Patients in persistent vegetative states are unable to move, communicate, or respond to their surroundings. Lost in a state of unconsciousness, these patients are no longer able to maintain any level of awareness. Remarkably, scientists have recently found a method of communicating with some vegetative-state patients, using simple yes/no questions to effectively read minds.
In the study, published in the New England Journal of Medicine, scientists in the UK and Belgium observed 54 vegetative-state patients and used functional MRI to observe brain activity in real time. Patients were then instructed to associate playing tennis with the answer “yes” and navigating city streets with “no.” In healthy people, different parts of the brain are activated when thinking about something active, like tennis, in comparison to something that requires spatial skills, like moving around a city.
Brain activity was scanned in response to questions with known answers, such as “Is your brother’s name Michael?” Five of the patients were able to accurately answer these yes/no questions, suggesting that traces of thought may be present in some vegetative-state patients.
So what does this study mean? If vegetative-state patients are able to communicate with physicians by this method, can they offer insight into their level of comfort or pain? Can they answer the yes/no question of whether they would like to live or die? Could we accept their answer in full confidence?
This study is promising, but it’s important that we don’t over-exaggerate the results. Only five out of 54 patients showed this ability to communicate- that’s less than 10% of patients in the study. More importantly, it is difficult to associate the general brain activation observed in the study with competence and the ability to make decisions.
Generally, this study should inform future understanding of awareness and capabilities of vegetative-state patients. However, it should not be used to justify unqualified use of life support for all. The media often sensationalizes issues surrounding the rights of vegetative state patients, such as in the case of Terri Schiavo, so we need to be careful to consider this study within its proper context: improving the care of vegetative-state patients.
- blog authored by Rachel Smith