Vegetative State Man 'Talks' By Brain Scan 202
c0lo writes "'Severely brain-injured Scott Routley hasn't spoken in 12 years. None of his physical assessments since then have shown any sign of awareness, or ability to communicate, thus being diagnosed as vegetative (vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world).' Scott Routley was asked questions while having his brain activity scanned in an fMRI machine. British neuroscientist Prof Adrian Owen said Mr Routley was clearly not vegetative. 'Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is.' As a consequence, medical textbooks would need to be updated to include Prof Owen's techniques, because only observational assessments (as opposed to using mind-readers) of Mr. Routley have continued to suggest he is vegetative. Functional MRI machines are expensive (up to $2 million), but it's quite possible that a portable high-end EEG machine, costing about $75,000, can be used at a patient's bedside. Phillip K. Dick's world is one step closer."
Must be boring. (Score:2)
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I'm pretty sure that I read a book about that, and the title was "I Have No Mouth and I Must Scream"...
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That was a computer, though, wasn't it? Harlan Ellison? Maybe I'm thinking of something else.
The story depressed the hell out of me, I and feel really bad for the guy. I'd be trying to wire him up to the TV remote or a web browser next just so he can get some entertainment.
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Wouldn't one of those Emotiv EEG (http://emotiv.com/) headsets do the job? It would be insane to not let him communicate in some way now that they know he is conscious.
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Yeah they might need a bit more precision and low latency control for certain games.
But don't underestimate what can be done with a few "buttons" as long as the latency is low enough:
https://www.youtube.com/watch?v=lx24B6RwekQ [youtube.com]
Broly (guying playing with his face) is playing Chun-Li vs Daigo (one of the top SF players in the world).
Seems he's not the only person: https://www.youtube.com/watch?v=wrfwSinBUkY [youtube.com]
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If they could do something like that House episode where a "locked in" guy could communicate a binary response thanks to sensors, a special browser could could provide a list of links and he could navigate up and down. C'mon, this is a whole new world of handicapped accessibility to explore.
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Re:Must be boring. (Score:4)
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Yes they were inspired by the Movie.
But unlike a dickless AC it is original.
Them movie does not have the lyrics nor the music in it.
Not even close.
And the movie is from a book (Score:3)
Book -> Movie -> Song
Oh and the concept is hardly original because the book was inspired by reading of the Prince of Wales visiting a real life soldier who had been similarly wounded.
Reality->Book -> Movie -> Song
Gosh, it is almost as if people get inspiration from other people. THIEFS!
Re:Must be boring. (Score:4, Interesting)
http://pub.psi.cc/ihnmaims.txt [pub.psi.cc]
Maybe if you're considering Mr. Routely, the man in the article, to be similar to the AM computer from the story. The human protagonist has that thought ("I Have No Mouth and I Must Scream") at the end of the story, but I think what makes that story great was that it really describes the computer. It becomes intelligent, butit's just a world-spanning computer. It has consciousness, but no real purpose, drive or desires, and that's what drives it mad. I find that whole concept really intriguing, because we see a lot of "machines taking over the world" stories in which humans are eliminated because they're considered "inefficient" or simply because the cold, calculating machine sees no value in human life as the machines have no emotions (skynet), but in IHNMAIMS, the computer very much has emotions, it's just that it's hateful. So, instead of humans being eliminated by a machine of cold, cruel logic, they're eliminated and/or tortured by a sadistic machine driven by hatred. Really interesting.
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I'm pretty sure that I read a book about that, and the title was "I Have No Mouth and I Must Scream"...
There is another book although he isn't vegetative just trapped in his body, called 'Johnny Got His Gun'.
http://en.wikipedia.org/wiki/Johnny_Got_His_Gun [wikipedia.org]
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Must be pretty boring to be conscious but unable to do anything at all.
Shades of _Johnny Got His Gun_, by Dalton Trumbo.
Comment removed (Score:5, Insightful)
Re:Must be boring. (Score:4, Insightful)
Well, he could answer "yes" to the question "do you want us to kill you?",
and "no" to the question "do you want to live a little longer?".
Locked-in syndrome is to me the most terrifying end I can conceive.
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Obligatory South Park joke
Doctor: Hi Bob, I have a question for you, do you want us to terminate your life? One blip for yes, two blips for no.
Bob: Blip blip
Doctor: Double yes. Thanks Bob, see ya tomorrow.
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I'm loath to ask: (Score:5, Interesting)
Re:I'm loath to ask: (Score:5, Funny)
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I'm uncomfortably reminded of the Facilitated Communication scam, except replacing holding their hand with an fMRI scanner. I'd hope no one dies based on cutting edge research into interpreting brain scans.
I'm more worried about someone being unnecessarily kept alive and hogging all those delicious organs...
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Are you in need of some fava beans? Perhaps a nice Chianti?
Dialog, damaged (Score:2)
You think that's bad, go read "Make Room, Make Room" by Harry Harrison, and then go subject yourself to "Soylent Green."
That is the bloody poster child for Hollywood fapping not only all over the book's story, but also the meaning of the story, the order of the story, the characters in the story... worst SF movie ever made, hands down, because it didn't just suck, it was the magical transformation from a book that most definitely did not suck, to a
Re:I'm loath to ask: (Score:5, Insightful)
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I for one would rather die.
How lucky you are; if you are laid low as Scott has been you won't have to wait a decade to tell anyone.
Re:I'm loath to ask: (Score:5, Interesting)
Not me. Keep me going. I would rather be bored then dead. They might be able to cure me someday.
In the mean time please leave the TV on. maybe get an EKG machine that lets me interface with a computer.
You sir, are a quitter.
Re:I'm loath to ask: (Score:5, Interesting)
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Perhaps. But would you be able to tell the difference?
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That isn't the case for this man. He is apparently acquiring information from after his accident (unless this experiment is biased and the conclusions are all crap, but that's a different discussion).
Purgatory? Solitary confinement? Depending on your philosophy, a few years of that may be preferable to death. A
Re:I'm loath to ask: (Score:5, Funny)
Think about it... you would be trapped in a dark abyss entirely inside your head
Happened to me once. So I separated the darkness from the light. And the darkness I called night and the light I called day. After that I made up all kinds of stuff. Useless but entertaining.
Then how can he read the question? (Score:2)
Of course, you can always make things worse theorizing but in this case, they guy can read and now also answer.
In a civilized country, he would just get an MRI machine since that is what he needs and we can affords it with our means. Oh wait, that is communism right. Yeah, the Romney thing is to let him suffer because euthanasia also isn't allowed.
It is not like providing a 2 million dollar/euro machine for every vegetative person is going to break any countries economy.
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Of course, you can always make things worse theorizing but in this case, they guy can read and now also answer.
In a civilized country, he would just get an MRI machine since that is what he needs and we can affords it with our means. Oh wait, that is communism right. Yeah, the Romney thing is to let him suffer because euthanasia also isn't allowed.
It is not like providing a 2 million dollar/euro machine for every vegetative person is going to break any countries economy.
Can we afford it? An MRI machine costing thousands (tens of thousands?) of dollars for every patient in a vegetative state, plus staff to maintain it and to interpret the results. I suppose we have the resources to do it if we made that our top priority, but at what cost? Is the MRI machine for one person more valuable than buying an ambulance for a small town (might save a few lives with that ambulance)? Is the MRI machine for one person more valuable than a school lunch program for an inner city ele
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However, this implies that you wouldn't be able to receive _any_ stimuli.
I don't think it's too far-fetched to assume that, if we're soon to be able to reliably "read" brain signals from people who're so totally trapped, we'll also soon see true direct machine-to-mind communication. I.e. being able to inject stimuli directly into the parts of the mind that process basic awareness -- the holy grail of virtual reality.
That, of course, means that, as Scott Adams said, "the holodeck will be humanity's last inv
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Thus the Matrix is born.
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Comment removed (Score:5, Funny)
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In the mean time please leave the TV on.
Depending on what channel it's set to, that could be a fate far worse than death.
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At what cost to society? Or do you have enough personal savings to hire an engineer create that device, have a dedicated EKG machine, a hospital room, and a staff to maintain your body?
(P.S. I'm not really sure if you were serious or not, but either way it makes for good discussion)
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You mean like being a patient such as Mr. Routley and having your organs harvested? Generally, donors are not given pain medication, only tranquilizers to keep their bodies from flinching, since it's assumed that people in such a state are "gone." I brought this up to my brother, the anesthesiologist, when this story was in the news a few months back, and he insisted that there was no need for anesthesia. That's the consensus of the medical community.
That puts us a step ahead of vivisection—but only b
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A donor would be brain-dead (AFAIK) which means irreversible loss of activity in the brain. And that means there is no receiver of any pain signals. (Comparable to a head amputation.)
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Absolutely. If I end up in a vegetative state, use me for parts and move on with your lives.
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I definitely agree now, and as a default, I want that assumed. However, If possible, I would like the opportunity to be asked, especially if there was a chance to be a part of research into people in my condition to potentially make communication easier or even computer interface possible, which could totally change the equation.... even if just for a little while.
Though, in some ways the only place you ever are is in your mind, I could see it being a totally different experience for some people. I can't im
Kill me, please (Score:4, Informative)
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I've had trauma surgeons tell me that advance directives/living wills are very frequently overridden by family.
It makes sense, in a degenerate way: the docs and the hospital have better things to do than sue families to get them to follow their invalid family member's advance directive document. It would be a PR disaster, and it's just easier to leave a patient as a full code on a vent rather than fighting a family willing to attempt to get an injunction from a court.
Basically, what I was told was that thes
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Someone save this post. His family might need it later.
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They don't need to (Score:2)
Most of the time they just kill them without asking.
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I've heard the researcher interviewed, and while they've considered this question they're not ready to ask it.
Even assuming you can ensure the answer is reliable, and the patient is competent (he's still brain damaged), euthanasia is a very delicate subject.
Sounds like a match. (Score:4, Interesting)
EEG == $75k? (Score:5, Insightful)
How does one charge $75,000 bucks for something that can be found in the land of open source?
http://openeeg.sourceforge.net/buildeeg/ [sourceforge.net]
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fMRI is in real time - they can ask him questions and watch the oxygen levels of the different brain regions light up. They already have a a general model of what does where. So by getting him to think different things, they can see different areas light up.
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You mean consciousness not conscience. It's the difference between Jiminy Cricket and the sound of crickets.
On the other hand, if you want to see a film interpretation of the above idea, see the Torchwood mini-series Miracle Day. It fills your head with all sorts of scary questions.
Re:EEG == $75k? (Score:5, Insightful)
Sure, we can get these things to cost $5000 like a good hearing aid. But I'm not sure that version is going to be used to make the final assessment of whether there is a living person in a locked-in patient or not.
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75K seems a good amount for taking something that could be done in Open Source and making it safe, reliable, and repeatably measurable for use in a hospital.
Sure, we can get these things to cost $5000 like a good hearing aid. But I'm not sure that version is going to be used to make the final assessment of whether there is a living person in a locked-in patient or not.
Developmental costs of 75,000 seem unlikely to suffice. Factor of 10, maybe, but most likely to get such a device
certified you are talking 7.5 million.
After that, per unit cost depends solely on the parts involved, and these are pretty cheap. Knocking them
out for 5grand seems entirely possible.
You can buy a Defibrillator [amazon.com] on Amazon.com for a thousand bucks, with no license, training, or certification for use. And it is designed to generate potentially life ending voltages.
There is nothing unsafe about EE
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EEGs are just sensitive amplifiers. They aren't hard to make [avenhaus.de], lots of engineering classes have made them in one form or another.
Data collection and interpretation are other matters entirely.
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EEGs are just sensitive amplifiers. They aren't hard to make [avenhaus.de], lots of engineering classes have made them in one form or another.
Data collection and interpretation are other matters entirely.
That information is implicit in this thread.
But you are not going to bring home brew medical devices into a hospital in anything but the most backward of third world countries.
Certifying such a device for hospital use will take years and money. Just ask the people who already supply these things to hospitals.
This subthread is about making a life-support decision based on such a tool.
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Unfortunately, right now you might have to allocate tens of Millions to such a company just to operate the patent defense. Never mind that this was a vacuum tube device. There are current patents on computer implementations.
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Stethoscopes don't really have any moving parts, and I would be extremely surprised to hear of life or death decisions based solely on a Stethoscope.
The money in medical software/hardware isn't building it, it's certifying it.
Neither does an EEG.
And life and death decisions based solely on a Stethoscope have been the standard for 100 years.
As for certifying it, see my first sentence.
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I assume that there is a slice of the 'sold as a medical device' premium; but that you start looking at a considerable premium if you make greater demands on the sensitivity and precision of the device. If you are hunting signals down into microvolt amplitudes, and don't want to get out your good bone saw, I suspect that a $2 op-amp doesn't always cut it.
How can Agilent sell $15k oscilloscopes when you can download Arduino firmware with oscilloscope functions for free? Sensitivity, sample rate, features, pr
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$15K is one thing, $75 is quite another.
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Once again,. someon on /. has no clue baout how the world actually wqorks.
They need to pay people.
It needs to get certified.
Maintained
Tested regularly,
be durable.
make a profit.
So, yeah shit cost money and time.
Now, if I had someone I knew in that state and I couldn't get one through the hospital, I would build on to bring with me. It wouldn't be a medical device.
Hope for treating "Locked-in" Syndrome (Score:4, Interesting)
If even a small percentage of people suffering with "Locked-in" Syndrome [wikipedia.org] are reachable it will be a major win. Think "Johnny Got His Gun" or "The Diving Bell And The Butterfly" for cinematic examples of "Locked-in" Syndrome.
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Johnny could at least nod out Morse code if I recall.
There was an episode of House like this. A "ocked in" guy was hooked up to sensors, and he had to teach himself to think certain ways to move a pointer on a computer screen so he could at least give yes and no responses.
Morse Code (Score:5, Insightful)
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London, Ontario (Score:2)
fMRI has problems (Score:5, Interesting)
fMRI has problems and is very subject to interpretation, misuse and manipulation.
For example the now classic dead fish fMRI tests:
http://www.wired.com/wiredscience/2009/09/fmrisalmon/ [wired.com]
I am very skeptical of this until it has been repeated, tested and evaluated in other settings by different researchers.
For some reason when reading the story, it really reminded me of "facilitated communication" which is a terrible, cruel scam non-communicative and vegetative or near vegetative state people are subject to. I realize this is different, but really not very different.
Re:fMRI has problems (Score:4, Interesting)
You also have to be careful when thinking about this due to the different conditions that could all be lumped into "vegetative states".
Someone with localized damage could appear vegetative, but really just be "locked in". In other words, they could have a largely intact brain, except for key regions blocking movement/communication. They would appear vegetative, but actually be able to react in ways that would show up in fMRI. This research could prove to be valid in such cases.
Someone like Teri Shiavo, though, is a whole different story. Her brain was so damaged that most of it was simply gone (damaged material is cleared out by the immune system). She mostly had a big empty cavity in her head filled with fluid. It's unlikely that fMRI would show any response in such a case. And even if it did, with that much damage it would be impossible to make any guess as to what that activity might mean.
Non-verbal Autism (Score:2)
This work might also have implications for non-verbal autistic people, who historically were presumed to be severely retarded.
False positive? (Score:5, Interesting)
Case in point: http://www.wired.com/wiredscience/2009/09/fmrisalmon/ [wired.com]
"So, as the fish sat in the scanner, they showed it “a series of photographs depicting human individuals in social situations.” To maintain the rigor of the protocol (and perhaps because it was hilarious), the salmon, just like a human test subject, “was asked to determine what emotion the individual in the photo must have been experiencing.”
The salmon, as Bennett’s poster on the test dryly notes, “was not alive at the time of scanning.”
If that were all that had occurred, the salmon scanning would simply live on in Dartmouth lore as a “crowning achievement in terms of ridiculous objects to scan.” But the fish had a surprise in store. When they got around to analyzing the voxel (think: 3-D or “volumetric” pixel) data, the voxels representing the area where the salmon’s tiny brain sat showed evidence of activity. In the fMRI scan, it looked like the dead salmon was actually thinking about the pictures it had been shown."
Not the first time (Score:2)
Re:Not the first time (Score:5, Informative)
Actually, the BBC gave a link to the NEJM article. What have they done with those 5 patients since then?
http://www.nejm.org/doi/full/10.1056/NEJMoa0905370 [nejm.org]
Willful Modulation of Brain Activity in Disorders of Consciousness
Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D.
N Engl J Med 2010; 362:579-589
February 18, 2010
DOI: 10.1056/NEJMoa0905370
Results
Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.
Conclusions
These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
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What have they done with those 5 patients since then?
however, it remained impossible to establish any form of communication at the bedside.
Sounds like all they've done is frustrate the hell out of them, but I hope I'm wrong.
My dad's brain damage and amazing recovery (Score:5, Informative)
The only directive he had ever given me was that he didn't want to live on a machine... That ventilator weighed heavily on me. The doctors told me that he had three days to come out of his coma or he probably never would. In an effort to try to get any type of response out of him, they would twist his nipples so hard that they bled. My sister's 14th birthday was on day 5 of the affair and I decided that there was a difference between living on a machine and recovering from a serious incident for a few days. If he didn't come out of the coma, I would pull him off the ventilator on day 7 - just in case he hung on, I didn't want him to die on my sister's birthday.
He woke up on day 3 and ended up on the ventilator for about a week. It was that incident that finalized his brain damage, Essentially, he was a 41 year old that lost the entire top half of the right side of his brain. He wasn't moving his left side at all, he wasn't able to talk well, his short term memory was totally gone, he couldn't even sit up without falling over and could barely swallow a pureed and thickened diet. After 2.5 months of trying to get him stable enough to leave, he went to rehab where he stayed for another 2.5 months.
After rehab, he came home to live with me... and he regained almost all of his mental faculties. He could walk with assistance, having regained most of the major muscle control in his left leg, but his primary long term deficits were the loss of his left arm and the neglect of the left side of his field of vision. The kicker? He remembers every word that was said to him while he was in a coma. The doctors can't believe that the person they see corresponds to the brain imaging that they're looking at... while they expect that amount of plasticity in a younger individual, it's extremely rare in an adult. Needless to say, he was pretty happy with his life, though he faced the usual depression and whatnot that comes with such a significant change in his lifestyle.
Fast forward to this year... he had mastoiditis in the same ear as that infection back in 1998 and took two courses of antibiotics to get rid of it. Five months later, he went blind and started exhibiting stroke symptoms. I took him to the hospital and he was diagnosed with an abscess in his occiptal lobe (visual cortex) that penetrated the ventricles, causing ventriculits. To do imaging and a lumbar puncture, they ended up needing to sedate him and he ended up on a ventilator. Broad spectrum antibiotics (flagyl, vancomycin, and ceftriaxone) were started that night. A week in, he was, once again, no longer responding to pain.
Once again, I was stuck with confronting my father being on a ventilator and essentially in a coma. Once again, the doctors came through telling me that the odds of survival weren't very good and that, given the previous brain damage to the other side of his brain, now that both sides were involved and with little reserve brain left, he almost certainly wouldn't recover.... but there was still a chance that, if I stopped treatment, he could survive, though it wasn't likely. I decided that my dad would want the only option that gave him any chance of an outcome worse than death, so I co
Quality of live is relative (Score:3)
People say easily "I would want to die if I was like that" but when you are like that... quality of life is not hard set. When you get older, you know you are going downhill one way or another. Ask a youngster who says he rather be dead then in a wheelchair how he feels about a walker. To most young people, old age is a horror but when you get there, you find that there is more to live then perfect health. Would you want to see your grandchild even if both of you were in diapers? That is real life.
I can re
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Thanks for sharing your story and good luck your father, you and your family.
My father suffered a severe stroke in 1994 (He was 46) which caused his heart to stop numerous times. He was comatose for 2 weeks and doctors told my mother there was too much brain damage from the lack of oxygen due to the multiple heart failures. My mother and grandparents could not bear the thought of pulling the plug. He came out with severe brain damage and was said not to be in a vegetative state but in an altered state. He w
Not moving is very painful (Score:2)
He must be in severe pain. Unless his injuries have left him with no ability to feel his body, he would likely be in agony.
Johnny Got Hist Gun (Score:2)
Johnny Got His Gun
http://en.wikipedia.org/wiki/Johnny_Got_His_Gun_(film) [wikipedia.org]
I don't know which is worse... (Score:2)
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Oh dear [wikipedia.org]!
If only they had thought to use EEG and neuroimaging techniques during her attempted rehabilitation and the subsequent EOL battle...
Oh, wait, they did, and didn't find anything.
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If only they had thought to use EEG and neuroimaging techniques during her attempted rehabilitation and the subsequent EOL battle...
Oh, wait, they did, and didn't find anything.
TFS says this is a new fMRI technique and that EEG techniques could be developed (but obviously haven't yet).
fMRI was denied for Schaivo:
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That man shows activity when hooked to an EKG machine.
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Not to worry, none of the brain structures observed in TFA still existed in her head.
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But is it to release you from the burden or them? Seems like a question that can be asked of them now.
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Fuck you.
Never, ever turn me off.
How about we find away to communicate instead of just killing them?
hmm?
You are a small minded, mean SOB.
Gosh, someone provokes god in the same sentence as killing people. I'm shocked I tell you. Yes I am aware I might be committing the genetic fallacy.
Re:Just kill them all for the love of god (Score:5, Insightful)
I'm not even sure why they let vegetative people live if they've been in that condition for so long. If they're truly unconscious then they're already gone, and if they're not you definitely want to kill them. It makes me sick that we even *potentially* leave people in such a state for so long.
You cannot say that someone else should die, without asking them, simply because **you** imagine you would want to in that situation. That would violate just about every single code of ethics imaginable. The situation changes a bit if they have previously expressed a desire not to be kept alive in such a situation (which is often followed, although mind you even in that case, it's hard to know if they really meant it, since they had no prior experience with which to make an educated judgment), but to presume that another should die because of what you think or want is one of the grossest violations of human rights possible.
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I except = weasel words (Score:2)
You wouldn't need to say "expect" unless you knew you were a weasel trying to project YOUR opinion on "most" people (most is another weasel word).
It is simply not up to you and thank goodness for that. Their are no simple answers on this and most certainly not ones based on one persons opinion who isn't in that situation.
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The trouble is that not choosing isn't an option. And, if a patient cannot communicate or is too young/brain-damaged/mentally ill/etc. to communicate their preference, you can't usefully ask(this particular case, apparently, now may be able to communicate, solving the ethical problem).
This puts you in the position of being forced to act on somebody else, without having access to their opinion. What, then, do you base your actions on? Do you do unto them as you would do unto you? Do you do some polling and d
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You cannot say that someone else should die, without asking them, simply because **you** imagine you would want to in that situation. That would violate just about every single code of ethics imaginable.
Actually, one could argue it's supported by the moral codes of most religions, as they all tend to feature some form of reciprocity [wikipedia.org]. Of course, this would be a simplistic argument since any one religion you look at will have other principals, philosophies, and fads affecting how this gets interpreted and applied.
Personally, while I think the Golden Rule has significant weaknesses as a moral guideline, I think it can be helpful in situations like this where you don't have the ability to communicate with t
The diving bell and the butterfly (Score:2)
http://en.wikipedia.org/wiki/The_Diving_Bell_and_the_Butterfly [wikipedia.org]
probably based on this, book written by author in this state.