NeuroRehabilitation - Volume 19, issue 4

Authors: Shewmon, D. Alan

Article Type: Research Article

Abstract: Neurophysiological research on the vegetative state (VS) presupposes a clearly defined patient population. VS has been variously defined in three domains: anatomy, behavior, and consciousness. Research on each conceptual type of “VS” is reviewed. Certain key elements of official VS dogma are cast into doubt or flatly contradicted by recent noninvasive neurophysiological studies. “Behavioral VS” is often the manifestation of a multi-modular disconnection syndrome rather than the complete absence of cortical functioning. Some “behavioral VS” may represent a “super locked-in state,” with some primitive awareness of self and environment, including the capacity to experience pain. The term VS should be …dropped and replaced with one that reflects what is truly known and verifiable about the condition and the individual patient. Show more

Keywords: vegetative state, cortex, consciousness, pain

DOI: 10.3233/NRE-2004-19411

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 343-347, 2004

Authors: Ashwal, Stephen

Article Type: Research Article

DOI: 10.3233/NRE-2004-19412

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 349-360, 2004

Authors: Sgreccia, Elio

Article Type: Research Article

Abstract: This article intends to precise the anthropologic fundaments of the Persistent Vegetative State starting from the concept of the human person, as it has been described in relation to the philosophical-theological thought of Thomas Aquinas and other more recent personalists (J. Maritain, E. Mounier, E. Gilson, S. Vanni Rovighi). This view is largely shared by the catholic thought and is present in the Teachings of the Catholic Church. The central point of reflection is in affirming the double unity of the human person: the substantial unity of the spiritual body-soul; the uniqueness of the animative principle (soul) as “form” of …corporeity. The spiritual soul is the active principle not only of the superior activities (thought, liberty) but also of the vegetative-sensitive activity of the organism which is part of the person. Thus, as long as a vital unit exists in the individual person, there will exist the presence of a spiritual soul in the organism, defined as a whole unit, and the subject must be considered alive, even when gravely and persistently hindered in the application of his/her cognitive functions. Show more

Keywords: personalism, philosophical anthropology, St. Thomas metaphysics, vegetative state, brain death

DOI: 10.3233/NRE-2004-19413

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 361-366, 2004

Authors: Borgonovi, Elio

Article Type: Research Article

Abstract: In a context of limited resources and continuous increase of healthcare expenditures, policy makers need to carefully evaluate the economic impact of their decisions. In the last decade economists have been particularly productive in offering to the decision makers a set of tools able to compare costs and benefits of each single medical procedure. The underlying assumption is that it is not acceptable the investment of considerable amounts of resources in medical procedures able to guarantee only limited improvements in health outcomes. In this particular type of context, an open issue is represented by the delicate topic of the …provision of prolonged life sustaining treatments (PLST) to patients in vegetative state. The author, sustains that the provision of this type of treatments can be justified under a mere economic perspective. The traditional economic evaluations focus their attention only to the concept of incremental absorption of resources failing to capture other relevant dimensions: total costs and budget impact. The overall cost related to PLST due to the relative low unit cost and the low prevalence of patients in need of these treatments, represents a negligible part of the total health care budget. Hence, the emphasis on costs, in this circumstance, is misleading, especially considering that the current health care systems in the developed countries are characterized by wastes and inefficiencies that unduly increase costs. In addition, PLST provide a high return in terms of new knowledge, giving valuable insight on the clinical management of other severe health conditions. Long term therapies can also be considered a highly effective learning environment for health professionals. Finally, prolonged life therapies and treatments can also be considered an environment for experimenting “creative” solutions and approaches. Show more

Keywords: economics, costs, economic evaluation, prolonged life sustaining treatments

DOI: 10.3233/NRE-2004-19414

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 367-371, 2004

Authors: McMahon, Kevin T.

Article Type: Research Article

Abstract: A wide range of medical, legal and ethical opinion regarding withholding or withdrawing medically assisted nutrition and hydration (ANH) from vegetative state (VS) and persistent vegetative state patients (PVS) has been presented in professional journals over the past twenty years. This article concerns the moral aspects of this debate as it has developed within the Catholic Church, especially in the United States. It presents traditional Catholic teaching about the extent and limits of the moral obligation to employ medical means in the preservation of human life, and examines how this teaching applies to the specific question of supplying ANH to …PVS patients. It provides a critique of two contradictory views on the morality of discontinuing ANH for PVS patients presented by Catholic theologians. It examines the teaching of Pope John Paul II, who identifies ANH as a natural means of preserving life that must be maintained as long as it preserves the patient's life or alleviates his suffering. Finally, it discusses the practical implications this papal teaching has for the treatment of PVS patients in all Catholic health care facilities. Show more

Keywords: vegetative state, nutrition, hydration, tube feeding, catholic, morality, John Paul II

DOI: 10.3233/NRE-2004-19415

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 373-379, 2004

Authors: Borthwick, C.J. | Crossley, R.

Article Type: Research Article

Abstract: Jennett and Plum's 1972 naming of post-coma unresponsiveness as “persistent vegetative state (PVS)” characterised the condition as essentially irrecoverable and insentient. The evidence for these propositions was always weak, and they have been largely disproved by more recent research. Nonetheless, the definition and the attitudes it embodies remain generally accepted, resting as they do on a firm foundation of medical attitudes to disability and a public eagerness to evade uncomfortable facts. The first step in altering our approach to people with this form of communication impairment must be to rectify our understanding of the terminology.

Keywords: vegetative state, persistent vegetative state, permanent vegetative state, post-coma awareness, locked-in syndrome, disability

DOI: 10.3233/NRE-2004-19416

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 381-389, 2004

Authors: Calipari, Maurizio

Article Type: Research Article

Abstract: The topic of therapeutic proportionality represents one of the main emerging issues in the contemporary bioethical debate. This paper intends to outline the development of moral doctrine on the use of therapeutic means. It first presents a synthesis of the reflection produced by moral Tradition with the definition of the concept of “ordinary and extraordinary means”; then the official teaching of the Catholic Church on the subject is summed up briefly up to the present day and finally, on the basis of the main points which will emerge during this itinerary, the author proposes his own attempt to create a …new synthesis on the ethics of the use of therapeutic means. Such synthesis, which the author terms as “the principle of ethical suitability in the use of means for the preservation of life”, is an evaluative dynamism which, continuing along the lines set out by classical terminology (ordinary and extraordinary means), tries to apply the contents of moral Tradition to the new emerging perspective (proportionate and disproportionate means), underlining the specificity of each term, in a context of ethical systematization able to provide concrete evaluation criteria, at the service of the practical choices of patients and health care personnel. Show more

Keywords: ordinary and extraordinary means, proportionality in therapy, nutrition and hydration, catholic teaching on therapies proportionality, aggressive medical treatment

DOI: 10.3233/NRE-2004-19417

Citation: NeuroRehabilitation, vol. 19, no. 4, pp. 391-397, 2004