Wakefulness ‘can lead to false hopes’
Her father said she responded to his teasing by making a face at him.
“It tells us she’s still with us,” he said.
But in Schiavo’s persistent vegetative state, family members can be deceived by eye movements and reflexes, experts say.
“It creates this ironic combination of wakefulness without awareness,” said Dr James Bernat, a neurology professor at Dartmouth Medical School in New Hampshire.
That is because in a persistent vegetative state, the brain centres that control wakefulness are functioning, but those that permit conscious awareness of oneself or the environment are damaged or destroyed.
As a result, patients close their eyes to sleep and open them when they wake.
That is in contrast to a coma, in which the eyes remain closed and a person is neither aware nor awake, or brain death, in which there is no sign at all that the brain is functioning.
Dr Bernat declined to comment specifically on the Schiavo case. He said outward signs of persistent vegetative state can give family members false hope.
“There’s a normal tendency of family members to interpret movements as evidence of awareness,” said Dr Bernat, who has seen that happen with his patients.
He said when family members claim a loved one in a persistent vegetative state is purposefully looking at them, he asks to accompany them to the bedside and see for himself. Sometimes, family members have noticed genuine signs of consciousness and investigation shows the diagnosis was incorrect, he said.
But in his experience, Dr Bernat said most of the time the family has been wrong.
Doctors try to help the family understand how it’s possible to be awake but not aware, he said.
Patients can recover after even a year or two in a persistent vegetative state, Dr Bernat said, but a vegetative state caused by lack of blood or oxygen delivery to the brain, that has gone on more than five years, is considered permanent.
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