Severely brain-damaged and apparently unresponsive patients may be conscious, British researchers have discovered. In a startling study published in the journal Science, brain imaging techniques detected clear signs of awareness in a woman who was in a vegetative state after a motor vehicle accident. When she was asked to imagine herself playing tennis and walking through her house, the motor control areas of her brain flared up. "If you put her scans together with the other 12 volunteers tested, you cannot tell which is the patient’s," Dr Adrian Owen, of the UK Medical Research Council, told the New York Times.

Scientists are divided on the significance of these findings. First of all, most experts told the media that this woman’s injuries were far less severe than Terri Schiavo, the brain-damaged Florida woman who died last year. Wary of arousing false hopes of recovery amongst relatives, they stressed that they could not generalise from a single intriguing case. Dr Nicholas Schiff, of Weill Cornell Medical College in New York, said that it was not clear "whether we’ll see this in one out of 100 vegetative patients, or one out of 1,000, or ever again." A French scientist who reviewed the study for Science said that the results are "not totally convincing of consciousness".

However, the article has certainly rattled the notion that all "vegetative" patients are unconscious. "One always hesitates to make a lot out of a single case, but what this study shows me is that there may be more going on in terms of patients’ self-awareness than we can learn at the bedside," Dr. James Bernat, a professor of neurology at the Dartmouth Medical School, told the Times. "Even though we might assume some patients are not aware, I think we should always talk to them, always explain what’s going on, always make them comfortable, because maybe they are there, inside, aware of everything."

Neuroscientist Dr Narender Ramnani at Royal Holloway University of London, told the Daily Mail that, "This adds weight to the view that she, and perhaps many other patients like her, might be quite capable of decision-making and have a rich and complex internal life," he said. The case raises important ethical questions, he added. "Given that such patients might be conscious and capable of making their own decisions, is it acceptable for others to terminate their lives without the consent of these patients?"

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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