One typically thinks of advances in medical science and technology as unalloyed benefits. The ability to cure illness, mitigate pain, and make more accurate diagnoses are some of the uncontroversial results of medical progress. Yet as a new study of vegetative states demonstrates, such advances can raise ethical quandaries for physicians and the families of patients diagnosed as vegetative. The study, conducted in Belgium and published in the British medical journal, Lancet, showed that using the brain-scanning technique known as positive emission tomography (PETs) provided a more accurate neurological assessment than other devices, such as MRIs. The assessment provides more information about “minimally conscious” states, originally thought not to exist in such patients. Evidence from recent research demonstrated the existence of minimal consciousness in vegetative patients, but without the details that emerged in the Belgian study. It revealed that not only do patients who are minimally conscious have some level of awareness or responsiveness, but they may have some chance of improving to regain higher levels of consciousness.
Why does this new research pose ethical quandaries? Aside from the acknowledgment by a researcher in the Belgian study that the diagnostic technique is not ready for routine use, a bigger problem is uncertainty in its ability to predict significant improvement or recovery. This can lead to “false positives”–diagnoses that show minimal consciousness and a prospect of improvement in brain function when that will not occur. This situation produces uncertainty among medical experts and families hopeful that their loved one will recover cognitive function. As the Belgian researcher stated, “We shouldn’t give these families false hope.” In such circumstances, both physicians and families may be unlikely to remove life supports even after a significant time has elapsed, creating anguish about whether and when to “pull the plug.” Until recently, the problem of uncertainty was that of “false negatives”: diagnoses that patients in a vegetative state had no consciousness at all when, in fact, they may have been minimally conscious. With the new study, uncertainty about eventual improvement looms as a barrier to timely decision making. It is often the case that lingering uncertainty is worse for people who have to make decisions than receiving a bad prognosis that is definitive. Continue reading