The Cinch Review

“Vegetative” patients show cognition

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Webster’s Dictionary defines a vegetative state, in the medical sense, as being “a state in which there is a total loss of cognitive functioning and in which only involuntary bodily functions (as breathing or blinking of the eyes) are sustained.”

And we know what that diagnosis means, in terms of the kinds of treatments given to such patients and the kinds of “end of life” decisions which family members make, based on the confident assertions of doctors. Well. A study just published provides a stark example of just how much we still have to learn. The cost of the presumption that we already knew these things is another question. From the Wall Street Journal: Study Finds Cognition in Vegetative Patients.

In a new study published in the New England Journal of Medicine, four of 23 patients diagnosed as being in a vegetative state showed signs of consciousness on brain-imaging tests.

Even more significantly, one patient was able to answer yes and no questions using the researchers’ technique—indicating the potential for communication with people previously considered unresponsive.


Each patient in the New England Journal of Medicine study was placed in a functional MRI scanner and asked to imagine playing tennis, a task that activates the part of the brain associated with movement. Participants also were asked to imagine walking around their home, or on familiar city streets, which activates areas in the brain involved in spatial navigation. Four of the 23 vegetative patients responded to the commands and exhibited brain activity in the same areas as healthy control subjects.

Then the researchers used the technique to see if it might enable patients to answer simple yes-no questions, such as “do you have any brothers?” Patients were instructed to answer by imagining one of the two scenarios—playing tennis if the answer was yes, for example, or walking around one’s home if no. One of the four vegetative patients responded correctly to the questions, said Adrian M. Owen, a neuroscientist at the Medical Research Council in the U.K. and one of the study’s authors.

“There is a minority of vegetative patients who aren’t what they appear to be,” said Dr. Owen. “They have cognitive capabilities far beyond what they appear capable of.”

At Secondhand Smoke, Wesley J. Smith rightly reflects again on the case of Terri Schiavo. I think that the possibility — and in the light of this study, the probability — that some patients in a so-called “persistent vegetative state” have had food and water withdrawn and have died with a conscious awareness of what was being done to them is chilling and disturbing and it ought to be. But I believe that Smith is also correct in this even more fundamental point: “Conscious or unconscious, people should not have to earn the right to receive basic sustenance. What we did to Terri Schiavo was a blight on the legal system and bioethics.”

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