Persistent Vegetative State and Futility: Should Communication by fMRI Change the Law?
Earlier this month, I discussed Adrian Owen’s research using fMRI scanners to communicate with patients who appeared to be in a Persistent Vegetative State (PVS) . By interpreting brain activity in Canadian PVS and minimally conscious patients, the researchers claim that patients can not only answer questions, but even lay down new memories.
The question of how this new research will affect patients diagnosed with PVS or minimally conscious patients is already being tested in court. Yesterday, the Vancouver Sun reported on the case of Kenny Ng, a minimally conscious patient following a major car crash 7 years ago. Mr. Ng’s wife, Lora, wishes to withdraw hydration and nutrition. According to her lawyers, Doctors advised this course of action shortly after his car accident, but, hoping for an improvement, Mrs Ng had initially refused. After 7 years with no outward signs of improvement, Mrs Ng has asked for nutrition and hydration to be removed, ending his life. However, Mr. Ng’s parents and siblings argue that Owen’s research is “exactly what Kenny has been waiting for over the last seven years”, and that he should be kept alive so he can be assessed for inclusion in Owen’s trials.
If the decision is made in favour of the family, as Thaddeus Pope highlights, it will represent a major change to previous US and Canadian case law.
Owen has made a major scientific breakthrough. However, it is not clear that the discovery of consciousness means that the treatment should not be withdrawn. Paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings.
A more detailed discussion of the ethical issues is available at:
1. Skene, L., Wilkinson, D., Kahane, G., and Savulescu, J. (2009). ‘Neuroimaging and the Withdrawal of Life-Sustaining Treatment from Patients in Vegetative State’. Medical Law Review. 17: 245-261. doi: 10.1093/medlaw/fwp 002 ISSN: 1464-3790
2. Wilkinson, D., Kahane, G., Horne, M., and Savulescu, J., (2009). ‘Functional Neuroimaging and Withdrawal of Life-sustaining Treatment from Vegetative Patients’. Journal of Medical Ethics. 35: 508-511.
3. Wilkinson, D. and Savulescu, J. (2011) ‘Knowing when to stop: futility in the ICU’. Current Opinion in Anaesthesiology April 2011 Vol: 24 (2) pp 160-165
4. Wilkinson, D., Kahane, G., and Savulescu, J., (2008). ‘Neglected Personhood’ and Neglected Questions: Remarks on the Moral Significance of Consciousness’, American Journal of Bioethics. 8:9 31- 33.