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Word Count: 998
In the last century with the advent of plastic tubing new ethical issues have been raised regarding nutrition and hydration of patients in comatose or that of persistent vegetative states By performing fairly simple procedures artificial nutrition and hydration ANH may be provided to almost all patients including those unable to swallow2 Therefore patients who would otherwise imminently die may sometimes be kept alive for months or years A Controversial issue that CPallis describes in his commentary on whole brain death is that of patients who are in persistent vegetative state PVS PVS patients are not capable of voluntary action or behavior They are not aware of their environment and do not have the capacity to experience pain or suffering1 It is sometimes described as when a person is technically alive but hisher brain is dead However that description is not completely accurate In persistent vegetative state the individual loses the higher cerebral powers of the brain but the functions of the brainstem such as respiration breathing and circulation remain relatively intact4 Spontaneous movements may occur and the eyes may open in response to external stimuli but the patient does not speak or obey commands1 However these patients are not terminally ill and may survive for years if ANH are provided In such cases the fundamental question is do physicians and families have an obligation to continue supplementation indefinitely despite the fact they will never regain consciousness Although in regard to patients who are at closer stages of dying and for whom ANH will provide absolutely no benefit few would agree that we have an ethical obligation to supplement these patients2 There are other patients for whom the burdens clearly outweigh the benefits and for whom continuation can be predetermined with no debate If the case is that the PVS patient is in effect never going to regain consciousness would it not be more humane to allow these individuals to be rid of any
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