Status Updates From Rights Come to Mind: Brain ...

“Paradoxically, it is sometimes easier to find a bed if the patient is vegetative and not in MCS…would require more specialized placement [where] cognitive rehabilitation and physical therapy would be available”pg97

Severe brain injury presents a more complex portrait of failure to physicians than death.
“Adequate functional status has not been achieved…the inability to have convinced the family to forgo care and let the patient die”pg88

“A rushed discharge is often attributed to reimbursement issues. And while finances are often the proximal cause…other factors are at play”pg88

Much ink is printed about OPO representatives and organ donation requests to family members of patients. I think the author’s ultimate point is relatively small and straightforward: coma or brain injury should not - by default- identify a patient for possible organ donation.

I’m not sure if I agree with this conclusion, I’ll need to think about it. Organs are needed fast upon death, should be considered.

Writhing 24 or 48 hrs, neurosurgeons/neurologists can generally group brain injury patients into one of three groups: doomed(won’t recover past vegetative state), will do well, and indeterminate (more information is needed, maximal treatment efforts will be needed to know maximum possible recovery potential)
Summary from pg46

“Plum was interested in the vegetative state in order to appreciate the utility of treatment for those who might be helped”pg45

“even as the acute care of severely brained injured patients has progressed during this same period, patients with severe brain injuries have become increasingly vulnerable to treatment decisions that might preclude potential recoveries”

“While terminal unconsciousness indicates that death is near, the loss of consciousness in brain injury…could be the first step toward recovery.”pg31

“We are little more advanced than when our predecessors were studying infectious diseases one hundred years ago”pg27

“A failure to explicitly state the options was problematic… the superior knowledge of the physician speaking with surrogates imposes an ethical obligation to provide guidance, without dictating or omitting”pg25

“Mr. [steve] Carrier recalled, ‘… what kind of damage, you mean *brain damage*? Like I still didn’t get it, and that’s when he said, ‘yeah, brain damage’’…saying if she makes it through this we could be in rehab for a year or more, and that’s when it really hit home, that it was that serious”pg24

“The patients described here are ones left in the middle: medicine saved their lives but left them only partially restored, leaving families with ethical questions for which they are unprepared”pg11

“[Minimally conscious state patients] remain sociologically - if not legally - outside the regulatory protection of the ADA. The neglect and disregard continues, making the sad point that before this population is deemed worthy of disability rights, society needs to acknowledge even more fundamental rights of citizenship.” - pg9