Pulling the Plug on a Conscious Person?

By Ashley Sewell

“She would not have wanted to be kept alive this way.” “We just can’t afford to have him on life support forever.” Discussing life support is a difficult conversation for any family, especially when the unresponsive loved one did not leave any indication of what he or she wanted. But imagine having that conversation when your relative can both hear and understand the discussion centering on whether or not to pull the plug on their life.

Newly-released results of a UK/Belgian study indicate some persistent vegetative state (PVS) patients while paralyzed may be able to effectively communicate via brain waves. Functioning Magnetic Resonance Imaging (fMRI) technology detects blood flow during neurologic activity; brain function requires oxygen, so when the brain is active more oxygen-rich blood is supplied and the fMRI tracks it. 54 patients with severe brain injuries were studied and 5 were shown to answer simply phrased yes/no questions. Once clinicians knew these patients were more coherent, more attention was paid to bedside interactions and 3 of the 5 were credited for at least some physical response.

PVS has a 40% misdiagnosis rate – meaning patients are declared vegetative when they should be classified with higher levels of consciousness; life support is still needed to carry out the mechanical and chemical functions of the body while feeding tubes supply nutrition and hydration. When the decision is made to take a person off of life support, it is often done through the removal of this feeding tube. Dehydration is often considered a “natural” cause of death and gives the family time to not only make peace with their decision, but also say good-bye.

But what about the person who is conscious, paralyzed, and slowly dying without any means to save their own?

Once the body reaches extreme dehydration, the kidneys stop working which means toxins are no longer filtered out of the body and that eventually leads to heart failure and a quiet death. This can take anywhere from 10 to 28 days. For patients who are terminally ill, it is thought to be a peaceful departure from this life, but are PVS patients with some degree of awareness terminal?

For those who are pro-life, protecting human life extends not only to the womb, but to the end of life as well. Regarding ethics, morals, and religion, it is traditionally a decision made on a case-by-case basis by an intimate group of people. Fundamentally, however, each American is entitled to the pursuit of life (in addition to liberty and happiness) which begs to question what role the courts should play in end-of-life decisions.

In the well-known case of Terri Schiavo, the court upheld the principle of guardianship (in her case, Michael, her husband who sought to end her life under the supposition that Terri wouldn’t have wanted an artificially sustained existence) and denied all motions set forth by her Roman Catholic parents who declared they would fight for their devout daughter. Ms. Schiavo’s cerebral cortex, the area of the brain used for consciousness, language, and thought, was liquified by her injury and, therefore, unable to function in any capacity. Given the information we have today, it is safe to assume Terri was not aware of her surroundings or situation despite her alleged smiles and eye contact.

On the other hand, Rom Houben, a Belgian man, spent 23 years silently suffering in what doctors thought was a persistent vegetative state before he emerged. When he “woke up” doctors found that Rom was paralyzed but maintained a higher degree of brain function throughout his coma. Impaired, he uses a special computer to recall conversations nurses had between themselves in his room and dreams he had over the course of two decades. Physically unable to give any indication that he was mentally competent, Rom’s family continued to sustain his life in the hope that he would recover.

New technology will continue to sustain human life longer than ever thought possible and the federal court will more than likely keep deferring these types of cases to state courts. These new developments are more reasons for concern over current health care reform legislation. PVS patients will require substantially more money to sustain and may not have as great of a chance for fMRI testing or even compliance with family wishes if the federal government is footing the bill. This very issue questions the legality of President Obama’s health care reform because, after all, the Constitution does not explicitly grant Congress the power to make any decisions directly or indirectly centering on the medical treatment, life, or death of an individual.

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