Bioethicist raises ethical questions over long-term life support

Former Israeli Prime Minister Ariel Sharon has been in a vegetative state since suffering a massive stroke in January 2006.

But according to researchers, 84-year-old Sharon recently showed remarkable signs of brain activity, responding to the voices of family members — leaving many wondering if he might one day soon wake up.

Art Caplan, a bioethicist and founding director of the Division of Medical Ethics at New York University’s Langone Medical Center, says we’ve long assumed people in a vegetative state can no longer think, aren’t aware of what’s around them and can’t be conscious. But now that’s beginning to change.

“I think people are very concerned that maybe when they’ve been dealing with loved ones in the past or that they’re missing some signal that somehow or another there’s someone who’s been diagnosed in a permanent vegetative state that’s not brain dead,” he said.

Sharon’s family has kept him in an immobile, non-responsive state for years, Caplan says. They recently brought in a scientist to try new tests to see if they provoked some sort of reaction.

But these new tests could be the wrong approach to finding out if the brain is still active, Caplan said.

“Consciousness assumes that there is something there to be aware, that there’s a self there or a person that’s processing all this information,” he said. “I think it may be the case that his brain is able to process certain stimuli and fire up certain circuits.”

Sharon’s brain damage was severe and no one his age has ever woken up or come out of such a vegetative state, Caplan said.

“I don’t think any of us would really want to be trapped in our body for seven years, particularly if we were in a very disturbed state of mind,” he said.

In Sharon’s case, there are three possibilities of what could happen next.

“One, is there’s nothing happening, he just (has) brain reflexes. The other is he’s there, but he’s there in a very strange state that would be horrific to be trapped the way he is and then the third is, maybe he is there,” he said.

What these new technologies can reveal about brain activity is important, Caplan said, but it’s important not to overstate their importance, because people end up in a comatose state for different reasons.

“Even though people see certain things going on in someone in a permanent vegetative state, there are some reflexes there. They are digesting their food, they’re not dead, there’s some brain activity, we have to realize the quality of life can be awful,” he said.

In Sharon’s case, Caplan said, he’s in a state that’s starting to be called “minimally conscious.”

“But in all these situations, let’s keep in mind, people of goodwill, loving family members, partners, friends, they could still say ‘I don’t care if his brain is active, he would not want to be bed-bound, in a minimally conscious state. That’s not a situation I want to prolong with technology,'” he said.

But the sort of care that’s needed for these people can be incrediby costly. It can also take up valuable spots in hospitals and intensive care units. Caplan says family members should consider altnerative means of caring for their relatives, if they find them in such a state.

“We shouldn’t have 5,000 to 10, 000 people in intensive care in the United States alone, when we can barely provide basic care for our children,” he said.