It is usually the other way around. Doctors want to put an end to a severely damaged life that, in their medical opinion, has no chance of revival; the family want their loved one kept alive; it is up to judges to make the final decision, which usually, though not always, goes in favour of the medical argument for death. The case of the 53-year-old woman in a persistent vegetative state (PVS), reported in the Guardian on Monday, has introduced a new dimension. Her family wanted her to die with dignity, but a judge ruled that, before any steps were taken that would result in her death, the doctors should treat her with a so-called "miracle drug", Zolpidem, which - and here the medical evidence is by no means clear or unanimous - has caused some patients in PVS to "wake up". (She may already have been given it, but, if so, we do not know the outcome.)
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Zolpidem may turn out to have a dramatic effect on the whole right-to-die debate, and on the way that families, doctors and the law will look on PVS from now on. The astonishing thing about Zolpidem is that it has been around for some time, commonly used as a sleeping pill - its apparent ability to awaken PVS patients was discovered by pure accident in South Africa. But no one knows why it works in that way, and it is almost impossible to predict what effect - if any - it would have on any particular recipient. (There is a school of thought that believes that if the drug works, the diagnosis of PVS must have been wrong.) Louis Viljoen, the young South African through whom the strange properties of Zolpidem were discovered, is still alive. For seven years he has been given a pill every day; it keeps him awake for just over two hours, and cannot be immediately repeated. There have been other successes, less spectacular, though many have not woken at all.Two crucial issues arise. If it is difficult to predict how the drug will act on the person given it, should we not, logically, be trying it on all PVS patients at the centre of a right-to-die dilemma - indeed, on everyone in the same condition - on the off-chance that it will work? It does no harm if it doesn't, and it doesn't take long to know if the patient is responding. It's cheap, too. But the use of Zolpidem to see if it acts on PVS raises an unbearably sensitive question. Is it necessarily in the best interests of patients to be "woken up"? They will never really recover. At best they will have a few hours awake daily; but most will have been brain damaged by the original trauma that sent them into PVS. Worst of all prospects, they will become aware of their condition and their disabilities, and not wish to be there. The family of the 53-year old woman knew about Zolpidem but argued that, even if it produced results, she would still be greatly damaged and, if aware, would not want to live that way. But neither they, nor anyone else, can ever know that for sure.