Persistent Vegetative State Raises Ethical Questions

posted November 24, 2003

by Johanna Kenrick of Campanile

When a loved one is stuck in between being conscious and dead, perhaps permanently, what should those around them do? Allow them to live in a persistent vegetative state, or "pull the plug" on this friend or family member? The answer depends on many circumstances; however, in the case of Terri Schiavo, it may be best to let a loved one go.

Schiavo, a 39-year-old from Florida who has not been fully conscious for 13 years, is in the middle of a raging argument – the moral dilemma of whether to continue to support or unplug her feeding tube. Unplugging this tube would cause her to die of dehydration in about 10 days. The dilemma was started between her parents and husband, but it has become an even larger debate, encompassing all who hold an opinion.

When does one allow a family member to die? The answer to this question depends on many different circumstances, but it is usually futile to keep a relative alive longer than five years, because this period allows time for a recovery but does not require the family members to sacrifice their money and lives to provide for someone who might not benefit from it.

When people are in the hospital, friends and family members rally around them, visiting with balloons. Someone in a persistent vegetative state, however, is in the hospital for years at a time.

While people can visit and interact with an aunt just out of surgery or even a terminally-ill patient, relationships with the unconscious are one-sided. Those visiting may soon find themselves building their lives around someone who does not even know or understand that they exist. In families with small children, this can be especially unhealthy.

Unlike adults, young children have trouble understanding how someone can be alive but not functioning. And if it is a parent who has been debilitated, the child is not only missing out on a parent, but gaining false hope that Daddy or Mommy will come back to life – an occurrence so rare that no reliable statistics are kept on it.

A survey done in 1988 about the persistent vegetative state from the Hasting Centre Report shows that to keep a patient in a persistent vegetative state alive at a nursing facility (usually the most practical, since hospitals are often overcrowded and not as able to focus on one person), costs on average $126,000 to $180,000 per year. This cost can put a huge burden on a family.

While still having to deal with living costs and emotional trauma of an unhealthy loved one, the family must also struggle with a huge amount of bills that insurance (if they have it) might not fully cover. When a family could be spending money on education, food and even health care for those who are not suffering from persistent vegetative state, they are instead draining their bank accounts to pay for the care of someone who is, one, barely living and, two, not making a lasting contribution to their lives.

These are two of the main reasons not to keep a loved one in a persistent vegetative state for over five years. After this period of time, it is highly unlikely that the patient shall recover, and, if he or she does, it is often only a temporary partial recovery and then a relapse – such as in the famous case of the 1996 "coma cop" who briefly became conscious after seven years. However, it was later discovered that he was in a minimally conscious state unlike Terri Schiavo. Patients in a minimally conscious state are more responsive than those in a persistent vegetative state and have a greater possibility of recovery.

This is not the case with Schiavo. Many supporters of her parents, who wish to continue feeding her, note that in video tapes made of her, Schiavo sometimes seems to react to those around her, smiling at her mother or opening her eyes when someone enters a room. These actions can make a recovery appear more plausible.

However, they are misleading, as associate director of neuropsychology at the John F. Kennedy Medical Center Joseph Giacino told Time magazine in 2003. "There are many, many behaviors that look like conscious behavior that are reflexive or automatic," he said. "[The video tape in Schiavo] is not compelling evidence. It's interesting and suggestive. But most of these responses could occur in a vegetative state."

Overall, the emotional and fiscal trauma caused by a relative in a persistent vegetative state can hurt family members and friends severely. Keeping such a strong source of stress and sadness alive might do more harm than good. An unconscious person can not contribute to any relationship, and friends and family might find themselves centering their lives around a person who cannot interact with them. It is worse than a death, because deaths allow people to move on and let go.

Similarly, scientific journalist P. Singer said about the case of Karen Ann Quinlan in 1984, "Karen Ann Quinlan:hasn't been aware of the extra years of life she has had, and thus she has no benefit from them."