At the end of life, a vegetative state (VS) means the brain stem functions allow basic life (breathing, sleep cycles) but the cerebrum (thought/awareness) is gone, so a person seems awake (eyes open) but isn't aware of themselves or surroundings, lacking purposeful response, though reflexes like smiling or crying might occur. This chronic state, often called Persistent Vegetative State (PVS) after weeks, sees diminishing recovery chances, with death often resulting from infections or organ failure, rather than the VS itself.
Most people who remain in a vegetative state die within 6 months of the original brain damage. Most of the others live about 2 to 5 years. The cause of death is often a respiratory or urinary tract infection or severe malfunction (failure) of several organs. But death may occur suddenly, and the cause may be unknown.
VS/UWS patients do not respond to sound, hunger, or pain. Patients cannot obey verbal commands and lack local motor responses. Additionally VS/UWS patients cannot talk in comprehensible terms and may become noisy, restless, and hypermobile.
When someone is dying, their heartbeat and blood circulation slow down. The brain organs receive less oxygen than they need and so work less well.
It's important to distinguish brain death from a coma or a vegetative state. In a coma, there is still some brain activity, and the individual may have the potential for recovery. In a vegetative state, there might be partial brain function, but the person lacks awareness and meaningful responsiveness.
Conclusions: Strong evidence shows that some patients diagnosed as being in a vegetative state can hear and understand what is being said in their environment. Interviews with previously unconscious patients and electrophysiological methods show that awareness can be detected in patients perceived to be unconscious.
Thus some patients can regain awareness after more than four months in a vegetative state, and, although few reach full independence, most can achieve an improved quality of life within the limitations of their disabilities. The recovery period is prolonged and may continue for several years.
As people get closer to dying, they may sleep more, become drowsy or be difficult to wake. They may fall asleep while talking. A person may slowly lose consciousness in the days or hours before death. When visiting someone with advanced cancer, be aware that visiting may be tiring and difficult for the dying person.
The hardest deaths to grieve often involve a child, a spouse/life partner, or a loss due to suicide or homicide, as these challenge fundamental beliefs about life's order, shatter primary support systems, or add layers of trauma, guilt, and unanswered questions, leading to potentially complicated grief. However, grief is deeply personal, and the "hardest" loss is ultimately the one that feels most significant to the individual.
Two hundred consecutive hospice patients were studied. The incidence was noted of pain, dyspnea, moist breathing, nausea and vomiting, confusion, restlessness, jerking and twitching, difficulty in swallowing, incontinence and retention of urine, sweating, moaning and groaning, and loss of consciousness.
There is no rule about how long a person can stay on life support. People getting life support may continue to use it until they either recover or their condition worsens. In some cases, it's possible to recover after days or weeks of life support, and the person can stop the treatments.
For a diagnosis of brain death:
May moan or make other sounds, especially when tight muscles are stretched. May cry or smile or make other facial expressions without a clear cause. May briefly move eyes toward people or things but these looks are not sustained.
This care may include:
Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. The vegetative state is also called a "coma vigil".
The persistent vegetative state is “a form of eyes-open permanent unconsciousness in which the patient has periods of wakefulness and physiological sleep/wake cycles, but at no time is the patient aware of himself or herself or the environment.” If this state persists for more than 3 months in children, the long-term ...
Many people wonder if their departed loved ones visit them after death. Spiritual beliefs vary widely, but many cultures and religions hold that our connections with those who have passed continue in some form. Some believe that after death, loved ones can reach out through dreams, signs, or other subtle ways.
The five stages – denial, anger, bargaining, depression and acceptance – are often talked about as if they happen in order, moving from one stage to the other.
It is best to give gifts that are comforting and practical. Meal delivery, home services, blankets, candles, and gestures like memorial gardens and cremation keepsakes are often welcome.
Tell Them It's Okay to Let Go
First, assure them that while it's normal to want to hold on at the end of life, it's okay to let go. Don't force things, but do remind your loved one of how much you love them. Let them know you're not angry and don't hold any resentment that they're dying.
The 3 C's of grief are Control, Connection, and Continuity - three fundamental psychological needs that become disrupted after loss and require intentional attention during the grieving process.
Breathing may become irregular with periods of no breathing or apnea lasting 20-30 seconds. Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.
Conclusion. Continuing artificial life support for patients who are brain dead may produce harm to patients, families, and others involved. Declaration of brain death should not be delayed to wait for families or to justify hospital care. Instead, appropriate family care should be provided after the death declaration.
Costs of care averaged > $90,000/yr per patient.
Life span is significantly reduced in those in a persistent vegetative state, with average life expectancy reported as 2 to 5 years [17]. Survival beyond 10 years is rare. After 12 months in a posttraumatic persistent vegetative state, recovery of consciousness is unlikely in both adults and children [17].