Brain scans of patients in vegetative state reveal some activity

A stunning new study published in the New England Journal of Medicine found that many “patients in a vegetative state … are more conscious than previously believed. They showed brain activity when questioned about familiar names or given instructions.”

In a front-page story, the New York Times reports that the study showed “the limits of the current bedside test for diagnosing mental state,” which “experts said … could alter the way some severe head injuries were diagnosed.”

The finding may also “raise troubling ethical questions about whether to consult severely disabled patients on their care.”

For the study, researchers placed 54 patients “inside advanced brain scanners,” finding that five patients’ scans “flashed exactly like any healthy conscious person’s would,” the Washington Post reports on its front page.

Of those five patients, four “had received a vegetative state diagnosis, and one was thought to be only minimally conscious.” While “three showed signs of awareness during intensive standard bedside tests…two did not.”

The Los Angeles Times reports that “the study demonstrates that a form of brain scanning called functional magnetic resonance imaging might be used to discern the extent of a patient’s consciousness.”

The researchers “cautioned that the failure of some patients to show responses could have a wide range of meanings,” including “that they were temporarily asleep or unconscious.”

Still, experts “noted that the positive signals appeared only in people with traumatic brain injury — not in patients whose brains had been deprived of oxygen,” the AP reports. They also “said it is not clear what degree of consciousness and mental abilities the signs imply.”

In an accompanying editorial, Dr. Allan Ropper, a neurologist at Brigham and Women’s Hospital in Boston, “cautioned against families gleaning a false sense of hope,” noting that “evidence of consciousness was found in only a small percentage of patients,” HealthDay reported.

Nicholas D. Schiff, an associate professor of neurology and neuroscience at Weill Cornell Medical College in New York City, told the New York times that the study should “change the way we think about these patients.”

“I think it’s going to have very broad implications,” he said.

Dr. Joseph J. Fins, chief of the medical ethics division at Weill Cornell Medical College in New York, said the research opens up questions about whether the patients should be asked if they want to be killed via euthanasia — but it has its problems.

“If you ask a patient whether he or she wants to live or die, and the answer is die, would you be convinced that that answer was sufficient?” he told the Times.

“We don’t know that. We know they’re responding, but they may not understand the question. Their answer might be ‘Yes, but’ — and we haven’t given them the opportunity to say the ‘but.’”

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