One of the most interesting (and hope-inspiring) topics to hit the press lately has been the story of a man thought to be in a vegetative state, who has responded to doctors at Cambridge via brainwaves detected in fMRI technology. The man, who sustained heavy head trauma in a car accident five years ago, has been physically unresponsive since the event. Over the last few days, the case has garnered lots of ink on most major news networks, who have consistently recognized the instance as critical for the ongoing debate on the "definition of death" and end-of-life ethics.
The results of recent tests conducted on patients thought to be in a permanent vegetative state were released by British and Belgian researchers in a paper entitled, "Willful Modulation of Brain Activity in Disorders of Consciousness." The findings were published in the New England Journal of Medicine. Overall, only 5 of 54 patients who were tested responded to the stimuli presented by the researches, who used functional magnetic resonance imaging (fMRI) to detect and decipher brain wave activity. But even with only a limited percentage of returns, the research is groundbreaking.
In the test, patients were asked to alter their thoughts—concentrating on either spatial imagery or motor imagery—which the scientists tracked as enacting different parts of the brain. One of the patients, a Belgian auto accident victim, even went on to answer a series of "yes" and "no" questions using the response technique. The 29-year-old man used the two types of mental imagery to respond accurately to biographical questions about his life. According to CNN, the fMRI technique was never formerly attempted on patients thought to be in vegetative states.
The importance of this recent study is vast, particularly given last year's story of a man, thought to be in a vegetative state for 23 years, who returned to consciousness and revealed that he was aware of his surroundings the whole time.
Just as vitally, the results of the Cambridge study also promise to shape the future of the ongoing bioethical debates surrounding end-of-life ethics and the proper treatment and care of those in non-responsive states. Clearly, patients who are able to respond to audible or visual stimuli by way of voluntary brainwave modulation are entirely alive, and they ought to be treated as such. With this insight into the mind of someone in an ostensibly vegetative state, physicians will have another factor to deal with when considering whether or not to remove patients from life support; and family members will possibly be given access to the thoughts of their incapacitated relatives.
Of course, the real essence of this budding debate is much more controversial, and revolves around whether or not patients in an otherwise vegetative state can ethically decide their own fate by communicating a wish to die to doctors and caretakers. According to Arthur Caplan, head of the University of Pennsylvania's Center for Bioethics, "The more these measures of consciousness get complex and fine-tuned, the harder it is to write a recipe about them." (LA Times) In short, doctors and family members may now be forced to listen to and deal with the articulated desires of loved ones, who in many cases will simply want to escape from the isolation and pain of their injuries.
At bottom, it is important to remember some basic guidelines that ground ethical behavior in these tough situations. To begin, patients in a persistent vegetative state (PVS) are still human persons, and they demand all the treatment that a human person in a non-vegetative state demands (e.g. access to nutrition, hydration, etc.). The lack of purposeful or intentional activity on the part of a PVS patient does not indicate the absence of life, even if higher brain activity is irreparably stopped. And so, patients must continue to be given the normal care mentioned above (although the parameters of the extent and duration of this sort of treatment are highly debated). At the very least, to remove normal, nutritional care with the intention to end the life of the patient is tantamount to murder (the intentional taking of innocent human life), and is therefore never morally permissible.
Perhaps one of the gravest points of contention will surface if families and caretakers of PVS patients implement fMRI scans to determine whether or not a loved one is responsive to stimuli, and if not, use the negative result as a justification of the removal of normal hydration and nutritional care. A huge dilemma is imaginable in cases where "PVS patients" are temporarily unable to respond to stimuli, but are not entirely and permanently unresponsive. If doctors or family members used negative results of such a test to indicate PVS permanence, it's possible to imagine that many non-vegetative state patients would be deemed as in a PVS, and thus allowed to die. Science can only report positive findings, and it cannot (and ought not) infer to a persistent vegetative state based on the lack of evidence in one test.
Ultimately, the fMRI technology that has given us a glimpse into the mind of PVS diagnosed patients is a medical breakthrough. But with the advent of increased technology always comes the need for heightened ethical and moral awareness. Without a doubt, this research will revolutionize the debate on end-of-life care and the "definitions of death"; but we must keep vigilant to ensure that it doesn't, at the same time, create a false faith in the scope of scientific knowledge.
