Pascal's Wager and the persistent vegetative state

Bioethics

Volumn 21, Issue 2, 2007, Pages 84-92

  Stone, Jim ^a  

^a NONE   (United States)

Author keywords

Advance directive; Informed consent; Minimally conscious state; Pascal's Wager; Permanent vegetative state; Persistent vegetative state

Indexed keywords

ARTICLE; CONSCIOUSNESS; HUMAN; HYDRATION; MEDICAL CARE; NUTRITION; PERSISTENT VEGETATIVE STATE;

ACTIVITIES OF DAILY LIVING; ADULT; ADVANCE DIRECTIVES; AGED; FEMALE; HUMANS; INFORMED CONSENT; LIFE SUPPORT CARE; MALE; MIDDLE AGED; PERSISTENT VEGETATIVE STATE; PROGNOSIS;

EID: 33846139033     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2007.00528.x     Document Type: Article

References (47)

1. J. Stone. Advance Directives, Autonomy, and Unintended Death. Bioethics 1994; 8:3: 223-246, note 37.
2. T.A. Mappes. Persistent Vegetative State, Prospective Thinking, and Advance Directives. Kennedy Inst Ethics J 2003; 13:2: 119-139, p. 128. All references to Mappes are from this article.
3. Ibid: 121.
4. Multi-Society Task Force on PVS. Medical Aspects of the Persistent Vegetative State. Part I. N Engl J Med 1994; 330: 1499-1508, p. 1501.
5. Mappes, op cit. note 2, p. 124.
6. MSTF, op. cit. note 4, p. 1501.
7. MSTF on PVS. Medical Aspects of the Persistent Vegetative State. Part II. N Engl J Med 1994; 330: 1572-1579, p. 1575. Note that the 'severe disability' requirement is dropped in the second case.
8. N. Latronica et al. Approach to the Patient in Vegetative State. Part III: prognosis. Minerva Anestesiol 2000 Apr; 66(4): 241-248, p. 241.
9. C. Borthwick. The Permanent Vegetative State. Issues Law Med 1996; 167-185, p. 179.
10. H.L. Levin et al. Vegetative State After Closed-Head Injury: A Traumatic Coma Data Bank Report. Arch Neurol 1991; Vol. 48: June: 580-585, p. 580.
11. Ibid: table 5, 583. Only one of those five recovered from trauma-induced PVS; this individual was severely disabled. However it's a mistake to generalize from one case that the prospect for recovering independence for such individuals is lower than for non-trauma induced PVS. The Task Force acknowledges a moderately disabled late-recovery from trauma-induced PVS reported by The Traumatic Coma Data Bank, but appears to question whether recovery was late (MSTF, op. cit. note 7, p. 1575).
12. Concerning the 434 patients considered above, by the end of one year 7% had made a virtually complete recovery, 17% were moderately disabled (which means they're independent), and 28% were severely disabled (Ibid: table 3, 1574).
13. Mappes, op. cit. note 2, 137, note 16.
14. Ibid.
15. Ibid: 128.
16. Ibid.
17. Ibid.
18. Ibid: 129.
19. MSTF, op. cit. note 7, p. 1572.
20. Mappes, op. cit. note 2, p. 129.
21. Here are two better recoveries than my sister's, both from non-traumatic 'permanent' VS. First, a woman, 26, recovers after six months in PVS; she returns home to her parents, with regular periods in a home for severely disabled people. She remains in a wheelchair and communicates by letter board. In two years tests show she's in a normal range for most tasks assessed; she remains wheel-chair bound and can't speak. She has made almost a complete cognitive recovery and feels positive about her life (B. A. Wilson et al. Cognitive Recovery From 'Persistent Vegetative State': Psychological and Personal Perspectives. Brain Inj 2001 Dec; 15(12): 1083-1092).
22. Second, a 43-year-old man remains in a VS for 18 months after cardiac arrest. Over a six-month period he regains speech and limited use of hands and legs. His verbal IQ is 100, with some recent-memory impairment. He tells stories and jokes but can't read (G.A. Rosenberg et al. Recovery of Cognition after Prolonged Vegetative State. Ann Neurol 1977; 2: 167-168).
23. Mappes, op. cit. note 2, p. 130.
24. Mappes, op. cit. note 2, p. 129. 'Typically' doesn't jibe with the 40% recovery to moderate disability mentioned earlier.
25. Mappes, op. cit. note 2, pp. 129-130.
26. J.T. Giacino et al. The Minimally Conscious State: Definition and Diagnostic Criteria. Neurology 2002; 58: 349-353. All quotations in the above paragraph are from 351.
27. Mappes, op. cit. note 2, p. 137, note 14.
28. J.L. Bernat. Questions Remaining About the Minimally Conscious State. Neurology 2002; 58: 337-338, p. 338.
29. D.A. Shewmon. Correspondence. Neurology 2002; 58: 506-507, p. 506.
30. D. Coleman. Correspondence. Neurology 2002; 58: 506-507, p. 506.
31. Mappes, op. cit. note 2, p. 130.
32. L.J. Nelson & R.E. Cranford. Michael Martin and Robert Wendland: Beyond the Vegetative State. J Contemp Health Law Policy 1999; 15:425: 427-453, p. 447.
33. Ibid: 453.
34. Ibid: 448.
35. Ibid.
36. Ibid: 434.
37. PT was discontinued finally, because she plainly didn't want it.
38. S. Ashwal & R. Cranford. 2002. The Minimally State in Children. Semin Pediatr Neurol 2002; 9 (1): 19-34, p. 33.
39. Ibid: 29.
40. Ibid: 31.
41. Ibid.
42. Ibid: 26.
43. See J. Stone, op. cit. note 1.
44. In obtaining informed consent we don't just feed people statistics; we point out standard advantages alleged in favor of the options, especially when these may not occur to them.
45. See Nelson and Cranford, op. cit. note 32.
46. Thanks for discussion or comments to John Cottingham, Mary Crane, RN, Thomas Marzen, David Newman, MD, and Ronald Sandler. Special thanks to Judith Crane.