Study reveals brain activity of patient in ‘vegetative state’
NASHVILLE, Tenn. (BP)--A patient said to be in a persistent vegetative state (PVS) had the capacity to understand and respond to verbal commands, a team of European researchers reported in the journal Science Sept. 8.
Researchers used functional magnetic resonance imaging (MRI) technology to examine the brain of a woman who was critically injured in an automobile accident in July 2005. When they provided voice commands, such as instructions to imagine herself in a game of tennis, portions of the woman’s brain showed a surprising amount of activity, not unlike those of healthy people who agreed to participate in the same study.
“Her decision to cooperate ... by imaging particular tasks when asked to do so represents a clear act of intention, which confirmed beyond any doubt that she was consciously aware of herself and her surroundings,” the researchers noted in the study.
Richard Land, president of the Southern Baptist Convention’s Ethics & Religious Liberty Commission, said the results of the study were “very encouraging to this woman and those treating her.” He said the same kind of tests “should be done on all people who have this kind of brain injury to help us determine whether they are in a persistent vegetative state or whether they are in a minimally conscious state and the degree to which there is any hope for recovery of brain function.”
The findings have rekindled the debate surrounding the starvation death of Terri Schiavo in 2005 and are prompting further discussion of long-term care for brain-damaged patients. Southern Baptist ethicists are calling the findings further proof that, when there is doubt, the justice system should side with life. They also said the justice system had clearly erred in the Schiavo case.
Schiavo died of complications from dehydration after husband Michael Schiavo and pro-euthanasia attorney George Felos successfully argued before a Florida court to have her feeding tube disconnected. She had been receiving nutrition and hydration through a tube since her collapse and subsequent brain injury in 1990.
C. Ben Mitchell, associate professor of bioethics at Trinity Evangelical Divinity School and a research fellow with the ERLC, said the new study is a reminder “that we know far less than we think we know about what is happening in the brain of comatose patients.”
“In this case, the patient was hardly ‘vegetative.’ In fact, she was quite alive. A PVS diagnosis should not be a death sentence, but a cause for special care. We may well be caring for someone who is aware of every conversation, every act of compassion, and every hint of abandonment,” Mitchell said.
Initially, Michael Schiavo pledged to take care of his wife for the remainder of her natural life, but after he received a $1.2 million medical malpractice settlement in 1992, he refused to provide further rehabilitative services for her. In 1998, he filed suit in court to have Terri’s life ended, arguing that Terri had stated that she would not want to live in a persistent vegetative state. The court accepted the hearsay as evidence of Terri Schiavo’s end of life wishes.
The decision to allow Schiavo to die touched off a 12-year legal battle in which the parents of Terri Schiavo, Bob and Mary Schindler, argued that their daughter was able to respond to their voices and verbal commands, just as the patient in the most recent study had. Bob Schindler issued a statement following the publication of the findings last week.
“This new case is not surprising to our family,” Schindler said. “We are seeing a growing amount of evidence indicating that the diagnosis of ‘Persistent Vegetative State’ (PVS) is often mis-diagnosed, resulting in dangerous and potentially fatal consequences for people with brain injuries, as documented in this new account of a brain injured woman. The danger of this diagnosis is that it is being used as a reason to kill innocent people with disabilities, like Terri. We believe that this PVS diagnosis is inhumane and it should be abolished.”
Land echoed the sentiment, saying that the PVS diagnosis could lead to a barbaric conclusion to life.
“The giving of food and water to people who are not able to feed themselves and hydrate themselves is an act of mercy and an act of charity in a civilized society. To deny access to food and water is indeed ‘euthanasia by omission,’” Land said, referencing the opinion of the late Pope John Paul II. Land said the practice of depriving PVS patients of nutrition and hydration should be condemned by all civilized societies.
“Just a reminder: When Terri Schiavo’s feeding tube was removed, it took her about 13 days to die of dehydration, which is approximately how long it would take anyone reading these remarks to die if they were not in critical medical condition. In other words, Terri Schiavo was nowhere near death. Her death was not imminent from any medical complication. It took her as long to die as it would take any normal human being who was denied hydration,” Land said.
According to the American Association for the Advancement of Science, researchers in the recent study at the University of Cambridge “noticed activity in the language-processing regions” of the patient’s brain “when words were spoken to her, specifically with sentences containing ambiguous words such as ‘creek/creak.’”
“Investigating further, the authors asked the patient to imagine herself playing tennis or visiting all of the rooms in her house. Again, her brain responses closely matched those of healthy volunteers and perhaps show a deliberate effort to follow instructions,” the AAAS news report said.
While the authors of the study warn against drawing conclusions about all PVS patients from their study of a single patient, they agree that the patient’s responses could force the use of new techniques to measure the brain activity of patients thought to have irreversible brain damage. Study author Adrian M. Owen, who led the Cambridge team of neurologists that reported the findings, told the New York Times the conclusions were “stunning.”