While many medical care professionals are caring, compassionate individuals who diligently care for all patients no matter what their state, utilitarian attitudes continue to creep into the medical culture. Evidence can be found in articles such as, “The undead” from the December 9, 2007 issue of The Sunday Times.

The overarching attitude is that to live in a state of unresponsiveness is a terrible cause of suffering. The author of this article borders on adopting this attitude,

More certain is the grim reality of hospital wards and long-term care homes where the persistently vegetative and the minimally conscious languish, sometimes for decades.

To write this article I have had the sobering experience of witnessing the plight of patients with severely impaired consciousness – the intubations, the double incontinence, the stricken semicircle of wheelchairs parked before the unwatched day-room TV. And I have met the anguished families of those who are denied final grieving and closure for a loved one condemned to what appears a living death. All too often I have spoken to a wife or husband, or mother or father, who will travel anything up to two hours each way by taxi, every day, to spend time with an unresponsive child or spouse.

There is no doubt that an unresponsive state causes suffering for the patient and for the family. However, as I explored most recently in “The Language of the Culture of Death,”, suffering can have great value. The quote above shows how much a patient’s suffering can draw her family toward love.

The article offers anecdotal evidence that unresponsive patients are often neglected. They are given poor care and no therapy. It is almost as if the medical establishment says, “Oh well – he’s not really alive anyway. Let’s not waste our time.”

Up to 12,000 people under 40 in this country suffer traumatic brain injury every year, and there are serious deficiencies in their rehabilitation, according to Professor John Pickard, head of neurosurgery at Addenbrooke’s hospital, Cambridge: “The tendency for patients to be left to languish on general medical, surgical and orthopaedic wards continues to their detriment.” The shocking term being used by campaigning neurologists and neurosurgeons is that unknown numbers of patients are being just “warehoused”.

The depersonalization of these patients is much to their detriment, especially since mounting evidence shows that the assumption that a patient is in a “persistent vegetative state” is often wrong.

The biggest, most tragic clinical myth about brain injury today is that PVS can be reliably diagnosed by bedside observation alone. It has in fact been known for at least a decade, ever since a key survey of brain-injured patients, that misdiagnosis of the condition runs at more than 40%, a statistic originally calculated by Professor Keith Andrews, former head of the Putney hospital, and confirmed by recent surveys in Europe and North America. This means that valuable rehabilitation strategies are routinely neglected, and misdiagnosed patients end up on unsuitable wards or in care homes where their needs are neither understood nor met.

One rehabilitation psychologist pointed out that consciousness needs to be exercised just like a muscle. If a patient is neglected and denied treatment (as was Terri Schiavo, for example), there will be no progress toward awareness. If consciousness is exercised (balanced with periods of rest), consciousness can strengthen. Patients who are neglected due the assumption that their lives are useless are denied this chance.

However, even patients who have no chance for recovery deserve better than they often get. Loss of awareness does not mean loss of human dignity or personhood. Once again we see the weakness of the naturalistic “personal autonomy” ethic that is trying to replace the ethic of human dignity. As the article points out (after a quick anecdote),

Even minimally aware patients can retain emotions, personality, a capacity to suffer – and, as the young biker showed, attitude.

While the main point of this article was to point out that patients are often misdiagnosed with PVS, and that doctors are devising scans that can offer a more accurate diagnosis of the extent of brain damage, the article also brings up the question of the treatment of any unresponsive patient.

The Cambridge project is not, however, without potential ethical and social problems. Scanning for minimal consciousness in those who appear vegetative can in some cases yield ambiguous results. Evident brain reactions can sometimes be fickle: now here, now gone. Some experts worry the technology could have drastic consequences for relatives where there is scant prospect of a patient’s return to interaction. At the Putney hospital, which houses more than 220 brain-injured and neurological patients, I was told by a research psychologist about a patient in a PVS of about three years’ duration, known as Mrs K, whose family might well be devastated if a scan were to reveal indications of awareness.

The main reason for removing nutrition and hydration from unresponsive patients is to release the family from the obligations of love – to “allow them to get on with the grieving process.” However, these people are not in “the dying process.” Their bodies are not shutting down. They are not brain dead (which leads to the failure of bodily functions). They are simply unresponsive. When nutrition and hydration are removed, these patients die of thirst just like any fully responsive person denied of food and water would.

More heinously, the article points out that there is increasing pressure to declare PVS patients dead so that their organs can be harvested. The attitude that feeds this pressure is that their lives are useless, so their death may as well benefit someone who has a chance to live a “real” (productive) life. This is the same attitude that attempts to justify cannibalizing unborn babies to benefit the health of “really living” human beings.

Brain damage that leaves a patient unresponsive causes great suffering from everyone touched by it. We need to decide if that suffering will draw us to love or if we will give in to the philosophy that would devalue our loved ones in their time of greatest need.

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