By: Barry E. Haimo, Esq.
December 22, 2015
What Is a Persistent Vegetative State?
For many families, witnessing a loved one enter a persistent vegetative state is incredibly traumatic and hard to understand. Different than a coma, a persistent vegetative state is a condition marked by cycles of sleeping and wakefulness, just like if the person was conscious. Despite this, the person will have no awareness of his or her surroundings. They will not react to movement, family interactions, noises, and so on, and they will be fully incapable of controlling their bodily functions (in other words, they will be incontinent and bedridden).
These individuals do maintain some sort of brain function, but it is only enough to keep the hypothalamus and brainstem in operation. These areas are in control of the autonomic nervous system, and control behaviors such as breathing, blinking, swallowing, and so on. Essentially, the person appears to be awake, but they will not be able to respond to any stimuli or move their bodies.
Many family members have reported feeling increasingly emotional or stressed when dealing with a loved one in a persistent vegetative state since sometimes they appear to be functioning and capable of reacting to their environment – even though the family members know that this is not the case.
A persistent vegetative state is also different than brain death. While brain death means that the body can no longer support life, with a persistent vegetative state is more like the brain is in limbo – it still allows the person to survive on a basic level.
In pertinent part, Florida Statute, Section 765.404, states as follows:
Persistent vegetative state.—For persons in a persistent vegetative state, as determined by the attending physician in accordance with currently accepted medical standards, who have no advance directive and for whom there is no evidence indicating what the person would have wanted under such conditions, and for whom, after a reasonably diligent inquiry, no family or friends are available or willing to serve as a proxy to make health care decisions for them, life-prolonging procedures may be withheld or withdrawn under the following conditions:
(1) The person has a judicially appointed guardian representing his or her best interest with authority to consent to medical treatment; and
(2) The guardian and the person’s attending physician, in consultation with the medical ethics committee of the facility where the patient is located, conclude that the condition is permanent and that there is no reasonable medical probability for recovery and that withholding or withdrawing life-prolonging procedures is in the best interest of the patient. If there is no medical ethics committee at the facility, the facility must have an arrangement with the medical ethics committee of another facility or with a community-based ethics committee approved by the Florida Bio-ethics Network. The ethics committee shall review the case with the guardian, in consultation with the person’s attending physician, to determine whether the condition is permanent and there is no reasonable medical probability for recovery. The individual committee members and the facility associated with an ethics committee shall not be held liable in any civil action related to the performance of any duties required in this subsection.
When a person has been in this unresponsive cycle for over one month, they are officially considered to be in a persistent vegetative state. Thankfully, sometimes these individuals recover considerably from this state and are able to live more normally. However, statistically speaking, individuals who have remained in this state for over 12 months are not likely to come out of it. In fact, people who are in this state can live in such a way for years and years while never improving.
How to Handle a Persistent Vegetative State
For many families, this brings about a difficult decision: do you terminate life support, or do you maintain it? In the United States, a family can request the end of life support once a person has been classified as in a persistent vegetative state.
There are ethical concerns here, of course, as technically the person’s brain function is maintaining itself on some level. The body is being provided the oxygen and blood that it needs to function, but there is absolutely no indication that the person is ever conscious.
Sometimes a person will have a living will in place that explains their wishes, but it is not uncommon for someone to not have made their wishes known in any official capacity.
An attorney can also help in the event that the hospital administration or other family members make it known that they do not wish to remove life support. This is a very stressful and emotional situation for all involved. If your loved one’s wishes are in question or were never clarified.
The best course of action, of course, is for you to clarify your personal wishes about end-of-life care before such a situation arises. Obviously, an estate planning attorney can help you with this as well, either by working with you to create a living will or drawing up paperwork to select a health care surrogate to make medical decisions for you in the event that you are unable to make them for yourself.
Barry E. Haimo, Esq.
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