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INDEPTH: TERRI SCHIAVO
Awake but not aware: a persistent vegetative state
CBC News Online | March 22, 2005

A legal battle involving a severely brain-damaged Florida woman has drawn public attention to the medical condition known as "persistent vegetative state."

Terri Schiavo gets a kiss from her mother, Mary Schindler, in this image taken from video and released by the Schindler family, August 2001. (AP Photo/Schindler family video)

Terri Schiavo suffered severe brain damage in 1990 when her heart stopped temporarily. She received a medical diagnosis of "persistent vegetative state" by court-appointed doctors. Her husband and parents have fought in the courts over whether or not she should be kept alive through the use of a feeding tube.

Patients in a persistent vegetative state, according to medical literature, have lost all brain function. They are awake, breathing on their own, but unaware of their surroundings or what is going on around them. Massive brain damage has destroyed their conscious minds.

This medical condition follows either a traumatic event or a chronic condition. It sometimes follows a coma. But a coma is different in that a patient is neither awake nor aware.

Patients in a persistent vegetative state are bedridden and require feeding because they cannot feed themselves. They may open their eyes spontaneously, they may grunt or scream, smile briefly and move their limbs. They may cry or grimace occasionally.

But while they may blink their eyes if stimulated, they are not doing so as a response to a visual threat. Some may chew or clamp their teeth. They are incontinent, as well.

Patients in this condition cannot speak or obey commands. They may appear somewhat normal, but they are functioning at an extremely low level. They are not aware of their environments. The condition is considered "persistent" because it continues in spite of medical intervention or treatment.

Some patients may regain some awareness after being in a vegetative state but others will remain barely alive with very little functioning for years or decades. A common cause of death for a patient in this condition is infection, such as pneumonia.

FAMOUS CASES

Karen Ann Quinlan
In 1975, Karen Ann Quinlan was only 21 when she collapsed after going to a party where she swallowed sedatives and alcohol. Doctors saved her life, but she suffered severe brain damage and fell into a persistent vegetative state. She was given a feeding tube and put on a respirator. Her family fought through the courts for the right to remove her from the respirator and therefore end her life. Her story became familiar in the right-to-die debate.

In 1976, the New Jersey Supreme Court allowed her parents to turn the respirator off, but in a surprise twist, she kept breathing on her own and, sustained by the feeding tube, she lived in a coma in a New Jersey nursing home until 1985, when she died of pneumonia.

Nancy Cruzan
In 1983, Nancy Cruzan was 26 years old when she was involved in a single-car accident that left her with irreversible brain damage. Within a month, doctors determined that she was in a persistent vegetative state. She was kept alive by a feeding tube and constant medical care.

Her parents fought a legal battle to have the feeding tube removed and the case went all the way to the U.S. Supreme Court. Their bid to have her disconnected from the tube was supported by the American Medical Association, the American Academy of Neurology, the American Nurses Association and the Society for the Right to Die. It was the first right-to-die case heard by the U.S. top court.

In 1990, the Supreme Court decided that the Cruzans did not have a constitutional right to remove her from the feeding tube and that states have the right to demand "clear and convincing evidence" on what the victim would want in such cases.

Her parents continued their legal battle and convinced a Missouri judge with new evidence later that year that their daughter would not have wanted to be kept alive. The judge ruled in their favour in late 1990. She was removed from the feeding tube and died 12 days later.

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