When Enough is Enough

As technology continues to advance, people are becoming more and more reluctant to believe that Persistent Vegetative State (PVS) is irreversible and are therefore more willing to hold on longer to their loved ones. Brain imaging allows physicians to see the structure and function of the brain as well assist them in locating areas of the brain that have been affected by neurological disorders, and to find new treatments for these disorders. It is brain imaging that aids the physician in determining whether a patient is in PVS as opposed to a coma.

Even through the use of brain imaging, achieving 100% accuracy on a diagnosis of a mental state is not feasible. I believe that it is the margin of error that gives people hope that maybe something was overlooked. That like Kate Adamson, their loved one is in a “locked in state” as opposed to PVS and that they too will come back to life.

As hopeful as this all sounds, the question that comes to mind is how much is enough? If a person has been diagnosed with PVS and has been in this mental state for the last seven years, at what point do doctors refrain from administering brain-imaging tests? At what point is the feeding tube removed? How many times do we need to confirm that this patient is “brain dead”? An advocate for the patient may say that doctors and hospitals are to do whatever it takes. If you ask a detached taxpayer, they may say that it has been seven years and enough is enough.

Economics play a large role in this debate. The family wants the medical professionals to do anything and everything possible to keep their loved one alive, but the question must be asked, who is paying for these 10 years of medical services? There is no doubt that the medical technology keeping the patient alive is expensive. So who fits the bill? Another issue is whether or not the resources are being used adequately. America has been in a healthcare crisis for some time now, where people are not able to receive standard medical care because there is not enough money in the health care system. Is it fair to allocate scarce resources in this manner? Is this patient with PVS merely occupying a hospital bed that could have been used for a patient with a better quality of life?

I am not sure if there will ever be a clear and cut answer to these questions. It is a sensitive topic that involves life and death. Some would argue that the patient is already legally dead, while others would argue that the patient is very much alive and are just “trapped”. Regardless of whether or not one believes that the patient in PVS is dead or alive, there needs to be some sort of finality. One would think that the final answer was when a physician declares the patient legally dead by way of brain death, however time and time again we see that this in fact is not the final answer. If this is not the answer than what is? When is enough actually enough?

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