DQ 7-2
Responses 7-2
1.
“A coma is a state in which the cortex or higher brain areas of a person are damaged resulting in loss of consciousness, inability to be roused, and unresponsiveness to pain, sound, touch and light." This type of damage can be reversible or irreversible and can be caused by things such as trauma to the brain, lack of oxygen to the brain, or stoke caused by bleeding or clots. (Arenella, 2019).
“A vegetative state exists when a person is able to be awake, but is totally unaware. A person in a vegetative state can no longer ‘think’, reason, relate meaningfully with his/her environment, recognize the presence of loved ones, or ‘feel’ emotions or discomfort” (Arenella, 2019). End stage dementia can progress into a vegetative state, as can someone who is in a coma.
“The recovery rate is very dependent upon the cause of the coma/Persistent Vegetative State (PVS), whether the cause is reversible or not, the amount of damage to the brain, the region of the brain that is damaged, and the amount of time that the person is in a comp or a PVS. When the cause of a coma is corrected before permanent brain damage occurs, the coma generally reverses within days” (Arenella, 2019). The statistics of comas and PSV’s reversing and the patient recovering, doesn't make it easier for a family to decide what do in a situation regarding their loved one. It’s hard to let go of anyone we love, however, we need to look at the big and overall picture. In many cases, we know that our loved ones wouldn't want to live in a coma or a vegetative state. They can’t feel anything or do anything. A person on PVS does have sleep-wake cycles and can cough, sneeze and smile. “However, all of these types of movements are automatic behaviors that do not require any functioning of the thinking part of the brain” (Arenella, 2019). This can be confusing and conflicting for loved ones who aren't ready to give up. If we know that a loved one who is in a coma or PSV wouldn't want to live this way, then we need to set aside our own sorrows and let that person move on peacefully. It would be even better if the patient had a living will that stated this information as we would have solid proof that this person felt strongly enough about it that they put it into writing and noted that they didn't want to live this way.
"A person in profound coma or suffering from a PVS is unable to experience hunger, thirst or pain. In a person in deep coma or a PVS, the cortex does not function. Therefore, this person would not suffer due to lack of artificial tube feedings” (Arenella, 2019). This should give the family some relief knowing that if they decide to stop all artificial life saving measures, there loved one isn't hurting and won’t feel any pain.
Reference: Arenella, C. Coma and persistent vegetative state: an exploration of terms. Retrieved from: https://americanhospice.org/caregiving/coma-and-persistent-vegetative-state-an-exploration-of-terms/on May 2, 2019.
2.
Coma is where the cortex of the brain is damaged and results in a loss of consciousness, the patient will be unable to be roused, has no response to pain, sound, touch, or light. If lower brain areas are also damaged the patient may need a respirator to breathe. The damage could be reversable or irreversible. A vegetative state is where the higher levels of the brain are no longer functional. When a patient is in a vegetative state they can be awake but unaware. They are not able to think, reason, relate meaningfully with their environment, recognize people, and feel any emotions or discomfort. Both coma or patients in a vegetative state are chair or bed-bound and completely dependent on all care including feeding, drinking, they cannot speak and have no urine or bowel controls. If the vegetative state lasts longer than four weeks, it is considered a persistent vegetative state (Arenella, n.d.). According to Dr. Fred Plum, the definition of the term persistent vegetative state is where “the body functions entirely in terms of its internal controls. It maintains temperature. It maintains digestive activity. It maintains heart beat and pulmonary ventilation. It maintains reflex activity of muscles and nerves for low-level conditioned responses. But there is no behavioral evidence of either self-awareness or awareness of the surroundings in a learned manner” (Pozgar, 2016).
Modern medicine has allowed the capability to sustain vegetative functions of patients that are in irreversible comas and medical equipment can sustain heartbeat and respiration. Appeals courts recognize that irreversible cessation of brain function constitutes death, and ethicists believe “where death is imminent and inevitable, it is permissible to forgo treatments that would only provide a precarious and painful prolongation of life, as long as the normal care due to the sick person in similar cases is not interrupted” (Pozgar, 2016). A patient that has a permanently nonfunctioning brain is considered to be in an irreversible coma or brain dead. This is determined if the patient shows no awareness or is unresponsive to external stimuli, no movement or breathing, and no reflexes.
Courts will honor an individual’s desire to refuse extraordinary medical care and that a third party may not exercise judgement on behalf of the patient if the patient is unable to express their desire to decline treatment. In order for a court to determine the existence of a patient’s intention to reject the prolonging of life by artificial means include statements regarding the individual’s beliefs, the commitment to those beliefs, the seriousness with which the statements were made, and any interferences that could have surrounded the circumstances (Pozgar, 2016). The importance of a patients living will help determine outcomes and the ethical choices family members are faced with making. It is important for family to know the differences between persistent vegetative state and a coma because unlike a coma, a patient that is in a PVS will have sleep-wake cycles, they can cough or sneeze, cry or smile, move their arms or legs, have reactions to touch, sound and light. Their eyes may move and stop randomly and may appear to be staring in the direction of someone which could be misinterpreted by a family member as a responsive behavior. They can be confusing for loved ones giving them the impression that the patient is aware but unable to communicate but these are all automatic behaviors and do not require the thinking part of the brain (Arenella, n.d.).
Arenella, C. Coma and Persistent Vegetative State: An Exploration of Terms. Retrieved from https://americanhospice.org/caregiving/coma-and-persistent-vegetative-state-an-exploration-of-terms/
Pozgar, G.D. & Santucci, N.M. (2016). Legal Aspects of Health Care Administration (12th ed.). Burlington, MA: Jones & Bartlett Learning.
3.
COMA is a condition which in person has suffered brain injury which will leave the person with no consciousness at all or with very limited consciousness. People in a coma are completely unresponsive. They do not move, do not react to light or sound and cannot feel pain. Their eyes are closed. The brain responds to extreme trauma by effectively shutting down. It’s very unusual for a coma to last more than a few weeks at most. After a few days or weeks in a coma a person who does not die usually ‘wakes up’ in the sense that their eyes open. If they have only been in a coma for a few days, they may ‘wake up’ to full consciousness with relatively little damage. If the person has very severe brain injuries though, they may move from coma into a vegetative or minimally conscious state (Healthcare, 2017).
Coma is a state in which the cortex or higher brain areas of a person are damaged resulting in loss of consciousness, inability to be roused, and unresponsiveness to pain, sound, touch and light. If lower brain centers are damaged, a respirator may be required for the person to breathe. The damage may be reversible or irreversible Just like Terri Schiavo (Ditto, 206).
VEGETATIVE STATE the person is still unconscious. They have no awareness of themselves or their environment. They may move parts of their body, but this movement is not voluntary. Movements can include grinding their teeth, thrashing, and facial movements such as grimacing, yawning or smiling. They might jerk as a reflex response to loud noises or move a hand away from a source of pain. They may produce sounds (grunting or moaning) or even occasional words.
A vegetative state exists when a person is able to be awake but is totally unaware. A person in a vegetative state can no longer “think,” reason, relate meaningfully with his/her environment, recognize the presence of loved ones, or “feel” emotions or discomfort. The higher levels of the brain are no longer functional. A vegetative state is called “persistent” if it lasts for more than four weeks.
The main difference between ‘coma’ and the ‘vegetative state’ is that at some point the person’s eyes will be open and there will be times when they seem to be ‘awake’. A patient with a coma should last less than three weeks. It becomes very difficult for family to decide what to do when they have a love one in either to of the two stages. It is very difficult to see a love one in such situation but at times the right decision needs to be made in order for the patient and everyone else. If the person comes out of the coma stage, what is it to say that they come out of it 100% the same and if they come out of PSV, who is to say that the family will be able and capable to deal on what stage the person is in. Some patients will rise to take care of a person that comes out of both coma and vegetative state. But who is to say that this is what the patient wanted? I know for myself; I wouldn’t want for my love ones to put their life on hold to take care of me. I would want for them to let me go peacefully while I’m not feeling any pain rather than to have them take care of me and try to help me try to become independent of myself again. Unless they there is a 75% and up that I will be able to over come the situation and be able to function on my own again.
Ditto, P. H. (206). What Would Terri Want? On the Psychological Challenges of Surrogate Decision Making. Retrieved from https://eds-b-ebscohost-com.lopes.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=f3c29da2-16bd-4bc5-ac82-f418358c2f42%40sessionmgr101