Professor Derick Wade
Brief Outline:
Professor Derick Wade of the Oxford Centre for Enablement explains the meaning of the words such as “coma”, “vegetative state” and “locked-in syndrome” and answers questions such as 'how can you be sure that someone is not conscious?' and if they can feel pain. He also describes processes for best interests decision-making.
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Professor Derick Wade of the Oxford Centre for Enablement
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Professor Derick Wade of the Oxford Centre for Enablement talks about the meaning of the words “coma” and the “vegetative state”.
Professor Derick Wade of the Oxford Centre for Enablement talks about the meaning of the words “coma” and the “vegetative state”.
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How can you be sure that someone is not conscious? Derick Wade describes how he assesses whether or not a patient is conscious.
How can you be sure that someone is not conscious? Derick Wade describes how he assesses whether or not a patient is conscious.
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Right, well in terms of being sure that someone is unaware of themselves, in the end that’s a human clinical judgment. So there is no electrical test or scanning test that will tell you definitively that this person is aware or not aware. So the way that I do it and most people do it is to look at somebody’s behavior – in other words the way they move, the way their face moves, their hands move, their arms move, whatever it might be, and to say, “Does that behavior require the person to be aware, or is that entirely a reflex?”. So has that person extracted some meaning from what is happening? So if the bell goes, if a telephone bell goes and somebody reaches out as if to pick up a telephone and as if to put it to their ear, they’ve obviously understood that it’s a bell, which means telephone, and they obviously know that a telephone is something that you pick up with your hand. If the bell goes and they just jump, they’ve heard the noise, but they don’t take any meaning from it. They’d do the same if I clapped my hands, rang a bell, opened the window, probably, with a loud bang. So they’ve got to get some meaning out of it. And in terms of their movements, if they’re doing something that implies they have an abstract goal. So if I pinch somebody on their hand to see how they respond to pain, and they withdraw their hand, that’s a reflex. If I pinch anybody, if I pinch you, you would withdraw your hand – among other things. If I pinch someone who’s conscious they will also try to take my hand away, hit me, they’ll do a whole lot of other things. Which imply that they’ve worked out that somebody is doing something and they want to stop it. So if somebody was apparently in a coma, or apparently in the vegetative state, and I pinched their hand on the left, and the right hand comes across, catches hold of my hand, and pulls it away, clearly that means they’re aware. They were aware that somebody, me, was causing them pain and they thought how can they remove it. So in the end, saying somebody is vegetative means that you have determined that nothing that they do requires them to have formulated a goal, formulated an idea, or understood the meaning of what is happening around them. And that does come down to commonsense, in a way. You have to decide that. Because people in the vegetative state will respond to noise - by startle or jump, will respond to pain – by moving away, often will have some spontaneous movement, their eyes will move all over the place, they might yawn, sometimes they might stretch or they might move their arms. Rarely do they do a lot of movement – I have seen them, but that’s rare. But they’re not immobile or unresponsive. It’s the nature of the response that determines reflex against awareness.
Can a vegetative patient feel pain?
Can a vegetative patient feel pain?
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The key difference between locked-in syndrome and the vegetative or minimally conscious state is that someone with locked-in syndrome is mentally intact, as Derick Wade explains.
The key difference between locked-in syndrome and the vegetative or minimally conscious state is that someone with locked-in syndrome is mentally intact, as Derick Wade explains.
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