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from the pathway-to-freedom-or-fate-worse-than-death? dept.
Surgery to embed a nerve-stimulating implant in a patient in a persistent vegetative state (15 years), resulted in the patient reverting to a "minimally conscious" state.
After lying in a vegetative state for 15 years, a 35-year-old male patient in France appears to have regained minimal consciousness following months of vagus nerve stimulation, researchers report today in Current Biology.
The patient, who suffered severe brain damage in a car crash, had shown no signs of awareness or improvement before. He made no apparent purposeful movements and didn't respond to doctors or family at his bedside. But after researchers surgically implanted a device that stimulates the vagus nerve, quiet areas of his brain began to perk up—as did he.
His eyes turned toward people talking and could follow a moving mirror. He turned his head to follow a speaker moving around his bed. He slowly shook his head when asked. When researchers suddenly drew very close to his face, his eyes widened as if he was surprised or scared. When caregivers played his favorite music, he smiled and shed a tear.
Note that "respond" is on the level of "turning his head when asked, though that took a minute."
A few thoughts on this:
- Medical advances are COOL!
- Hopefully, this advance can help some folks.
- This makes ethical questions concerning patients in persistent vegetative states more urgent:
- (e.g. the question of whether/when to pull the plug has become even more confusing)
- This introduces some new ethical questions:
- Is it ethical to "bring back" someone after 15 years? (the world has changed quite significantly)
- Is it ethical to "bring back" someone to a state where they're might just barely be conscious enough to realise how much their state sucks?
(Score: 3, Interesting) by Grishnakh on Tuesday September 26 2017, @02:13PM (33 children)
I'll answer the ethical questions according to my opinion:
Is it ethical to "bring back" someone after 15 years? (the world has changed quite significantly)
Answer: yes. I would want to be brought back if possible. Sure, a lot has changed in 15 years, but it's not *that* much (not like the past 100 years), mainly new technologies. 15 years ago was only 2002: 9/11 had just happened, we had W as president, we were gearing up for 2 wars. This guy will have to learn about 2 wars that happened, and are now mostly over, Obama's presidency, and now Trump being pres for less than a year. He'll have to worry about war with NK, but that's about how things were in 2002, just with different countries and no (small) nukes. The big thing is he'll have to learn about smartphones, and hopefully he won't get led down the wrong path and get an Apple. If he was a Linux enthusiast, he'll be pretty disappointed in the lack of progress: there's a bunch of distros that really do "just work", and well, but there hasn't been that much uptake (it's better than 2002, but not enough), and a lot of time has been wasted re-inventing the DE wheels, but on the upside he'll be able to do almost any normal tasks, including ALL web browsing, on a Linux PC. Cars are a lot nicer than in 2002 though.
Anyway, the point is, it won't be that hard for him to adjust. It's not like he's coming from the distant past where social attitudes were completely different (e.g., slavery was accepted, women couldn't vote, etc.). The biggest social thing that's changed is gay marriage and growing acceptance of LGBTetc. And that doesn't really affect you in daily life (any more than it did in 2002) unless you're LGBT yourself or have friends or relatives who are; you see it more in news and online forums than anywhere else unless you specifically go to certain places or events.
Is it ethical to "bring back" someone to a state where they're might just barely be conscious enough to realise how much their state sucks?
Personally, I'd say yes, probably. If they managed to get this guy back to this state now when only recently they would have considered him a permanent vegetable, then there's no guarantee his current present state is the best he can hope for: they could come up with something even better in a year, maybe even have him fully functional in a few years.
(Score: 3, Interesting) by bradley13 on Tuesday September 26 2017, @02:20PM (6 children)
Serious question: sanity? If the person was truly unconscious - unaware - for 15 years, it may not be an issue. But if they were "locked in" (aware, but completely unable to respond) for 15 years. What are the chances that they are still sane?
On a vaguely related note: There is also the interesting case of hyperbaric oxygen treatment [livescience.com]. I've linked to a skeptical article, but the doctors in this case claim that a young child's brain was able to regenerate substantial damage.
Everyone is somebody else's weirdo.
(Score: 2) by Grishnakh on Tuesday September 26 2017, @02:28PM
That's a good point about sanity. But can't they determine if they were "locked in" and aware just by reading brain waves? (Note: IANANS (neuroscientist))
(Score: 0) by Anonymous Coward on Tuesday September 26 2017, @05:25PM
That's a strange question to ask. How would sanity in such a circumstance even be defined? In any case, there have been cases of recovery by "locked in" patients after a number of years, not to mention coma patients who report having had a sense of awareness for years. I've never seen anybody make a digestable evaluation of their sanity.
(Score: 3, Interesting) by Immerman on Tuesday September 26 2017, @07:26PM (1 child)
I doubt it would be a big problem. I mean just look at how much time non-locked-in people voluntarily choose to inflict basically the same experience on themselves by watching TV...
And honestly, if you've never done it I'd recommend spending a week or two not interacting with anyone or anything beyond basic self-maintenance.. Just you and your thoughts, until you learn to put them to rest. The first few days are the hardest - after that it starts getting considerably easier and after a few weeks you start wondering how you ever survived the constant nonproductive "busyness" of "normal" life.
(Score: 0) by Anonymous Coward on Wednesday September 27 2017, @01:52AM
I tried that and that made me an hermite but it did not put my thoughts at rest...
(Score: 2) by edIII on Tuesday September 26 2017, @08:49PM
If you like that thought, you may like this short science fiction story - The Jaunt [wikipedia.org]
Technically, lunchtime is at any moment. It's just a wave function.
(Score: 0) by Anonymous Coward on Wednesday September 27 2017, @02:09AM
Didn't our Soylenti mothers tell us to eat our vegetables?
(Score: 4, Interesting) by FatPhil on Tuesday September 26 2017, @02:33PM (18 children)
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 2) by goodie on Tuesday September 26 2017, @03:39PM (3 children)
Yes, but at the same time, you would be able to let the person decide whether they want to die. In many instances, the family has to go with "that's what he/she would have wanted". If I had to make that call, I'd be pretty miserable. Personally, I would want to have the option of making my will clear that yes, I want to die. But as you pointed out, this requires proper euthanasia legislation so that these people are not worth off for many more years than they were in their vegetative state.
(Score: 3, Interesting) by vux984 on Tuesday September 26 2017, @04:38PM (2 children)
No. You would NOT be able to let the person decide whether they want to die. This person is not sufficiently conscious / competent to make that decision. I thought that was FatPhil's entire point. That THIS person has been brought back to this 'minimal level of consciousness' but CANNOT choose to die. Even if proper euthanasia legislation existed, he wouldn't qualify as competent enough to make the decision.
(Score: 3, Insightful) by Fnord666 on Tuesday September 26 2017, @05:23PM
Isn't that the point of a living will? At a time when you are competent to make that decision for yourself, you legally dictate what you want to have happen.
(Score: 2) by Immerman on Tuesday September 26 2017, @07:30PM
Bullshit.
They may not be *legally* allowed to choose for themselves, but whoever has the legal authority to make that choice for them has the option of respecting their wishes.
(Score: 0) by Anonymous Coward on Tuesday September 26 2017, @03:49PM (6 children)
I am not you, so I can't tell if you have such a strong telepathy to know how it is to be him at this time, but I believe that you are just projecting your own affinities and choices onto him.
There is a catch 22 on that: You can't decide instead of a sentient human that they want the suffering to end.
Perhaps they keep hope of recovery? It is a very individual perk, how much will for survival one has.
You would have to wait for them to be able to tell you if they want to end their lives, and not decide based on how you imagine you would feel, or what would you want if you were in their place.
None of us had been dead, and most (or perhaps even none) of us haven't been locked in or comatose. And even if some of us had been vegetative for a certain period of time, I am sure if they recovered that they are feeling it is a good thing they weren't switched off back then.
The only ethical reason why we should still cut off vegetative people who might slowly and perhaps limitedly recover is to harvest good organs for fully sentient, but healthy organs lacking people, who could then fully function and return the favor to society. Screw those comatose sleepy lazy bags sucking electricity and other necessities for too long! If we start saving all presently "donor cases", we will have to let too many ... normal people die or suffer. Every donor is multi-useful, one cadaver can solve problems for many patients from the transplantation waiting list.
/sarcasm
We should never settle for cadaver transplantation of organs as the permanent solution for organ failure. As medicine advances, we will find ways to save more and more cases which now are primary supply of organs. We shouldn't pit people one against other, to make one's life extension or betterment depend on untimely death of another. We urgently have to find alternative solutions, but unfortunately today transplantations from "mostly dead" are the easiest, most cost-effective path, and that makes research for alternatives (artificial or grown organs) unprofitable, and simultaneously research on brain recovery both "unethical" and lacking in number of cases to research.
(Score: 4, Informative) by Grishnakh on Tuesday September 26 2017, @04:30PM (5 children)
We should never settle for cadaver transplantation of organs as the permanent solution for organ failure.
Don't worry, we never will. Transplanted organs (from donors) are not a great solution, as you have to take anti-rejection drugs for the rest of your life, which ruin your immune system and make it easy for some disease to kill you early. That's why they've been working on "growing" replacement organs using your own cells; this is one big hopeful application of stem cell research. Hopefully, in the near future, if your liver or heart fails, they'll hook you up to a machine for a little while so they can take your cells, grow a new organ in a week or two, then transplant this organ into your body where it'll be accepted since it's your own cells.
Of course, this is also why we have movies like "The Island", and some other British movie I forget the name of which, starring Keira Knightley with a similar plot but not-so-Hollywood ending. The idea here is that you make clones of people while they're younger, grow the clones to adulthood and keep them around and healthy so that they can be harvested of organs and body parts for the originals as they suffer injuries or age-related problems. This of course all came about as a reaction to cloning, esp. after Dolly the sheep. But there's some obvious problems here: the ethical problem obviously of taking perfectly normal, conscious people and murdering them for their body parts because they're "just a clone" for one. But in addition, there's the practical problem where you need to wait ~20 years before your clone has organs that are mature enough to be used in your adult body. That's OK if you're rich and can afford to have a clone made of yourself that far ahead. But it'll suck if you kill the clone for one vital organ (like the heart), but then a year later now you desperately need her lungs or eyes or even a leg, and it's gone because there wasn't a good and economical way to store the remainder of the clone's body. So modern research is on just growing the organ, with the latest idea I heard being to create a plastic 3D-printed "scaffold" for the organ then growing the body's cells on that. Here's some articles about this:
https://en.wikipedia.org/wiki/Organ_printing [wikipedia.org]
https://www.theguardian.com/technology/2017/jul/30/will-3d-printing-solve-the-organ-transplant-shortage [theguardian.com]
There's really no ethical issues here since you're not murdering clone-people, you don't need any cadavers or vegetable-people to take organs from, and you're just using your body's own cells to grow yourself a new organ. It's not here yet, but it certainly looks plausible, and should have some remarkable benefits for our lifespans when it's deployed.
but unfortunately today transplantations from "mostly dead" are the easiest, most cost-effective path, and that makes research for alternatives (artificial or grown organs) unprofitable
Not true. As the articles I cited pointed out, there's plenty of research going into grown organs. Even if there were plenty of donor organs available (which there aren't, not by a long shot), the rejection issues are too great; those anti-rejection drugs are going to shorten your lifespan, so there's absolutely a demand for grown organs because of that alone (but more really because of the very limited supply of donor organs). In addition, donor organs today are worth an absolute fortune, because of their rarity, plus also because of the difficulties in storing and transporting them when they're needed. And worse, they're frequently rejected by the recipient, which means they'll probably end up dying soon, and also the organ is wasted. Grown organs promise to be much, much cheaper and avoid all the problems with donor ones. As a bonus, you get a spiffy, brand-new, pristine organ, instead of one that's decades old and subject to whatever abuses the donor put it through (e.g. drug use, mediocre health, etc.).
(Score: 2) by darnkitten on Tuesday September 26 2017, @08:41PM (2 children)
Never Let Me Go, based on the (predictably better) book of the same title by Kazuo Ishiguro.
(Score: 2) by Grishnakh on Wednesday September 27 2017, @03:22AM (1 child)
It was a pretty dark and depressing movie, but the one thing I didn't get was why the kids, after finding out there was no legal way to avoid organ-harvesting after investigating some rumor they heard about it, simply gave in and reported to be harvested as ordered. They weren't prisoners; they could drive around as they pleased and lived somewhat independently. They didn't seem to have much of a survival instinct.
(Score: 2) by darnkitten on Sunday October 01 2017, @02:06AM
Part of it, at least in the novel, was that their "society/culture" was engineered by the powers-that-be to give them a sense of responsibility to each other, e.g. the younger ones cared for the older ones (who had cared for the younger ones as children) who were being actively harvested; also, the hope of being set free if they were "good enough" or "fell in love" kept them from rebelling, as it held out a (nonexistent) reward for not rebelling, similar to the way slaves were kept in check with rumours of occasional freeings coupled with the promise of rewards and punishments in the afterlife.
They were also kept isolated enough from the rest of society that they would appear "different" and thus easier to track down if they did attempt escape.
Mostly, though, I think, it comes from being a postwar British-designed society with postwar British attitudes in a British novel--Stiff Upper Lip, Keep Calm and Carry On, Respect Authority, and all that. Winston and Julia in 1984 could have resisted hard enough to be killed, but didn't.
(Score: 1) by acid andy on Tuesday September 26 2017, @10:03PM (1 child)
There's an easy, if even more horrifying, answer to that. One clone made for each possible organ needed. That could of course be multiplied even further if the patron desires more spares. Y'know - just in case! *shudders*
If a cat has kittens, does a rat have rittens, a bat bittens and a mat mittens?
(Score: 2) by Grishnakh on Wednesday September 27 2017, @03:15AM
That's an obvious solution of course, but remember the word "economical". Sure, BillG could afford to have a small army of clones like this, but most people won't: having clones is like having slaves: it costs a fair amount of money to house and feed and maintain a human being, especially if you're not getting any free labor out of them. This is why this isn't likely to ever be much of a problem, aside from the ethical problems. This is why there's a lot of research going into 3D-printed organs now; the ethics aren't the big problem, it's the economics. Printing an organ on-demand will be relatively very, very cheap, plus far more convenient.
(Score: 2) by DeathMonkey on Tuesday September 26 2017, @05:38PM
Brain rejuvenation for some. Miniature American flags for others.
(Score: 2) by JoeMerchant on Wednesday September 27 2017, @02:14AM (2 children)
Depends on the individual, of course, but I think most long-term heavy medical support expected to end in death is tantamount to torture.
Doctors are trained to always preserve life, but when the quality of that life is negative I think our current ethical framework is lacking.
🌻🌻 [google.com]
(Score: 2) by FatPhil on Wednesday September 27 2017, @11:10AM (1 child)
I wonder whether any of these clauses, from the 1960s Tufts version, support the motion which I will tastelessly dub "better dead than veg":
- "avoiding [...] overtreatment" - if you can't improve things, are you actually "treating" at all, in which case doing such treatment-which-isn't-treatment is surely overtreatment?
- "warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug" - I'd say that a property of any doctor who agrees to let a patient die painlessly at a time of their own chosing is definitely showing sympathy and understanding.
- "Above all, I must not play at God." - you might say this cuts both ways, forcing someone to stay alive is just as much controlling the life or death of another, which is fairly playing-godish, as forcing someone to die. Which is why we have the concept of concent, to remove that aspect of responsibility from such decisions - the doctors inform the decisions of others, rather than actually making the decisions. And with that in mind I think it does mean that an "I must *by my oath* keep this person alive at all costs" decision should be mapped onto playing (hand of) god.
As you can see, I like to think they do support the motion, but of course others may differ in their interpretation.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 2) by JoeMerchant on Thursday September 28 2017, @03:21AM
My Grandfather had to argue vigorously with his doctors to NOT amputate his leg, he had had a year to think about it and in that time he had decided for himself that he would rather be dead that missing a leg. The doctor's kept quoting "always preserve life" but at least my Grandfather had the right to deny himself treatment. If he had been incapacitated, they probably would have "treated" him...
🌻🌻 [google.com]
(Score: 2) by TheLink on Thursday September 28 2017, @04:04AM (2 children)
http://www.telegraph.co.uk/news/health/news/7966357/Pensioner-tells-how-he-beat-locked-in-syndrome-after-massive-stroke.html [telegraph.co.uk]
http://www.telegraph.co.uk/men/the-filter/another-mans-shoes/10877490/What-its-like-to-have-locked-in-syndrome.html [telegraph.co.uk]
https://www.vice.com/en_us/article/ppx3z7/being-in-a-coma-is-like-one-long-lucid-dream-511 [vice.com]
https://thoughtcatalog.com/hok-leahcim/2014/06/17-former-hospital-patients-reveal-what-it-felt-like-to-be-in-a-coma/ [thoughtcatalog.com]
There's many more if you look.
The fact is a lot of life for "normal" people involves struggling and suffering, and at times many do feel like suicide, but at other times they feel they still want to continue.
p.s. lameness filter doesn't like this comment in plain old text but works when "HTML Formatted".
(Score: 2) by FatPhil on Thursday September 28 2017, @05:52AM (1 child)
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 2) by TheLink on Thursday September 28 2017, @06:32AM
The thing is most people are bad at predicting how they happy they would be in a future given scenario. So they might think they would want euthanasia but maybe they wouldn't when it actually happens. I've read of someone who had locked-in syndrome and said it was actually quite pleasant - dreamy, floating around, and just one day was "pulled" to consciousness. Not everyone has the same experience of course (some may have nightmares instead).
There's plenty of evidence showing that people who end up paraplegics don't stay very unhappy or even depressed and suicidal, many bounce back closer to their "built-in" defaults. A similar thing happens for lottery winners.
http://nymag.com/scienceofus/2016/01/classic-study-on-happiness-and-the-lottery.html [nymag.com]
Heck maybe if the technology improves perhaps some locked-in people could still be able to interact in VR and would rather stay locked in playing entertaining games and hanging out with their friends all paid for by taxes than to be among those forced to wake up and work ;).
(Score: 2) by number11 on Tuesday September 26 2017, @04:00PM (1 child)
It's clear that it is very important for everybody to complete an "Advance Health Care Directive" (aka "Living Will") so that you can make your choices while your brain is still in working order. Even if you don't expect to be needing it any time soon (sometimes car crashes happen without your prior agreement). Use forms appropriate for your state, different states may have different requirements; I have no idea what options are available for those outside the USA but it can't hurt to make your wishes known in advance, in writing. Otherwise the choices may be made by random relatives, doctors, government officials, or passersby, without your input.
(Score: 0) by Anonymous Coward on Wednesday September 27 2017, @05:07AM
What if your state may not agree with your wishes? If I were in a hopeless condition, I would want to be euthanized. If my state does not permit that because it considers it a sin, insanity or against policy, can I permit my family to move me to a location where I can be euthanized?
(Score: 2) by frojack on Tuesday September 26 2017, @05:16PM (3 children)
Have you ever had major surgery?
I would expect "minimally conscious" would be that state you are in when awaking from anesthesia, unable to see, maybe you can hear, maybe not, doctors and nurses having to hold you down as you struggle against the panic of not knowing where you are, why you can't breath, totally unable to understand what is going on, because you can't hold a coherent thought for more than an instant...
I can't imagine a worse state to be trapped in.
No, you are mistaken. I've always had this sig.
(Score: 2) by Grishnakh on Tuesday September 26 2017, @05:34PM (2 children)
Have you ever had major surgery?
I would expect "minimally conscious" would be that state you are in when awaking from anesthesia, unable to see, maybe you can hear, maybe not, doctors and nurses having to hold you down as you struggle against the panic of not knowing where you are
Huh? I've had surgery several times with general anesthesia, the most recent time about 2 years ago, and the first time being having my wisdom teeth removed. I don't remember any of this; I just came to. I was a little bit groggy at first, and couldn't walk, but it seemed a lot better than what most people describe for their alcoholic hangovers. It was far better than some other times in my life I can recall, such as having the flu or food poisoning.
(Score: 2) by frojack on Tuesday September 26 2017, @06:15PM (1 child)
I hope you never need open heart surgery.
Tooth surgery isn't even close. You were merely asleep. I've been there as well.
No, you are mistaken. I've always had this sig.
(Score: 2) by Grishnakh on Wednesday September 27 2017, @03:19AM
No, for my wisdom teeth I was under full anaesthesia. It was apparently quite a process getting them out.
And as I said, I've had a couple other, much more recent surgeries, with full anesthesia (propofol I think was one of the drugs used). It just wasn't a big deal. I just came to, and was fully conscious and alert pretty soon afterwards. And I didn't need any of the opioid painkillers they gave me by default either, despite an incision a couple inches long.
(Score: 0) by Anonymous Coward on Wednesday September 27 2017, @09:21AM
Said it before: In the last few decades of the 20th century, a number of previously uncontacted Australian aboriginal tribes lept *fifty thousand* years into the future.
12 months later they're living in towns and cities, adapted to being passengers in cars, taking buses, watching TV etc.
So long as we haven't drastically changed socially, it's seemingly no big deal.