Maria Korp may get more time to improve before treatment is declared futile
There seems to be hope that Maria Korp (whom I wrote about in an earlier post), a victim of attempted murder diagnosed as being in a PVS (Persistent Vegetative State), may get a longer chance to live.
She may have 12 months for a chance to show improvement before a judgement is made about whether treatment would be "futile" or not and her diagnosis is changed to Permanent Vegetative State, at which point her court-appointed guardian will have to decide whether to let her live or withold treatment to bring about her death. Maria Korp's doctors had said they would be making that judgement and changing her diagnosis to permanent after 3 months, but other physicians are arguing that 3 months is not long enough and called the 3-month standard "archaic", pointing to more recent standards published in 2003:
National Health and Medical Research Council guidelines, introduced in December 2003, say patients in a persistent vegetative state -- such as Mrs Korp -- should be monitored for 12 months.
Melbourne bio-ethicist Dr Nick Tonti-Filippini said the guidelines provided the best standard for such patients.
Those standards suggest patients should be observed for six to 12 months, before a persistent state is revised to a permanent state.
Decisions about whether to stop treatment are normally made when a permanent state is declared. The guidelines also say "vegetative state" should be changed to "post-coma unresponsiveness".
Maria Korp's doctors at The Alfred hospital have said she would be classified as permanently vegetative after only three months.
But Dr Tonti-Filippini said this was "archaic". "It's not up to date," he said.
The entire article can be found here.
The British Medical Association says, "Current methods of diagnosing pvs cannot be regarded as infallible. Before a pvs diagnosis is made, all appropriate clinical steps must be taken to eliminate other possibilities and clinicians must be aware of the dangers of prematurely diagnosing the patient's condition as "permanent". The BMA has consistently recommended that the diagnosis of irreversible pvs should not be considered confirmed (and therefore treatment not be withdrawn) until the patient has been insentient for 12 months. The Association recognises that distinction can be drawn between different categories of pvs patient depending on factors such as the patient's age and the manner in which the damage to the brain occurred. For some categories, pvs can be diagnosed with considerable certainty within three months. The BMA, however, recommends that decisions to withdraw treatment should only be considered when the patient has been insentient for 12 months. The BMA believes that the minimum 12 month period currently provides an essential safety net.
The BMA recommends that the diagnosing clinician should seek views from two other doctors, one of whom should be a neurologist. In any case of doubt as to whether the patient's condition is irreversible, decisions about possible withdrawal of medical treatment must be deferred."
Since there are concerns about the common misdiagnosis of PVS and because patients have been known to recover after more than a year in a PVS, I would agree with the argument for getting rid of the term "Permanent Vegetative State" altogether--a suggestion that has also been made by a number of other organizations and physicians.
Here is an article on the problems with a diagnosis of Permanent Vegetative State:
THE PERMANENT VEGETATIVE STATE; ETHICAL CRUX, MEDICAL FICTION?
By Chris Borthwick, published in Issues in Law and Medicine, 1996
You can find several more articles by Borthwick about PVS here: http://home.vicnet.net.au/~borth/PVS.htm
She may have 12 months for a chance to show improvement before a judgement is made about whether treatment would be "futile" or not and her diagnosis is changed to Permanent Vegetative State, at which point her court-appointed guardian will have to decide whether to let her live or withold treatment to bring about her death. Maria Korp's doctors had said they would be making that judgement and changing her diagnosis to permanent after 3 months, but other physicians are arguing that 3 months is not long enough and called the 3-month standard "archaic", pointing to more recent standards published in 2003:
National Health and Medical Research Council guidelines, introduced in December 2003, say patients in a persistent vegetative state -- such as Mrs Korp -- should be monitored for 12 months.
Melbourne bio-ethicist Dr Nick Tonti-Filippini said the guidelines provided the best standard for such patients.
Those standards suggest patients should be observed for six to 12 months, before a persistent state is revised to a permanent state.
Decisions about whether to stop treatment are normally made when a permanent state is declared. The guidelines also say "vegetative state" should be changed to "post-coma unresponsiveness".
Maria Korp's doctors at The Alfred hospital have said she would be classified as permanently vegetative after only three months.
But Dr Tonti-Filippini said this was "archaic". "It's not up to date," he said.
The entire article can be found here.
The British Medical Association says, "Current methods of diagnosing pvs cannot be regarded as infallible. Before a pvs diagnosis is made, all appropriate clinical steps must be taken to eliminate other possibilities and clinicians must be aware of the dangers of prematurely diagnosing the patient's condition as "permanent". The BMA has consistently recommended that the diagnosis of irreversible pvs should not be considered confirmed (and therefore treatment not be withdrawn) until the patient has been insentient for 12 months. The Association recognises that distinction can be drawn between different categories of pvs patient depending on factors such as the patient's age and the manner in which the damage to the brain occurred. For some categories, pvs can be diagnosed with considerable certainty within three months. The BMA, however, recommends that decisions to withdraw treatment should only be considered when the patient has been insentient for 12 months. The BMA believes that the minimum 12 month period currently provides an essential safety net.
The BMA recommends that the diagnosing clinician should seek views from two other doctors, one of whom should be a neurologist. In any case of doubt as to whether the patient's condition is irreversible, decisions about possible withdrawal of medical treatment must be deferred."
Since there are concerns about the common misdiagnosis of PVS and because patients have been known to recover after more than a year in a PVS, I would agree with the argument for getting rid of the term "Permanent Vegetative State" altogether--a suggestion that has also been made by a number of other organizations and physicians.
Here is an article on the problems with a diagnosis of Permanent Vegetative State:
THE PERMANENT VEGETATIVE STATE; ETHICAL CRUX, MEDICAL FICTION?
By Chris Borthwick, published in Issues in Law and Medicine, 1996
You can find several more articles by Borthwick about PVS here: http://home.vicnet.net.au/~borth/PVS.htm
Copyright 2009. All rights reserved.
Posted by purple_kangaroo at 11:24 PM[Permanent link]
2 Comments:
Very good point. PVS is not a disease, but rather a collection of characteristics that can result from many different causes, including disease or injury.
I agree that it is inappropriate to talk about a persistent vegetative state. I think that it is probable that Maria's condition continues to be very serious, and she is in a far worse condition than Terri, or at least that is what is suggested by the news reports and even the guardianship case.
PVS has a connotation that I dislike and I agree that we should not call it a diagnosis but a symptom of a condition, in this case that of severe brain injury.
BTW, my uncle recovered from a severe brain injury up to a point. He now has alzheimer's disease and could not come to my sister's funeral
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