Persistent Vegetative State: an Ethical Reappraisal

Overview

Journal Neurol Sci

Specialty Neurology

Date 2011 Dec 2

PMID 22131038

Authors

Daniela Tarquini

Maria Congedo

Fabio Formaglio

Maddalena Gasparini

Norina Marcello

Corinna Porteri

Eugenio Pucci

Silvia Zullo

Carlo A Defanti

Affiliations

Soon will be listed here.

Abstract

New knowledge from scientific research on vegetative state (VS) and its consequences in clinical practice are reviewed. The ambiguity of the concept of consciousness and the difficult issue of its moral significance are then examined. The Authors stress the need for longitudinal prognostic studies, the promotion of an expert widespread use of standardized behavioural scales, and recommend that the ethical debate about VS rely upon the widest consensus of the scientific community.

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References

Kahane G, Savulescu J . Brain damage and the moral significance of consciousness. J Med Philos. 2009; 34(1):6-26. PMC: 3242047. DOI: 10.1093/jmp/jhn038. View

Rossini P, Altamura C, Ferretti A, Vernieri F, Zappasodi F, Caulo M . Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics?. Brain. 2003; 127(Pt 1):99-110. DOI: 10.1093/brain/awh012. View

Boly M, Coleman M, Davis M, Hampshire A, Bor D, Moonen G . When thoughts become action: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients. Neuroimage. 2007; 36(3):979-92. DOI: 10.1016/j.neuroimage.2007.02.047. View

Bonito V, Primavera A, Borghi L, Mori M, Defanti C . The discontinuation of life support measures in patients in a permanent vegetative state. Neurol Sci. 2002; 23(3):131-9. DOI: 10.1007/s100720200040. View

. Document on the persistent vegetative state by the Società Italiana di Neurologia (SIN) Working Group on Bioethics and Neurology. Ital J Neurol Sci. 1993; 15:643-6. View

Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S . Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009; 9:35. PMC: 2718857. DOI: 10.1186/1471-2377-9-35. View

. Medical aspects of the persistent vegetative state (1). N Engl J Med. 1994; 330(21):1499-508. DOI: 10.1056/NEJM199405263302107. View

Giacino J, Hirsch J, Schiff N, Laureys S . Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Arch Phys Med Rehabil. 2006; 87(12 Suppl 2):S67-76. DOI: 10.1016/j.apmr.2006.07.272. View

Childs N, Mercer W, Childs H . Accuracy of diagnosis of persistent vegetative state. Neurology. 1993; 43(8):1465-7. DOI: 10.1212/wnl.43.8.1465. View

10.

Giacino J, Ashwal S, Childs N, Cranford R, Jennett B, Katz D . The minimally conscious state: definition and diagnostic criteria. Neurology. 2002; 58(3):349-53. DOI: 10.1212/wnl.58.3.349. View

11.

Jennett B . The vegetative state. J Neurol Neurosurg Psychiatry. 2002; 73(4):355-7. PMC: 1738081. DOI: 10.1136/jnnp.73.4.355. View

12.

Giacino J, Kalmar K, Whyte J . The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004; 85(12):2020-9. DOI: 10.1016/j.apmr.2004.02.033. View

13.

Estraneo A, Moretta P, Loreto V, Lanzillo B, Santoro L, Trojano L . Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state. Neurology. 2010; 75(3):239-45. DOI: 10.1212/WNL.0b013e3181e8e8cc. View

14.

Fernandez-Espejo D, Bekinschtein T, Monti M, Pickard J, Junque C, Coleman M . Diffusion weighted imaging distinguishes the vegetative state from the minimally conscious state. Neuroimage. 2010; 54(1):103-12. DOI: 10.1016/j.neuroimage.2010.08.035. View

15.

Owen A, Coleman M, Boly M, Davis M, Laureys S, Pickard J . Detecting awareness in the vegetative state. Science. 2006; 313(5792):1402. DOI: 10.1126/science.1130197. View

16.

Seel R, Sherer M, Whyte J, Katz D, Giacino J, Rosenbaum A . Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil. 2010; 91(12):1795-813. DOI: 10.1016/j.apmr.2010.07.218. View

17.

Andrews K, Murphy L, Munday R, Littlewood C . Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ. 1996; 313(7048):13-6. PMC: 2351462. DOI: 10.1136/bmj.313.7048.13. View

18.

Vanhaudenhuyse A, Noirhomme Q, Tshibanda L, Bruno M, Boveroux P, Schnakers C . Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain. 2009; 133(Pt 1):161-71. PMC: 2801329. DOI: 10.1093/brain/awp313. View

19.

Monti M, Vanhaudenhuyse A, Coleman M, Boly M, Pickard J, Tshibanda L . Willful modulation of brain activity in disorders of consciousness. N Engl J Med. 2010; 362(7):579-89. DOI: 10.1056/NEJMoa0905370. View

20.

Boly M, Faymonville M, Schnakers C, Peigneux P, Lambermont B, Phillips C . Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol. 2008; 7(11):1013-20. DOI: 10.1016/S1474-4422(08)70219-9. View