[Guest post by DRJ]
British scientists have discovered you don’t need physical signs to tap into the vegetative mind. As described at this link, researchers used brain scans to communicate with individuals in total vegetative states. The findings may change completely how physicians determine whether someone is in a vegetative state:
“Doctors traditionally base these diagnoses on how someone behaves: if for example, whether or not they can glance in different directions in response to questions. The new results show that you don’t need behavioural indications to identify awareness and even a degree of cognitive proficiency. All you need to do is tap into brain activity directly.
The work “changes everything”, says Nicholas Schiff, a neurologist at Weill Cornell Medical College in New York, who is carrying out similar work on patients with consciousness disorders. “Knowing that someone could persist in a state like this and not show evidence of the fact that they can answer yes/no questions should be extremely disturbing to our clinical practice.”
The implications for medical ethics are apparently profound:
“One of the most difficult questions you might want to ask someone is whether they want to carry on living. But as Owen and Laureys point out, the scientific, legal and ethical challenges for doctors asking such questions are formidable. “In purely practical terms, yes, it is possible,” says Owen. “But it is a bigger step than one might immediately think.”
Bigger than deciding not to hydrate or feed someone?
PS – A New Scientist editorial links an NIH abstract that discusses how “unsettling” it can be to discover awareness in vegetative patients, and how that may increase pressure to discontinue their life support. The editorial’s conclusion:
“However, this research now offers a way to ask someone if they wish to end their life. The ethical issues surrounding assent to suicide will be just same as for someone who is terminally ill. The central question remains: are they capable of making a life-or-death decision and deciding their own fate.”
Sometimes it seems like medical scientists view life-or-death decisions as primarily about choosing death.