Friday, September 08, 2006

How "Vegetative" is that "Vegetative State?"

From Yahoo News for 9/7/06:
Advanced brain scanning uncovered startling signs of awareness in a woman in a vegetative state, British scientists reported Thursday - a finding that complicates one of medicine's ethical minefields.

Many of us really don’t find this particular issue to be that much of an ethical minefield. Most ethical decisions are not that complicated; they are usually just uncomfortable and hard to live up to. I know when I find myself in a “complicated” ethical situation, it is usually because I am trying to weasel out of something. I don’t like it, but it isn’t really all that “complicated.”

The work is sure to elicit pleas from families desperate to know if loved ones deemed beyond medical help have brain activity that doctors don't suspect. "Can he or she hear and understand me?" is a universal question.

It's far too soon to raise hopes, the British researchers and U.S. brain specialists stress. There's no way to know if this 23-year-old woman, brain-damaged over a year ago, will recover, and therefore if her brain activity meant anything medically. Her brain injury may not be typical of patients in a vegetative state.

Can someone explain that sentence to me? She only matters if she can recover, but if she can’t get better, then what she is now “doesn’t mean anything?” I don’t mean to put words in the reporter’s mouth - maybe he means something else - but that is how the statement comes across to me.

Scientists don't even agree on whether the woman had some real awareness - she seemed to follow, mentally, certain commands - or if her brain was responding more automatically to speech.

"This is just one patient. The result in one patient does not tell us whether any other patient will show similar results, nor whether this result will have any bearing on her," cautioned neuroscientist Adrian Owen of Britain's Medical Research Council. He led the novel brain-scanning experiment, reported in the journal Science.

But if we don’t know, then shouldn’t we default on the side of not killing them?

[…] "It raises the questions of ethics and experience of these patients, I think, to a new level," said neuroscientist Joy Hirsch of New York's Columbia University Medical Center. "It raises the tension about how we treat these patients."

But, "making medical decisions based on this information at this point in time we say is not appropriate," warned Hirsch, who is conducting similar research and already receives "just heartwrenching" requests for help.

Ultimately, in the case of people who aren’t dying (i.e. just being fed and hydrated), this isn’t a medical decision at all. It is a moral decision. Medical decisions involve questions of best treatment, or whether a particular treatment is a waste of time. There may indeed be medical decisions about whether attempts at rehabilitation are warranted. The question that occupies society, however, as demonstrated in the case of Terri Schiavo, is whether to feed and water such folk - and that is not a matter of medicine.

The woman was injured in a car crash. By the time Owen scanned her brain five months later, she had been pronounced in a vegetative state - physically unresponsive to a battery of tests. A small percentage of people make some recovery after spending a short period in a vegetative state.

Those who don't improve after a longer period are classified as in a "persistent vegetative state," such as the late Terry Schiavo, who became a subject of political controversy over the question of taking such patients off life support. An autopsy showed she had irreversible brain damage…

[…] Owen and colleagues contend their fMRI experiment showed the car-crash victim had some preserved conscious awareness despite her vegetative state.

How could they tell? First, they checked that she could process speech. Upon being told "there was milk and sugar in the coffee," the fMRI showed brain regions reacting the same in the woman and in healthy volunteers.

Then came the big test. Owen told the woman to perform a mental task — to imagine herself playing tennis and walking through her house. Motor-control regions of her brain lit up like they did in the healthy people he compared with her.

"There is no other explanation for this than that she has intentionally decided to involve herself in the study and do what we asked when we asked," Owen said in an interview.

Other scientists say that's not clear-cut…

Again, if it’s not clear cut, feed them! You’re not being required to take them dancing, or buy them season tickets to the Cowboys games, for heaven’s sake!