What's going on in there?

The news is full of a story about researchers who tested a woman in a vegetative state and found some interesting responses:

The 23-year-old woman in the current study was injured in July 2005. Within weeks, she opened her eyes and began sleep-wake cycles — typical of patients in a vegetative state — but she showed no sign of awareness or ability to respond to her environment.

A persistent vegetative state, in which the patient is awake but has no awareness of self or surroundings, is a state between coma and brain death. As many as 35,000 Americans are in such a state.

Owen and his colleagues studied her brain for five months using functional magnetic resonance imaging or fMRI. The technique highlights areas of the brain that receive increased blood flow when in use.

When researchers spoke sentences to her, a specific part of the brain showed activity — the same part that lights up in healthy people hearing the same sentences. When the sentences included homonyms like "creek" and "creak," additional parts became active. Random noises generated no response.

Finally, when they asked her to imagine playing tennis or wandering through her house, different areas of the brain were illuminated — again identical to the areas responding in healthy volunteers.

Eleven months after the accident, the team reported, the woman began tracking a small mirror with her eyes, a sign that she might be transitioning to what is known as a minimally conscious state, often a sign of further recovery.

Fins speculated that she had already begun undergoing this transition when the fMRI tests were conducted and that those tests simply detected it earlier than her behavior indicated.

The researchers have refused to say what her current condition is.

The Washington Post article

That is good news, and indicative of the mysteries we are nowhere near to unpacking - but the moral point isn't shifted by this: even if there is no awareness, if a person is functioning, breathing on his or her own, etc, and needs food and water to be provided by others - we have no moral right to withhold that nutrition and hydration.

(And let us try not to fight old battles all over again. There are countless situations in which the dying reject food, consciously or not - that is part of the process of dying in many cases - in which, as life ebbs, all that a person can take is sips of water. That end-of-life scenario, which is part of the way dying can naturally occur. No one advocates force-feeding steak into people at the end of life who can't swallow or whose bodies are shutting down. But when someone is not dying, it is immoral to refuse to feed or give him water. There are innumerable gray areas, as well, but I think the fundamental point even precedes the question of nutrtion and hydration - when someone is profoundly cognitively disabled...what is our responsiblity to that person?)

Wesley Smith comments

Comments

[Maureen]

What's clear to me is that anybody, in any state, who's bedridden for long periods needs stimulating experiences on a regular basis. The brain responds better and has something to get better for, if it's given something to work on.

And no, I'm pretty sure keeping the TV blaring at all times doesn't count. That'd be enough to send you _into_ a coma!

Picking out an interesting variety of programs, music, audiobooks, etc, and having them on part of the day might help, though -- sorta like educational TV for coma patients, maybe. Dora the Explorer-type interactive questions and instructions. Maybe podcasts that have someone talking about their day, since they're more personal in tone -- like a visitor.

But I'm sure real visitors and daily therapy would probably help most.

[Donald R. McClarey]

Isn't it about time that society "pulled the plug" on the pvs diagnosis? As it has developed it is simply a sentence of death by which certain people with grave injuries can be put to death legally. This study demonstrates our woeful ignorance as to just what is going on in the mind of someone who is labeled pvs. Do not expect, however, this study to slow one whit the true advocates of euthanasia.

[chris K]

And they should always keep in mind the woman with the PVS diagnosis who came out of it to proclaim that she was aware of what people were saying and was screaming on the inside but could not communicate. She was interviewed during Terri's ordeal.

And about those brain cells:

http://www.medicalnewstoday.com/medicalnews.php?newsid=49878

[Laura(southernxyl)]

"Isn't it about time that society "pulled the plug" on the pvs diagnosis?"

Let's do.

I couldn't believe the people who thought Terri's autopsy results were significant. Put a completely unimpaired person in a hospital bed in a dimly lit room with absolutely no stimulation, not even the stimulation of chewing and swallowing food, for ten years, and see what his brain would be like.

[Ken]

Some WSJ editorial months ago referred to "'Persistent Vegetative State' -- the magic words that cause the relatives to immediately pull the plug or face accusations of being Right Wing Fundamentalist Christians."

[John Jansen]

I haven't read many articles on this woman's case, but I can say that the Chicago Tribune story was hopelessly biased.

At one point, the writer editorialized that this was "the only case of its kind," and later noted that "there's no indication this young woman's experience is common."

Two questions:

(1) Wouldn't it have been more objective to have said -- if it's true -- that this is the only documented case of its kind?

(2) Exactly what indication is there to suggest that this young woman's experience is not common?

[jane M]

This reminds me of the doctors who used to say that newborn babies couldn't really see very well, and laughed at mothers who said the baby looked at them. Turns out that babies *look at faces* and when doctors started showing them pictures of faces, instead of whatever else, the babies snapped to attention. But they had ALWAYS been doing this, only now they had an imprimatur. If I were in a "vegetative" state and someone told me to mimic hitting a tennis ball I might not "pay attention" as you might say.

[Petra]

A persistent vegetative state, in which the patient is awake but has no awareness of self or surroundings

It is quite obvious from this story and from stories of patients who have woken up from pvs that this is not the case. We only don't know what patients in pvs go through, if their experiences are all similar etc.

Besides, there are states where people are unable to communicate, yet fully aware (locked-in syndrome or the thing Stephen Hawking has). If we lived a century ago and, say, Hawking didn't have the means to communicate with others through a computer, heshould be under the ground by now, according to such people.

I completely agree with Amy however: consciousness does not matter; as long as someone breathes on their own, he/she is very much alive.