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8.10f. Vegetative State and Coma (Vegetative State and Coma on PhilPapers)

See also:
Beaumont, J. Graham & Kenealy, Pamela M. (2005). Incidence and prevalence of the vegetative and minimally conscious states. Neuropsychological Rehabilitation 15 (3):184-189.   (Cited by 1 | Google | More links)
Bekinschtein, Tristan; Tiberti, Cecilia; Niklison, Jorge; Tamashiro, Mercedes; Ron, Melania; Carpintiero, Silvina; Villarreal, Mirta; Forcato, Cecilia; Leiguarda, Ramon & Manes, Facundo (2005). Assessing level of consciousness and cognitive changes from vegetative state to full recovery. Neuropsychological Rehabilitation. Vol 15 (3-4):307-322.   (Cited by 2 | Google | More links)
Bernat, James L. (2006). The concept and practice of brain death. In Steven Laureys (ed.), Boundaries of Consciousness. Elsevier.   (Cited by 5 | Google)
Boly, Melanie; Faymonville, Marie-Elisabeth E. & Peigneux, Philippe (2004). Auditory processing in severely brain injured patients: Differences between the minimally conscious state and the persistent vegetative state. Archives of Neurology 61 (2):233-238.   (Google)
Botros, Sophie (1995). Acts, omissions, and keeping patients alive in a persistent vegetative state. In Philosophy and Technology. New York: Cambridge University Press.   (Google)
Cattorini, Paolo & Reichlin, Massimo (1997). Persistent vegetative state: A presumption to treat. Theoretical Medicine and Bioethics 18 (3).   (Google)
Abstract: The article briefly analyzes the concept of a person, arguing that personhood does not coincide with the actual enjoyment of certain intellectual capacities, but is coextensive with the embodiment of a human individual. Since in PVS patients we can observe a human individual functioning as a whole, we must conclude that these patients are still human persons, even if in a condition of extreme impairment. It is then argued that some forms of minimal treatment may not be futile for these patients; they may constitute a form of respect for their human dignity and benefit these patients, even if they are not aware of that. Moreover, it is important to consider the symbolic significance of care: while many believe that PVS is a kind of imprisonment, for others providing food and fluids is the only way to testify our proximity to these persons. The best policy would be to provide, as a general rule, artificial nutrition and hydration to PVS patients: this treatment could be withdrawn, after a period of observation and reflection by the family and proxies, on the basis of the proxies' objection to the continuation or of the patient's advance directives specifically referring to this situation
Celesia, Gastone G. (1997). Persistent vegetative state: Clinical and ethical issues. Theoretical Medicine and Bioethics 18 (3).   (Google)
Abstract: Coma, vegetative state, lock-in syndrome and akinetic mutism are defined. Vegetative state is a state with no evidence of awareness of self or environment and showing cycles of sleep and wakefulness. PVS is an operational definition including time as a variable. PVS is a vegetative state that has endured or continued for at least one month. PVS can be diagnosed with a reasonable amount of medical certainty; however, the diagnosis of PVS must be kept separate from the outcome. The patient outcome can be predicted based on etiology and age. Using outcome probabilities and etiology as criteria, patients can be subdivided in 5 groups and reasonable management guidelines can be suggested. Three levels of care can be provided to PVS patients: high technology, supportive and compassionate care. Pragmatic options for the various subgroups of patients are suggested. Management decisions will remain difficult for both the family and the health-care team. The role of the physician in these difficult cases is to share the decision-making with the family
Coleman, Diane; Shewmon, D. Alan & Giacino, J. T. (2002). "The minimally conscious state: Definition and diagnostic criteria": Comments and reply. Neurology 58 (3):506-507.   (Google)
Combs, Allan; Kahn, David & Krippner, Stanley (2000). Dreaming and the self-organizing brain. Journal of Consciousness Studies 7 (7):4-11.   (Google)
de Giorgio, C. M. & Lew, M. F. (1991). Consciousness, coma, and the vegetative state: Physical basis and definitional character. Issues in Law and Medicine 6:361-371.   (Google)
Ditto, Peter H. (2008). What would Terri want? : Advance directive and the psychological challenges of surrogate decision making. In James L. Werth & Dean Blevins (eds.), Decision Making Near the End of Life: Issues, Development, and Future Directions. Brunner-Routledge.   (Google)
Fins, Joseph J. & Plum, F. (2004). Neurological diagnosis is more than a state of mind: Diagnostic clarity and impaired consciousness. Archives of Neurology 61 (9):1354-1355.   (Cited by 12 | Google | More links)
Fins, Joseph & Schiff, Nicholas D. (2005). The afterlife of Terri schiavo. Hastings Center Report 35 (4).   (Google)
Gillett, Grant (1992). Coma, death and moral dues: A response to Serafini. Bioethics 6 (4):375–377.   (Google | More links)
Gill-Thwaites, H. & Munday, R. (2004). The sensory modality assessment and rehabilitation technique (SMaRT): A valid and reliable assessment for vegetative state and minimally conscious state patients. Brain Injury 18 (12):1255-1269.   (Google)
Graham, D. I.; Maxwell, W. L.; Adams, J. H. & Jennett, Bryan (2006). Novel aspects of the neuropathology of the vegetative state after Blunt head. In Steven Laureys (ed.), Boundaries of Consciousness. Elsevier.   (Google)
Greenberg, Daniel L. (2007). Comment on "detecting awareness in the vegetative state". Science 315 (5816).   (Cited by 1 | Google | More links)
Hausman, David B. & Kappler, A. Serge (1978). Death as irreversible coma: An appraisal. Journal of Value Inquiry 12 (1).   (Google)
Jennett, Bryan (2006). 30 years of the vegetative state: Clinical, ethical and legal problems. In Steven Laureys (ed.), Boundaries of Consciousness. Elsevier.   (Google)
Jennett, Bryan (2002). The Vegetative State: Medical Facts, Ethical and Legal Dilemmas. Cambridge University Press.   (Cited by 81 | Google | More links)
Abstract: A survey of the medical, ethical and legal issues that surround this controversial topic.
Jouvet, M. (1969). Coma and other disorders of consciousness. In P. Vinken & G. Bruyn (eds.), Handbook of Clinical Neurology. North Holland.   (Cited by 20 | Google)
Kahane, Guy & Savulescu, Julian (2009). Brain-Damaged Patients and the Moral Significance of Consciousness. The Journal of Medicine and Philosophy 34 (1):6-26.   (Google)
Abstract: Neuroimaging studies of brain-damaged patients diagnosed as in the vegetative state suggest that the patients might be conscious. This might seem to raise no new ethical questions given that in related disputes both sides agree that evidence for consciousness gives strong reason to preserve life. We question this assumption. We clarify the widely held but obscure principle that consciousness is morally significant. It is hard to apply this principle to difficult cases given that philosophers of mind distinguish between a range of notions of consciousness and that is unclear which of these is assumed by the principle. We suggest that the morally relevant notion is that of phenomenal consciousness and then use our analysis to interpret cases of brain damage. We argue that enjoyment of consciousness might actually give stronger moral reasons not to preserve a patient's life and, indeed, that these might be stronger when patients retain significant cognitive function.
Kobylarz, Erik J. & Schiff, Nicholas D. (2005). Neurophysiological correlates of persistent vegetative and minimally conscious states. Neuropsychological Rehabilitation. Vol 15 (3-4):323-332.   (Cited by 5 | Google | More links)
Laureys, Steven; Majerus, S. & Moonen, Gustave (online). Assessing consciousness in critically ill patients.   (Cited by 11 | Google)
Laureys, Steven; Owen, Adrian M. & Schiff, Nicholas D. (2004). Brain function in coma, vegetative state, and related disorders. Lancet Neurology 3:537-546.   (Cited by 54 | Google | More links)
Laureys, Steven; Faymonville, Marie-Elisabeth E. & Ferring, M. (2003). Differences in brain metabolism between patients in coma, vegetative state, minimally conscious state and locked-in syndrome. European Journal of Neurology 10.   (Cited by 4 | Google)
Laureys, Steven (2005). The neural correlate of (un)awareness: Lessons from the vegetative state. Trends in Cognitive Sciences 9 (12):556-559.   (Cited by 14 | Google | More links)
Lizza, John P. (2009). Commentary on "the incoherence of determining death by neurological criteria". Kennedy Institute of Ethics Journal 19 (4):pp. 393-395.   (Google)
Machado, C. & Shewmon, D. E. (eds.) (2004). Brain Death and Disorders of Consciousness. Plenum.   (Cited by 2 | Google | More links)
Mappes, Thomas A., Persistent vegetative state, prospective thinking, and advance directives.   (Google)
Abstract: : This article begins with a discussion of persistent vegetative state (PVS), focusing on concerns related to both diagnosis and prognosis and paying special attention to the 1994 Multi-Society Task Force report on the medical aspects of PVS. The article explores the impact of diagnostic and prognostic uncertainties on prospective thinking regarding the possibility of PVS and considers the closely related question of how prospective thinkers might craft advance directives in order to deal most effectively with this possibility
Nachev Parashkev, & Husain, Masud (2007). Comment on "detecting awareness in the vegetative state". Science 315 (5816).   (Google)
Owen, Adrian M.; Coleman, Martin R.; Boly, Melanie; Davis, Matthew H.; Laureys, Steven; Jolles, Dietsje & Pickard, John D. (2006). Detecting awareness in the conscious state. Science 313:1402.   (Google)
Owen, Adrian M.; Coleman, Martin R.; Boly, Melanie; Davis, Matthew H.; Laureys, Steven; Jolles, Dietsje & Pickard, John D. (2007). Response to comments on "detecting awareness in the vegetative state". Science 315 (5816).   (Google | More links)
Owen, Adrian M.; Coleman, Martin R.; Menon, D. K.; Berry, E. L.; Johnsrude, I. S.; Rodd, J. M.; Davis, Matthew H. & Pickard, John D. (2006). Using a hierarchical approach to investigate residual auditory cognition in persistent vegetative state. In Steven Laureys (ed.), Boundaries of Consciousness. Elsevier.   (Cited by 8 | Google)
Owen, Adrian M.; Coleman, Martin R.; Boly, Melanie; Davis, Matthew H.; Laureys, Steven & Pickard, John D. (2007). Using functional magnetic resonance imaging to detect Covert awareness in the vegetative state. Archives of Neurology 64 (8):1098-1102.   (Google)
Perrin, Fabien; Schnakers, Caroline; Schabus, Manuel; Degueldre, Christian; Goldman, Serge; Brédart, Serge; Faymonville, Marie-Elisabeth E.; Lamy, Maurice; Moonen, Gustave; Luxen, André; Maquet, Pierre & Laureys, Steven (2006). Brain response to one's own name in vegetative state, minimally conscious state, and locked-in syndrome. Archives of Neurology 63 (4):562-569.   (Cited by 3 | Google | More links)
Posner, J. B. (1978). Coma and other states of consciousness: The differential diagnosis of brain death. Annals of the New York Academy of Science 315:215-27.   (Cited by 7 | Google)
Prigatano, George P. & Johnson, Sterling C. (2003). The three vectors of consciousness and their disturbances after brain injury. Neuropsychological Rehabilitation 13 (1):13-29.   (Cited by 7 | Google | More links)
Protevi, John (ms). The Terri schiavo case: Biopolitics and biopower: Agamben and Foucault.   (Google)
Abstract: While Agamben acknowledges the Arendtian and Foucaultian thesis of the modernity of biopower, he will claim that sovereignty and biopolitics are equally ancient and essentially intertwined in the originary gesture of all politics; sovereignty is the power to decide the state of exception whereby bare life or zoe is exposed "underneath" political life or bios. Agamben then finds in the concentration camp the modern biopolitical paradigm, in which the state of exception has become the rule and we have all become [potentially] bearers of exposed bare life in that we are all subject to what I will call a "de-politicizing predication": to use the current American jargon, being named an "enemy combatant."
Protevi, John, The Terri Schiavo case: Empathy, love, sacrifice, singularity.   (Google)
Abstract: In the first part of this talk I show how some ideas in the new "4EA" branch of cognitive science (embodied, embedded, extended, enactive, affective), which gets away from the computer metaphor to talk about affective cognition as the direction of action of an organism, can be illuminated by Deleuze's ontology. Now that may sound ridiculous, as Deleuze's terminology is notoriously baroque – how could it ever "illuminate" anything? So I'm going to be using plain English translations of his concepts; I think his concepts are too good, too useful, for his terminology to be such a barrier to entry. Then I'm going to use this mixture of Deleuze and 4EA ideas to examine a case study which has, besides its metaphysical and psychological implications, some ethical, political, and legal ones as well. So to deal with them we'll deal just a bit with Agamben and Foucault
-, - (1995). Recommendations for the use of uniform nomenclature pertinent to patients with severe alterations in consciousness. Arch Phys Med Rehabilation 76:205-209.   (Google)
Schnakers, Caroline; Giacino, Joseph; Kalmar, Kathleen; Piret, Sonia; Lopez, Eduardo; Boly, Mélanie; Malone, Richard & Laureys, Steven (2006). Does the FOUR score correctly diagnose the vegetative and minimally conscious states? Annals of Neurology 60 (6):744-745.   (Cited by 1 | Google)
Schiff, Nicholas D. (2006). Multimodal neuroimaging approaches to disorders of consciousness. Journal of Head Trauma Rehabilitation. Special Issue 21 (5):388-397.   (Cited by 1 | Google | More links)
Schotsmans, P. (1993). The patient in a persistent vegetative state: An ethical re-appraisal. Bijdragen, Tijdschrift Voor Filosofie En Theologie 54 (1):2-18.   (Cited by 3 | Google | More links)
Seifert, Josef (2004). Consciousness, mind, brain, and death. In C. Machado & D. Shewmon (eds.), Brain Death and Disorders of Consciousness. Plenum.   (Cited by 2 | Google | More links)
Serafini, Anthony (1992). Gillett on consciousness and the comatose. Bioethics 6 (4):365-374.   (Google | More links)
Serafini, Anthony (1993). Is coma morally equivalent to anencephalia? Ethics and Behavior 3 (2):187 – 198.   (Google | More links)
Abstract: In this article I contend that the tendency to equate coma with anencephalia is a mistake. A key idea here is that there is a type of "mental-state" predicate that is applicable to the comatose but not to anencephalics. One of the moral implications of this is that the concept of "brain death", its alleged popularity notwithstanding, is badly confused. Also, because anencephalics have no mental life, there are few moral grounds for hesitating to use anencephalics as organ donors
Sharova, E. V. (2005). Electrographic correlates of brain reactions to afferent stimuli in postcomatose unconscious states after severe brain injury. Human Physiology 31 (3):245-254.   (Google)
Shewmon, D. A.; Holmes, G. L. & Byrne, P. A. (1999). Consciousness in congenitally decorticate children: Developmental vegetative state as self-fulfilling prophecy. Dev Med Child Neurol 41:364-374.   (Cited by 27 | Google | More links)
Shepherd, Lois L. (2009). If That Ever Happens to Me: Making Life and Death Decisions After Terri Schiavo. University of North Carolina Press.   (Google)
Abstract: Disorders of consciousness and the permanent vegetative state -- Legal and political wrangling over Terri's life -- In context--law and ethics -- Terri's wishes -- The limits of evidence -- The implications of surrogacy -- Qualities of life -- Feeding -- The preservation of life -- Respect and care : an alternative framework.
Shea, Nicholas & Bayne, Tim, The vegetative state and the science of consciousness.   (Google | More links)
Abstract: Consciousness in experimental subjects is typically inferred from reports and other forms of voluntary behaviour. A wealth of everyday experience confirms that healthy subjects do not ordinarily behave in these ways unless they are conscious. Investigation of consciousness in vegetative state (VS) patients has been based on the search for neural evidence that such broad functional capacities are preserved in some VS patients. We call this the standard approach. To date, the results of the standard approach have suggested that some VS patients might indeed be conscious, although they fall short of being demonstrative. The fact that some VS patients show evidence of consciousness according to the standard approach is remarkable, for the standard approach to consciousness is rather conservative, and leaves open the pressing question of how to ascertain whether patients who fail such tests are conscious or not. We argue for a cluster-based ‘natural kind’ methodology that is adequate to that task, both as a replacement for the approach that currently informs research into the presence or absence of consciousness in VS patients, and as a methodology for the science of consciousness more generally
Smythies, J. R. (1999). The biochemical basis of coma. Psycoloquy 10 (26).   (Cited by 4 | Google | More links)
Abstract: Current research on the neural basis of consciousness is based mainly on neuroimaging, physiology and psychophysics. This target article reviews what is known about biochemical factors that may contribute to the development of consciousness, based on loss of consciousness (i.e., coma). There are two theories of the biochemical mode of action of general anaesthetics. One is that anaesthesia is a direct (i.e., not receptor-mediated) effect of the anaesthetic on cellular neurophysiological function; the other is that some alteration of receptor function occurs. General anaesthetics are mainly GABA agonists but some (such as ketamine) are glutamate antagonists. They also affect other systems, particularly cholinergic ones. There are various comas of metabolic origin. For example, a combination of small doses of the iron chelators desferrioxamine and prochlorperazine induce a profound and long lasting coma in humans. The mechanisms that might mediate this include redox mechanisms at the glutamate synapse, post-synaptic endocytosis of dopamine and iron, and intracellular iron-dopamine complexes, which are powerful dismuters of the superoxide anion. New findings in cell biology relating to endocytosis and recycling of receptors are discussed in a wider context. These biochemical events may induce coma by two mechanisms: (i) Consciousness may depend on widespread cortical (or cortico-thalamic) activation. (ii) Whereas these biochemical changes are widespread, only the changes in a subset of consciousness' neurons may count. An experimental program to distinguish between these two alternatives is proposed
Stanczak, D. E.; White, J. G. & Gouview, W. D. (1984). Assessment of level of consciousness following severe neurological insult: A comparison of the psychometric qualities of the Glasgow coma scale and the comprehensive level of consciousness scale. Journal of Neurosurgery 60:955-60.   (Google)
Stins, John F. & Laureys, Steven (2009). Thought translation, tennis and Turing tests in the vegetative state. Phenomenology and the Cognitive Sciences 8 (3).   (Google)
Abstract: Brain damage can cause massive changes in consciousness levels. From a clinical and ethical point of view it is desirable to assess the level of residual consciousness in unresponsive patients. However, no direct measure of consciousness exists, so we run into the philosophical problem of other minds. Neurologists often make implicit use of a Turing test-like procedure in an attempt to gain access to damaged minds, by monitoring and interpreting neurobehavioral responses. New brain imaging techniques are now being developed that permit communication with unresponsive patients, using their brain signals as carriers of messages relating to their mental states
Stone, Jim (2007). Pascal's Wager and the persistent vegetative state. Bioethics 21 (2):84–92.   (Google | More links)
Suchy-Dicey, Carolyn (2009). It takes two: Ethical dualism in the vegetative state. Neuroethics 2 (3).   (Google)
Abstract: To aid neuroscientists in determining the ethical limits of their work and its applications, neuroethical problems need to be identified, catalogued, and analyzed from the standpoint of an ethical framework. Many hospitals have already established either autonomy or welfare-centered theories as their adopted ethical framework. Unfortunately, the choice of an ethical framework resists resolution: each of these two moral theories claims priority at the exclusion of the other, but for patients with neurological pathologies, concerns about the patient’s welfare are treated as meaningless without consideration of the patient’s expressed wishes, and vice versa. Ethicists have long fought over whether suffering or autonomy should be our primary concern, but in neuroethics a resolution of this question is essential to determine the treatment of patients in medical and legal limbo. I propose a solution to this problem in the form of ethical dualism. My paper deviates from this text in many ways, but especially in the inclusion of autonomy and happiness as part of ethical theories, rather than guiding principles. This is a conservative measure in that it retains both sides of the debate: both happiness and autonomy have intrinsic value. However, this move is often met with resistance because of its more complex nature—it is more difficult to make a decision when there are two parallel sets of values that must be considered than when there is just one such set. The monist theories, though, do not provide enough explanatory power: namely, I will present two recently publicized cases where it is clear that neither ethical value on its own (neither welfare nor autonomy) can fully account for how a vegetative patient should be treated. From the neuroethical cases of Terri Schiavo and Lauren Richardson, I will argue that a dualist framework is superior to its monist predecessors, and I will describe the main features of such an account
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Young, G. B.; Ropper, A. H. & Bolton, C. F. (1998). Coma and Impaired Consciousness: A Clinical Perspective. McGraw-Hill.   (Cited by 18 | Google)
Abstract: All-encompassing text examines every aspect of coma from neurochemistry, monitoring, and treatments to prognostic factors.
Young, Andrew W. (2003). Face recognition with and without awareness. In Axel Cleeremans (ed.), The Unity of Consciousness. Oxford University Press.   (Google)