Joseph J. Fins, Rethinking Disorders of Consciousness: New Research and Its Implications.

Joseph J. Fins, Rethinking Disorders of Consciousness: New Research and Its Implications, HASTINGS CENSER REP., Man-Apr. 2005, at 22.

Over the past several years, deciding whether to withdraw life-sustaining therapy from patients who have sustained severe brain injuries has become much more difficult. The problem is not the religious fundamentalism that infused the debate over the care of Terry Schiavo. Rather, the difficulty stems from emerging knowledge about the diagnosis and physiology of brain injury and recover,/ The advent of more sophisticated neuroimaging techniques like MRI and PET scans, in tandem with electrophysiologic and observational studies of brain-injured patients, have led to an effort to differentiate disorders of consciousness more precisely. The crude categories that have informed clinical practice for a quarter century are becoming obsolete.

It used to be enough for a neurologist or neurosurgeon to write a note in the chart grimly recording the patient's neurological exam and then concluding with the global statement, "no hope for meaningful recovery." It can no longer be so simple. With a better understanding of brain injury and mechanisms of recovery, we should be suspicious of blanket statements that might obscure important differences among different patients' prospects for recovery, although even those patients we now think may recover may still be left with profound disability.

Recovery from coma depends on a patient's age, the site of injury, and whether the damage was done by trauma, anoxia (oxygen deprivation), or other processes. The most severe brain injuries may lead to brain death. If patients survive and begin to recover from coma, they often first enter into the vegetative state, first described by Bryan Jennett...