National Geographic

Deader than dead: people in vegetative states are viewed as deader than corpses

In 1990, Terri Schiavo suffered a heart attack that left her in a persistent vegetative state. She came out of her coma but severe brain damage left her unresponsive with no detectable brain activity. Trapped in a state of “wakeful unconsciousness”, her condition triggered a lengthy legal battle between her husband, who wanted to end her life support, and her parents, who wanted to keep her alive. The debate over Schiavo’s moral rights raged for the better part of a decade, and the arguments were filled with people who claimed that her condition was a “fate worse than death”.

The phrase reflects a curious tendency to view people in a persistent vegetative state (PVS) as being deader than dead. Kurt Gray from the University of Maryland has found that people, especially religious ones, tend to think of PVS patients as having less mental capacity than a corpse.

Together with Anne Knickman and Daniel Wegner from Harvard University, Gray asked 201 volunteers to read an account of a car accident. The protagonist – David – either lived, died or entered into a PVS. “David’s entire brain was destroyed, except for the one part that keeps him breathing,” the third description read. “So while his body is still technically alive, he will never wake up again.’’

Gray asked the volunteers to rate how strongly they agreed with six statements about David’s state of mind. The results clearly showed that people see PVS patients as being more dead than dead. The volunteers were more likely to agree that dead David, compared to his PVS counterpart, could influence the outcome of situations, know right from wrong, remember the events of his life, have emotions and feelings, be aware of his environment, and have a personality.

Gray thinks that this odd pattern stems from the old notion of mind-body dualism, the philosophy which states that the mind and body are separate things. Such beliefs are especially common among people from religious faiths that believe in souls, which live on after death. If that’s the case, a dead person is merely a disembodied mind. Indeed, Jesse Bering has found that people generally hold intuitive beliefs about the minds of dead people. If it’s not a religious afterlife, then it’s ghosts or something similar.

To test this idea, Gray repeated his experiment, but changed the vignette where David lives to another where he died. This one was written to draw attention to his corpse. It read: “David died on impact. After, being embalmed at the morgue, he was buried in the local cemetery. David now lies in a coffin underground.’’

Among people with little in the way of religious beliefs, the emphasis on David’s cadaver brought their responses in line with their views of PVS patients. That’s predictable – in previous studies, people tend to lose their intuitive beliefs about the minds of the dead if they focus on their bodies. However, this didn’t work for the highly religious volunteers. They still ascribed more of a mind to deceased David than to vegetative David.

Finally, Gray found that the “fate worse than death” trope is actually true for many people. When 55 volunteers read first-person stories of people who were involved in car accidents, they felt that entering a PVS would be worse than dying, for themselves and their families.

People in vegetative states have awoken from a coma, but remain completely unresponsive to the world around them. Lights and noises fail to stir them and there are no signs that they understand words or expressions. Adding the word “persistent” can be infuriating. It implies that the patient is highly unlikely to recover, but it doesn’t rule out the odds of such a recovery. By blurring the lines between life and death, it plays havoc with our sense of morality and our perceptions.

Gray argues that while people tend to see dead people as disembodied minds, they see people in a PVS as mindless corpses. As he writes, “These results suggest that for vegetative patients, life or death may depend more upon the mind of person making the decision than the mind of the patient.”

Reference: Gray, Knickman & Wegner. 2011. More dead than dead: Perceptions of persons in the persistent vegetative state. Cognition http://dx.doi.org/10.1016/j.cognition.2011.06.014

There are 35 Comments. Add Yours.

  1. Jorge Silva
    August 2, 2011

    Strange, I always thought that highly religious people were also more inclined to be against ceasing life support for patients in vegetative states. Yet, this study seems to show that they perceive such patients as being “deader than dead”. Either I’m wrong on the first or from what this article says, it should follow that the religious should be more supportive of ending life support in these situations.

  2. Ed Yong
    August 2, 2011

    Nope, both are true. Religious people are more likely to view PVS patients as deader than dead, AND more likely to be against ending life support. The authors described this as “ironic”.

  3. Cathy
    August 2, 2011

    I read through Terry Schiavo’s autopsy, out of morbid curiosity (it was linked in a recent article on PSV.) Apparently, her brain had shrunk to half its size and the brain case had filled with fluid. She really was deader than dead – if the brain is a muscle, hers had definitely atrophied.

  4. Mo
    August 2, 2011

    I find the “deader than dead” idea very odd. To me, to be in a PVS is to be trapped, completely and utterly. The soul cannot leave the body until it has ceased to function; therefore, the soul of said person has not yet left, but has no ability to leave either. I would say that someone in a PVS is forever trapped between life and death, neither living nor dead.

    @Cathy: I will have to find her autopsy and read it. However, I would say, it is not the size of the brain that matters but rather the connections that may or may not exist that determine if a person is indeed in a PVS or not. New studies show that a brain can be significantly damaged, but if the connections are there, even weak ones, there is hope for something better.

  5. Sandra
    August 2, 2011

    I used to think that way too, but now that I have gotten to know many devoted Christians I realize they think differently then I originally thought. They believe so strongly in the soul moving onto heaven that death is more of a release. To leave someone in a vegetative state would be against Gods will and probably leave the soul in limbo. It’s somewhat embarressing to me that everything I used to perceive was the complete opposite. It’s the people without faith who cling to life with fear of the unknown.

  6. Jay L. Gischer
    August 2, 2011

    The dilemna comes because of the belief that the soul is trapped in the body. Which makes turning off life support murder, even though the death would be a release.

    The argument I would make is that in the case of a PVS, the soul has already departed, and that keeping such a body breathing and circulating blood is a well-meaning mistake, a sort of necromancy. I think that the problem that such an argument would have is that a person in a PVS doesn’t really look dead.

  7. Mo
    August 2, 2011

    Jay, that depends. If a machine is performing all the basics (breathing, circulation) and there are no more internal brain connections, then yes, the person is dead and in all likelihood, the soul too has departed. However, a person in a PVS generally can breathe on their own and has circulation. For example, what was turned off for Terri was not a breathing machine, but her feeding tube. She was perfectly capable of breathing on her own.

  8. Alicia
    August 2, 2011

    “If a machine is performing all the basics (breathing, circulation) and there are no more internal brain connections, then yes, the person is dead and in all likelihood, the soul too has departed.”

    A soul is such an abstract thing that I find it hilarious that someone can link it to a certain bodily behavior. Does the soul escape with breath? With brain connection? With a heart beat? How can you be so matter-of-fact about something that is so intangible?

    This argument is one that will never be won by either side. I personally wouldn’t want to be in a PVS and would ask my loved ones to rid me of such a life, but then again, how will I ever know until I’m in the situation? I won’t. But then again, if pushed, I can only imagine how frustrating it would be not to respond to anything. Being around life, yet not being able to participate in it, would be a travesty.

  9. Daniel
    August 2, 2011

    The whole premise of this article is flawed. First off “deader than dead” is not equivalent to “fate worse than death”.

    One does not need to believe in any kind of mind/body dualism to see a PVS as worse than death either. A PVS patient is an enormous financial burden to their family in a way that a dead person is not. In this sense it is clearly worse than death.

    Secondly, I suspect that despite doctors, scientists, whoever’s assurances, there persists a fear that the PVS patient may in some way be experiencing pain or distress. It is not necessary to posit a mind separate from the body to believe in this situation. Our present understanding of how self, and consciousness arise from the activity of the brain leaves sufficient room for fear, not that irrational fears even need that leeway. In any case situation not possible if they’re truly dead and you reject mind body dualism. Therefore clearly a “fate worse than death”.

  10. Mo
    August 2, 2011

    @ Daniel: All of this is very true. You do not need to believe in a soul or mind/body dualism to fear being in a PVS. And correct, “deader than dead” does not equal “fate worse than death”.

  11. Ed Yong
    August 2, 2011

    The “deader than dead” and “fate worse than death” bits are separate results from separate experiments – see paragraphs 8 and 4 respectively. I grant you that para 2 suggests they’re tied, but they are not one concept and the same.

    Daniel’s points about financial burden, experiencing pain etc. do not explain the fact that people are less likely to agree that PVS patients “influence the outcome of situations, know right from wrong, remember the events of his life, have emotions and feelings, be aware of his environment, and have a personality” than to agree that dead people can do those things.

    @Alicia – You’re confusing PVS with locked-in syndrome, which is different. PVS = no brain function. Locked-in = brain function, can’t do anything.

  12. Mo
    August 2, 2011

    Ed,

    I think that is because of the definition of soul. For example, I believe in a soul (self essence is a good way to say it) that is separate from the consciousness and body, but I also do not believe in a mind/body duality. In other words, the soul itself does not animate the body. So, for people who believe in the duality or that a soul animates the body, how they see all of those things would be different than how I would see it.

    For people who see it as soul = mind, then yes, I can see how they would be in your words “less likely to agree that PVS patients “influence the outcome of situations, know right from wrong, remember the events of his life, have emotions and feelings, be aware of his environment, and have a personality” than to agree that dead people can do those things.” They would see it, I think, as the soul has been fundamentally damaged or killed where if the person had died without brain (and therefore soul) damage the soul would not be damaged and therefore still capable of doing those things in the afterlife.

  13. Phillip Moon
    August 2, 2011

    5. Sandra Says:
    “… It’s the people without faith who cling to life with fear of the unknown.”

    Sandra. I am relying on my memory here, but several studies have shown that many religious have a strong tendency to hang on to life using extraordinary means to stay alive. Atheists and agnostics, humanists and such do not fear the unknown, as there is no reason to do so. Death is death. Non functioning brain mean no more you. Nothing to fear.

    That does not mean that if there is reasonable hope of recovery we don’t make the effort. That’s a healthy reaction.

  14. chris
    August 2, 2011

    This is correct Phillip. Nonbelievers have no fear of death. We don’t believe in an afterlife. We believe in life before death. There is nothing to fear. In any case, the idea of eternity cheapens everything.

  15. Walter S. Andriuzzi
    August 2, 2011

    “The authors described this as “ironic”.”
    Inconsistent, contradictory? Such is religion
    ***
    “Nonbelievers have no fear of death”. Personally speaking, I’m a nonbeliever and yet I would be a liar to deny I’m afraid of dying. Probably more of the process, especially if slow and painful, but still I’m afraid. As are a few other fellow atheists I had the chance to speak with of the subject. I feel that expressions like “nonbelievers have no fear of death” are no less cheap than their religious counterparts like “believers have no fear of death because they know it’s just the door to the afterlife” (or whatever). One thing is to rationally analyse the matter and say, as Phillip does, that death should not be feared. But fear isn’t rational. Nonbelievers shouldn’t be ashame of fearing death – no person should be

  16. Old Geezer
    August 2, 2011

    @Walter, I would like to distinguish between “death” and “the process of dying.” I have no fear of death as I believe it is the natural outcome of having lived. That there is no place to go afterwards is no different than what many of us experience living from day to day. OTOH, I do not wish to experience a long and/or painful process of dying. The latter is simply the mechanical means that takes us to the former. I am told that I was dead for a period of time on the operating table. No problem. I did not experience the process. If, as I have seen working with Hospice patients, the process is long, drawn out and painful. that would be disturbing.

  17. Walt Wenger
    August 2, 2011

    There is also the question of whether a person who has been diagnosed (by whom and how accurate is this diagnosis – as one familiar with diagnoses which are obviously ridiculous, but are still diagnoses by medical doctors) in a PVS is, still in fact a human being. If not, then why can’t the body be sold to a butcher for meat? If the person still is a human being, then all the protections of the laws and constitution apply (assuming US citizenship) — so then why is it that these protections are denied? I know this is and has been happening to my son, yet simply getting laws which are currently in effect enforced is not possible unless I can pay a bunch of attorneys a great deal of money that I don’t have. The medical profession as well as Medicaid, Departments of Health, etc. use PVS patients as a way of getting huge amounts of funding for providing no services at all or inadequate services under current law. I know, I have been there and I am still there in trying to get services for my son — after 20 years of tying simply to get the current laws enforced — and failing.

  18. Sam
    August 2, 2011

    this article reminded me of a great film i watched for the first time the other week called Awakenings (1990). Although not technically related its a great example of people making assumptions of the mentally impaired.

    http://www.imdb.com/title/tt0099077/

  19. Mark Sediski
    August 2, 2011

    Further proof that people are idiots, and religion is a mind virus that destroys the ability to reason. Think about it: What religion compels people to believe is that a person can lose all mental capability, including the ability to think, love, and communicate, but then if life support is terminated, they magically and suddenly REGAIN all those abilities! Magic is so wonderful! Of course, by “magic”, I mean “wishful thinking”.

  20. Walter S. Andriuzzi
    August 3, 2011

    @ Old Geezer: Good for you. As for me, I’m still afraid. Or, to use different words, let’s say I’d hate to die. Even if it would be a fast and totally painless process, I’d still hate/fear (tick appropriate) it. Probably because I’m still young and feel there’s so much I can do. Or perhaps because I’d lose so many of Ed’s Saturday’s missing links ;)

  21. Jinchi
    August 3, 2011

    Most people, believers and nonbelievers alike, fear death. Individuals may not, although my guess is that most of the people claiming that they don’t fear death aren’t actually facing it in the near future.

  22. oldebabe
    August 3, 2011

    I AM old, so death is soon to occur, and that’s okay – I’m tired. It’s the not-knowing-when that is off-putting. And there is or course the real fear that one will suffer and/or be in pain. Making one’s final exit from life, when and where, should be one’s own decision, but is dificult unless one has money (Dignitas), is already a resident of a permissive State, or has seamy connections (or a VERY understanding physician), which can be a problem. In any case, it will be the last adventure – something new to experience, if only for a moment…

  23. Rich
    August 3, 2011

    “What religion compels people to believe is that a person can lose all mental capability, including the ability to think, love, and communicate, but then if life support is terminated, they magically and suddenly REGAIN all those abilities!”

    This is not necessarily the case at all. If I were religious – I’m not – it would be clear to me that the persons ‘soul’ was doing whatever soul’s do while the body was being kept alive. And went on doing it after the body died.

    I would be believing this with a complete lack of evidence but, I suggest, your assertion suffers the same lack.

  24. Daniel J. Andrews
    August 3, 2011

    I’m not afraid of death…I just don’t want to be there when it happens. :) (stolen from Woody Allen).

  25. Ron Watts
    August 3, 2011

    amazing seeing god, soul, and limbo in the same sentence– they are all fiction

  26. Chris Hynde
    August 3, 2011

    I don’t really understand the point of this article. What is the rate of people in PVS reawakening? Does it happen at all? Is brain capacity ever restored?

    If not then the only issue I see is one of accepting that the patient in a PVS is somewhere between living and dead but not in any way close to being fully alive. The question seems to be how far are people willing to go to keep a physical body minimally functional without hope of that body ever achieving sentience again.

    I’m sure that for some people letting go of a loved one’s body is too hard to accept. Even though one can never really interact with that person again it would mean full acceptance of their permanent and irrevocable loss.

    Sad situations that should be handled individually with common sense and dignity.

  27. Hernan
    August 3, 2011

    to Sandra, comment 5: I think you are completely wrong in your thinking about people without faith. Religious people are the ones who has fear.
    For non believers in the supernatural it is clear that the end is “the end” and there’s no thinng such as hell or heaven.

  28. John Alansan
    August 4, 2011

    After reading many of the above comments, I was wondering if someone could point me to a peer reviewed source for the exact location of the soul in the body, please?

    I’ve been through my medical textbook literally hundreds of times and can’t find a single reference to it. I’m beginning to think the printers may have produced a faulty print run or something.

    Thanks.

  29. Lynn
    August 4, 2011

    I used to think the plug should not be pulled, but changed my view on the matter. She was trapped in her body. The kind thing was done for her.

  30. Angela
    August 5, 2011

    If I had a plug, I’d punch whoever was gonna pull it. But I don’t anymore. If someone did pull it back then, then nobody would get punched. http://thoughtfulveg.blogspot.com/2011/08/ask-retard.html

  31. Mark
    August 5, 2011

    Yes, “soul” and “God” ARE fiction. They are not terms that describe things that we can measure or see. However, given that criteria, anything that one describes of what happens after death is fiction.

    @Philip and Chris
    Your “belief” in no afterlife is no more “fact-based” than those who believe in an afterlife. Physicians and scientists measure life based on physical properties like electrical activity in the brain. But even they cannot be certain of what happens to us when they can no longer measure physical attributes. Philip, your statement, “Non functioning brain mean no more you” is fiction because you have no proof of your statement.

    To illustrate my point, let’s pretend that we are living in the dark ages. We watch a ship sail away and we know that it exists because we can see it sailing away. Once that ship goes over the horizon, we have no proof that the ship still exists because we have no physical measurements by which to prove that. Of course, anyone saying out loud, “Can’t see ship. Ship doesn’t exist,” would have been thought to be looney because ships usually came back to port.

    We also have no way of “proving” what the existence of a person in a PVS consists of. Just because there is no measurable brain activity doesn’t mean that nothing is happening. It means that we cannot measure what is happening. In fact, there are hundreds of thousands of people who were brain dead (electrical activity could not be measured) for varying amounts of time who then came sailing back to port. And many of them have very profound tales of what they saw over the horizon. The fact that you believe that, once the ship is over the horizon, it ceases to exist, doesn’t prove them wrong.

    Therefore, some can conjecture that PVS is a “fate worse than death”, some may say that “brain dead is dead” or we can just as easily conjecture that our life force has simply moved on to an immeasurable state. Any scenario could be just as true as the other.

  32. Swift Loris
    August 5, 2011

    If I knew for certain that my consciousness would cease with death, it would be a big relief. I’m not religious and don’t “believe” in an afterlife…but I’m not absolutely sure there isn’t one.

  33. Emmy
    August 5, 2011

    I agree about the soul – we should define these terms so we’re not commenting in the dark. Without a physical process, the soul can only be assumed to refer to consciousness, which is still extremely vague.

    Non-believers are not afraid of death? Ha! I can only speak for myself – but I enjoy life. Disappearing and being forgotten sounds like no fun at all. Being sick I may exprerience some scale of suffering. But it’s the only life I have. Why would I do anything but fight for it?

    I think we can all agree on one thing: none of us has ever been dead before. How can we say it’s “better” than any state while we’re alive? Of course if there is unreasonable suffering – in which case, I would hope all victims and their families would have an ongoing choice about whether to continue treatment.

  34. Stephan
    August 20, 2011

    I would like to add that I am very impressed by the tone and civility in this comment section. I haven’t read every single comment, but most. And I was expecting the kind of rabid, insulting, counterproductive tone that one is used from, say, Youtube. It once again strengthens my “faith” in science and scientifically minded people. Some are, after all, talking about a highly contentious issue – the soul/the afterlife. I myself am an atheist, and I will confess freely that it is difficult for me to take people who believe in these sorts of things seriously. However, it is very refeshing that, like myself, people here are at least making the effort (on both sides of the issue, to be fair).
    And if I may add one more note, because this was an issue above: I, again, an atheist, am actually qite afraid of death. Yes, intellectually I’m well aware that there is nothing to be afraid of, and yet this is no unambiguous statement because it is precisely THE NOTHING that one might irrationally be afraid of. Again, I know that there won’t be an “I” around to perceive it, indeed, if it were even possible to be perceived it wouldn’t be the nothing. But the very concept of nothingness scares me, since everything I am and know is predicated upon somethingness. But nontheless it has been my experience (which may well be flawed) that it is indeed religious people who cling to life more (obviously, this study confirms this), and I never understood why. Shouldn’t religious individuals be celebrating when someone dies? It is, after all, the beginning of something inconceivably beuatiful for the deceased. And yet they tend to oppose ending life support in many cases. I suppose that this has to do with Barrett’s “theological correctness”. On some level they may actually not believe what they claim or believe to believe. Maybe the afterlife is more of a formally professed notion, and we know that it is also an intuition that most individuals have (see Bloom’s common-sense dualism), but maybe this intuition isn’t powerful enough to translate into action sometimes.

  35. Mubasher
    December 7, 2011

    i am from pakistan.my mother had a cardiac arrest on 27 sep 10.it took us more then 10 mins to take her to hospital resultantly she suffer anoxic brain injury (deprivation of oxygen to brain).she is in PVS since then.she has no awareness as to what is happening around.she is in hospital since last 14 months.i am the one who is emotionly suffering alot alongwith my other brother and sisters but i still think that term Deader than Dead is wrong,because we have faith in Allah that he can do which medical doctors do not believe.Please pray for her that she become healthy as before.

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