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Supposedly Brain-Dead Patients Signal With Their Brains

If it's true that some brain damaged patients are actually capable of communicating with their brains, even though there are no movements made by their bodies, wouldn't that make "right to die" issues so much more complicated?  But I'm jumping ahead here... Let me share the research and let you come to your own conclusions....

Martin M. Monti, PhD, of the UK Medical Research Council, along with his British and Belgian colleagues, studied a total of 54 patients who were diagnosed as either being in a vegetative state (having non-associative muscle movements) or in a minimally conscious state (having some ability to respond, but inconsistently). The patients underwent functional magnetic resonance imaging (fMRI); that is, their brain activity was observed immediately after they were given certain instructions by the examiners.

 

Willful Modulation of Brain Activity in Disorders of Consciousness: Figure 1Willful Modulation of Brain Activity in Disorders of Consciousness: Figure 1

 

One of the instructions was to imagine being on a tennis court hitting a ball back and forth with a tennis instructor.  The second was to imagine navigating a familiar room or driving through a familiar neighborhood.  The research team had previously tested their technique on healthy volunteers with success.

  • Of the 54 patients, four who were classified as vegetative and one who was classified as minimally conscious responded on the fMRI to one of the instructions, and one patient responded to both instructions.
  • Three of the five patients were also able to make some physical movement when tested at their bedsides. 
  • All five of those capable of responding through fMRI had suffered head trauma; no patients who were stroke victims, or otherwise damaged by lack of oxygen to the brain, were able to respond to the instructions. (So, no, Terry Schiavo, would not have responded to these instructions.)

More recently, a clinic in Liège, Belgium is following the progress of a 27-year old brain damaged man who has begun to communicate via MRI with correct yes and no answers to questions about himself and his family. Yet, the researchers are not ready to call these responses "consciousness," as consciousness implies a fuller use of cognitive skills.

This study will undoubtedly lead to more studies and more questions and more confusion about what is life.

“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?” Dr. Joseph J. Fins, chief of the medical ethics division at Weill Cornell Medical College in New York, told the New York 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.’"

 

New England Journal of Medicine, New York Times, WebMD