End of Life
March 31, 2009
Persistent Vegetative State
 “People diagnosed with PVS have damaged or
dysfunctional cerebral hemispheres, and this results in
their not being aware of themselves or their surroundings.
They are incapable of thinking and of deliberate or
intentional movement.”
 Brainstem is preserved
 “Persistent” after four weeks; if no change after three
months, unlikely to recover
 Breathe
 Excrete
 Hearts beat
 Muscles move (reflex)
 Sleep-wake patterns
 Eyelids blink and Eye move, but no vision
 Smile (reflex)
 Tears (reflex)
-Munson, Ronald, ed. Interventions and Reflections. p. 676.
Minimally Conscious State
Show some awareness
Awake
Minimal responsiveness
Greater activity in cerebral cortex than
that of PVS
“…demonstrate one or more of four
types of behaviors on a reproducible or
sustained basis: following simple
commands; gestural or verbal yes/no
responses; intelligible verbalization;
and purposeful (as opposed to
reflexive) behavior.” -Eisenberg
Locked-in Syndrome
 “Locked-in syndrome is a rare neurological disorder
characterized by complete paralysis of voluntary muscles
in all parts of the body except for those that control eye
movement. It may result from traumatic brain injury,
diseases of the circulatory system, diseases that destroy
the myelin sheath surrounding nerve cells, or medication
overdose. Individuals with locked-in syndrome are
conscious and can think and reason, but are unable to
speak or move. The disorder leaves individuals completely
mute and paralyzed. Communication may be possible with
blinking eye movements”
 http://www.ninds.nih.gov/disorders/lockedinsyndrome/lock
edinsyndrome.htm
What can brain scans tell us?
 Images
 Video
Four concepts of Death
1.
Traditional: no longer breathing and heart is not
beating (“cardiopulmonary”)
2. Whole-brain: irreversible cessation of brain function
(no electrical activity, no brain stem function)
3. Higher-brain: permanent loss of consciousness; brain
stem continues to regulate breathing and heartbeat
4. Personhood: individual ceases to be a person (usually
includes criteria such as reasoning, remembering,
emotional response, sense of the future, interacting,
etc.)
Munson, Ronald, ed. Interventions and Reflections. P. 684685.
What counts as humanity?
1.
2.
3.
4.
5.
“Consciousness (of objects and events external
and/or internal to the being), and in particular the
capacity to feel pain”
“reasoning (the developed capacity to solve new
and relatively complex problems)”
“Self-motivated activity (activity which is relatively
independent of either genetic or direct external
control)”
“the capacity to communicate, by whatever means,
messages of an indefinite variety of types, that is,
not just with an indefinite number of possible
contents, but on indefinitely many possible topics”
The presence of self-concepts, and self-awareness,
either individual or racial, or both”
-Warren, Mary Anne. “On the Moral and Legal
Status of Abortion.” Intervention and Reflection.
Ronald Munson, ed. p. 591.
Infant “personhood”
Three considerations:
1. How much neurological
development is required for
personhood?
2. How much neurological impairment
is necessary to rule out
personhood?
3. Is any significance to be placed on
the principle of potentiality as it
applies to personhood?
-Weir, Robert. “Life-and-Death Decisions in the Midst
of Uncertainty.” Interventions and Reflections.
Ronald Munson, ed. p. 651.
Patient’s Best Interests
Standards
1.
2.
3.
4.
5.
6.
7.
8.
Severity of the patient’s medical condition
Availability of curative or corrective
treatment
Achievability of important medical goals
Presence of serious neurological impairments
Extent of the infant’s suffering
Multiplicity of other serious medical problems
Life expectancy of the infant
Proportionality of treatment-related benefits
and burdens to the infant
-Weir, Robert. “Life-and-Death Decisions in the Midst of
Uncertainty.” Interventions and Reflections. Ronald
Munson, ed. p. 655.
So how does this compare
to abortions?
“A being who has had experience,
has lived and suffered, who
possesses memories, is more
human than one who has not.
Humanity depends on formation by
experience.”
 Noonan, John T. “An Almost Absolute Value in
History.” Intervention and Reflection. Ronald
Munson, ed. p. 574
Another view…
“Take, for example, the most
common argument. We are asked
to notice that the development of
a human being from conception
through birth into childhood is
continuous…”
 Thomson, Judith Jarvis. “A Defense of Abortion.”
Intervention and Reflection. Ronald Munson, ed. p.
577
fMRI and Terri Schiavo
Help determine diagnosis of PVS
versus MCS instead of just
behavioral diagnosis
Help make end-of-life decisions
Case Presentation- Helga Wanglie
Family vs. Physicians (two groups)
-Define the family’s point of view
and decide what else could support
this opinion
-Define the physician/hospital point
of view and decide what else could
support this opinion
Deep Brain Stimulation
Dr. Nicholas Schiff, Time Article
Banjo Clip