Dehumanizing The Vulnerable Must Stop

February 10, 2010 09:00 AM

The latest scientific breakthrough involving severely disabled patients suggests that diagnoses of “vegetative state” are highly overrated, not to mention inaccurate. As the CNN headline reads, “’Vegetative state’ man responds to questions”:

A man presumed to have been in a vegetative state for five years has communicated with the outside world for the first time since suffering severe head injuries in a car crash, researchers said Thursday.

The finding by British and Belgian researchers has huge implications for the care and treatment of patients in a coma-like state. It comes two months after a Belgian car crash victim whose condition was misdiagnosed as a vegetative state for 23 years was revealed to have been conscious the whole time.

The researchers, based at Cambridge and Liege universities, realized that diagnosis was wrong when the man responded to questions about his life as scientists monitored activity in his brain.

Using a scanning technique called functional magnetic resonance imaging (fMRI), the patient's brain activity was mapped while he was asked to answer "yes" or "no" to questions such as "Is your father's name Thomas?"

The patient communicated answers by wilfully changing his brain activity.

Dr. Adrian Owen, co-author of the research from the Medical Research Council, said: "We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts.

Colleague Dr. Steven Laureys, from the University of Liege, said the scans had given the patient his only means of communication since the accident. He added: "It's early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life."

This study should be the pivotal point in examining, as a society, how we view those who are severely disabled. It should challenge the theory that such patients are better off dead.

But the reality is that these facts about the human person and his dignity do not resonate among those practitioners of medicine and medical ethics who prefer the practice of early dismissal from living as the better way to go with patients deemed to be “vegetative.” 

As soon as this latest study was published, naysayers stood at the ready to pour cold water on findings that might get in the way of the societal pressure to get rid of those who appear to be less than communicative. In the same way that some argue that the only legitimate sign of personhood is “awareness” among the preborn and newborn, similar claims have been made for years about the severely disabled. Allan H. Ropper, M.D. opined in the New England Journal of Medicine:

What is left of the human being when the brain is badly damaged has been a question for philosophers and theologians. Now, however, an imaginative series of experiments using functional magnetic resonance imaging (MRI) of the brain, culminating in the article by Monti and colleagues in this issue of the Journal, has revealed a form of preserved cognition in ostensibly unconscious patients.

The unfortunate term "vegetative" has been used to describe patients whose eyes open after a period of coma but who lack any meaningful responses to stimuli. Open eyes give the impression of normal alertness, but the patient's behavioral repertoire is limited to reflexive actions such as posturing or purposeless movements, roving eye movements, swallowing, and yawning.

Note that Ropper delegates the question of what a human being actually is to philosophers and theologians, thus excusing medical practitioners from having to worry about a pesky little thing like respecting the human person even though he or she may “appear” to be comatose or brain dead. Ropper argues that the use of the MRI with such patients could cause problems. However, it is my humble opinion that Ropper’s negative position about this study is far more dangerous than one might at first believe. Why? Consider Ropper’s closing thought, which sent chills down my spine. He writes, “The article by Monti et al. is provocative; however, physicians and society are not ready for ‘I have brain activation, therefore I am.’”

Such arrogance should not be overlooked.

Isn’t Ropper’s argument the very same one used to deny the humanity of the preborn child? What sort of scientist views a human being in terms of a sliding scale of attributes to be subjectively evaluated by fellow human beings? 

Such ideas have nothing at all to do with the fundamental fact that a human being is—he exists—from his beginning to his death regardless of his attributes or abilities. Neither his human rights, nor his identity as a person, should be subjectively weighed by other individuals.

When registered nurse Nancy Valko read a commentary with references to Ropper’s position, she opined in an e-mail: “It seems that every time there is a new and positive development regarding the severely brain-injured person, the New York Times gets anxious and defensive. I've worked with and seen some patients recover myself. I'm excited, not surprised. Studies as far back as 1991 have shown that 43 percent of the so-called 'vegetative' patients are misdiagnosed.”   

So why the negativity from folks like Ropper and New York Times writer, Benedict Carey, who asks readers, “Who, exactly, lives behind those blank eyes? And, for that matter, what name do we give to this conscious state that looks totally absent, except for the ghostly blinking pixels on a brain imaging machine?”

Could it be that many honestly believe that human beings who are severely disabled are actually less that actual human beings? I’m not a mind reader, but it sure seems that way. And my opinion is not isolated. 

Wesley J. Smith, well-known author, lecturer, not to mention a man intimately familiar with the Terri Schindler Schiavo case, reflected upon reading of the new study:  

The bioethics mainstream has rejected the equality/sanctity of human life for the so-called quality of life ethic. It began with the odios advocacy of Joseph Fletcher in the Hastings Center Report back in 1972, claiming that the inability to communicate meant that one had lost humanhood (now called personhood). Thus today, not only unconscious but conscious patients are dehydrated to death in all fifty states and it is shrugged off as medical ethics.

Chilling, but sadly, all too true. When Washington Post reporter Rob Stein wrote about the new study, his perspective confirmed what Smith said:

The research inevitably raised questions about patients such as Terri Schiavo, a Florida woman in a persistent vegetative state whose family dispute over whether to discontinue her care ignited a national debate over the right-to-die issue that led to congressional intervention in 2005. Schiavo's brother, Bobby Schindler, said the new study highlights the limits of medicine to provide an accurate diagnosis.

"I wish this could have been used on my sister to see what could have been done to help her," Schindler said in a telephone interview.

[E]xperts also stressed that the research does not indicate that many patients in vegetative states are necessarily aware or have any hope of recovery. Many, like Schiavo, have suffered much greater danger to their brains for far longer than the patients in the study.

Again, it is the subjective judgment that Terri and so many patients like her are beyond hope that seems to be the lynch pin among reporters and ethicists who really don’t want the public exuding hope. They don’t oppose the utilitarian ethic currently in force. 

But people like Terri Schiavo’s brother, Bobby Schindler, are not pleased with the status quo. The Catholic News Agency interviewed Bobby, who started the Terri Schindler Schiavo Foundation to champion for the rights of severely disabled persons. His thoughts on this latest study versus current practices in the United States summarize exactly where all thinking Americans should be on the question of who has the right to put another person to death: 

Schindler said the study backs other findings about the “unscientific, inaccurate” diagnosis of a persistent vegetative state (PVS) and shows how it is “often” wrong when diagnosing people with severe injuries.

“As in the case of my sister, they’re using this diagnosis as a criterion to kill.”

Asked whether the case offers insight into how unresponsive patients should be treated, he replied:

“Nobody should have to earn the right to hydration. We should do everything we can to care for these people, regardless of how responsive or unresponsive they are.”

Schindler lamented that people are being “indoctrinated” to see killing as “an act of compassion.”

“We are morally obligated to care for these people,” Schindler told CNA.

“They should stop any further dehydration deaths, because we’re learning how inaccurate the PVS diagnosis is.”

We agree. American Life League asks medical practitioners, bioethicists and others for due diligence. A culture steeped in direct killing as the effective means of solving problems, eliminating troublesome patients and discarding undesirable preborn children is a culture in the throes of death. It’s time to turn the corner and affirm human personhood.

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