Conscious in a Vegetative State? a Critique of the Pvs Concept

ISBN-13: 9789048166916 / Angielski / Miękka / 2010 / 354 str.

Peter McCullagh

Opis

Having been originally introduced as a term to facilitate discussion of a specific group of patients regarded as entering a state of unawareness following coma, the Persistent Vegetative State (PVS) has established itself as an apparently discrete medical condition with clear-cut implications for ethicists and lawyers that exceed any scientifically based understanding. As a consequence of this upgrading, conclusions drawn about the status and hence the management of this uncommon condition have been increasingly extended to other patients with much more common forms of disability. This book traces the origins of prevailing perceptions about PVS and submits these to critical examination. In doing this it comes to the conclusion that inadequate attention has been paid to acknowledging what is not known about affected individuals and that assumptions have consistently come to be traded as facts. Re-examination of the basis of the PVS and the adoption of a more scientific approach is long overdue and is owed to the community at large which has generally been provided by many medical practitioners with a dumbed-down account of the condition. The book will be of interest to philosophers, medical graduates and neuroscientists but is also intended to remain accessible to the general reader with an interest in the wider implications of trends in medical thinking for attitudes towards many classes of patient. It has an extensive bibliography and will be of specific interest to bioethicists and lawyers with professional interests in PVS. "

Spis treści

Contents.- Acknowledgements.- Introduction. Chapter 1: History and Context of the Persistent Vegetative State. 1.1. Twenty-five years on: an idea.- 1.2. Responses to an idea.- 1.3. The naming of PVS 5.- 1.4. Pre-existing names.- 1.5. Perceptions engendered by a name.- 1.6. The interface between PVS and brain death.- 1.7. Revising brain death: implications for PVS.- 1.8. Semantic implications.- 1.9. Evolution of the title.- 1.10. Alive or dead?.- 1.11. Dying for how long? An exercise in terminal semantics.- 1.12. Artificial hydration, nutrition and semantics.- 1.13. PVS and the right to die movement.- 1.14. Utilisation of PVS patients.- 1.15. Personhood and PVS. Chapter 2: The Pathological Basis of Vegetative States. 2.1. Interpretation of the pathological features of patients in vegetative states.- 2.2. Early pathological reports of patients in a vegetative state.- 2.3. Neuropathological features of two defining cases of persistent vegetative state.- 2.4. Neuropathological reports of series of patients in vegetative states.- 2.5. Neuropathological delineation of the PVS from the locked-in syndrome.- 2.6. Effects of medical management on PVS pathology.- 2.7. Deafferentation as a factor impeding assessment of conscious status.- 2.8. From the individual to the general: perceptions of typical PVS neuropathology and personhood.- 2.9. Recapitulation. Chapter 3: Authoritative Statements. 3.1. Authoritative statements and guidelines.- 3.2. The American Academy of Neurology (A.A.N.) guidelines.- 3.3. The American Medical Association (A.M.A.) report.- 3.4. The American Neurological Association (A.N.A.) statement.- 3.5. The Multi-Society Task Force (M.S.T.F.) on PVS consensus statement.- 3.6. Other U.S. reports.- 3.7. U.K. statements.- 3.8 Recapitulation. Chapter 4: Consciousness 4.1. Relevance of studies of consciousness to its definitional absence in PVS.- 4.2. Terminology.- 4.3. Vigilance: attention: habituation.- 4.4. Neuroanatomical and neurophysiological aspects of consciousness.- 4.5. Communication.- 4.6. Unconscious mental activity.- 4.7. Personhood and PVS.- 4.8. Recapitulation. Chapter 5: Sentience. 5.1. Statements on sentience from authoritative sources.- 5.2. Assessing sentient status - individual patients' experience.- 5.3. Assessing sentient status - neuroanatomical requirements.- 5.4. Assessing sentient status - clinical tests.- 5.5. Responses of others to the possibility of retained or regained sentience on the part of a patient in a PVS.- 5.6. The use of analgesic agents in managing PVS patients.- 5.7 Recapitulation. Chapter 6: Electrophysiological and Imaging Studies of Patients in Vegetative States. 6.1. The electroencephalogram (EEG).- 6.2. Somatosensory evoked potentials (SEP).- 6.3. Imaging of the brain.- 6.4. Structural imaging: computed tomography (CT) scanning.- 6.5. CT indications of brain atrophy in neurologically intact subjects with anorexia nervosa.- 6.6. Functional imaging: cerebral blood flow.- 6.7. Functional imaging: magnetic resonance.- 6.8. Functional imaging: positron emission tomography (PET): the first study of patients in a PVS.- 6.9. The equivalence of PVS and anaesthesia?.- 6.10. The inconsistency between level of anaesthesia and depression of cerebral metabolism.- 6.11. Subsequent PET studies of patients in a PVS.- 6.12. Inter-subject variation in PET-calculated cerebral metabolic rates.- 6.13. PET assessment of changes in cerebral metabolic rate during development.- 6.14. Sedatives and PET-calculated cerebral metabolic rates.- 6.15. Influence of brain atrophy on brain metabolism studies.- 6.16. Location of lesions in vegetative patients using PET.- 6.17 Recapitulation. Chapter 7: An Analogy between Anaesthesia and the Persistent Vegetative State. 7.1. The issue of awareness under anaesthesia at the time of the M.S.T.F. statement.- 7.2. Inferences about unconscious subjects from st