Talk:Vegetative state/Archive 1

American woman
"The case of the American woman Terri Schiavo is often cited as an example of PVS" It seems clunky to call her "the American woman Terri Schiavo", maybe it's just me though. Hondje 05:08, 27 Mar 2005 (UTC)
 * I agree and have therefore removed it. "The American woman" was unnecessary. Aidje 18:17, 2005 Mar 31 (UTC)
 * It won't be in a few years time, when most people have forgotten her case, but PVS is still an issue. -- Karada 23:01, 17 Jun 2005 (UTC)
 * I don't think that's going to happen for quite some time. The similar case of Karen Ann Quinlan is still widely remembered and occurred in the 70s. 73.173.114.38 (talk) 01:03, 19 February 2015 (UTC)

Eye tracking
"This is also suspect "Eye tracking is often the earliest symptom of recovery."" Agreed, from what I have read on other sites, limited eye tracking is a normal reflex reaction, which often gives the impression that the patient is somehow aware. I propose removing it, but I'd like to find a good medical source stating one way or the other before axing another users contribution.

This line is should not exist: "in many cases family members who visit the patient will detect evidence of awareness when doctors with limited patient contact will deny it."

This is also suspect "Eye tracking is often the earliest symptom of recovery."

Seems a bit one-sided toward recovery and may warrant a NPOV designator. After all, many PVS patients never recover.

Many PVS patients certainly never recover, and the text doesn't contest this, or even suggest (as I might) that some part of this may be due to termination of nutrition and hydration. However, the percentage of people diagnosed as being in PVS who eventually demonstrate consciousness varies in different studies between 6% and 76%, and in either case the point needs to be made that absolute certainty is impossible. Frankly, I think that anyone proposing NPOV should be obliged to cite some evidence for their belief. -Unsigned

Coma definition
From the page on Coma: One can be in a coma but still exhibit spontaneous respiration; one who is brain-dead by definition cannot do so. Just mentioning it because this page on vegitative states says that patients in a coma are unable to breathe on their own.
 * Depends on the definition. If the cortex and much of the brainstem are dead but the medulla oblongata is still being perfused, it is possible to be simultaneously braindead and breathing spontaneously. T@lk  21:08, 25 Jan 2005 (UTC)

Corrections/clarifications
1) Terri Schiavo is not in PVS.

Not even close. Her father described her condition like this:
 * ''Terri laughs, Terri cries, she moves, and she makes child-like attempts at speech with her mother and me.
 * ''Sometimes she will say "Mom" or "Dad" or "yeah" when we ask her a question. When I kiss her hello or goodbye,
 * she looks at me and "puckers up" her lips.

2) Some definitions of PVS say that the patient does NOT experience sleep-wake cycles:
 * http://cancerweb.ncl.ac.uk/cgi-bin/omd?persistent+vegetative+state

So I changed the article to reflect that lack of concensus:


 * "They may experience sleep-wake cycles, or be in a state of chronic wakefulness."

3) Many definitions of PVS mention that the patient is unresponsive to external stimuli:
 * ''Dorland's Illustrated Medical Dictionary Stedman's MSN Encarta

So I added that fact:


 * "They are unresponsive to external stimuli, except, possibly, pain stimuli." NCdave 20:15, 24 Feb 2005 (UTC)

Various court-appointed doctors have ruled that Terri Schiavo is in PVS. Q.v.. This element needs a "dispute" note or, better yet, it should simply state the facts, which are that court-appointd doctors have held her to be in PVS, while her parents seem to dispute this. The above poster clearly has not read the definition of PVS, since he/she claims that the fact that Schiavo laughs, cries, etc., is evidence that she is not in PVS, when in fact these are part of the definition of PVS. Someone from wiki please help this page become NPOV. Tcassedy 03:52, 26 Feb 2005 (UTC)

Terri Schiavo's autopsy found massive and irreversible damage to her brain that was completely consistent with PVS. 73.173.114.38 (talk) 01:05, 19 February 2015 (UTC)

I don't have time to give much info right now, but as a graduating law student who has recently done a semester of Bioethics, I will agree that the current wiki PVS definition seems to be overly slanted towards exactly what folks like Schiavo's parents would have readers learn.

I would also note that I don't think the page even mentioned that some physicians refer to PVS as "permanent" rather than "persistent."

The definition also needs to note that many or most "recoveries" from PVS are probably just the result of misdiagnosis (patient not in PVS to start with) and usually occur within a shorter rather than longer period of time.

I will reasearch this more, but as one of many medical students who have been watching this case... she is not in PVS. She may have a much lower IQ than someone who was not the subject of questionable abuse, but not PVS. Her responces on the television (when you aren't listening to the reporter) are actually to what is going on around her. When someone called her pretty she laughed like a child. The reports of her saying " I want" with a really bad slur *when she was asked what she wanted*. Her responces are not random. If she were a veggie I think this debate would be different. Why her doctor called her this and isn't changing his mind.. why there wasn't more testing to differentiate this more.. why there was no reablilitation.. really weird case. It will be over soon though. By her urine out put.. she dies in the next few days from the lack of water. She may not improve from what damage has been done, but she is still functioning. It is not just wikipedia, but also the medical textbooks that have been refered to that support that the first doctor was incorrect.  can't examine, but can only say what it looks like from TV. She seems to be a misdiagnosis.

hmm
 * I'm sorry, but most of what you have claimed has been debunked by reputable medical practitioners. If you can provide good citations for any of your claims that would be greatly appreciated. --Viriditas  | Talk 02:11, 1 Apr 2005 (UTC)

Content removed
Individuals in persistent vegetative states are often referred to as vegetables, though the term may be considered derogatory.
 * Wikipedia is not a usage guide, or slang and idiom guide. Further, the claim that individuals who are diagnosed as being in a PVS are "often referred to as vegetables" is false. This is a serious encyclopedia article about a topic in neurology, not a childish guide to pejorative slang.  User:63.173.114.141  has failed to provide an authoritative reference for this claim.  A search of PubMed does not turn up any relevant sources. Merriam-Webster's Medline Plus medical dictionary does not support this definition. A search of the article by The Multi-Society Task Force on PVS (1994). "Medical Aspects of the Persistent Vegetative State". New England Journal of Medicine Part 1Part 2 330: 1572-1579, also turns up nothing. --Viriditas  | Talk 03:09, 3 Apr 2005 (UTC)
 * Give me a break! Of course you're not going to find terms like "vegetables" used in medical journals. That doesn't change the fact that it is a very common term used by the man/woman on the street to refer to individuals in PVSes. Restored content. 63.173.114.141 03:33, 3 Apr 2005 (UTC)
 * Give us a break. By your logic vagina article must contain several dozen of its slang synonyms. Mikkalai 05:31, 3 Apr 2005 (UTC)
 * Well, if that's inappropriate for Wikipedia, the end of Vegetable should be edited too.-Grick(talk to me) 06:57, Apr 3, 2005 (UTC)
 * It's not quite the same. An equivalent for Vegetable would be to have a comment like "Kids often refer to them as crap" - it shows another name for a vegetable, and not another meaning for the same word.Hondje 07:07, 3 Apr 2005 (UTC)

I'm not sure if the anon is wrong. The word is used very often in the public discourse (although it seems it ususally does refer to coma), and it would be a shame to remove the reference altogether.

Incidentally, many Wikipedia articles contain interminable lists of slang terms. A brief glance at flatulence, vomiting and Ecstasy (drug) for good examples. I've often wondered if that is not over the top. JFW | T@lk  22:56, 5 Apr 2005 (UTC)
 * I disagree. The word is not exactly used in the medical literature, and as far as public discourse is concerned, in the states at least, it is discouraged.  For example, Al Franken on the radio program, Air America Radio was discussing the Schiavo case a few days ago and almost used the word, but changed it at the last minute to another term.  Can you give me examples of the term being used "very often" in serious public discorse?  Tangentially, I want to point out that according to his edit history, the editor (63.173.114.***) who keeps adding this claim has engaged in edit wars on almost every page he has contributed to on Wikipedia. --Viriditas  | Talk 00:12, 6 Apr 2005 (UTC)
 * Use in public discourse is discouraged? Sure. I don't disagree with that. That's why I've never removed the language (originally added by a different editor) that the term is generally considered derogatory. Edit wars? Anyone who edits politically contentious pages will wind up disagreeing with someone on how something should be worded. Seeking consensus is fine, but sometimes we must Be bold. 63.173.114.141 00:42, 6 Apr 2005 (UTC)
 * Practically every contribution you've made to Wikipedia has been reverted, so that tells me something. Also, you have failed to substantiate your claim in any way.  Where's the evidence? --Viriditas  | Talk 00:52, 6 Apr 2005 (UTC)

I didn't know that; I wasn't judging the book by its cover. Every sensationalist newspaper uses the V-word occasionally in both PVS and coma. JFW | T@lk  00:23, 6 Apr 2005 (UTC)
 * Formal sources seem to avoid the term 1, compared to 2. Still, in informal settings, the term "vegetable" is used quite often. I think this could go either way.-Grick(talk to me) 01:33, Apr 6, 2005 (UTC)
 * The references you posted do not use the term "vegetable". --Viriditas | Talk 05:02, 6 Apr 2005 (UTC)

I think I'll place my comment on the top to make spotting it easier.
 * moved to Content Removed section, as it seems more appropriate.

Hondje, In correcting your big eraser, I did not revert, but, instead, reworded the passage to make it shorter and to the point. In the end, however, your claim that it was a POV (Point of View) is wrong. The edit does not say that Terri was --or was not --in PVS. It simply said that there was a shift in public opinion, and listed documentation to support that. These are the cold, hard facts, not opinions or points of views. Besides, the arguments that Terri WAS in PVS are listed as well, are they not? Lots of documentation is listed, so a little more clarification is not out of order, especially since there was no mention of an actual example, one you could see with your own two-eyes. --GordonWattsDotCom_In_Florida 02:50, 14 May 2005 (UTC)
 * The videos themselves are POV, not pointing out they exist. Sorry for not being clear. The whole reason they're on the internet was to sway people into thinking that Schiavo wasn't in PVS, which makes them rather POV in my opinion.  If you're going to link to them, link to the videos of where she sits there drooling and obviously oblivious to the world as well, so that you're not just using bits that were taken out of context. Additionally, this isn't the Terri Schiavo article, and isn't the appropriate place for these videos. Taking a gander at your website, I get the hopefully incorrect impression that you aren't going to see why they're POV, being a big 'don't pull the tube' guy.  As an aside, IMHO, .wmv is an inappropriate file type for a encyclopedia, since it isn't an open format.  Of course you sometimes can't help it, but it really sucks for those of us who don't use Windows.Hondje 06:00, 14 May 2005 (UTC)


 * I think you're trying to strive for balance in the evidence, Hondje, which is good. Now, your suggestion that such things like videos of Terri belong on the page about Terri makes sense, but you can not completely divorce the issue of PVS from the issue of "Terri," so the reading public needs to know of the full real deal on PVS, and mention of Terri (brief mention) is appropriate. --GordonWattsDotCom_In_Florida 08:53, 15 May 2005 (UTC)
 * That being said, you argue that the videos are "pro-Terri." Yes, I'll agree that they (by themselves) would be "POV," and think your novel suggestion that the drooling hours (if I could get hold of such videos) would be a good balance. However, those vids are not public (as far as I know?). Nonetheless, the fact that the court ruled Terri to be PVS would offer an opposing view, and I would agree that it should be mentioned if the videos are mentioned. --GordonWattsDotCom_In_Florida 08:53, 15 May 2005 (UTC)
 * That looks better now, I don't have a problem, thanks. Hondje 19:09, 15 May 2005 (UTC)


 * You don't like .wmv files? I understand some folk have trouble openeing them, so, I might search the Internet Universe for other types of files if I post them --and I should mention to the reader which types of files are which. Argh! Tedious research and typing, lol... --GordonWattsDotCom_In_Florida 08:53, 15 May 2005 (UTC)
 * Well, gotta make do with what you can - we live in a Microsoft world. Maybe someday I'll write up a bot to download all the .wmvs and other closed formats, and convert them to something Free. Hondje 19:09, 15 May 2005 (UTC)

From Jennett, of Jennett and Plum who coined the term "Persistent Vegetative State"


 * Bryan Jennett "The Vegetative State", Cambridge University Press (2002) --


 * "(In the Oxford English Dictionary) 'vegetative' is used to describe 'an organic body capable of growth and development but devoid of sensation and thought." ... "Some commentators, including the Pro-Life Committee of Catholic Bishops in the US, have expressed concern that the word vegetative can suggest that the patient is a vegetable and therefore subhuman, and they have urged the medical profession to seek a less discriminatory and demeaning alternative."

The term obviously is offensive to some people, and understandably so, even though Jennett thought the root source was logical when he coined the term. There has been controversy over the word "niggardly". People have taken great offense at times, but the word is benign. Still, anyone can understand what the problem is. Maybe a solution here is to quote from Jennett's book to show even he recognizes there is a controversy. After all, PVS was his idea. Tropix 05:08, 2005 Apr 17 (UTC)


 * That seems fairly reasonable, though compromising with blantent trolls runs contrary to instinct. Thanks for your contribution to the page, but make sure to use the 'show preview' button before commiting changes - it makes edits easier to follow. :) Hondje 06:24, 17 Apr 2005 (UTC)

"Some authorities hold that PVS is, in fact, irreversible, and that the reportedly recovered patients were not suffering from true PVS.

Some authorities hold that PVS is irreversible and that the case reports of recoveries were misdiagnosed and not true cases of PVS.

Organization in brevity - looks cleaner to me, but it is trivial.

Regarding use of vegetable, I applaud the decision to block its use. Please guard against using emotionally laden terms, for they may form the foundation for ad populum and ad misericordiam fallacies."
 * I moved this here from the actual article. This seems like talkpage material, anyway. MSDOJD, you can move it back if you would please adapt it to be appropriate for the article, somehow. Thanks, Apol0gies 17:06, 14 Apr 2005 (UTC)

Section added
I moved a paragraph from the Terri Schiavo page to the PVS article, as it was not about Schiavo at all, just about PVS. Please review if you can. Proto 13:34, 3 May 2005 (UTC)

Legal and medical definitions

 * "Persistent vegetative state" means a permanent and irreversible condition (Florida law)

This means that the US state of Florida has defined PVS as permanent and irreversible. This would seem to lead to some interesting conclusions:
 * 1) The law could be wrong. PVS might, in rare cases be reversible.
 * 2) The law could be right. In that case, anyone diagnosed with PVS who nonetheless recovers, was misdiagnosed. -- Uncle Ed (talk) 22:44, Jun 17, 2005 (UTC)

My suggestion
Instead of the perplexing dichotomy above, how about describing it like this:
 * Some people fall into a vegetative state which persists indefinitely.
 * Doctors generally regard this syndrome as incurable.
 * In a few cases, vegetative patients have recovered - althought this is exceedingly rare.

This separates the legal issues arising from the medical diagnosis, which is after all little more than the observation that the patient is in a coma and they can't wake her up.

A doctor may issue a prognosis, e.g., "I don't think she'll ever recover."

A jurisdiction (such as a US state) may then create a law which provides that patients diagnosed with incurable PVS (a) must be kept alive; or (b) may be kept alive if someone wants to pay for their care; or (c) shall not be kept alive, unless their legal guardian demands it, a living will exists, next of kin say so, etc.; or (d) shall always be euthanized.

Let's see if this perspective helps us sort out and describe the POVs expressed about the Terri Schiavo case. -- Uncle Ed (talk) 22:58, Jun 17, 2005 (UTC)

Clarifications needed
The article says:
 * There is controversy in both the medical and legal fields as to whether this condition is irreversible.

This article does not present very much scientific evidence suggesting it is reversible. Either add to this article information on PVS' reversibility or take out this sentence about controversy.

This article says:
 * Some authorities hold that PVS is, in fact, irreversible, and that the reportedly recovered patients were not suffering from true PVS.

Who are they? what are their credentials? and what studies have been done? if these questions i've just asked cannot be answered, this sentence needs to be axed from the article. Wikipedia cannot have articles that say "some authorities hold" without saying who and how. Kingturtle 04:59, 8 September 2005 (UTC)

Pill found that may effect PVS
There is an interesting article here ( http://news.bbc.co.uk/1/hi/health/5008744.stm ) that perhaps can be mentioned in this entry.. 12:37, 24 May 2006 (UTC)

Ran across another article, this one in The Guardian, which describes people who recover from PVS after taking zolpidem. However, I'm not nearly so sure of my paraphrasing skills/medical knowledge to try to add it to the article. Additionally, I can't find too many news articles at a first glance on Google News (the links it gives me are the Free Internet Press and the UK's Daily Mail), so I figure I'll leave the article-editing to people who have a better idea of what's going on than I do. magistrate 03:39, 17 September 2006 (UTC)

Added a bit in the Zolpidem section, summarizing the results of the only other published (in PubMed) article on zolpidem in PVS. I'm not sure how to make the footnotes work, however, so if someone could fix that it woiuld be nice. I did add the article in the references, and placed a note in the text for where the footnote should go. Jes roo (talk) 19:08, 3 January 2008 (UTC)

Only known incurable illness?
>"although it is widely accepted as the only known incurable illness in the world," from introduction. What about HIV, or hepatitis? I'm almost positive that there are a host of other "incurable illnesses." Any comments or citations? I'm planning to remove this in a few hours. Icewolf34 15:33, 14 August 2006 (UTC)
 * I agree. Get rid of that line. -Unsigned

"only uncurable illness" was removed
PVS is clearly not the only uncurable illness. ALS, MS, AIDS have no known cure. There are treatments to slow these diseases, however, there is no definitive cure for ALS, MS, AIDS and others.
 * I imagine the author was thinking of "irreversible" and "no future cure" rather than "presently incurable." Please sign your posts. - Cyborg Ninja 04:40, 2 October 2007 (UTC)

"Cortical Death" ??? Please cite and expand
I would like to see some citations to the statement "PVS is also known as cortical death"

If this is an up and coming term, I don't mind it being included in the article, but I think readers such as myself should be given citations so we can see who the advocates of this new terminology are.

In my opinion, "vegetative" is already terribly pejorative and undermines the perception of the patient as ... well, a patient...a human being worthy of being treated with dignity. I think the label "cortical death" is just another way of further advancing the presumption that the patient is "essentially dead" and can therefore be treated as dead. I suspect advocates of this term are looking to lay the ground work for organ harvesting of this new class of "brain dead" patients. So, while they are free to use this term, I'd like to see who the advocates of this terminology are.

If there are no cites to medical journals in favor of this terminology, it should be removed on the premise that it is just some wikipedia contributor's invention.

As an aside, as recent MRI research has shown that PVS patients do have cortical activity in response to verbal suggestions, the term "cortical death" is clearly not derived from evidence based medicine. It instead just codifies certain presumptions. See Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science. 2006 Sep 8;313(5792):1402.

75.41.212.179 20:21, 9 November 2006 (UTC) Dave 11/9/06


 * Cortical death means the cerebral cortex no longer functions, regardless of whether the brainstem has function. The cerebral cortex is to do with higher control (i.e. "thought") and the brainstem is more to do with transduction of higher signals to/from physical outputs/inputs and control over involuntary actions (heart beating, breathing). So (cerebral) cortical death will mean the body still keeps itself alive, but there are no thoughts or mind remaining. Cortical death will result in a vegetative state that persits (permenantly).


 * However, I would say that cortical death and PVS are NOT synonymous. If the cortex is truely dead, there can be no recovery. Also, although in most of the world death is defined by brainstem death, in some countries (of which I believe USA is one), death is defined by cortical death. Death is not the same as PVS, therefore PVS cannot be the same as cortical death. I have read that the majority of coma is as a result of malfunction of the circuitry controling sleep and wakefulness; meaning the person simply cannot switch back to wakefulness. This is NOT cortical death and this is something patients CAN recover from. I assume cortical death and PVS would look different on an EEG, although i have not seen either first hand.


 * "Vegetative" in medical terminology isn't to compare the patient to a vegetable, the words are just from the same root, so are similar. --KX36 18:16, 14 March 2007 (UTC)

Definition
The medical definition is worded as follows: Any person with an illness that is not able to function properly without artificial help.

This poorly worded definition reads like PVS is a type of person.

Also, it seems to be far too broad. Would someone with a pacemaker, for example, qualify to be in a PVS? 206.53.197.24 (talk) 23:35, 11 January 2009 (UTC)

Removed template:death
Yeah. all those death topics in the "other" row- genocide, suicide, human sacrifice. maybe I'm not viewing this whole thing properly, but it seems weird to connect them all with this page. anyone have any thoughts? Headlikeawhole (talk) 03:11, 16 January 2009 (UTC)

Christian bioethics
I found this interesting letter by John Paul II about the vegetative state. It would be interesting if we could quote it in an independent section about bioethics and religion. ADM (talk) 07:03, 17 April 2009 (UTC)

Remove "contradictory" tag? I clarified classification section vis a vis "persistent" v "permanent" states as country-dependent usage
Please let me know what you think about the edits. I explained how "persistent vegetative state" is used in the US (and I believe elsewhere), and then how the UK recommends a different system with "continuous" and "permanent", the latter of which has presents a legal presumption of medical "impossibility" in the UK court process. I also clarified what was previously called "legal/ethical definitions" (now legal/ethical issues) by qualifying that PVS is recognized as "death" in "no legal system", since readers may infer this means ending life support is impossible. There is not yet a statutory process for declaring the authoritative medical opinion that recovery of cognitive functions is impossible for PVS cases like there is for brain death. However, as we know the court system does grant petitions, after varying degrees of effort and controversy, to the same end.

If anyone seconds this opinion that the "contradictory definition" tag can be removed, I'll take it down. Also, if someone could fix my references to ensure they are formatted correctly, that'd be great since I'm new to Wikipedia editing and haven't a moment more to work on this for now. Thanks and I look forward to comments. Wilytilt (talk) 18:18, 29 October 2009 (UTC)

Disambiguation of "residual"
This page links to residual, a disambiguation page. Whether it should say residual should be thought about. Michael Hardy (talk) 20:27, 5 May 2011 (UTC)

Co-administration of Lithium to facilitate neurogenesis
Anecdotal evidence suggests that long term co-administration of Lithium Carbonate may restore regions of the brain which are intermittently activated by zolpidem, and possibly other drugs. More research is needed, however the presumption is that Lithium is increasing neurotrophins, which in turn facilitate neurogenesis and neuroregeneration in these areas. — Preceding unsigned comment added by 173.24.169.239 (talk) 03:11, 11 August 2013 (UTC)

Longest documented case of PVS
In the section "Notable PVS Patients", it says: The longest documented case of survival in a persistent vegetative state was Elaine Esposito, who remained PVS for thirty-seven years and 111 days from 1941 to 1978.

However, in the list (just above the statement) is a link to Aruna Shanbaug who is still in a vegetative state after 40 years.

Shouldn't the line about the "longest documented case" be changed? Or are these two different scenarios (I can't see how or why).

Kuncherto (talk) 02:34, 23 January 2014 (UTC)

New study
A new PET study was recently published; might update some info on that technique in the article. -- Beland (talk) 01:46, 12 June 2016 (UTC)

Restored material
I restored material regarding case studies of treatments that showed promise based on peer reviewed medical articles from around 2009---hardly "dated." This material was in the article for several years until it was wholesale removed, without discussion or consensus in Nov 2014. I believe it is important to keep this material in the article to give references that will help people researching this topic. If there is a desire to avoid these references as being presented as "treatment recommendations" -- which is a fair concern -- they could be put into a new section, called something like "Case studies of unverified treatments." Bottom line: there is no proven treatment that works for every case or even most cases. But the peer reviewed research that has been done deserves a place in the article.97.91.202.83 (talk) 15:39, 30 November 2016 (UTC)