Trapped inside their bodies, apparently switched off to the world, but still alive: they are the undead. Or so we thought. Forty per cent of patients in a ‘vegetative state’ are misdiagnosed. Now British scientists are leading the field in trying to put that right.
Although Kate could not speak, or hear properly, or make any kind of signal, or take in sustenance except through a tube into the stomach, she was sometimes aware of herself and her surroundings. She had a raging thirst that was not alleviated by the ward staff. She was racked with pain. Sometimes she’d cry out, but the ward staff thought it was just a reflex action. Kate suffered so much pain and despair that she tried to take her own life by holding her breath.
Then a Cambridge neuroscientist called Dr Adrian Owen put her in a special kind of scanner and performed an unprecedented experiment. It revealed evidence of fluctuating levels of brain activation when she was presented with pictures of her parents. From that point, she started her long journey back into the world. This is a story about brain-impaired patients who come gradually out of coma into “minimal awareness” after being misdiagnosed as being in PVS: breathing, appearing to be wakeful, yet deemed to be dead to themselves and the world. It is also about the disastrous consequences of such misdiagnoses, estimated in the UK and other countries to be running at two in five cases. And, crucially, it is about a neuroscientific research programme that is set to transform the prospects of diagnosis, treatment and rehabilitation of brain-injured people the world over.
And then there is this:
But here’s at least one mordantly amusing and true story told to me by a psychologist at Putney’s Royal Hospital for Neuro-disability. “Young man with motorbike head injury in a coma. His mum, a keen evangelical, comes every day with friends to sing Onward, Christian Soldiers by his bedside. She’s hoping to stimulate his brain into action. It works: he comes round, but he can’t speak. So they fit him up with one of those Stephen Hawking-type laptops, and the first words he speaks are: “For God’s sake, Mum, shut it!” That’s about as funny as it gets on a brain-injury ward, but there’s a serious take-home message. Even minimally aware patients can retain emotions, personality, a capacity to suffer - and, as the young biker showed, attitude.
As important as this news is, I actually don’t think it matters much to the ethical discussion surrounding the care of patients in so-called persistent vegetative states. I wrote about it after the last PVS breakthrough-study a while back for the Weekly Standard :
Always wary of the political and moral implications of their results, there were the predictable claims that the results shouldn’t been seen as having broad implications to other PVS patients. Of course the PVS patient par excellence, Terri Schiavo, was immediately brought up: James Bernat, a neurologist at Dartmouth Medical School, claimed, “I’m quite confident that [Schiavo] would not have responded in this way.” At the same time, however, he too was taken aback: “It’s a little disturbing. This suggests there may be things going on inside people’s minds that we can’t assess by interacting with them at the bedside.”
The reason, of course, that some find this study disturbing is because they believe it would entail a different moral status, and thus medical treatment, of the PVS patient. No longer dehumanized to mere biological life, the patient might retain activity in the mind, and thus rightly be classified as a person. Even some pro-lifers make the mistake of arguing along these lines, as if this recent study vindicates the anti-euthanasia position. “See, she has a mental life, we just can’t notice it through our normal five senses,” so the argument would go.
This, however, is a mistake. And those who uphold the inherent dignity and equal worth of all human beings regardless of age, handicap, disability, or incapacity should beware of championing this study and future studies like it. For the intrinsic value of human life is not contingent upon the results of brain scans indicating mental activity. To think that it is would require one either to affirm body-self dualism or to reject the proposition that the lives of all human beings are of equal, intrinsic worth. Both positions are untenable.
Read the rest to find out why.