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    Sunday, October 08, 2006

    Zombie Medicine: The always interesting BioEdge has a post about a discussion among ethicists on the appropriate use of persistent vegetative state patients:

    A discussion in the current Journal of Medical Ethics shows that there is a growing interest in using their bodies for medical experiments. They would be especially useful in studying the long-term effects of transplanting animal organs. The patients often survive for years, and if a virus affected their brains or other vital organs, very little harm would be done.

    Some bioethicists have even contended that PVS patients are actually dead and can be treated as cadavers.

    The ethicists apparently suffer the same confusion the media suffer when it comes to the definition of persistent vegetative state. It is not brain death. I've detailed the ambiguous nature of its definition before, and recent events in South Africa suggest that in many cases (up to 60% in one man's practice) it's neither persistent nor completely vegetative.

    Yet, in their journal, two of the four papers on the topic use the term "living dead" to refer to these patients. What a neat turn of phrase. It not only misrepresents their pathology, but it robs them of their humanity and turns them into the equivalent of monster movie zombies.

    posted by Sydney on 10/08/2006 11:25:00 PM 4 comments


    I've read your critism of using the diagnosis of PVS as a justfication for terminating care. You're right in that the criteria for PVS is somewhat arbitrary; it's subject to the whims of the diagosing clinician and not an objective test.

    However, I am puzzled by your statements at the end of the TCS Daily article. You seem to be making a normative claim that since science is presently incapable of objectively determining the "alive-ness" or "dead-ness" of someone, we should keep these people alive, or at least not treat them like cadavers for medical research.

    I think you're forgetting that each human life has a value that is conferred upon it by the rest of the society, just as any other thing in this world (tangible and intangible). For example, we value the environment; we value the ability to enjoy the green trees and the clean air. We also value the ability to drive cars. How these values compare with one another determines our environmental policy, how much we drive, how much we tax gasoline and such. If we perceive the trees to have little value, then we'd burn carbon fuel as much as we want.

    Likewise, we confer value to a person in PVS. We confer value to the resources we'll expend in keeping this patient alive. We may also confer value to the "advancement of science through medical research." These relative values determine whether we want to keep a patient alive or otherwise. I believe you make the mistake of assuming that any individual "human life" can be valuable above all else. It is not.

    When you refer to a slippery slope, it isn't that our decision process has changed, or that the burden of proof is suddenly on one side instead of another. What has changed is the value we place on the "sanctity of life." Life isn't infinitely invaluable and we, as a society, are making the statement that we don't want to keep people alive just for the sake of "life."

    Other values won out, and these values will continue to evolve as civilization evolves.

    By Blogger Biomed Tim, at 1:11 AM  

    Tim: For many of us, value isn't placed on a human life solely by the rest of society, but primarily, perhaps solely, by God. If you consider it from that point of view, you'll have to come to a quite different conclusion.

    I'm not sure I want anything to do with a society which holds a life valuable only for the monetary contributions it makes. If you accept that, than the life of a profoundly retarded person is also forfeit to research for exactly the same reason, and it's not a far step from there to reach Mengele.

    By Blogger LibraryGryffon, at 1:56 PM  

    I believe you use the term "we" rather loosely. You imply you are speaking on behalf of a majority of the population, or perhaps even a significant minority. This is presumptuous, to say the least.

    It is exactly this kind of thinking that does, indeed, lead to the slippery slope of the relativism of the worth of a human life, relative being a word you chose to use several times. Defining a person as alive or not, is something that the medical world does indeed do, every day. And this is key. One is alive, or one is not. You may think there is a continuum, but there is a threshold defined by science (and legally recognized) that would say otherwise. To lose this distinction leads to turmoil, as with the abortion debate. It is only in the setting of brain death that organs can be donated for use by others, and it is only in this setting that any, less clearly beneficial activities such as medical research, should take place. PVS patients, by medical, legal and moral distinction, are indeed alive.

    To lose this distinction leads to situations such as the Groningen Protocol, which has actively killed newborns in the Netherlands and which is now taking aim at the mentally handicapped. I could really push the analogy and point out that many times society has valued perfectly healthy individuals very, very little. for Pete's sake,on the past, your argument was used to jusity slavery and a whole host of other ills.

    Our society has accepted the threshold librarygryffon has described, at least in regard to end-of-life decisions. Many of them do not necessarily agree with its divine origins- no matter. The rights of the individual are so thoroughly ingrained inn the fabric of this country, that there is very little danger of this viewpoint fading away any time in the near future.

    In addition, bioethicists as a group are often not involved in patient care. In addition, they often have a very difficult time encompassing moral arguments. Just because they advance something as an argument, does not make it a valid one.

    By Anonymous Dani, at 4:07 PM  

    I think doctors and people in the medical community are called upon to provide a balance with the chance the patient will recover. I have always felt that it's better to err on the side of doing too much to treat the patient than too little. Treating a patient who may be aware and able to feel pain, but not respond by using them as a human guinea pig in experiments when they can't consent is wrong. Just like using mental patients for health experiments. China may offer its prisoner organs up for sale, but here we try to at least pretend to refrain from cruel and unusual punishment. If you think people would consent to this type of testing, you can talk them into signing a card like state has for organ donation. No consent, no experimentation.

    By Anonymous Dara, at 3:08 PM  

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