Geometry.Net - Health_Conditions: Persistent Vegetative State

World Medical Association Statement On Persistent Vegetative State
WMA policy Statement on persistent vegetative state. Includes a definition, recovery and guidelines.Category Health Conditions and DiseasesThe World Medical Association, Inc. WMA Policy Statement on Persistent VegetativeState. World Medical Association Statement on persistent vegetative state.
http://www.wma.net/e/policy/17-v_e.html

Extractions: Preamble Present requirements of health reporting fails to provide an accurate estimate of the incidence and prevalence of worldwide individuals in a persistent vegetative state (PVS). Ten years ago, a prevalence of 2 to 3 per 100,000 was estimated for Japan. It seems likely that the absolute number of such cases has risen appreciably as a consequence of current practices in critical medicine, cardiorespiratory support, parenteral feeding, and control of infections in severely brain damaged patients. How to deal with this emotionally painful, financially costly, and generally unwanted outcome of modern medical treatment is an increasing problem. Recovery Once qualified clinicians have determined that a person is awake but unaware, the permanence of the vegetative state depends on the nature of the brain injury, the duration of the period of unawareness, and the estimated prognosis. Some persons less than 35 years old with coma after head trauma, as well as an occasional patient with coma after intracranial hemorrhage, may recover very slowly; thus, what appears to be a PVS at one to three months after an event causing coma may in rare cases evolve into a lesser degree of impairment by six months. On the other hand, the chances of regaining independence after being vegetative for three months are vanishingly small. Rare exceptions are claimed, but some of these may have represented patients who entered an unrecognized locked-in state shortly after reawakening from a coma-causing injury. Ultimately, all have been severely disabled.
The Persistent Vegetative State
Addresses the medical facts, describes the landmark cases that have led to research into this condition, Category Health Conditions and DiseasesAddresses the medical facts of the persistent vegetative state, describes the landmarkcases that have led to research into this condition, defends the
http://www.geocities.com/HotSprings/Oasis/2919/

Extractions: Despite the fact that there are an estimated 14,000 individuals in the United States alone who are maintained in a state of permanent unconsciousness, termed a persistent vegetative state, most lay people know very little about this condition. In fact, many health care professionals themselves are unaware of the medical facts and ethical questions of the persistent vegetative state. Unlike patients in a coma, patients in a persistent vegetative state exhibit a cyclic state of circadian sleep and wake cycles. However, the definition of a persistent vegetative state is a chronic state of "wakefulness without awareness." Thus, although patients in a persistent vegetative state may be awake, they are unaware. But what exactly is a persistent vegetative state, and what ethical and medical questions may arise in the treatment of individuals in such a state? The medical definition of death A definition of the persistent vegetative state Evidence that patients in a persistent vegetative state are unaware Irreversibility of the persistent vegetative state ... Other sources of information on the persistent vegetative state Please share your comments, experiences with the persistent vegetative state, or any other information that families and health care professionals faced with a similar situation may find useful.
Coma And Persistent Vegetative State
A look at coma and persistent vegetative state. Includes a discussion on treatments and prognosis.Category Health Conditions and Diseases By keywords Receive HealthLink via email! Subscribe now . Coma and PersistentVegetative State. A coma is a profound or deep state of unconsciousness.
http://healthlink.mcw.edu/article/921394859.html

Extractions: Subscribe now >> A coma is a profound or deep state of unconsciousness. The affected individual is alive but is not able to react or respond to life around him/her. 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, which sometimes follows a coma, refers to a condition in which individuals have lost cognitive neurological function and awareness of the environment but retain noncognitive function and a perserved sleep-wake cycle. It is sometimes described as when a person is technically alive, but his/her brain is dead. However, that description is not completely accurate. In persistent vegetative state the individual loses the higher cerebral powers of the brain, but the functions of the brainstem, such as respiration (breathing) and circulation, remain relatively intact. Spontaneous movements may occur and the eyes may open in response to external stimuli, but the patient does not speak or obey commands. Patients in a vegetative state may appear somewhat normal. They may occasionally grimace, cry, or laugh. Is there any treatment?
Responding To Patients In The Persistent Vegetative State - An Ethical And Legal
Discusses the withdrawal of food and fluids from PVS patients without other complicating conditions Category Society Issues Endof-LifeResponding to Patients in the persistent vegetative state. Donal P. O'Mathuna,Ph.D. 40 Paul Schotsmans, The Patient in a persistent vegetative state.
http://www.xenos.org/ministries/crossroads/donal/pvs.htm

Extractions: Responding to Patients in the Persistent Vegetative State Donal P. O'Mathuna, Ph.D. Philosophia Christi 19.2 (Fall 1996): 55-83. This journal is a publication of the Evangelical Philosophical Society Modern medicine has provided people with many great benefits, but it has also forced people to make difficult ethical decisions. One of the hardest of these is to let a loved one die when medical technology could keep him or her alive. People must now decide if and when they would want certain treatments withheld or withdrawn from themselves or others. The ethical issues involved raise questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, professional responsibilities, and many more. The withdrawing of food and fluids from patients in persistent vegetative state (PVS) is one of these tragic situations. This term was first coined in 1972, and the condition has since been the subject of much ethical and legal debate.
Persistent Vegetative State
persistent vegetative state. An introduction to duty of care issues, with reference to a UK case
http://www.cbpp.ac.uk/docs/paper001.html

Extractions: Persistent Vegetative State An introduction to duty of care issues, with reference to a UK case A paper given by Dr Andrew Fergusson, Head of Policy, Centre for Bioethics and Public Policy, UK to the Seventh National Seminar of the National Council of Ethics for the Life Sciences in Evora, Portugal on 7th November 2000 Persistent vegetative state (PVS) was first so-named by Jennett and Plum in 1972 ( ) although experts in the UK now prefer to call it 'permanent vegetative state'. It is caused by permanent loss of function of the cerebral cortex. Patients are believed to have no awareness of self or of their environment Severe head injury (40%) Compared with the following two categories of causes, greater uncertainty about prognosis means that PVS should not be diagnosed until after 12 months have elapsed from the original injury. Hypoxia (40%) This is usually due to cardiorespiratory arrest due to disease, trauma, or medical accident. Other (20%): These represent various acute cerebral insults including hypoglycaemia, poisoning, and acute brain diseases. In these latter two categories, prognosis is more certain so some say PVS can safely be diagnosed after 6 months.
NINDS Coma Information Page
Coma and persistent vegetative state data compiled by The National Institute of Neurological Disorders and Stroke.
http://www.ninds.nih.gov/health_and_medical/disorders/coma_doc.htm

Extractions: Once the patient is out of immediate danger, although still in coma or vegetative state, the medical care team will concentrate on preventing infections and maintaining the patient's physical state as much as possible. Such maintenance includes preventing pneumonia and bed sores and providing balanced nutrition. Physical therapy may also be used to prevent contractures (permanent muscular contractions) and orthopedic deformities that would limit recovery for the patients who emerge from coma. What is the prognosis?
PetersNet: Jane D. Hoyt, M.Ed., Persistent Vegetative State
to redefine death to include persons in "persistent vegetative state" (PVS) in order to discontinue care and/or use
http://www.petersnet.net/browse/831.htm

Extractions: Visit PetersNet for access to our complete Catholic search engine. Persistent Vegetative State Author: Jane D. Hoyt, M.Ed. Title: Persistent Vegetative State Larger Work: Euthanasia: Imposed Death Pages: Human Life Alliance of Minnesota Education Fund, Inc., 1999 Description: An article which briefly explains what is meant by the expression, a "persistent vegetative state". 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."[1] 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.
3 Landmark Cases Of The Persistent Vegetative State
3 Landmark cases of the persistent vegetative state
http://www.geocities.com/HotSprings/Oasis/2919/cases.html

Extractions: Helga Wanglie Helga Wanglie was 86 when she broke her hip in Decemeber of 1989 after falling on a rug in her Minneapolis home. She was treated and released from a local hospital and moved to a nursing home. In January of 1990 she was readmitted to the hospital and placed on a respirator, due to respiratory complications. Attempts to wean her from the respirator were unsuccessful, and in May of 1990 she was transferred to a long-term care facility that specialized in treating respirator-dependent patients. Wanglie suffered a heart attack while under the care of this facility. Resuscitation efforts were successful, although she had been deprived of oxygen for several minutes, resulting in severe and irreversible brain damage. She was readmitted to the hospital on May 31, 1990, where she continued to use a respirator and was provided food and fluids through a tube implanted into her stomach. After repeated evaluations, she was diagnosed as PVS (persistent vegetative state) with the complication of permanent respirator dependency. Wanglie had left no written record of her wishes in the form of a living will or advance directive, and was no longer in a position to indicate her preferences. Because of her prognosis, the medical staff suggested that the family reevaluate continuing the extensive care required to prolong her existence. Relatives opposed termination of treatment. Doctors countered that in Wanglie's case, they would have to go beyond the limit of "reasonable care" to maintain her existence.
Responding To Patients In The Persistent Vegetative State - An Ethical And Legal
This article was published in Philosophia Christi 19.2 (Fall 1996) 5583. This journal is a publication of the Evangelical Philosophical Society.
http://www.crossrds.org/donal/pvs.htm

Extractions: Responding to Patients in the Persistent Vegetative State Donal P. O'Mathuna, Ph.D. Philosophia Christi 19.2 (Fall 1996): 55-83. This journal is a publication of the Evangelical Philosophical Society Modern medicine has provided people with many great benefits, but it has also forced people to make difficult ethical decisions. One of the hardest of these is to let a loved one die when medical technology could keep him or her alive. People must now decide if and when they would want certain treatments withheld or withdrawn from themselves or others. The ethical issues involved raise questions about autonomy, quality of life, appropriate use of resources, the wishes of family members, professional responsibilities, and many more. The withdrawing of food and fluids from patients in persistent vegetative state (PVS) is one of these tragic situations. This term was first coined in 1972, and the condition has since been the subject of much ethical and legal debate.
PetersNet : View Document
to redefine death to include persons in "persistent vegetative state" (PVS) in order to discontinue care and/or use
http://www.petersnet.net/research/retrieve.cfm?RecNum=831
Persistent Vegetative State
persistent vegetative state (PVS) is subject to a high degree of error as a diagnosis,a high measure of confusion as to definitiuon, and an inflation of the
http://www.thalidomide.ca/gwolbring/pvsilm.htm

Extractions: In 1994 a Multi-Society Task Force made up of representatives of the American Academy of Neurology, the Child Neurology Society, the American Neurological Association, the American Association of Neurological Surgeons, and the American Academy of Pediatrics produced a Consensus Statement on the Medical Aspects of the Persistent Vegetative State (PVS). This Statement presents a picture of the degree of diagnostic certainty achievable in this area that is in many respects misleading. Its attempt to propose a condition called Permanent Vegetative State, which would be based on a high degree of medical certainty either that there is no further hope for recovery of consciousness or that, if consciousness were recovered, the patient would be left severely disabled, confuses two different issues. In 1994 a Multi-Society Task Force made up of representatives of the American Academy of Neurology, the Child Neurology Society, the American Neurological Association, the American Association of Neurological Surgeons, and the American Academy of Pediatrics produced a Consensus Statement on the Medical Aspects of the Persistent Vegetative State (PVS). 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 behavioural responses to visual, auditory, tactile, or noxious stimuli; (3) no evidence of language comprehension or expression; (4) intermittent wakefulness manifested by the presence of sleep-wake cycles; (5) sufficiently preserved hypothalamic and brain-stem autonomic function to permit survival with medical and nursing care; (6) bowel and bladder incontinence; and (7) variably preserved cranial-nerve reflexes (pupillary, oculophalic, corneal, vestibulo-ocular, and gag) and spinal reflexes..... A wakeful unconscious state that lasts longer than a few weeks is referred to as a persistent vegetative state.
Persistent Vegetative State
Response by the Centre for Bioethics and Public Policy to the NuffieldCouncil on Bioethics Public Consultation Document Genetics
http://www.cbpp.ac.uk/docs/paper005.html

Extractions: Response by the Centre for Bioethics and Public Policy to the Nuffield Council on Bioethics Public Consultation Document: Genetics and Human Behaviour: the ethical context We are very grateful for this opportunity to respond to the Council's consultation on behavioural genetics and welcome the Council's intent to promote public understanding and discussion. As a centre promoting medical ethics in the Christian and Hippocratic tradition, we hold that each human being possesses the same human dignity. We believe that each one of us is made in the image of God and that each person reflects God's likeness in a unique way. Answers to the questions as numbered from 4.1 to 6.14 What do you think are the likely advantages and disadvantages of research in behavioural genetics? Advantages: Behavioural genetics research might be helpful in finding genetic causes of certain mental diseases and so in finding cures for the same diseases. Disadvantages: Classifications, attitudes and judgments made in regard to human behaviour are linked to culture. Hence, it is arguably not methodologically possible to reduce human character or most types of human behaviour to genes. In particular, individual actions will always be interpreted and judged in different ways depending on the social context. This means that human actions will always be subject to interpretations and judgments relating to different kinds of human inter-action and discourse. To be precise, human actions are subject to moral, legal and historical judgments as well as to psychological, sociological, and anthropological explanations or explanations in terms of genes or brain activity.
NEJM -- Medical Aspects Of The Persistent Vegetative State- First Of Two Parts
Special Article from The New England Journal of Medicine MedicalAspects of the persistent vegetative state First of Two Parts.
http://content.nejm.org/cgi/content/short/330/21/1499

Extractions: Find Similar Articles in the Journal Notify a friend about this article Add to Personal Archive ... Medline Citation ABSTRACT This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children. The vegetative state is a clinical condition of complete unawareness of the self and the environment, accompanied by sleep-wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions. In addition, patients in a vegetative state show no evidence of sustained, reproducible, purposeful, or voluntary behavioral responses to visual, auditory, tactile, or noxious stimuli; show no evidence of language comprehension or expression; have bowel and bladder incontinence; and have
NEJM -- Neuropathological Findings In The Brain Of Karen Ann Quinlan -- The Role
Neuropathological Findings in the Brain of Karen Ann Quinlan The Role of theThalamus in the persistent vegetative state Hannah C. Kinney, Julius Korein
http://content.nejm.org/cgi/content/abstract/330/21/1469

Extractions: Hannah C. Kinney, Julius Korein, Ashok Panigrahy, Pieter Dikkes, and Robert Goode Table of Contents Full Text of this article Related Letters to the Editor Find Similar Articles in the Journal ... Related Articles in Medline Articles in Medline by Author: Kinney, H. C. Goode, R. Medline Citation ABSTRACT Background Karen Ann Quinlan had a cardiopulmonary arrest in 1975 and died 10 years later, having never regained consciousness. Her story prompted a national debate about the appropriateness of life-sustaining treatment in patients who are in a persistent vegetative state and led to the development of medicolegal guidelines for the care of such patients. This report describes the neuropathologic features of Quinlan's brain. Methods The entire brain and spinal cord were systematically sampled for histologic examination. The brain stem and central cerebrum were embedded en bloc and serially sectioned. Three-dimensional
NOTES ON THE PERSISTENT VEGETATIVE STATE:
NOTES ON THE persistent vegetative state The Persistent VegetativeState (PVS) is characterized by permanent unconsciousness even
http://www.ee.cua.edu/~georgvis/religion/olga/PVS.htm

Extractions: NOTES ON THE PERSISTENT VEGETATIVE STATE: The Persistent Vegetative State (PVS) is characterized by permanent unconsciousness even though the patient may appear awake. This person can undergo sleep cycleshe/she is unaware of his/her environment. the higher centers of the brain are destroyedthe lower centers are intact. The patient is insensitive to pain and suffering. In 1972PVS was identified as a new syndrome. Many doctors donít understand the neurology surrounding this diagnosis. The higher centers of the brain such as the cerebral cortex are associated with thinking and feeling. The lower centers of the brain such as the brain stemcontrols such functions such as the opening of the eyes. The higher centers are destroyed because of a higher rate of metabolism of glucose and oxygen. We need a constant supply of thiswhile the lower centers are more resistant to deprivation in this area. This diagnosis is done clinicallyone must establish whether it is due to a lack of oxygen to the brain of if it is a result of a head injury. With the latterespecially in childrenthe full diagnosis may take 6 to 8 months. PVS is an extremely reliable diagnosis though it is not 100% sure. There are some rare cases where people do emerge from a state identified as PVS.
Persistent Vegetative State
persistent vegetative state. Leif Gustafson. Introduction. Persistent vegetativestate (PVS) has been at the center of much controversy in recent years.
http://www.cwu.edu/~chem/courses/Chem564/finalpapers/PVSfinal.html

Extractions: Persistent Vegetative State Leif Gustafson March 15, 2000 Introduction Determining PVS This definition includes difficult to define terms such as awareness, and this problematic definition has led some people to question the validity of the syndrome. It has also lead to problems in the diagnosis of PVS. The crux of the problem lies in the determination of a persons internal mental state using external proof. Different tests have been used in an attempt to determine criteria for its diagnosis, because in using conventional methods of observation of function it takes weeks to diagnose a patient as being in PVS. Glucose metabolism, EEG, CT scans, and positron-emission tomography (PET) have all been used to increase understanding and diagnostic ability for PVS. However, information from these tests have not been able to provide any conclusive diagnostic information. It is possible that these tests or a combination of them will be useful as diagnostic tools in the future, but more data must be collected before any determinations can be made. This lack of diagnostic certainty has led to the misdiagnosis of many patients as being PVS when they actually are not. One study showed that in a sample of 62 patients in nursing homes who were diagnosed with PVS eleven had been misdiagnosed and another study showed that eighteen of 49 patients were misdiagnosed (Borthwick). These errors have come from the lack of information about the criteria that are necessary for a person to be considered PVS as well as a lack of time and methods used for determining a patient as having PVS.
Coma And Persistent Vegetative State
COMA and persistent vegetative state CONTENTS. What are coma and persistentvegetative state? Is there any treatment? What is the prognosis?
http://www.neuroskills.com/tbi/coma.shtml

Extractions: Where can I find more information? DESCRIPTION: TREATMENT: Once the patient is out of immediate danger, although still in coma or vegetative state, the medical care team will concentrate on preventing infections and maintaining the patient's physical state as much as possible. Such maintenance includes preventing pneumonia and bed sores and providing balanced nutrition. Physical therapy may also be used to prevent contractures (permanent muscular contractions) and orthopedic deformities that would limit recovery for the patients who emerge from coma. PROGNOSIS: The outcome for coma and vegetative state depends on the cause and on the location, severity, and extent of neurological damage: outcomes range from recovery to death. People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. Recovery usually occurs gradually, with patients acquiring more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Patients recovering from coma require close medical supervision. A coma rarely lasts more than 2 to 4 weeks. Some patients may regain a degree of awareness after vegetative state. Others may remain in a vegetative state for years or even decades. The most common cause of death for a person in a vegetative state is infection such as pneumonia.
Euthanasia In Cases Of A Persistent Vegetative State - Discussion And Comments -
Euthanasia in Cases of a persistent vegetative state. Comment by MaynardS. Clark (2 Apr 2000) The issue of prolonging life is a
http://www.all-creatures.org/discuss/euthanasia.html

Extractions: QUESTIONS AND ANSWERS Home Page Archives Table of Contents Euthanasia in Cases of a Persistent Vegetative State Comment by Maynard S. Clark (2 Apr 2000): The issue of prolonging life is a very complex one, and this issue is brought up in a number of ethical thinkers in the vegetarian movement, most notably Dr. Peter Singer at the Princeton Center for Bioethics (New Jersey). Many handicapped, senior rights, and prolife groups have picketed Singer at Princeton (and elsewhere) and even at Harvard Medical School (where I heard him several weeks ago). As you probably know, even the diagnosis of persistent vegetative state is a difficult one and the brain injury literature is full of information on its frequent misdiagnosis. Almost every person who has sustained a severe brain injury has had their family told by competent medical personnel that their loved one is going to die ... and in the unlikely case that "such an one" should live, s/he would be (likened unto) a "vegetable" with an unacceptable quality of life. Despite this pessimistic diagnosis, the brain injury rehabilitation programs across the United States are full of patients, young and old, who somehow "beat the odds" and recover.
SMART Therapy And Persistent Vegetative State
SMART AND persistent vegetative state, PART ONE Research by occupational therapistspublished in the British Medical Journal in July claims that almost half
http://www.smart-therapy.org.uk/smart_article1.shtml

Extractions: Research by occupational therapists published in the British Medical Journal in July claims that almost half of the diagnoses of patients with persistent vegetative state may be wrong. In this two-part article, Helen Gill, head occupational therapist at the Royal Hospital for Neuro-disability, Putney, South-West London examines the assessment system upon which this research was based and highlights the central role played by occupational therapists in the assessment of PVS. What is persistent vegetative state?
SMART Therapy And Persistent Vegetative State 2
Occupational Therapy News November 1996 Issue. SMART AND PERSISTENTVEGETATIVE STATE, PART TWO Research by occupational therapists
http://www.smart-therapy.org.uk/smart_article2.shtml

Extractions: November 1996 Issue. SMART AND PERSISTENT VEGETATIVE STATE, PART TWO: Research by occupational therapists published in the British Medical Journal in July claims that almost half of the diagnoses of patients with persistent vegetative state may be wrong. In this two-part article Helen Gill, head occupational therapist at the Royal Hospital for Neuro-disability, Putney, South-West London, examines the assessment system upon which this research was based and highlights the central role played by occupational therapists in the assessment of PVS. The invaluable role of the occupational therapist in the assessment of the PVS patient: From the occupational therapist's experience of working with PVS patients, it is the author's opinion that occupational therapy is the only profession whose holistic values enable the professional to assess accurately the patient's response to the sensory stimulation program and to facilitate a meaningful method of communication. The occupational therapist's professional values are concerned with the reduction of the patient's incapacity and the development of the patient's autonomy. This is supported by Yerxa (1983), who describes the occupational therapists role as 'teasing out, facilitating and releasing the patients optimal potential'. This clearly reflects the invaluable role that the occupational therapist has to play in the assessment and potential rehabilitation of the PVS and the slow to recover brain injured patient in the future.

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