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

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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