Artificial nutrition and hydration in the vegetative state : a paradigm shift in scientific perspectives and moral reasoning

Abstract

The persistent vegetative state is a term first coined in 1972 by neurosurgeon Bryan Jennett and neurologist Fred Plum. It refers to a condition in. which there is no awareness of the self or the surroundings, even though, there may be times when the patient seems awake. This condition is the result of a severe cerebral injury and is usually associated (although not limited to) with the destruction of the cerebral neocortex. The brainstem which is the heart of the vegetative functions such as heart rate and rhythm, respiration and gastrointestinal activity is intact, and for this reason PVS patient breathe normally and their heart beat is regular. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally frown, cry, or laugh. But although individuals in a persistent vegetative state may appear somewhat normal, they do not speak and they are unable to respond to commands. Personality, memory, purposive action, social interaction, sentience, thought, and even emotional states are gone. Only vegetative functions and reflexes persist. The American Academy of Neurology has concluded that PVS patients do not experience pain or suffering. Individuals being diagnosed as PVS patients are seldom on any life-sustaining equipment other than a feeding tube. This gastronomy tube (gastrostomy) is inserted directly into the stomach and the liquid protein is delivered by an automated pump. If the individuals' reflexes are intact, the life expectancy can long several decades. This equipment will not cure the patient but their sole purpose is to maintain the status quo. Here is where the debates arise. Many people, maybe including us, might assert or share the wish that we would not want to be kept alive by a plu3tic tube if we were to find ourselves in such a state of illness with no hope of recovery. The avoidance of treatment could be made by a written declaration or making such a desire known to your loved ones. The question arising here would be: What would be defined as treatment? And what is simply care? Is the provision of nutrition and hydration always obligatory?