February 23, 2024

Consciousness still flickers in some “vegetative” patients

New study with astounding results

It’s hard to tell whether it is good news
or bad news, but it is exciting news. Researchers in Britain and Belgium
reported in the New England Journal of Medicine this week that they were able
to communicate with a 29-year-old man in a vegetative state by using an fMRI
scan. They asked him to think of tennis when he wanted to answer Yes and to
think of his house when he wanted to answer No. Different parts of the brain
lit up and he gave correct answers to 5 out of 6 questions.

Dr Adrian Owen, co-author of the research
from the Medical Research Council, said: “We were astonished when we saw
the results of the patient’s scan and that he was able to correctly answer the
questions that were asked by simply changing his thoughts. Not only did these
scans tell us that the patient was not in a vegetative state but, more
importantly, for the first time in five years, it provided the patient with a
way of communicating his thoughts to the outside world.”

Dr Steven Laureys, co-author from the
University of Liège, confirmed: “So far these scans have proven to be the
only viable method for this patient to communicate in any way since his
accident. It’s early days, but in the future we hope to develop this technique
to allow some patients to express their feelings and thoughts, control their
environment and increase their quality of life.”

The implications of this study are far-reaching,
as everyone instantly realized. Neurologists are already aware that 40% of diagnosese
of patients in a vegetative or minimally conscious state are flawed.
Now they have discovered that it may be possible to communicate with a handful
of them. In an
accompanying editorial
in the NEJM, neurologist Allan H. Ropper, of Brigham
and Women’s Hospital, in Boston, wrote: “brain activation was infrequent, but
it occurred often enough that it will now be difficult for
physicians to tell families confidently that their unresponsive
loved ones are not ‘in there somewhere’”. 

The divide between consciousness and
unconsciousness will also become blurred. Dr Ropper also argued that a response
through a brain scan does not necessarily imply that there is lively mental
activity or awareness of one’s predicament.

Another consequence which occurred to Dr
Ropper is the possibility of asking apparently “vegetative” patients whether
they would like their life support turned off. Without conscious consent, this
would be illegal nearly everywhere. With consent, it would constitute the
withdrawal of burdensome treatment, which is legal nearly everywhere. Perhaps
Terri Schiavo was just the beginning. ~ New England
Journal of Medicine, Feb 3
; Los
Angeles Times, Feb 4

Michael Cook
brain death
informed consent