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Friday, July 24, 2009

Neuroscience: Is the patient "vegetative" or "minimally conscious"?

Celeste Biever raises an important topic in "Doctors missing consciousness in vegetative patients" (New Scientist, July 21, 2009): About 40% of people diagnosed as in a "vegetative" state may be minimally conscious. Whereas a person in a persistent vegetative state may have no real awareness,
A minimally conscious state (MCS) is a sort of twilight zone, only recently recognised, in which people may feel some physical pain, experience some emotion, and communicate to some extent. However, because consciousness is intermittent and incomplete in MCS, it can be sometimes very difficult to tell the difference between the two.
Recent research focuses on efforts to disentangle the two conditions.

Minimally conscious people may benefit from therapies that provide no value for people in a persistent vegetative state. Another concern is that decisions to withhold food to bring about death (legal in many jurisdictions now) could be inflicted on people who are just conscious enough to be aware of what is happening.

See also: The inner lives of people classed as vegetative

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Saturday, October 13, 2007

The inner lives of people classed as “vegetative”

A must-read for anyone who could find themselves in a vegetative state (= you and me) is a recent article in the New Yorker by Jerome Groopman, summarizing the recent findings about the inner life of many people who appear to others to be no more responsive than zucchinis:
Bainbridge had not spoken or responded to her family or her doctors, although her eyes were often open and roving. (A person in a coma appears to be asleep and is unaware of even painful stimulation; a person in a vegetative state has periods of wakefulness but shows no awareness of her environment and does not make purposeful movements.) Owen placed Bainbridge in a PET scanner, a machine that records changes in metabolism and blood flow in the brain, and, on a screen in front of her, projected photographs of faces belonging to members of her family, as well as digitally distorted images, in which the faces were unrecognizable. Whenever pictures of Bainbridge’s family flashed on the screen, an area of her brain called the fusiform gyrus, which neuroscientists had identified as playing a central role in face recognition, lit up on the scan. “We were stunned,” Owen told me. “The fusiform-gyrus activation in her brain was not simply similar to normal; it was exactly the same as normal volunteers’.”

One fellow, recently reawakened, recalled his social security number from over two decades earlier and helpfully offered it to his mother while she was on the phone with a bureaucrat.

Kate Bainbridge herself, ex-vegetable, wrote to Groopman to offer an opinion:
Kate Bainbridge, the first vegetative patient that Adrian Owen studied in Cambridge, has also made considerable progress, recovering the use of her arms, and much of her mental function, although she is unable to walk. She still has difficulty talking, and uses a letter board to communicate with people who are not used to her speech. “Most scans show what is wrong with your brain, which doctors need to know,” Bainbridge wrote to me in an e-mail. “But Adrian Owen’s scans show what is working. I say they found parts of my brain were working. It really scares me to think what might have happened to me if I had not had the scans. They show people it was worth carrying on even though my body was unresponsive.”


Something to think about, when we hear people say - about old or sick or developmentally delayed people - "Oh, So-and-so doesn’t understand what we are saying." The Mindful Hack humbly suggests: Don’t risk it. And if it not something that shows concern for them, don't say it. Don't even think it.

For Mindful Hack stories on brain absent people, go here “How much brain does a man really need?”, and here “Just how much brain do YOU need?”.

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Wednesday, August 08, 2007

Recovery from vegetative state ...

Here's another case of a recovered "vegetable." Imagine if you knew that people thought you were dead - but you weren't.

By the way, Harvard materialist cognitive scientist Steve Pinker wonders whether
Would it be consistent with our moral principles to give parents the option of euthanizing newborns with birth defects that would consign them to a life of pain and disability?
A friend points me to Life Without Limbs for a reality check. Here's the audio file.

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