Persistent Vegetative States: Legal and Political Ramifications

Law_Politics.jpgOne controversial area where the brain, politics, and law collide is in cases where people suffer severe brain damage and are in a persistent vegetative state (this is more accurately termed complete vegetative state). In this state, the higher cortical functions of the brain are essentially wiped out. The person’s brain stem is often still intact so breathing, swallowing, eye-blink, and other basic functions still can occur. However, without the neocortex (cortex that is not brainstem), the person cannot really see, hear, speak, or think.

People in persistent vegetative states usually cannot survive on their own and have to have a feeding tube. They do not, usually, have to be on full life support because the brainstem is intact. This differs from brain death (not technically a medical term — it’s a legal term) where the brain and brainstem also have no activity; people in this state have to be on full life support. While many people can spontaneously recover from a persistent vegetative state, it is possible that those who do so were misdiagnosed to start.

TreePolitics comes into play because some people clash over how to deal with people in persistent vegetative states. In 2005 the Terri Schiavo case brought national media attention to this condition. Terri’s husband finally prevailed and Terri’s feeding tube was removed. She died within two weeks. A CT scan of hers is readily available online. It shows considerably enlarged lateral ventricles and marked cortical atrophy. Her pathology report indicated severe loss of cortical neurons in nearly every part of the cortex. There was no chance that she could ever recover functioning.

Ms. Schiavo had been in the vegetative state for 15 years at the time of her death. Some people still consider her death a court-sanctioned murder (these generally are people without any knowledge of the functioning of the brain). Her brain was in such poor condition that it was likely very similar to what would happen if all the white matter connecting brain regions together was severed and most cortical and many subcortical neurons destroyed, leaving her brainstem mostly intact. The political-legal conflict occurred in part because her parents kept hoping beyond hope for a miracle while her husband stated that Terri wouldn’t want to live how she was living.

Again, my belief is that people who spontaneously recover from persistent vegetative states were misdiagnosed to begin with. In any case, as time goes on recovery from a vegetative state becomes more unlikely with greater cognitive deficits. Schiavo was in a state where even if she had recovered she would have had very little cognitive abilities. One of the positive outcomes of Schiavo’s case was the scrutiny of vegetative states, with neurologists seeking for clearer definitions and more sensitive tests.

Jared Tanner, PhD

Jared Tanner has a Ph.D. in clinical psychology with an emphasis in neuropsychology. His interests are mainly neuroimaging and neuroanatomy. He spends his research time looking at the structure of gray and white matter in the brains of people with Alzheimer's disease and Parkinson's disease. With a focus on neuropsychology, he is also interested in how normal and abnormal brain structure relates to cognitive and behavioral functioning.
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