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Results for “Persistent Vegetative State”

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At least 127 records · Page 7Linked to original sources
PubMed2000

Masked intentions: the masquerade of killing thoughts used to justify dehydrating and starving people in a "persistent vegetative state" and people with other profound neurological impairments.

Denying food and water to profoundly impaired people who may not be conscious, or may only be "minimally" conscious, raises challenging ethical issues. While there is growing support for withdrawing/withholding food and water (assisted nutrition and hydration, or "AHN") from people described as being in a "persistent vegetative state" ("PVS") and people with other profound neurological impairments, such as advanced dementia, the issue remains controversial, and for many, unresolved. In this article, the author argues that if a profoundly impaired person is not imminently dying from a disease process, denying food and water causes him or her to die of dehydration and starvation. When provision of food and water does not create excessive burdens (such as extreme pain and discomfort), and if the food and water can be digested and absorbed, denying such nourishment is immoral and unethical. Under these circumstances, this denial (by commission or omission) is motivated by a real intention to cause death, whether or not that intention is explicitly recognized.

Attitude to Health↗
PubMed2000

[The care of adults in persistent vegetative state--a new challenge to nursing science?].

German scientists assume that new problems in nursing practice can be credited to an increasing number of accident-based long-term handicaps (Robert Bosch Stiftung 1996). This hypothesis is supported by epidemiological data as elaborated in the following article. Furthermore the critical examination of the terms "apallic syndrome" and "persistent vegetative state" leads up to the question which medical assumptions in relation to the phenomenon of the apallic syndrome are transferred to nursing. According to Feuser (1995) and for noted reason the medical perspective on the apallic syndrome appears to be similar to what can be observed in the practice of psychiatric care. This inheritance of medicine offers a new challenge to the nursing discipline which consequently will have to strengthen the own science.

Adult↗
PubMed2005

Terri Schiavo: the assessment of the persistent vegetative state in accordance with German law.

The case of Terri Schiavo in the USA served to intensify the debate in Germany which itself had in part already been characterised by fundamentalism. Now that some time has elapsed and the political debate has quietened, this case is to be taken up again in discussing the permissibility and the prerequisites of passive euthanasia for patients in a persistent vegetative state. A short reconstruction of the facts of the case (II) is to be followed by a survey of the case law of the Criminal Panels (III) which is essential to understand the present legal policy debate to be discussed at a later stage (IV).

Euthanasia, Passive↗
PubMed1985

Persistent vegetative state. Extension of the syndrome to include chronic disorders.

Twenty-nine institutionalized patients had the vegetative state as a sequela of chronic progressive neurologic disorders. During three years, the state was persistent; none improved, ten died. Eight similar patients were reviewed retrospectively post mortem. Eight patients with severe dementia, while acutely ill or sedated, temporarily met the criteria for persistent vegetative state (PVS) but improved when the underlying condition was treated. Abnormalities on electroencephalography or computed tomographic scan are not specific for the PVS. Electroencephalograms were normal in three patients with PVS. The computed tomographic scans showed extensive destruction of the brain parenchyma but were not different from those of severely demented patients without the PVS. The PVS is a feature of the terminal phase of several progressive neurologic disorders. Patients should be treated without excessive intervention.

Coma↗
PubMed1995

The lived experience of registered nurses involved in the withdrawal of nutrition and hydration in a persistent vegetative state (PVS) patient.

The purpose of this phenomenological study was to describe the experience of five Registered Nurses involved in the withdrawal of nutrition and hydration in a persistent Vegetative State (PVS) patient. Three female and two male nurses who had been involved in the care of a PVS patient within the last ten years were interviewed. The phenomenological design was used because it provided richness and clarity to the issues raised. Three major findings were identified as positive significant experiences for these nurses: support through 'talking': coping through 'thinking'; and, decision making being kept 'in-house' (family and central care giving team).

Attitude of Health Personnel↗
PubMed1996

Persistent vegetative state: what decides the cut-off point?

Advances in medicine and technology have allowed us early and effective diagnosis and treatment of many disease processes, with new and developing interventions ensuring this progression. However, in some illnesses and conditions, despite appropriate treatment, deterioration in the person's condition ensues. This may occur following a cardiopulmonary arrest, where resuscitation may have been 'successful' at the time, but the brain has suffered irreversible anoxic damage. It has been seen that only 10-25% of patients survive to discharge following a cardiac arrest (Broadway 1993), and the consequences of cardiopulmonary resuscitation can not only be costly but can leave the patient in a persistent vegetative state (PVS). PVS, however, does not confine itself to these patients alone, and can present following other cerebral traumas, including head injuries. This is therefore especially pertinent to intensive care nurses, who may find themselves caring for such patients in a critical care setting. Growing public awareness of this altered health state due, for instance, to the Tony Bland case in the UK in 1993, has highlighted a need for greater knowledge of the consequences of the condition and the proposed management of patients in PVS. This paper attempts to describe the course of this syndrome, and considers some of the ethical and moral issues surrounding the care and treatment of patients with PVS. The issues surrounding euthanasia are briefly explored together with the attitudes of those caring for these patients.

Critical Care↗
PubMed1993

Accuracy of diagnosis of persistent vegetative state.

We reviewed pre-admission diagnosis in all patients referred for inpatient brain injury neurorehabilitation over a 5-year period (n = 193). All patients more than 1 month postinjury with diagnosis of coma or persistent vegetative state were selected for review (n = 49). We found that 18 (37%) of these patients were diagnosed inaccurately. Inaccurate diagnosis was more likely if the injury was more than 3 months before admission and the etiology of injury was trauma (48%). Results were statistically significant when traumatic injuries were compared with anoxic injuries (p < 0.10). Errors in diagnosis may result from confusion in terminology, lack of extended observation of patients, and lack of skill or training in the assessment of neurologically devastated patients.

Adolescent↗
PubMed1994

Neuropathological findings in the brain of Karen Ann Quinlan. The role of the thalamus in the persistent vegetative state.

BACKGROUND: Karen Ann Quinlan had a cardiopulmonary arrest in 1975 and died 10 years later, having never regained consciousness. Her story prompted a national debate about the appropriateness of life-sustaining treatment in patients who are in a persistent vegetative state and led to the development of medicolegal guidelines for the care of such patients. This report describes the neuropathologic features of Quinlan's brain. METHODS: The entire brain and spinal cord were systematically sampled for histologic examination. The brain stem and central cerebrum were embedded en bloc and serially sectioned. Three-dimensional computer reconstructions helped visualize the topographic features of the lesions. RESULTS: Contrary to expectation, the most severe damage was not in the cerebral cortex but in the thalamus, and the brain stem was relatively intact. The neuropathological findings included extensive bilateral thalamic scarring, bilateral cortical scars primarily in the occipital pole and parasagittal parieto-occipital region, and bilateral damage to cerebellar and focal-basal-ganglia regions. The brain stem and basal forebrain and the hypothalamic components of the ascending arousal systems and brainstem regions critical to cardiac and respiratory control were undamaged. The lesions were consistent with hypoxia-ischemia after the cardiopulmonary arrest. CONCLUSIONS: Although the neuropathological findings in the case of Karen Ann Quinlan were complex, the disproportionately severe damage in the thalamus as compared with the cerebral cortex supports the hypothesis that the thalamus is critical for cognition and awareness and may be less essential for arousal.

Adult↗