Labels matter. Indeed, they can be the difference between life and death. Someone lying in a hospital bed labelled “minimally conscious state” will be kept on life support indefinitely. If the label says “vegetative state”, however, that life support could be turned off any time. A layman might not be able to tell the difference. But a doctor can.
Or can he? A worrying study just published in BioMed Central Neurology by Caroline Schnakers, Steven Laureys and their colleagues at the University of Liège’s coma science group suggests that perhaps he cannot—or, perhaps worse, that he prefers to use his intuition rather than the latest diagnostic techniques to tell the difference. As a result, many people may be at risk of early termination even when they show flickering signs that their consciousness has not departed entirely.
[…]
Distinguishing between these different kinds of coma patients has, everyone acknowledges, never been easy. Indeed, in 1996 Keith Andrews and his colleagues at the Royal Hospital for Neurodisability in London found that 40% of the patients in their hospital who had been diagnosed as being in a vegetative state, were not. But earlier this decade, two new tools became available, so things might have been expected to get better.
[…]
Dr Laureys’s measured conclusion is that neurologists do not like their skills to be replaced or upstaged by a scale. Minimally conscious state being a relatively new diagnosis, he says, it may be that some doctors are unfamiliar with its criteria, but that is all the more reason for deferring to the coma recovery scale. The trouble with a diagnosis based on conviction rather than measurement is that it is vulnerable to external influence. Insurance companies, for example, prefer a diagnosis of vegetative to one of minimally conscious, Dr Laureys says, because no expensive rehabilitation is required for those in a vegetative state.
“Turn off the machines, nurse, he’s used up his insurance.”
the wrong issue is being hyped.
The only relevant issue is an assessment of the patients odds on being returned to a conscious/interactive state of mind. The difference between vegetative, permanently vegetative, and minimal consciousness is one without meaningful distinction.
After that, yes, even brain death can be “mis-diagnosed” which is only another label but as with any mis-anything can have unwanted repercussions.
All you can do is the best you can do with the information available at the time.
When I was in high school I guy a had a class with and was on the golf team with got in a car accident and was in a coma on life support. I wonder if his body is still in a hospital somewhere being kept alive after all these years.
Don’t worry. If the Obama health care plan gets passed those life support units will be turned off. All of them. They are going to have a board to take care of things like that.
Of course if you withhold medical treatment to people in senior care you can empty out a lot of nursing home beds while you are at it. From what I can see Obama and his medical board have lot of plans to cut costs. They need an inhaler and you give them a pain pill and you don’t have to waste money on that senior any more.
If they aren’t going to put the money into health care I wondered why Health Reform was going to cost so much but if you read the plan a tad it becomes clear. This is going to be a major works program providing government jobs in various kinds of oversight. Everybody will be insured and minorities will be equally represented in medicine even if they didn’t pass the tests to get into medical school.
It will look good on paper and kill people in practice.
The article is written in a British magazine about a study done at a university in Belgium.
Socialized medicine at its finest.
Uncle Dave says: “Turn off the machines, nurse, he’s used up his insurance.”
But I thought everyone knew socialized medical care in Europe was free.
At least that’s what Michael Moore says.
JBenson==how long should someone be kept on a ventilator with artificial feeding when there is no reasonable expectation the patient will return to a conscious state?
Should the entity paying for this care have any input or should it be entirely at the families direction regardless of cost or outcome?
aka—can you ever be rational?
“Turn off the machines, nurse, he’s used up his insurance”
You joke about that, but if a wide-scale publicly run healthcare system is going to be put into place, a reasonable system of determining when to stop treatment, yes for economic concerns, will need to be instituted. The parents of Terry Schiavo wanting their darling daughter kept alive indefinitely because they can’t move on is not a reasonable factor for the determination.
> perhaps worse, that he prefers to use his intuition rather than the latest diagnostic techniques to tell the difference
That type of reasoning is misleading. Sometimes “latest diagnostic techniques” can actually be worse by pointing doctors in the wrong direction.
A specific example: “MRI’s were hoped to provide information X Rays weren’t able to provide in considering back surgery. After MRI became available the number of diagnosis of abnormalities in backs skyrocketed as did surgery which wasn’t really needed in 1994 the new England Journal of Medicine did MRI’s on ninety eight people who had no back complaints at all. The images were sent to doctors who did not know the patient had no complaint. Two thirds of the doctors found serious problems in the images justifying surgery.” (http://plaintifftriallawyertips.com/2009/06/13/how-we-decide.aspx)
#3, deoll the idiot,
Don’t worry. If the Obama health care plan gets passed those life support units will be turned off. All of them. They are going to have a board to take care of things like that.
I missed that one. Could you reference which part of the bill has that in it? Please.
#8, arpie,
Good point. Without having read your link I’m wondering though, how many of those diagnosed with back problems really did have a bad back even though they experienced no pain? No gotcha, I’m just wondering, and that is still a good point.
Taking your point to a different level though, to verify the physician’s “intuition”, how well could the patients answer the questions put to them?
I am totally weirded out. An old friend, whom I have known for 25 years was disconnected by his doctor, less than 20 hours ago. A ruptured aorta, stented in emergency surgery, but the damage to the brain was already done. All I can add, is that doctors need authority as well as responsibility.
#9. I can understand your confusion. It is called controlling costs. The board which both the House and Senate bill call far will set up what the English call a rationing board. The job of the board is to save money.
#9 Sorry I hit some keys and this program posted. Controlling costs and efficient equals the same thing. The main way to control costs and become more efficient is to not provide treatments for people with certain conditions especially if they are senior citizens. 90% of the money spent on medical care occurs in the last three years of a persons life and if they don’t get that high priced care you can save a fortune. You can do a cost versus benefit ratio and justify it.
There also seems to be major issues with timely treatments. If it takes a month on average to get a heart surgery in England and that is the number I saw then and much longer for gallstones then you have issues. People who don’t get timely treatment for cancer, heart disease, and yes gallstones die. They have the same problem in Canada.
One reporter claimed he got a appointment in England the next day because he had insurance but if he hadn’t had insurance it would have been a week. If your kid has the sniffles or a cold forget it.
Obama thinks he’s doing the right thing and for some people he may be. For most Americans he isn’t.
#11, deoll the idiot,
The board which both the House and Senate bill call far will set up what the English call a rationing board. The job of the board is to save money.
You still didn’t post where in the bill that “board” exists. You do seem to know all about it though. Is that because Boss Limpdick told you so? And Limpdick is always right.
You wouldn’t pulling another right wing nut on us would you? You know, making up shit because you don’t any facts or anything intelligent to say.
Why do any medical topics immediately degenerate in to arguments about socialized medicine, with terms like “liberal” and “right wing” getting tossed off? That has nothing to do with the article under discussion, which is purely medical.
Remember the Terri Schiavo case? There was no confusion about her *medical* state, since CT scans showed that her brain was fundamentally *trashed*. There are other ways of detecting mental activity which have come on in recent years, such as Functional MRI scans. It’s no longer just down to doctors’ hunches.
Actually there was plenty of confusion about the Schiavo case, since the judge refused to allow a number of tests to be run. The videos demonstrated her responsiveness to her environment.
Of course all of this confession that there is little scientific basis for the distinction between MCS and PSV comes too late for her.
#16, BB,
The Judge refused to allow the tests because they were just to delay with no useful information to come from them. The CT scans from 2002 definitely showed extreme brain damage.
http://en.wikipedia.org/wiki/File:Schiavo_catscan.jpg
That four second clip showing some sign of recognition was culled from 70 minutes of continuous taping showing all random movements. No one in their right mind could interpret that fleeting moment as anything other than random.
During the autopsy it was revealed her brain had totally degenerated and there had been no functional activity for years. The brain weighed half what it should for a person of her size and what was left was about half water.
Did I miss a set timescale for pulling the plug in the article?
I wonder if i would still be alive if i died there…
i was in a motorcycle accident 1980..was dead at the scene, revived, died again enroute to the ER, revived again in the ER, then lapsed into a coma for 18 days. (my nose was torn off in the accident, along with head trauma (regardless of wearing a helmet)
-at day 6, they declared me brain dead and recommend pulling the plug. they said i’d be most likely be a vegetable or severely brain damaged if i did wake up. (my parents thought otherwise)
i don’t recall hearing about any issues about keeping me on life support though.. (prvt ins with a medicaid back)
i woke up over a 7 hour period with no recollection of the past 7-8 months (still to this day) -and hungry. (no recall of any “lights” either)
-anyway, i guess i’d vote for 1, maybe 2 month grace on pulling the plug if you look “brain dead” on the EEG.
about the only benefit i can see if i was a U.K. resident when this happened, is that you probably would not have had to put up with my endless rambling posts here on DU.. 😮
-s
#6
This is the logic/argument that will be used by government bureaucrats to determine a patent’s future care if the new and improved health plan takes over.
It’s very efficient.
And if the government is paying the bill, this will be what everyone has to deal with.
But it’s a shame that the government feels it necessary to outlaw any medical care done outside it’s program…for what ever reason, for what ever cost.
If the bill passes, no one will ever be allowed to make up their own mind about their own or their relatives future…because a mindless bureaucrat who only reports to an unelected offical had determined otherwise based on the cost of care.
A government that forces this “care” on it’s citizens is not the type of government I grew up with or voted for.
#19, Rick,
A government that forces this “care” on it’s citizens is not the type of government I grew up with or voted for.
Gee, must suck to be you. Anyone that would rather have a faceless private company bureaucrat make decisions with no right of appeal for a service that effects someone life compared to a system where OUR elected representatives are in charge must be an idiot.
#20
I pay for medical use when I want it. If I want insurance for big bills I can choose to buy it. If I don’t like the way the insurance company treats me, I can change companies.
……are ya getting the general gist of this?
It’s a matter of choice – even with a big, bad, ugly insurance company, that is still a choice.
With the government plan (current proposals) I don’t have a choice – I am not allowed to pay for medical procedures as I need them. If I don’t buy government “insurance”, I will be fined. And of course, if I don’t pay the fine, I will be jailed.
Yes there is a very big difference between freedom of choice and no freedom at all.
What I find so amazing that so many people want to think a plan run by the government has to be so much better than private industry.
In spite of example after example of government waste, fraud, corruption, ineptness, indifference (to name a few) year after year, coming from both parties.
The only conclusion a sane person can determine is that government will continue to act as it always has….and medical care will be as efficient, effective, etc,etc, as everything else the government does – from catching illegal aliens to buying toilet seats for airplanes.