In an amazing finding, doctors have discovered a way to communicate with some patients who are in a persistent vegetative state. Terri Schaivo, who was at the center of a national “right to die” debate in 2005, was also in a vegetative state and allowed to die, though her brain did not show the activity that allowed these patients to communicate with doctors. The Los Angeles Times writes, “researchers report that five patients [of
54] thought to be in a persistent vegetative state showed brain activity indicating awareness, intent and, in at least one case, a wish to communicate.”
In that case, the patient was asked to answer yes or no questions—to answer ‘yes’ he thought of tennis, to answer ‘no’ he thought of walking through his house. Because they light up different parts of the brain by either thinking of physical activity or special movement, doctors could communicate with him.
Harvard University neurologist Allan H. Ropper wrote: “It will now be difficult for physicians to tell families confidently that their unresponsive loved ones are not ‘in there somewhere.’ … We cannot be certain whether we are interacting with a sentient, much less competent, person.”
“To be able to do what we have asked, you have got to be able to understand instructions, you have to have a functioning memory to remember what tennis is and you have to have your attention intact. I can’t think of what cognitive functions they haven’t got and still be able to do this,” Dr Adrian Owen, assistant director of the Medical Research Council‘s cognition and brain sciences unit at Cambridge University, told the Guardian newspaper.
In The New York Times, Dr. Joseph J. Fins, chief of the medical ethics division at Weill Cornell Medical College in New York, warns about using this ability to make life or death choices on behalf of patients. “If you ask a patient whether he or she wants to live or die, and the answer is die, would you be convinced that that answer was sufficient?” he said. “We don’t know that. We know they’re responding, but they may not understand the question. Their answer might be ‘Yes, but’ — and we haven’t given them the opportunity to say the ‘but.’
“We’ve opened up a communication channel with this technique, but in some ways it’s like a very bad cellphone connection.”
Aside from the obvious ethical issues involved—that doctors and family try to use this technology to communicate with those in persistent vegetative states—it open up other issues. If someone is unable to communicate, do automatically you allow them to die? Research does suggest that thinking can occur separate from brain function, so these findings don’t resolve that question.
It also suggests that for caregivers, whether to similarly disabled patients or people who have more obvious ability to function, that just because the body is not alert the mind may still be. Not only should you be careful what you say, but there is an opportunity for mental care giving. Reading, praying, and other such activities would give such a patient a much needed opportunity for interaction with the outside world as well has hope and purpose in a very challenging situation.
The full study can be found at the New England Journal of Medicine.
Image from the New England Journal of Medicine: “Functional MRI scans obtained from Patient 23 and one healthy control subject are shown. The top sets of scans obtained from the patient (Panel A) and the control subject (Panel B) show activation (yellow and orange) resulting from the motor imagery task (cued with the word “tennis”) as compared with rest periods (cued with the word “relax”), as well as the time course of the peak voxel in the supplementary motor area. The bottom sets of scans obtained from the patient (Panel C) and the control subject (Panel D) show activation (blue) resulting from the spatial imagery task (cued with the word “navigation”) as compared with rest periods, as well as the time course of the peak voxel in the parahippocampal gyrus. I bars represent standard errors. BOLD denotes blood-oxygenation-level–dependent.”