The Vegetative Mind
[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?
H/T Instapundit and the New Scientist link is here.
— DRJ
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.
“One of the most difficult questions you might want to ask someone is whether they want to carry on living.
I would never ask anyone that. To ask is to suggest the alternative.
cassandra in MT (d3d173) — 2/8/2010 @ 7:13 pmIn purely paractical terms, leave a living will, asking for a massive dose of morphine, instead of withdrawal of hydration and nutrition.
Preferrably in Oregon or, better yet, Amsterdam.
nk (db4a41) — 2/8/2010 @ 7:20 pmI added a PS with more links.
DRJ (84a0c3) — 2/8/2010 @ 7:23 pmIf you read the comments you will find links to a lot of concern about the nature of fMRI imaging. I’m agnostic, Though it seems natural to me, that if there is ANY question you should chose life.
Douglas (2c3ce5) — 2/8/2010 @ 7:23 pmThis seems to be good and exciting science, based on the precautions taken.
Earlier attempts to discern consciousness through “facilitated communication,” could be an artifact of the facilitator, the “Clever Hans” effect.
Brother Bradley J. Fikes, C.O.R. (9eb641) — 2/8/2010 @ 7:30 pmIs the Hans effect anything like a Hanz device ?
JD (7cdb18) — 2/8/2010 @ 7:44 pmThat’ll teach me. Skimming the title of the post, I initially thought that it was an opinion piece about our President and the Left in general.
Apogee (e2dc9b) — 2/8/2010 @ 8:01 pmGreat observation, Apogee.
JD (42d1cb) — 2/8/2010 @ 8:18 pmQuite a quizzibuck! No one can write credibly on thus lest confronted with this situation. The Left, however, have it easier. Not only does their pro-abortion stance give them experience in killing the innocent but their attempts to nationalise healthcare will give them the power to cut funding for those in a vegetative state. Yes, this is a real duketastrophe!
Longsps (c3ad57) — 2/8/2010 @ 8:34 pmWhat if the patient is a five year old boy who fell in a pool.
papertiger (630deb) — 2/8/2010 @ 8:35 pmThe Doc going to ask him questions he would scarsely understand under perfect circumstances, in order to decide his fate?
Sometimes it seems like medical scientists view life-or-death decisions as primarily about choosing death.
I think that is an insightful and true observation.
The basic narrative is, “modern medicine can do lots of things to keep a person, or at least their body alive, when it shouldn’t be done”. There are doctors who seem to focus on the “dysfunctional” aspects of why a person or family would “not want to die”.
I think the secular/materialistic view of existence causes one to focus on the utility (“tangible”) of a human life to the exclusion of the sanctity and mystery of life, with an accompanying pride and hubris that a mere mortal has the capacity to judge when a human life is “worth living”. Not that this is a new thing, as the concept of “being in love with this world, the here and now” to the exclusion of that which is transcendent is very old.
As you hint at, asking the wrong question will not get you the right answer.
MD in Philly (d4668b) — 2/8/2010 @ 8:35 pmThis topic pisses me off enough to punch random Democrats.
papertiger (630deb) — 2/8/2010 @ 8:41 pmSo Terry Schiavo’s nurses weren’t nuts?
Chris (c7c0c6) — 2/8/2010 @ 8:56 pmFor the record…
If I’m ever in a “persistent vegetative state”, give me a year. If I’m not back within 12 months, pull the plug.
Scott Jacobs (d027b8) — 2/8/2010 @ 9:15 pmIs the Hans effect anything like a Hanz device ?
No, the “Clever Hans” effect is subconscious cuing.
The term refers to a horse (Kluge Hans, referred to in the literature as “Clever Hans”) who responded to questions requiring mathematical calculations by tapping his hoof. If asked by his master, William Von Osten, what is the sum of 3 plus 2, the horse would tap his hoof five times. It appeared the animal was responding to human language and was capable of grasping mathematical concepts. It was 1891 when Von Osten began showing Hans to the public. (Hans could also tell time and name people,* but we will restrict our discussion of his amazing abilities to his mathematical skills.) It was eventually discovered (in 1904) by Oskar Pfungst that the horse was responding to subtle physical cues (ideomotor reaction) or as Ray Hyman puts it “Hans was responding to a simple, involuntary postural adjustment by the questioner, which was his cue to start tapping, and an unconscious, almost imperceptible head movement, which was his cue to stop” (Hyman 1989: 425). Yet, more than a dozen scientists observed Hans and were convinced there was no signaling or trickery (Randi 1995: 49). They were impressed that Hans performed almost as well without Von Osten as with him (Schick and Vaughn 1988: 116). But the scientists were wrong.
Brother Bradley J. Fikes, C.O.R. (9eb641) — 2/8/2010 @ 9:51 pmlike a Hanz device
Do you mean the “HANS DEVICE” that racecar drivers use to prevent upper spinal cord injuries, such as the one that killed Dale Earnhardt Sr.?
AD - RtR/OS! (3884b0) — 2/8/2010 @ 11:33 pmIf you’ve never been in this situation, you might talk to someone who has.
My mother had an operation which was unsuccessful, and was without oxygen to her brain for more than 15 minutes. The doctors told my father she had no brain function at all, qand told her she should be disconnected from life support. He literally agonized over what to do. If you think it was an easy decision, let me tell you I had never seen my dad upset on any other occasion in my life. He told us (we were all adults) he didn’t know what to do.
He finally instructed them to disconnect her from the ventilator. She survived another 5 years. He left what is called an advanced directive in place that she shouldn’t be treated for any medical problem which arose. She finally died of an untreated infection. I have no idea whether she was aware of anything for all those years, or felt pain. The doctors told us she did not.
JEA (1eb0e1) — 2/9/2010 @ 7:44 amSo why not just harvest the organs of people in vegetative states and graft them to the bodies of other people? They would still be alive in the sense that their component cells are still alive.
Michael Ejercito (526413) — 2/9/2010 @ 12:39 pmToo close to what happens in the PRC with harvesting of organs from executed prisoners, and the questions that arise as to whether or not they deserved their fate, or was it compelled by the need for income from the harvested organs.
Now, if there were a legal, above-board, market in organs for transplant, and donors were supplying their organs with full-disclosure, that would be something else.
AD - RtR/OS! (ca88dc) — 2/9/2010 @ 1:08 pmBut, as of now, we don’t allow donors to be paid for their munificence.
So, we have a shortage of organs.
For the record, I’m not sure why Michael Ejercito quoted me in his post at #18. Perhaps I did not express myself well. Nothing I said was intended to imply that I agree with the sentiment in #18, especially as some sort of default position. If the persistance of living tissues as a transplant in another is taken as transcendence, that is not what I was discussing.
MD in Philly (d4668b) — 2/9/2010 @ 3:27 pm