Studies have shown that as many as 40 percent of patients believed to be in a persistent vegetative state are misdiagnosed and are actually minimally conscious. Why is this? What should be done? Experts tackled these complex and difficult questions at an International Neuroethics Society (INS) event in San Diego last Friday.
There are several levels of consciousness involving awakeness and awareness. Patients in a coma are neither awake nor aware. Those in a vegetative state are awake, but not aware. Minimally conscious patients are awake with intermittent periods of awareness. There is also locked-in syndrome, in which patients are awake and aware but unable to move or communicate verbally.
Too often, patients are labeled as vegetative when in fact they are minimally conscious. Sometimes, the initial assessment is not wrong. According to Dana Alliance member Joe Fins, M.D., many who suffer a traumatic brain injury or other devastating health event that leaves them in a vegetative state remain in that state upon leaving the hospital three to four weeks later. But it is not uncommon for a patient to improve to minimally conscious some time after.