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Having been originally introduced as a term to facilitate discussion of a specific group of patients regarded as entering a state of unawareness following coma, the ‘Persistent Vegetative State’ (PVS) has established itself as an apparently discrete medical condition with clear-cut implications for ethicists and lawyers that exceed any scientifically based understanding. As a consequence of this upgrading, conclusions drawn about the status and hence the management of this uncommon condition have been increasingly extended to other patients with much more common forms of disability. This book traces the origins of prevailing perceptions about PVS and submits these to critical examination. In doing this it comes to the conclusion that inadequate attention has been paid to acknowledging what is not known about affected individuals and that assumptions have consistently come to be traded as facts. Re-examination of the basis of the PVS and the adoption of a more scientific approach is long overdue and is owed to the community at large which has generally been provided by many medical practitioners with a ‘dumbed-down’ account of the condition. The book will be of interest to philosophers, medical graduates and neuroscientists but is also intended to remain accessible to the general reader with an interest in the wider implications of trends in medical thinking for attitudes towards many classes of patient. It has an extensive bibliography and will be of specific interest to bioethicists and lawyers with professional interests in PVS.
Having been originally introduced as a term to facilitate discussion of a specific group of patients regarded as entering a state of unawareness following coma, the ‘Persistent Vegetative State’ (PVS) has established itself as an apparently discrete medical condition with clear-cut implications for ethicists and lawyers that exceed any scientifically based understanding. As a consequence of this upgrading, conclusions drawn about the status and hence the management of this uncommon condition have been increasingly extended to other patients with much more common forms of disability. This book traces the origins of prevailing perceptions about PVS and submits these to critical examination. In doing this it comes to the conclusion that inadequate attention has been paid to acknowledging what is not known about affected individuals and that assumptions have consistently come to be traded as facts. Re-examination of the basis of the PVS and the adoption of a more scientific approach is long overdue and is owed to the community at large which has generally been provided by many medical practitioners with a ‘dumbed-down’ account of the condition. The book will be of interest to philosophers, medical graduates and neuroscientists but is also intended to remain accessible to the general reader with an interest in the wider implications of trends in medical thinking for attitudes towards many classes of patient. It has an extensive bibliography and will be of specific interest to bioethicists and lawyers with professional interests in PVS.
A survey of the medical, ethical and legal issues that surround this controversial topic.
This reference is a comprehensive work in the field of neurotrauma and critical care. It incorporates the fields of head injury, spinal injury and basic neurotrauma research into one source. The major emphasis is on the treatment of patients with head and spinal cord injury, including the management of all other problems that bear upon the care of these patients.
Chapter 12 of this book is open access under a CC BY license. Well-established scholars from a variety of disciplines - including sociology, anthropology, media and cultural studies, and political sciences – use the social construction of death and dying to analyse a wide variety of meaning-making practices in societal fields such as ethics, politics, media, medicine and family.
This serial is firmly established as an extensive documentation of the advances in contemporary brain research. Each volume presents authoritative reviews and original articles by invited specialists.This volume concentrates on coma and consciousness science. presenting articles from leading figures in the area on the clinical and ethical implications of work in this field. The book provides a thorough review of the various aspects of coma science from a review of the concepts, questioning of recent advances, case studies, through to where research in the field is heading. - Provides the reader with a unique overview of all aspects of new advances in coma science - Broad focus with contributions by the top scientists worldwide in the respective disciplines
Whenever the legitimacy of a new or ethically contentious medical intervention is considered, a range of influences will determine whether the treatment becomes accepted as lawful medical treatment. The development and introduction of abortion, organ donation, gender reassignment, and non-therapeutic cosmetic surgery have, for example, all raised ethical, legal, and clinical issues. This book examines the various factors that legitimatise a medical procedure. Bringing together a range of internationally and nationally recognised academics from law, philosophy, medicine, health, economics, and sociology, the book explores the notion of a treatment, practice, or procedure being proper medical treatment, and considers the range of diverse factors which might influence the acceptance of a particular procedure as appropriate in the medical context. Contributors address such issues as clinical judgement and professional autonomy, the role of public interest, and the influence of resource allocation in decision-making. Chapter 6 of this book is freely available as a downloadable Open Access PDF at http://www.taylorfrancis.com under a Creative Commons Attribution-Non Commercial-No Derivatives (CC-BY-NC-ND) 3.0 license.
Joseph J. Fins calls for a reconsideration of severe brain injury treatment, including discussion of public policy and physician advocacy.
In this “riveting read, meshing memoir with scientific explication” (Nature), a world-renowned neuroscientist reveals how he learned to communicate with patients in vegetative or “gray zone” states and, more importantly, he explains what those interactions tell us about the working of our own brains. “Vivid, emotional, and thought-provoking” (Publishers Weekly), Into the Gray Zone takes readers to the edge of a dazzling, humbling frontier in our understanding of the brain: the so-called “gray zone” between full consciousness and brain death. People in this middle place have sustained traumatic brain injuries or are the victims of stroke or degenerative diseases, such as Alzheimer’s and Parkinson’s. Many are oblivious to the outside world, and their doctors believe they are incapable of thought. But a sizeable number—as many as twenty percent—are experiencing something different: intact minds adrift deep within damaged brains and bodies. An expert in the field, Adrian Owen led a team that, in 2006, discovered this lost population and made medical history. Scientists, physicians, and philosophers have only just begun to grapple with the implications. Following Owen’s journey of exciting medical discovery, Into the Gray Zone asks some tough and terrifying questions, such as: What is life like for these patients? What can their families and friends do to help them? What are the ethical implications for religious organizations, politicians, the Right to Die movement, and even insurers? And perhaps most intriguing of all: in defining what a life worth living is, are we too concerned with the physical and not giving enough emphasis to the power of thought? What, truly, defines a satisfying life? “Strangely uplifting…the testimonies of people who have returned from the gray zone evoke the mysteries of consciousness and identity with tremendous power” (The New Yorker). This book is about the difference between a brain and a mind, a body and a person. Into the Gray Zone is “a fascinating memoir…reads like a thriller” (Mail on Sunday).
Over the past decade, the hospitalist model has become a dominant system for the delivery of inpatient care. Forces such as national mandates to improve safety and quality, and intense pressure to safely reduce length of hospital stays, are now exerting pressure on neurologists. To meet these challenges, a new neurohospitalist model is emerging. This is the first authoritative text to detail the advances and strategies for treating neurologic disease in a hospital setting. It includes chapters on specific acute neurologic diseases including stroke, epilepsy, neuromuscular disease and traumatic brain injury and also addresses common reasons for neurologic consultation in the hospital including encephalopathy, electrolyte disturbances and neurologic complications of pregnancy. Ethical and structural issues commonly encountered in neurologic inpatients are also addressed. This will be a key resource for any clinician or trainee caring for neurologic patients in the hospital including practising neurologists, internists and trainees across multiple subspecialities.