Thursday, February 04, 2010

Persistent Vegetative State Not So Vegetative?

In a recent article in the New England Journal of Medicine, researchers have found that a group of individuals who were considered to be in a vegetative state were possibly conscious the whole time.  More from the Washington Post:
Many of the patients were labeled with the same grim diagnosis: "vegetative state." Their head injuries, teams of specialists had concluded, condemned them to a netherworld -- alive yet utterly devoid of any awareness of the world around them.
But an international team of scientists decided to try a bold experiment using the latest technology to peek inside the minds of 54 patients to see whether, in fact, they were conscious.
One by one, the men and women were placed inside advanced brain scanners as technicians gave them careful instructions: Imagine you are playing tennis. Imagine you are exploring your home, room by room. For most, the scanner showed nothing.
But, shockingly, for one, then another, and another, and yet two more, the scans flashed exactly like any healthy conscious person's would. These patients, the images clearly indicated, were living silently in their bodies, their minds apparently active. One man could even flawlessly answer detailed yes-or-no questions about his life before his trauma by activating different parts of his brain.
So the basic set up allows the researchers to monitor brain activity  using fMRI.  The premise of the persistent vegetative state is that these individuals should not be responding consciously to stimuli, such as asking them to imagine a certain scene or answer a yes or no question.  Here is the reaction of the lead researcher:

"It was incredible," said Adrian M. Owen, a neuroscientist at the Medical Research Council who led the groundbreaking research described in a paper published online Wednesday by the New England Journal of Medicine. "These are patients who are totally unable to perform functions with their bodies -- even blink an eye or move an eyebrow -- but yet are entirely conscious. It's quite distressing, really, to realize this."
 Of course it is 'quite distressing'!  For several years now, medicine and society have been sliding down the slippery slope of euthanasia.  Do we truly know enough about the brain and consciousness to accurately and morally judge an individual as being in a persistent vegetative state or brain dead?  I believe this research, even if it was only 5 individuals among a larger cohort, indicate that our ability to declare someone as being in a PVS or brain dead is lacking in many ways.  As a physician, based upon this study, would you be willing to say that an individual who is in persistent vegetative state should have all life support removed?  Or what about the young man on the table whose organs are coveted by half a dozen other families?  In this study, the individuals who responded were all victims of a traumatic brain injury, which is where many of the organ donations come from.  So, we must ask ourselves very carefully, how do we approach the individual who is termed brain dead? Or in a persistent vegetative state?  Do we have the right to remove them from life sustaining care?  As for the 'brain dead' individual, we know that by Church teaching we are able to remove extraordinary measures such as a ventilator, but can we justify the cutting out of a beating heart?  How do we know that they are truly brain dead?  Or the individual in the PVS.  We cannot abdicate our duty to protect their dignity and right to life, especially now as we see there is the possibility that the individual is very much awake within their bodies.  We must stop medicine from asking this question:
"If a patient wanted to die, if they were asked, 'Do you want to die?,' could they explain themselves adequately?" said Joseph J. Fins, chief of the division of medical ethics at Weill Cornell Medical College. "If they say yes, what does that mean? If this person said yes but meant maybe, or it was 'sort of yes,' we may not be able to understand that sort of nuance. You have to be very careful."

UPDATE: Further commentary from Pundit and Pundette and do not miss the commentary from Wesley J. Smith.


  1. Thanks, Brian. Linked to you.

  2. Thanks Jill. I follow your blog everyday. Keep up the good work!