Neuroznanstvena dekonstrukcija ideologiziranog »beznađa« vegetativnoga stanja

Anto Čartolovni - Pregledni rad

Neuroscientific deconstruction of the ideologised »hopelessness« of the vegetative state

Sažetak
Recentna neuroznanstvena istraživanja propituju dosadašnju predrasudu o vegetativnom stanju kao »beznadnom« stanju. Rezultati ovih otkrića ne samo da ruše već postojeće predrasude prema osobama u vegetativnom stanju, već daju i nov uvid u epistemološku problematiku točnosti dijagnosticiranja aktualnog stanja, popraćenu etičkim i društvenim implikacijama. Pružajući bolje razumijevanje same naravi svijesti i svjesnosti, upućuju na oblik moralne i socijalne odgovornosti prema tim osobama ne ostavljajući mjesta za »beznađe«. Stoga je prvotni cilj ovoga rada prikazati kako se uz razvitak uvida u stanje osoba s poremećajem svijesti, na samom početku paralelno razvijala i predrasuda »beznađa« kao nuspojava nedovoljnog i neadekvatnog znanja o naravi svijesti kod osoba u vegetativnom stanju. Ova ustaljena predrasuda imala je direktan utjecaj na donošenje kliničkih odluka o mjerama održavanja na životu: od povlačenja nutricije i hidratacije – do pitanja kardio-pulmonarnog oživljavanja pa onda do odvajanja od respiratora, smatrajući da osoba nema nade za oporavak nakon uspostave dijagnoze vegetativnog stanja. Stoga, ova predrasuda »beznađa« ne samo da nije ostavila duboko utaban, moralno upitan put za izvođenje pasivne eutanazije, već je, štoviše, bila iskorištena i ispolitizirana kao jedan od glavnih argumenata i primjera pro-eutanazijskih pokreta u borbi za ozakonjenje same eutanazije.

Abstract
Recent neuroscientific research challenges today’s prejudice of a vegetative state as a »hopeless« state. The results from these findings not only destroy the actual existing prejudices about people in a vegetative state, but they also provide a new insight into the epistemological problematics of the accurate diagnostic process of the actual state, followed up with ethical and social implications. They also provide a better understanding of the mere nature of consciousness and awareness, implying the moral and social responsibility towards these people, and at the same time leaving no place for »hopelessness«. Therefore, the primary aim of this article is to demonstrate how, with the development of these new insights into the state of disorders of consciousness, side by side, from the mere beginning has been developing prejudice of »hopelessness«, as a side-effect of insufficient and inadequate knowledge related to the nature of consciousness in the vegetative state. This conformity prejudice has had direct influence on clinical decision-making regarding artificial life-sustaining measures: from hydration and nutrition withdrawal, to do not resuscitate orders, and finally to ventilator withdrawal, retaining that the person has no hope for recovery after the determination of the vegetative state diagnosis. Furthermore, this prejudice of »hopelessness« has not only deeply paved the morally doubtful way for performing passive euthanasia, but was, even more, misused and politicised as one of the main arguments and examples of the pro-euthanasia movements in the fight for euthanasia legalisation.