Pills Had No Echinacea You are here : XtraMSN Health Library A to Z Conditions Mon 31 March 2003 A to Z Conditions Coma and Persistent Vegetative State A coma is a profound or deep state of unconsciousness. Coma may occur as an expected progression or complication of an underlying illness, or as a result of an event such as head trauma. A persistent vegetative state (PVS)sometimes follows a coma. PVS refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment.

25. Ethical Issues In Persistent Vegetative State Practice parameters assessment and management of patients in the persistentvegetative state. Medical aspects of the persistent vegetative state. http://www.worldrtd.org/BMJ vegstate.html

http://www.bmj.org/cgi/content/full/322/7282/352 ETHICAL ISSUES IN DIAGNOSIS AND MANAGEMENT OF PATIENTS IN THE PERMANENT VEGETATIVE STATE British Medical Journal (2001;322:352-354 10 February 01) P ersonal view p 372 Derick T Wade , consultant and professor in neurological disability. Rivermead Rehabilitation Centre, Oxford OX1 4XD Gastrostomy feeding has been withdrawn from around 20 people diagnosed as being in the permanent vegetative state in the United Kingdom, inevitably resulting in their death from dehydration. The clinical diagnosis is confirmed by healthcare professionals and legality is conferred by the courts, but the ethical position is not formally considered. This article outlines some specific ethical issues. Summary points The diagnosis of the permanent vegetative state cannot be absolutely certain There is no standard test of awareness and data on prognosis are limited Patients in the permanent vegetative state raise ethical issues concerning the nature of consciousness, quality of life, the value society attributes to life, and handling of uncertainty In an era of increasing demands on healthcare resources decisions have to be made about allocation of limited resources and how quality of life is to be judged Permanent vegetative state Diagnosis of permanent vegetative state The patient shows no behavioural evidence of awareness of self or environment

26. Untitled Document Sheet. Hospice Definition (Adopted from South Australian VES SAVES).Return to Top. persistent vegetative state PVS. The diagnosis http://www.worldrtd.org/terms&defns2.html

Return to Top For A - M Advance Directives Medical Futility Palliative Care Associated with care delivered to persons with terminal disease. To palliate means to relieve symptoms without curing them. In this regard, palliative treatment refers to that given, usually to patients who are incurably ill, with the aim of relieving their suffering and controlling their symptoms in the most effective way. The World Health Organization definition is: "The active, total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families." (WHO, 1990). Palliative Care/Hospice. Medical care designed to provide comfort and dignity when curative therapy is no longer appropriate. It offers control of pain and other symptoms as well as emotional and spiritual support. This approach has been comprehensively developed within the hospice movement which provides specialised medical, nursing and support services for terminally ill patients and their families. . (South Australian Voluntary Euthanasia Society - SAVES) See: Hospice Definition Fact Sheet Hospice Definition (Adopted from: South Australian VES SAVES) Return to Top Persistent vegetative state - PVS Diagnosis of permanent vegetative state

27. Permanent Or Persistent Vegetative State (PVS) Permanent or persistent vegetative state (PVS) The first important thingto acknowledge about a diagnosis of permanent or persistent http://www.sclhsc.org/mission_vision_values/ethics/pvs.asp

Exact Phrase Permanent or Persistent Vegetative State (PVS) The first important thing to acknowledge about a diagnosis of "permanent or persistent vegetative state (PVS)," is that it is a harsh term that seems to imply what is not, or should not, be intended. That is, it does not mean that the patient has ceased to be a human person with the dignity of every other human person. This human dignity cannot be diminished by disease or disability. Nevertheless, PVS is a profoundly serious condition. Though there are many questions about the continuation of medical treatment for these patients (because of the gravity of their circumstances) basic care should continue. The term "permanent vegetative state" was coined by neurosurgeons Bryan Jennett and Fred Plum in 1972 to describe a condition resulting from severe brain damage. Using their words, it is described as coma characterized by "wakefulness without awareness." In 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research accepted the definition of persistent vegetative state as the "inability to experience the environment." It is one type of permanent unconsciousness.

28. Enl101-sec12-f02: Persistent Vegetative State persistent vegetative state. From Katherine Corless (kacorless@ucdavis.edu)Date Sun Dec 01 2002 171321 PST. Next message Hoda http://listproc.ucdavis.edu/class/200210/enl101-sec12-f02/0141.html

persistent vegetative state From: Katherine Corless ( kacorless@ucdavis.edu Date: Sun Dec 01 2002 - 17:13:21 PST Next message: Hoda Kargozaran: "RE: own experience in the paper" Previous message: Jungmee Kim: "RE: own experience in the paper" Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] Hi class- Quick question, it seems the deeper I delve into my topic about a persistent vegetative state (of which Lia was in), the more complicated it becomes due to my lack of knowledge about the medical field. Is anyone else doing this topic, and are you having similar problems? I have been trying to find a clear cut definition of the disorder, but it seems every medical publication has a different opinion. I feel I am blindly arguing about something which could possibly be wrong due to me not fully understanding the medical condition. Thanks for any help... Kadie Next message: Hoda Kargozaran: "RE: own experience in the paper" Previous message: Jungmee Kim: "RE: own experience in the paper" Messages sorted by: [ date ] [ thread ] [ subject ] [ author ] This archive was generated by hypermail 2b29 Sun Dec 01 2002 - 17:13:56 PST

29. Persistent Vegetative State (PVS) persistent vegetative state (PVS). A vegetative state can be definedas a clinical condition of unawareness of self and environment http://www.ascensionhealth.org/our_essence/ethics/affiliates/issues/persistent.a

Persistent Vegetative State (PVS) A vegetative state can be defined as "a clinical condition of unawareness of self and environment in which the patient breathes spontaneously, has a stable circulation, and shows cycles of eye closure and opening which may simulate sleep and waking" [Working Group of Royal College Physicians, "The Permanent Vegetative State," The Journal of the Royal College of Physicians 430 (1996): 119-21]. Since patients in such a state sometimes show behavior that could be interpreted as evidence of consciousness, the diagnosis is not always self-evident. Additionally, the condition of being in a vegetative state is similar to that of other conditions that involve the absence or partial absence of awareness of self and the environment, such as coma, locked-in syndrome and akinetic mutism. The Multi-Society Task Force on PVS (MSTF) has recommended the use of seven clinical criteria in making the diagnosis. It also has been suggested that these criteria be reviewed through neurologic examinations repeatedly. According to the MSTF and the American Neurological Association , the vegetative state has to have endured for at least one month in order for it to be considered persistent [The Multi-Society Task Force on PVS, "Medical Aspects of the Persistent Vegetative State," New England Journal of Medicine 330 (1994): 1572-79; ANA Committee on Ethical Affairs, "Persistent Vegetative State: Report of the American Neurological Association Committee on Ethical Affairs,"

30. Alex Keegan - Persistent Vegetative State Drawing by Judith Wolfe. ALEX KEEGAN / persistent vegetative state. This ishis hill. He prays. persistent vegetative state I'm so sorry, Mary. . http://www.book.co.nz/keegie.htm

Drawing by Judith Wolfe ALEX KEEGAN / Persistent Vegetative State For ages, people had considered life to exist as long as an individual was breathing. It was later realised that respiration was a means of maintaining the heart which circulated the blood. Life was then attributed to cardio-respiratory action. As long as such activity maintained the nutritional needs of the brain, the individual was alive. But in the middle of this century physicians became aware that the brain required much more energy than other organs and, if its needs were not met, it would cease to function, while other parts of the body (requiring less energy) might remain viable and even regain their activity provided the circulation was maintained. The result would be a dead brain in a viable body. Is such a preparation alive or dead? A study by Younger et al at Case Western Reserve University found that nurses and physicians working in critical care and operating theatre settings differed in their reasons for accepting brain-death. Some thought brain-dead patients were dead because they would never wake up again. Others accepted them as dead because they had lost the integrating functions of the brain stem. Others indicated that they did not truly believe the patients to be dead but would die soon despite aggressive intervention. Others felt the patients were dead because the quality of their life was unacceptable. In the operating theatre nurses sometimes felt that the patient's spirit was in the room during organ retrieval surgery and only departed when the ventilator was turned off and the patient came to complete rest.

31. Persistent Vegetative State First Previous Next Last Index Home Text. Slide 5 of 12. http://moon.ouhsc.edu/jwinn/ethics/death/sld005.htm

32. Persistent Vegetative State persistent vegetative state. Brainstem function. K. Quinlan N. Cruzancases. Artificial nutrition and hydration. What would this person want? http://moon.ouhsc.edu/jwinn/ethics/death/tsld005.htm

Persistent Vegetative State Brainstem function Artificial nutrition and hydration What would this person want? Previous slide Next slide Back to first slide View graphic version

33. "Persistent Vegetative State" persistent vegetative state The ultimate focus of euthanasia enthusiastsis not those who are truly dying. Quite bluntly, if one http://www.humanlife.org/euth_supl/html/7-1.html

"Persistent Vegetative State" The ultimate focus of euthanasia enthusiasts is not those who are truly dying. Quite bluntly, if one is truly dying, nature will soon take its course. The real targets are those who are not dying quickly enough, those whom ethicist Daniel Callahan unkindly termed "biologically tenacious." There have been attempts to redefine death to include persons in "persistent vegetative state" (PVS) in order to discontinue care and/or use their organs/bodies for transplantation/experimentation. Experts disagree about what PVS is; some medical dictionaries do not even include the phrase. While standards have been proposed, they are not accepted by the entire medical community, and methods and time-frame for diagnostic testing are disputed. The person in PVS is neither unconscious nor in a coma, and typically has sleep-wake cycles, eye movement, and normal respiratory, circulatory, and digestive functions. Some have random movement, some do not; some can swallow, others cannot. Some have been physically injured from accidents, others suffer from stroke or dementia. In some cases, the brain itself appears to change, in other cases, it appears unchanged. Some patients are not actually in PVS, but are "locked-in." They may be mute and immobile but mentally alert and able to communicate by blinking or through aids such as computers - if someone gives them that opportunity. Others are severely physically disabled, which greatly impairs their ability to communicate.

34. JAMA -- Page Not Found It has been 30 years since a Glasgow neurosurgeon and a New York neurologist boldlysuggested the term persistent vegetative state to describe a syndrome in http://jama.ama-assn.org/issues/v289n1/ffull/jbk0101-5.html

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery MSJAMA Science News Updates Meetings Peer Review Congress The page you requested was not found. The JAMA Archives Journals Web site has been redesigned to provide you with improved layout, features, and functionality. The location of the page you requested may have changed. To find the page you requested, click here HOME CURRENT ISSUE PAST ISSUES ... HELP Error 404 - "Not Found"

35. ClinicalTrials.gov - Linking Patients To Medical Research Search Query Details. No studies were found for persistent vegetative state ALLFIELDS.Modify Your Search. Individual Terms, Count. persistent vegetative state , None. http://www.clinicaltrials.gov/search/term=Persistent Vegetative State

36. ClinicalTrials.gov - Linking Patients To Medical Research Search Query Details. No studies were found for ( Coma AND including Persistent VegetativeState ) ALLFIELDS. including persistent vegetative state , None. http://www.clinicaltrials.gov/search/term=Coma, including Persistent Vegetative

37. Coma - Vegetative State In other cases, the person descends into a vegetative state. If this lastslonger than a month or so, it is known as a persistent vegetative state. http://www.disability.vic.gov.au/dsonline/dsarticles.nsf/pages/Coma_vegetative_s

38. Gutowski: CPR For Patients In A Persistent Vegetative State? [CMAJ - July 14, 19 CPR for patients in a persistent vegetative state? CMAJ 1998;15919See response from C. Weijer Two of the major issues addressed http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-159/is

CPR for patients in a persistent vegetative state? CMAJ See response from: C. Weijer Two of the major issues addressed in this editorial are worth amplifying. The first is the concept of whether a life is worth living. We must never accept the concept that any life is not worth living. Once we do, we are on a slippery slope. There is very little difference between someone who is in a vegetative state for 2 years and someone who is in a vegetative state for 2 years less a day. Once the principle of the sanctity of human life is ignored, there may be no stopping the trend: the religion of death becomes accepted. The second issue concerns the controversy surrounding euthanasia, exemplified in the editorial by the example of an Orthodox Jew who believes in God. Human beings are not only body and soul, but also spirit. Unless this conceptualization is accepted we will never understand that even for someone in a PVS, the spirit still exists. We do not know whether or not such a person is receiving input through some of the senses. There have been reports of patients later able to describe in detail every word spoken in their presence while they were in a comatose state. Let us not play God. Let us maintain our traditional values and concepts. These values work. William D. Gutowski, MD

39. Brain Death And Brain Injury Resources of Bioethics devoted to the discussion of the ethical and medical issues associatedwith brain death, coma, and persistent vegetative state; anencephaly; organ http://www.changesurfer.com/BD/Brain.html

Network for the Definition of Death End-of-Life Ethics Links Brain Injury and Brain Death Resources Contents Brain Death Resources Anencephaly Resources Neurological Anatomy, Diagnosis and Therapy Resources Neurological Rehabilitation and Remediation ... Twice Dead is Margaret Lock's comparison of the adoption of the concept of brain in Japan and the United States. Brain Death Resources Program and Abstracts of the Symposia on Brain Death Brain Death : Proceedings of the Second International on Brain Death, Havana, Cuba... Are the brain dead really dead? "Consciousness as a definition of death: its appeal and complexity," Calixto Machado MD, PhD Clinical Electroencephalography. 1999 Oct;30(4):156-64 Word HTML "A new definition of death based on the basic mechanisms of consciousness generation in human beings" 1998. Calixto Machado MD, PhD "Death: Legal and Illegal" by Daniel Maguire in Atlantic Monthly , February 1974 When Death Is Not the End March 2, 1996. George Annas

40. The Vegetative State - Cambridge University Press This unique account by an unrivalled expert in the field, who himself collaboratedin coining the term ‘persistent vegetative state’, surveys the medical http://books.cambridge.org/0521441587.htm

Home Catalogue Related Areas: Medicine New titles Email For updates on new titles in: Medicine The Vegetative State Medical Facts, Ethical and Legal Dilemmas Bryan Jennett In stock Reviews ‘This book should be mandatory in every ITU, HDU and every Trust Ethics Committee. Every Medical or Clinical Director or Head of Service, or Nursing Director must read this. Others interested in this issue or in law or ethics will learn much from the style, references and practical application of the law, ethics and philosophy applied to medical care. The knowledge which Jennett distils applies to the serious issues of life and death.’Jeffrey C. McIlwain, Doctors.net ‘This is a unique book. the author is an international authority on the persistent vegetative state. Not only does he write clearly and authoritatively, but with a deep sense of the historical foundations of this controversial entity that creates significant medical, ethical, and legal challenges.’Daniel B. Hier, Doody’s Notes Contents Preface; 1. A syndrome in search of a name; 2. Diagnosis; 3. Epidemiology - frequency and causes; 4. Pathology of the brain damage; 5. Prognosis for recovery and survival; 6. Attitudes to the permanent vegetative state; 7. Medical management; 8. Ethical issues; 9. Legal issues in the USA; 10. Legal issues in Britain; 11. Legal issues in other countries; 12. Details of some landmark cases; Index. Cambridge University Press 2001.

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