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Kevin Frayer / AP, file
Former Israeli Prime Minister Ariel Sharon in June 2005, just over six months before he suffered a massive stroke.
Ariel Sharon, the former prime minister of Israel, has been in a permanent vegetative state since suffering a massive stroke on January 4, 2006. For the past seven years, a respirator and a feeding tube have kept him alive at Sheba Hospital in Tel Hashomer, Israel. He has never shown any reliable signs of awareness or consciousness – until last week.
The stroke left the man once dubbed by Israelis as “the Lion of God” bedbound and technologically dependent on machines for his existence.
In the past, some of his family felt that he was able to slightly move a finger and show some signs of responsiveness but his doctors believed that the strokes so damaged his brain that both recovery and any serious mental activity were impossible.
But last week, a team of doctors and neuroscientists from Israel's Soroka University Medical Center subjected the 84-year-old Sharon to a series of sophisticated brain scans. They were surprised at what they saw.
They showed him pictures of random houses, which he would not be expected to know. Then they flashed a picture of his own house before his eyes. When the images of his own home were shown, areas of his brain "lit up" with activity. Similarly his brain ”fired up” in response to hearing the voices of family members but did not when nonsensical gibberish sounds were presented to him.
Sharon is not the first person to surprise doctors who doubted that anything could be going on in a brain located in a body that was otherwise unresponsive for years. Other patients with massive brain injuries have shown some brain activity included one case in which a 23-year-old woman, when asked to imagine different scenarios including playing tennis, showed strikingly similar patterns of brain activity to those found in scans of healthy volunteers.
So what are we to make of this? Can doctors say with certainty that he won’t recover? Is Sharon really “in there” unable to move but alert and awake? Should we ever remove life-support from someone who has been severely brain injured by a stroke or traumatic injury or asphyxiation? These questions are hardly trivial since families and health care teams face them every day all over the world.
Can Sharon come back? Many Israelis and his family fervently hope so but older patients, especially 84-year-olds who have been through two strokes and remained unresponsive for seven years, do not come back.
Is he “in there”? Let’s hope not. Being trapped in your own body year after year unable to move anything or communicate in any way would be horrific.
What about the brain activity? The data that the doctors and scientists see is very hard to interpret. Something is going on in Sharon’s brain when he sees or hears familiar things. But is he really aware of what he sees or are well-worn neural pathways firing up when familiar stimuli are present without anyone home to appreciate them? No one really knows for certain, but it seems fair to say that a very damaged brain is not ”thinking” or aware or self-conscious in a manner similar to healthy human brains.
So what is the case for keeping Sharon alive? He is not dead—he has brain activity. Still, he may be suffering if he has any awareness of being trapped inside his own body. Prolonging his life may be causing incredible misery to him and others like him.
The best we can do is to let families try to decide what to do as long -- as they understand the facts and the uncertainties. And as long as they are willing to help pay the bill. Keeping Sharon or others like him alive in a very damaged, extremely limited state with no hope of recovery is not something that the government should pay for without some support from those who want life to go on.
The choice to keep Ariel Sharon alive is one that deserves respect but is also one that demands involvement—emotionally and fiscally. The choice to let him go also deserves respect. In this case, uncertain medical science can only give way to well-intentioned ethics.
Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.
Leave a Comment:
VERY interesting discussion, but CHILLING that it's up to the families "as long as they are willing to help pay the bill".
So families without resources have fewer ethical choices left to them?
No. What the article is saying is that if families wish to use scarce medical resources to keep a person in a vegetative state, who has virtually no hope of ever regaining consciousness, alive for extended periods of time, then it's only fair that the family shoulder at least a portion of the cost.
Anyone looking at this objectively would have said to take Ariel Sharon off life support years ago.
On a side note, if I'm ever in this situation I hope my family pulls the plug. The two scenarios are: A.) I have no consciousness and I'm just a body so it's a waste of resources or B.) I do have consciousness and I'm trapped in my own body, unable to move, speak, interact, or do much of anything for years on end. I think B is the more horrific scenario.
This is ghoulish. Let this man go home. Yes a few neurons are still sparking but his brain has been dead for 7 years. Let the rest of him go!!
Obamacare wanted to include an "end of life counseling" segment that would allow people to make these decisions as they got older or sicker along with their family as to whether they wanted to be kept vegetative. However, several Republicans including Sara Palin said that Obama wanted to "kill your grandma" It's a shame, because it would save billions of dollars for people who could use healthcare.
(1) IMO there is an ethics issue of consuming lots of public health care money in such a case, money that could be saving or significantly enriching others lives. And if society is experiencing a limited number of hospital beds, limited number of available doctors & nurses, then that is a different drain on resources that could be helping others.
(2) IMO it is unjustified for this author or people posting here to claim
is wildly making conjectures as if facts were known with strong certainty, when there is very little (certainly not a sufficiently substantial statistical data base of) historical or experimental data to illuminate reality. Why would it necessarily be "horrific"? There have been lots of hermits or recluses in history that chose to be alone, for reasons of privacy or reasons of spiritual pursuits -- if a person has lived a somewhat spiritual or somewhat cognitively-oriented life, perhaps s/he'd be thrilled to have tons of undisturbed hours to pray or to think about whatever-- poetry, science, science fiction, law cases, games, etc.
WOW! You just went to where obamacare is leading. Death panels. Well done in showing the left agenda. Isnt this just like the 1970's show Logan's Run? Over a certain age it's time to be "reclaimed". This country is doomed.
math, you had me until point 2. it would be horrific. let him go.
calyps; isn't it time for the o-really factor, yet?
I'm sorry, but I could hardly think of a more horrific existence. Unable to move, unable to communicate, maintained by machines, airway suctioning to keep the lungs clear, catheters deep into the urethra to allow urine to pass, nasopharyngeal tubes pushed deep into the stomach for nutrition, IV's fulfilling the bodies needs that the nasopharyngeal feedings don't, care provided by strangers, FOR 7 YEARS, or almost one tenth of his life...if there is anything left of this once proud, vibrant person surely his mind screams let me die so that I can escape this hell called prolonging life.
Any MD who has not had the "end of life" talk with his older patients isn't worth his salt! Both my husband and I have addressed what kind of measures we want with our Dr and what we do not want.
If Sharon would have voiced his desires, his family wouldn't have had to go through 7 years of grief and wondering.
The expense for a family of keeping someone alive in a vegetative state is just too great for most all people.
Forget the expense, Ariel is imprisoned in a body and brain that are no longer worth living in. Let him go. The nightmare of looking out and not being able to interact with existence (if you call a hospital room existence) is just too much to bear.
it is a torture. it is a hell he is living in. WIth due respect to this Lion of God let him go to his den for rest.
Death Panels are, in and of themselves, not all that bad. I would serve on them without reservations. Speaking as one with over 25 years dealing with, and caring for, hundreds in the same predicament, I think I would be a good judge of who 'lives' (you can call it that if you want, but we know it is merely existing, and not 'living') and who dies...
I do not see how forcing other people to pay for a loved one's care as being ethical. Its like having kids you can't afford and expexcting the rest of us to feed them. Not everyone can ride in the cart.
Call me a cynic but this article's last sentence pretty much sums up what the author wanted to do here.
"uncertain medical science can only give way to well-intentioned ethics"
Shame on such articles that portrend to present rational discussion but are intended to create doubt in science. Just like global warming .... the right and church are not interested in the science behind. They don't have to prove anything ... all they want to do is create doubt in people's mind about global warming. Unfortunately they have succeeded upto a fair degree.
Hopefully he's not overweight or the bioethicist will recommend shaming
I have been in on the end-of-life talks and have had to tell doctors to not perform heroic measures for my dad. The Republicans can scare you with the whole "death panels" talk but, seriously, doesn't THIS scare you more? That your "loved ones" can flog your body because they cannot let go and are hoping for some miracle? This man is gone. At eighty-four, he is NOT coming back. This frightens me MORE. This is my idea of hell. That my family would keep my shell alive, wasting valuable medical dollars on waiting on something that will never happen, wasting their lives. If you are too scared to have the talk and write up your wishes, shame on you! You are being selfish. Not only will you waste valuable resources, you will put your family through so much because you were too "uncomfortable" to have the talk. Make you wishes known by putting them in writing and making sure your doctors and the hospitals KNOW that you don't want to be a gork. I know that I don't.
Interesting post, until: "as long as they are willing to help pay the bill".
Only families with resources have the right to ethical decision choices according to this statement.
This is part of the reason health care is in such a dire state - people say we need to pay "whatever it takes" to prolong lives, and hiss at the notion that their families would have to help pay the bill. Families try to keep family members alive because it's the "right thing to do" and it's free for them.
But it's not free. The money that family isn't paying is coming from the taxes on everyone else's families. And the money isn't going to schools, food, vaccinations etc for those families. How is it more ethical to spend $5 million keeping one person alive in a vegetative state than it is to spend that $5 million giving basic medicine - which saves far more lives - to people who need it?
And if the health care system or economy collapses because we have racked up so much debt and we're far less able to provide advanced care to people in the future - where will people who take the "high ground" now be then?
And we need to pay for the doctor's annual golf club membership. We must not forget that. Oh, I just forgot to ask, why is US healthcare almost 3x as expensive per capita as healthcare in many other Western countries. I've never actually heard a satisfactory answer to that yet.
Healthcare in the USA is so expensive because so many profit from it and so many pay them for it.
Because they work hard and save lives. And its damn hard work. But I'll ask you the same question I ask everyone with your opinion: Why don't you become a doctor then? If they earn so much more than they deserve, then become one. Why not take advantage of that fantastic lifestyle? Hmm?
1) increased use of advanced technology
2) Increased spending at the end of life (like this story)
3) Lawyers and malpractice litigation
4) Defensive medicine (see #3)
fee for service and medical salaries are an issue as well, but less so than the above
Sounds like there is more concern that the bills get paid then for the patient
He has not been a viable "patient" for quite some time. In the US, Canada, Europe and Australia, ethical decisions about how long to retain a patient on life support are made every day, often based on a financial decision due to the quite costly alternative of prolonging life on a coma.
Yeah, make the decision on financial criteria. That sound so ethical.
IMHO-2730490 - Then let's see your checkbook solve the problem. Or, if you don't have the money, volunteer your time as a doctor to see to it that finances are never an issue. Or, if you don't have the money, or the skills, then what's your solution?
So it's a moral imperative to get a flu shot but not a moral imperative to do everything necessary to keep someone alive? This "bioethicist" needs to STFU.
Would you call being trapped in your body, unable to move, speak, or otherwise interact with the world being "alive"?
I'd call it torture.
So it's a moral imperative to get a flu shot but not a moral imperative to do everything necessary to keep someone alive?
Let me know when being comatose can spread to others, creating an epidemic that is capable of killing in particular infants and the elderly.
Jonathan - you undermine your argument with the childish expletive acronym. I sense moral cowardice, the drive for a position of unassailable moral comfort. People since time immemorial have had to make life and death decisions...this is one of the easier ones, I'd say. Y'know, Pope John Paul II could have remained Pope for Life on life support, but he decided to forego medical life extension. His example is inspiring.
Yep, Pope John didn't want the torture of being kept alive by a machine. What's the use of living if you are in pain and comatose the rest of your life?
Still more chilling, what if the patient is conscious in some level, but unable to speak, move or otherwise respond, wouldn't that be like torture?
"As long as they are willing to help pay the bill...", frightening attitude!
That disturbing comment aside, this story can serve as a reminder to anyone with a family member in a coma as well as the medical personnel caring for them to treat that patient with respect, consideration, and dignity. We really don't know how aware that person may be, and being trapped in your body with any level of awareness is a hideous enough situation without being treated poorly by your caretakers. Add thoughtless, careless, even cruel treatment and the patient is then in a level of Hell we cannot even imagine.
What's disturbing about that comment?
At this point, keeping him alive is more cosmetic than medical. He (hopefully) is brain dead. And if he isn't brain dead, he is being tortured.
@ Scubasteve.
You stated "He (hopefully) is brain dead" While I can see that you are comfortable living in this state wishing others to join you is morbid.
In addition your second comment "And if he isn't brain dead, he is being tortured." Is that how your parents feel?
im guessing this is an insult? weird
you are strange
Calyps,
I meant that I hope he is brain dead because the alternative was much worse.
Can you imagine being alive, and concious but unable to move or interact with the world for 7 years? Laying in bed all day, staring at the wall. If you've got an itch, you can't scratch it. If you're laying in an uncomfortable position, you can adjust yourself. If your eyes are open, you can't blink so they get dry and stingy. Doing that all day everyday for 7+ years? Terrible.
You life at all cost people can have the vegetative state. Hope he can't feel the rashes and bed sores or having that nice catheter changed every once and a while.
Let that war criminal and murderer ROT.
Do the world a favor and pull the plug.
But Assad is still alive, you can't pull the plug on him.
The world should dig up Arafat and kill him with AIDS again. Ariel Sharon knew he lived amongst vicious, murderous Arabs. He did what he had to do.
Now Ariel is soaking up Israeli resources and not benefitting from it. What a great revenge for the PLO.
IYHO: this has nothing to do with PLO revenge. Has to do with Sharon being old and fat. Old and fat people not uncommonly have strokes. That he's being tended to so well has to do with the reverence he inspired in Israel.
reread.If you want to keep someone alive when it's hopeless,it'll cost you.As an RN of almost 30 yrs,I can tell you.A story like this makes everybody think the 'miracle' will happen for THEIR family member.It costs 10k or more a DAY in critical care.Costs probably 1/4 in extended care.How MANY people do we keep alive for 1 year,2, 10,20? There are thousands,if not 10s of thousands of people who,sorry to say,should be dead.Ask a nurse,or doctor you know.THERE is the savings in health care.There is the flaw that makes our statistics look bad.We,and they i guess,keep people alive well past their 'expiration date'
This was a choice that was presented to me on January 16, 2013. My husband had been on a ventilator for 15 days. Feeding tubes gave him nutrition, and a fabulous set of nurses kept his chemistry in line. We had had prolonged discussions previous the the most recent illness. We had both signed living wills, and durable power of attorneys, giving the other the right to make decisions, if we were unable. I did not have to make the choices. I was his voice, when he could not be.
Tests showed that there was brain damage. If he pulled through the illness he was suffering from, he would have been bedridden, and most likely never able to communicate again. He was so clear, that if he could not function, and be able to interact meaningfully... we were to stop. Hardest statement I have ever in my life been forced to give voice to.
Honestly though... who among us wants to lay in a bed, and stare at walls. Who wants a machine to breathe for us. To have food delivered through a tube to our stomach. To never be able to laugh in the sun. I miss him terribly. I wish I could time warp time backward, and have it all to do over again. Just to hear the laugh once more.
We, as a family, had to make the same decision on Feb. 13, 2012. My father had an advanced medical directive, and we had all discussed many times what we wanted done if we were unable to make these decisions on our own. We followed his wishes, let him go, and he died within a very short time. While it is often a very difficult subject, the very best thing we can do while we are healthy is to make sure our loved ones know exactly how we feel. It doesn't make it any easier to be the one who voices the decision, but it does help a little.
Kat Kerr Davis, my sincere sympathies. Time will heal the pain of your loss.
Linda and Kat -
What loving decisions you made for your family member who was unable to speak for themselves. You respected their wishes and that takes strength, courage, and love. Bless you both.
agreed.
Both my parents died suddenly and in their bed due to natural causes (all the parts wore out at once).
That's the best for family and my mom's last words were "I'm so tired. I just want to go."
Please site empirical evidence.
The "would be" makes it a hypothetical statement, not an empirical fact.
This is a financial decision at the moment. If you're poor, you only have one choice. Maybe, the poor were given a gift.
You don't need evidence, you only need to try and imagine what that would be like. That requires thought, of course, which is something you seem to have trouble with.
Please be less of a jacka$$.
AnotherTexan...Troll...
As long as the entier brain has not ceased to function, there will be brain wave responses to "familiar" stimuli. But the part that is dead will not be revived. It is just an electrochemical response to the input. People should have a "living will" describing their wishes for such a situation. I'd guess most would opt to have the medical staff "pull the plug" rather than have their families bear the burden of keeping a dead person breathing.
My cousin at a relatively young age (in her 60s) was in a coma at UCLA in Los Angeles for over a year. The decision to terminate her treatments, which maily sustained her in a vegetative state, was based on ending her suffering as well as mounting seven figure hospital bills. Both factors are always the two main consideration for thousands of families facing same tragedy.
Don't pull the plug. Let's hope Sharon hears and understands EVERYTHING. If so, he is in the hell he deserves. Remember Sabra and Shatila. Someone should whisper those names in his ear every hour on the hour, every day.
It takes a special kind of anger and resentment to want to torture an 84 year old bedridden man. Let it go. You'll be a happier person, and a better person.
Jews are the worst for keeping people alive who should be allowed to die, it is religious, but they vote for demonrats and , therefore, support abortions, but will not let this guy die, in hospitals they will go to any length to keep themselves alive, or their families, cost means nothing. I saw one lady, 90, got a heart transplant!!!!! who the hell gave her a heart????? in NYC. never got off of the recovery table. It has to be immoral, inhuman, but they call it religious.
Let's move aside Sharon in this discussion. The only reason this made the front page was because his name was brought up, but it is something that needs to be addressed for everyone that might be afflicted by this.
To start, @AnotherTexan you're expecting to cite empirical evidence where "being trapped in your own body year after year unable to move anything or communicate in any way would be horrific." Look up Rom Houben. He is a man that was trapped in his own body for 23 years before people discovered he was very much alive and aware. He had to resort to meditation to relieve his sanity. There are many other similar cases out there where people have been found aware and have wished to be euthanized because it was torture, including Tonly Nicklinson. Though by comparison able to move more than Rom, he suffered from lock-in syndrome. Research it.
Finally, take a vacation for two weeks. Subject yourself to an experiment where you are on a bed, being fed by tubes. If you take enough ketamine, you'll experience a similar locked in state, where you can't move anything but you're well aware of what's going on. Tell me that it's anything but torturous. I certainly fear such a thing, and have been looking through the fine details of writing a will which gives power of attorney to a loved one, much like what Kat Kerr Davis described.
And Kat, it was the best thing you could have done for him. It is important to cherish a memory, not miss it. I hope you are able to move forward and enjoy life once more, in his memory.
The idea that we shouldn't consider the cost of treatment vs. the probability of a long term positive outcome is just nonsense. No matter how wealthy the society we have limited resources. If we spend millions on an extremely unlikely recovery of one person, then we have millions less to spend on preventative care or treatment of people with a much better prognosis. Is it sad that somebody dies who had a tiny but possible chance of recovering? sure, but the idea that it is better to spend massive resources on one person with a poor chance of recovery than it is to put those resources towards people with a better chance, and a long life ahead of them, is just stupid.
It may be stupid, logically, but tell that to a family who is facing a deeply emotional decision.
A feeding tube? Respirator? Can't move? 7 Years?
Lordy, let the man go....
A very famous and devout Rabbi from Israel named Yitzhak Kaduri, had a prophecy concerning Ariel Sharon. Stating when Mr. Sharon died, Jesus Christ (Yeshua Ha Mashiach) would return shortly after. It's not right to wish for Ariel Sharon to pass.....but when he does, stuff is going to get real, real fast.
Well that didn't take long. It's Yahweh's Will. Gag.
We should let people die with dignity than to keep them alive with machines. It's better to die with dignity than to live in agony and pain. If, he would have been my father, I would have pull the plugs long time ago. It's better to let someone go on a permanent sleep than to make someone sleep artificially. Life should have quality not quantity. Let the poor 84 years old man go to his eternal sleep. Machines can prolong his life and suffering but his death would bring him peace. Death is certain, only manner and time are uncertain but he died long time ago. So, there is no sense to prolong his life when he actually died many years ago.
As a trauma team member, and clinician who worked on critical care units I often dealt with patients and families in the grip of this nightmarish scenario. I can hardly think of a more dreadful condition to be in personally; or to be the chosen health care proxy for a loved one.
My dad who died a peaceful death of congestive heart failure at age 86 and was lucid and relatively comfortable within 72 hours of his death, made his wishes explicitly clear that he wanted no life support or other artificial means taken to prolong his life. I myself after seeing what such a life looks like in practice (at age 60) want no prolonged life support or heroic measures taken to prolong my life, after seeing what such an existence looks like up close and personal.
But subject to cost constraints, these decisions have traditionally been made by families, as Ariel Sharon's case shows. I wonder if Sharon himself left any written document expressing his own wishes? It is hard to believe that such an active and vital man would find spending seven years in a bed ridden ghost like state to be quality time.
My worst fear. Physically unable to check myself out. Can't imagine anything worse.
Everyone should have a living will (or as Republicans would put it... a way to "kill grandma").
Why don't they let the man live or die with dignity?
words like dignity , torture and ethics when talking about hte butcher of beirut ? Are you people kidding ? Don't you know this evil animal butchered 3500 Palestinians in Sabra and Chatilla ? Most of you making comments don't know ANYTHING about this animals history and actions and you all still have the audacity to speak well of this moron ?
I for one am GLAD they are torturing him if that's an applicable term. This monster could have been killed a thousand times over and his death each time won't begin to speak of the dead that he MURDERED.
Screw you all for beingt nice to this moron and may his soul burn in eternal damnation the talmudic jew animal. What a sick joke this forum is .... What are you all israeli apologists and jew lovers ?
"What are you all israeli apologists and jew lovers ?"
The discussion is not about Israel or "jew lovers", as your neo-nazi camp would put it, it is about bioethicism. But, this is way beyond your comprehension, too complicated, so back to the camp.
Racism and ethnic discrimination are the worst forms of ignorance.
The butcher of Sabra & Shatila still "lives", if you can call it that. The original Fat Ba$tard.
I like that a lot Patriot . I'm glad I'm NOT the only one that remembers sharon MURDERING 3500 innocent civilians in refugee camps for gods sakes..... Jeeze these people today ...
Assad murdered 60,000 just in the past two years - and continuing to kill. But, then, he is not a jew.
@ farideh
Why are you changing the subject? Ariel Sharon is the subject.
Are you trying to minimize his complicity in the murder of "only" 3,000+ Palestinians by comparing it with Assad's treachery?
This is obfuscation ... and false logic. Stop being an apologist for Ariel Sharon. He is an evil Fat Ba$tard whose bad karma is richly deserved. And yes, he has lots of company.
By Alexander Dziadosz and Oliver Holmes, Reuters
BEIRUT — At least 65 people, apparently shot in the head, were found dead
with their hands bound in a district of the northern Syrian city of Aleppo on
Tuesday, a pro-opposition monitoring group said.
Stop singling out and blaming jews for your failures and for having a miserable life. Read the article and may be you will learn a way to die in dignity, and not in misery. That is the essence of the article, not politics, not religion, not hate or bigotry. Everybody else on this forum understood this, debated it in an intelligent ways, except 2-3 muslim/liberal/nazi posters.
@ farideh
Stop changing the subject. Ariel Sharon is the subject ... and how his stewing in his diaper is quite appropriate given the way he lived his miserable life.
Farideh, there is nothing liberal about a Nazi, or most Muslims for that matter. I am not comparing thw two-- Nazism is based in hate, but most Muslims are just living their lives according to their culture and religion.
We can all agree that both Sharon and Assad are bad men who did bad things to many people. Evil is as evil does.
Have you ever woken up and for a second or two you are aware but you cant move your body....imagine that feeling forever.......no thankyou......if ANYONE cares for me......take me out by whatever means necessary!