Patients in Vegetative State May Be Aware
Remember the arguments put forth for why Terry Schiavo should be allowed to die? They revolved around the awareness of those said to be in a persistent vegetative state. Now, researchers reported in Science1 that a patient diagnosed in a vegetative state was aware of what was going on:
We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.
The researchers called the condition of vegetative state “one of the least understood and most ethically troublesome conditions in modern medicine.” The ran tests with functional MRI on a 23-year-old woman who had suffered severe injury in a car accident. Unresponsive but with preserved sleep-wake cycles, she was diagnosed as in a vegetative state by international criteria.
These results confirm that, despite fulfilling the clinical criteria for a diagnosis of vegetative state, this patient retained the ability to understand spoken commands and to respond to them through her brain activity, rather than through speech or movement. Moreover, her decision to cooperate with the authors by imagining particular tasks when asked to do so represents a clear act of intention, which confirmed beyond any doubt that she was consciously aware of herself and her surroundings.. Of course, negative findings in such patients cannot be used as evidence for lack of awareness, because false negative findings in functional neuroimaging studies are common, even in healthy volunteers. However, in the case described here, the presence of reproducible and robust task-dependent responses to command without the need for any practice or training suggests a method by which some noncommunicative patients, including those diagnosed as vegetative, minimally conscious, or locked in, may be able to use their residual cognitive capabilities to communicate their thoughts to those around them by modulating their own neural activity.
Another case was reported by the BBC News. A victim of an acute viral infection was diagnosed in a vegetative state. She could not move her facial muscles to indicate reactions, but was aware of what was being said around her, and felt scared. “I felt trapped inside my body,” she later reported. The only clue to her hopeful parents came from a brain scan that showed she was processing information presented to her.
Update 09/13/2006: Nature (443, 14 September 2006) published a news item (pp 132-133) and editorial (pp 121-122) on this finding, but claimed the patient in this case “seems to have been much less severely injured than the permanently vegetative Terri Schiavo, whose case inflamed the moral debate over whether those who show no signs of recovery should be allowed to die.” Surprisingly, even though the news item admits that there is a continuum of states, that some on the continuum may be progressing toward eventual recovery, and that the binary diagnosis of “vegetative state” can no longer be taken for granted, the editorial claims, “This case has little bearing on ethical questions over whether or not the most severe cases should be denied treatment and allowed to die,” because in the most severe cases the chances of finding any sign of awareness is negligible. Yet the parents and friends of Terry Schiavo constantly argued that she was aware enough to follow objects and display emotions. Since she was killed in March 2005, we will never know if she could have passed a similar fMRI scan test.
1Owen et al., “Detecting Awareness in the Vegetative State,” Science, 8 September 2006: Vol. 313. no. 5792, p. 1402, DOI: 10.1126/science.1130197.
Recall the anger and outrage against the people who protested the death of Terry Schiavo. Remember the claims that they were the ones being unreasonable and insensitive, and that the compassionate thing to do was to let Terry die, because she was not really living. Now picture the possibility of her hearing all these things said about her but trapped inside, unable to communicate. Imagine the fear and helplessness and pain of knowing you were being intentionally allowed to starve and dehydrate to death. How many other times has a similar decision been made to a patient assumed to be “vegetative” and unaware? Remember, these scientists said that negative responses in the brain scans are not definitive in diagnosing the awareness of a person.
What kind of nonsense applies a word like vegetative to a human being, anyway? What are they insinuating, that this patient is nothing more than a carrot or rutabaga? Notice how these researchers called the diagnosis of “vegetative state” as one of the “least understood and ethically troublesome conditions in modern medicine.” Haven’t we learned that dehumanizing an individual is often the first step toward rationalizing the unthinkable?