New England Journal of Medicine Reopens Old Wounds on Brain Death

[Pangloss]

http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html?mod=googlenews_wsj

 

Apparently some patients aren't as brain-dead as they appear. Certain kinds of questioning produce a result that appears to be cognitive in nature. The point from researchers appears to be not that there's no such thing as a persistent vegetative state, but that as many as 40% may be misdiagnosed.

 

That doesn't mean they're about to get up and walk out the hospital, it just means that they may be slightly more cognitive than previously thought. These patients were still unable to speak or communicate in any way short of something that can be detected only by an active MRI scan. (ouch)

 

Still, it raises some interesting questions and suggests interesting future lines of research. It also has legal and socio-political implications, suggesting that this type of test be conducted before life termination could be considered.

 

I'm just waiting for someone in the media or a right-wing pundit to bring up Terri Schiavo. That will be unpleasant, but given her tissue-loss situation it seems unlikely that she would have fallen into that category.

[Mokele]

Not to be callous, but to add another wrinkle to this situation: Chronic care for those who, regardless of mental state, are in a prolonged state of physical non-responsiveness, is tremendously expensive (which can place a huge burden on the family). fMRI machines are not exactly free in a box of Wheaties, nor are they exactly portable, nor are there many people who are knowledgeable enough to interpret it correctly.

 

So, where does this leave a family with no medical insurance, a kid in a comatose state due to a car wreck, and at a hospital in Nowheresville that's many, many hours from the nearest fMRI? Will they just have to risk it? Will there be legal rules that *prevent* them from pulling the plug, even if all other tests show no sign of brain activity? Are we going to have to funnel every comatose patient in the nation/world through the handful of these machines that exist?