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BY STEVE WEATHERBERegister Correspondent
ST. PETERSBURG, Fla. — A report
that a sedative has the contrary side effect of reviving patients in a what has
been termed a “persistent vegetative state” (PVS) has sparked calls for a
moratorium on the diagnosis.
A British specialist in nuclear
medicine, Ralf Clauss, and a South African general
practitioner, Wally Nel, reported in the journal Neurorehabilitation
in May that Zolpidem, sold under the commercial name Ambien as a remedy for insomnia, “may have efficacy in
Three long-term comatose patients
were revived briefly on a daily basis over several years with injections of Ambien.
The treatment began after one
patient was given Ambien to address his restlessness
while in his coma.
“Lo and behold, he woke up 15
minutes later,” Clauss told a second journal, Nature.
The conclusion to the official
report in Neurorehabilitation
was less folksy: “Zolpidem appears an effective drug
to restore brain function to some patients in the permanent vegetative state,”
It was this diagnosis that lay at
the heart of the debate that lasted more than a decade over the life of Terri Schiavo. Her family, the Schindlers
of Pinellas County, Fla., tried to save her life, while her husband argued that
she did not want to live dependent on life support. Though Terri’s “life
support” was a feeding tube, which is not considered an extraordinary measure
to keep someone alive, and though she was not “brain dead” or terminal, Michael
Schiavo ultimately won the right to let her die by
starvation and dehydration.
Clauss told the Register that he and his
research partner hoped their report would attract the interest — and money — of
a medical research company so that a much wider study could be conducted.
Indeed, a British company focused on
finding a cure for Alzheimer’s disease, Regen
Therapeutics, has expressed an interest.
Clauss said he was “uncomfortable” about
getting involved in the Schiavo debate but did
suggest that the MRI scan commonly employed to assess brain activity was
insufficient and that a scan that looks at the blood supply to the brain and the distribution
of the blood within the brain ought
also be used.
But groups formed to defend the disabled,
such as Not Dead Yet and the Terri Schindler-Schiavo
Foundation, believe that the Clauss/Nel study is more
evidence that the permanent or persistent vegetative state diagnosis ought to
be dropped entirely.
“We at the foundation (operated by Terri Schiavo’s parents and siblings) are seeing that the PVS
diagnosis is being commonly misdiagnosed … Common sense dictates that the
removal of food and water based on this misclassification must end until
further studies can be conducted,” said Terri’s father, Robert Schindler.
Her brother, Robert Schindler Jr., told
the Register the family did not believe Terri was in a persistent vegetative
state, but throughout her years of unconsciousness, her husband would never
allow any treatment for her.
“I don’t believe even if the diagnosis is
correct that we have the right to remove food and water,” he said. “If all that
is being done for a patient is that food and water is being given them, they
should not be terminated.”
staff ethicist at the National Catholic Bioethics
Center in Philadelphia, said the ethical issue in the
Terri Schiavo affair is very much alive. The issue,
he says, is, “Do people with PVS have lives worth living?” Those who answered
No believed also, he said, that they had the moral right to kill her.
“There’s nothing wrong with PVS as
a diagnosis,” he said. ”Nobody dies from PVS. Terri Schiavo
was stable in PVS for years. She died from starvation and dehydration. The
cause was the decision to take her food and water away. This was a case of
Furton agreed, however, with the
Schindler family that the PVS diagnosis was being used by some people as the
standard for permitting euthanasia. “There is a school of thought, he said,
that you are not a human being if you don’t have higher cognitive function.”
Disability advocacy groups like Not Dead Yet “ought to be very concerned about
this,” he said. “The message is: If you fall into a state sufficiently lacking
in human dignity you will be terminated.”
Diane Coleman, president of Not Dead Yet,
said her group has called for an end to the PVS diagnosis for years.
“This study just goes to reinforce our
position that PVS cannot be properly diagnosed,” she said. “There should
certainly be a moratorium on starving and dehydrating someone.”
John Paul II’s March 20, 2004 address
“Life-Sustaining Treatments and Vegetative
Advances and Ethical Dilemmas,” to members of an international congress, he
addressed the widespread use of the term “vegetative state”:
“In particular, the term permanent
vegetative state has been coined to indicate the condition of those patients
whose ‘vegetative state’ continues for over a year. Actually, there is no
different diagnosis that corresponds to such a definition, but only a
conventional prognostic judgment, relative to the fact that the recovery of
patients, statistically speaking, is ever more difficult as the condition of
vegetative state is prolonged in time.
“However, we must neither forget
nor underestimate that there are well-documented cases of at least partial
recovery even after many years; we can thus state that medical science, up
until now, is still unable to predict with certainty who among patients in this
condition will recover and who will not.
“Faced with patients in similar
clinical conditions, there are some who cast doubt on the persistence of the
‘human quality’ itself, almost as if the adjective ‘vegetative’ (whose use is
now solidly established), which symbolically describes a clinical state, could
or should be instead applied to the sick as such, actually demeaning their
value and personal dignity. In this sense, it must be noted that this term,
even when confined to the clinical context, is certainly not the most
felicitous when applied to human beings.
“In opposition to such trends of
thought, I feel the duty to reaffirm strongly that the intrinsic value and
personal dignity of every human being do not change, no matter what the
concrete circumstances of his or her life. A man, even if seriously ill or
disabled in the exercise of his highest functions, is and always will be a man,
and he will never become a ‘vegetable’ or an ‘animal.’”
Coleman cited British and American
studies indicating “persistent vegetative state” was misdiagnosed between 30%
and 43% of the time. “People can be really conscious and still not able to
communicate. PVS is that unreliable as a diagnosis.”
However, Kevin Keith, who teaches ethics
to medical students in New York,
said the studies showing misdiagnosis are a decade old, covering a period
before current diagnostic criteria were developed.
“We have no current data indicating that
PVS is being misdiagnosed. Ten years of evolution of diagnostic techniques have
only improved things.”
Keith is skeptical of the Ambien study. “If it holds up — and this is a far beyond
hypothetical supposition — it will certainly overthrow much of what we think we
know about PVS. But there are good reasons to be extremely skeptical that it
will be upheld.”
For one thing, the study has not been
subjected to “even a preliminary peer review, ... let
alone confirmation by other researchers.”
But Coleman is skeptical, in turn, of bioethicists who “feel that certain people should not have
status as persons.
“They think it’s futile to treat those
with dementia and strokes,” he said. “They don’t think it’s worth spending
health dollars on you.”
Steve Weatherbe is based in