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Think People in a “Vegetative State” Are “Brain Dead”?

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Gene Tarne - published on 10/13/14

A Hitchcock thriller shows that many of them are thinking as clearly as you are

Not for nothing was the great film director Alfred Hitchcock dubbed the “Master of Suspense.”  

“Breakdown,” an episode from his original TV series, Alfred Hitchcock Presents, is one of the many reasons why.

In the episode, a man gets into a car accident that leaves him almost completely paralyzed. Eventually, the sheriff and his men come upon the accident. But because the accident victim can neither move nor speak, the sheriff assumes he is dead and has him placed in the town morgue. A voice-over allows the viewer to hear the victim’s thoughts as he desperately, and with increasing panic, tries to communicate to those around him that he is not dead. In the final seconds of the episode, a tear rolls down the victim’s cheek, signaling to those observing him that he is not dead after all.

While Hitchcock used this tale of a man in a non-responsive state to create a story of ever mounting suspense, neuroscientists have recently, in a novel experiment, used Hitchcock’s same mastery of suspense to communicate with PVS (persistent vegetative state) patients who, like the character in “Breakdown,” no longer seem able to respond to those around them.

The researchers created an abridged version of another highly suspenseful episode from Alfred Hitchcock Presents to show to both PVS patients and healthy participants in the experiment. They chose a Hitchcock episode because watching his work – characterized by the building of successive and more intense levels of suspense – would require processing by those areas of the brain associated with higher cognition (“executive processing”). The researchers used functional magnetic resonance imaging (fMRI) to monitor the brain activity of both groups while they watched the episode.

The healthy participants all showed similar patterns of brain activity, both executive processing and sensory (visual and sound) processing.  

As did one of the two PVS patients involved in the experiment, a 34-year-old man who had been in a vegetative state for 16 years, since he was 18 (the other patent, a 20 year old woman, showed signs of sensory processing only). His brain activity while watching the episode “was actually indistinguishable from a healthy participant watching the movie,” says Adrian Owen, a neuroscientist and lead researcher on the experiment.

“We think he is understanding it and following it,” said Lorina Naci, the co-lead on the study.

This is the just the latest experiment conducted by Owen to identify conscious brain activity in PVS patients. His most famous experiment came in 2006 and involved a 23-year-old woman who was unresponsive and in a vegetative state five months after a traffic accident. Owen asked her to imagine playing tennis and then to imagine walking through a house – each activity being associated with activity in different parts of the brain. Her response was similar to that in healthy people, as Owen observed activity in the two different parts of the brain associated with playing tennis and walking through a house.

Owen further refined this test by asking the 23-year-old PVS patient to answer questions by imagining playing tennis for a yes answer and walking through a house for a no. The pattern of brain activity associated with her responses showed the patient answered five of the six questions correctly (there was no signal detected for the sixth).  

The results of these and similar tests conducted by Owen and his team show up to one in five patients thought to unresponsive as actually displaying signs of conscious brain activity.

Owen’s research highlights just how little is known about consciousness and cognition in PVS patients and those otherwise considered to be unresponsive or “brain dead.” Perhaps even more mysterious given our current understanding are those cases of patients “awakening” – suddenly and almost always unexpectedly – from an unresponsive state. Only adding to mystery is the fact that quite often such patients have clear recognition of events and conservations that took place while they were unresponsive – including conversations on euthanasia, or more colloquially, “pulling the plug.”

Locked-in” syndrome is a very rare and little know condition (although the movie The Diving Bell and the Butterfly has somewhat increased awareness of it) with symptoms strikingly similar to those displayed by the accident victim in “Breakdown:” the patient retains full awareness of his environment, yet remains paralyzed and unable to communicate with those around him. While locked-in syndrome affects only 1% of those who suffer a stroke, 90% who are so affected die within four months.

Not so Richard Marsh. After a stroke in 2009, Marsh succumbed to locked-in syndrome. Just over four months later, to the amazement of his family and doctors, he walked out of the long-term facility where he had been treated.   

Describing his experience, Marsh said “I had full cognitive and physical awareness … but an almost complete paralysis of nearly all the voluntary muscles in my body." He also recalls being able to “think and hear and listen to people but couldn’t speak or move. The doctors would just stand at the foot of the bed and just talk like I wasn’t in the room.” In a manner uncannily similar to the fictional accident victim in “Breakdown,” Marsh says “I just wanted to holler: ‘Hey people, I’m still here!’ But there was no way to let anyone know."

Several of the conversations Marsh recalls were between doctors and his wife about turning off the breathing machine that was keeping him alive. The doctors argued that Marsh had little chance of surviving, and even if he did, he would be “a vegetable.”

"I could hear the conversation and in my mind I was screaming ‘No!’" Marsh recounted.

Another case – one that has been highlighted on this website – is that of Miguel Parrondo, who awoke 15 years after falling into a coma as a result of a car accident. As in Marsh’s case, the doctors treating Parrondo recommended turning off his life support, but also like Marsh, his family resisted.

In an address to the participants in the International Congress on Life-Sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas,” St. John Paul II said:

The sick person in a vegetative state, awaiting recovery or a natural end, still has the right to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to the prevention of complications related to his confinement to bed. He also has the right to appropriate rehabilitative care and to be monitored for clinical signs of eventual recovery. . . .

I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory…”

Unfortunately, as the cases of Richard Marsh and Miguel Parrondo show, doctors and other health care providers today are all too quick to suggest “treating” patients in an unresponsive state by “pulling the plug.”

And if we are obligated to care for patients in a prolonged vegetative state, even when they are considered to be completely unaware of their surroundings and incapable of interacting with it, how much more incumbent is that obligation knowing, thanks to the research of Owen and others, that these patients may be far more conscious of their surroundings and able to communicate with us then we now know. And as Pope St. John Paul II reminds us in the same Address:

Even our brothers and sisters who find themselves in the clinical condition of a "vegetative state" retain their human dignity in all its fullness. The loving gaze of God the Father continues to fall upon them, acknowledging them as his sons and daughters, especially in need of help.

Gene Tarne
is a senior analyst with the Charlotte Lozier Institute (lozierinstitute.org). He has been involved with the life issues for over 20 years.

Tags:
EuthanasiaPope John Paul II
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