You Call This Living?

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As much as I regret bringing up anything that will revive the Terri Schiavo debate, and as skeptical as I am about how much brain-scan technologies in their current state actually tell us about the human mind as we experience it as living conscious beings, this is still worth noting and contemplating: a 23-year-old British woman in a persistent vegetative state apparently is understanding and reacting in her brain to verbal directions, by the standard methods neuroscientists interpret brain activity as equivalent to "understanding and reacting."

New ethical dilemma: if this sort of mental activity, if mental activity it is, exists but can't be manifest in communication or action, how much ethical value should it have in the debate over who is "truly human" or "deserving of life" that requires the use of medical care methods that others are paying for? Does it change any existing judgements as to what sort of life is "really" worth living for those contemplating Living Wills, or for those who interpret them? Will people now want to specify, "use extraordinary means to keep me alive as long as MRIs indicate I'm understanding what people say?" Or, given that none of us beforehand can know experientially what it is like to be in a persistent vegetative state with or without such MRI reactions, does this give us any more useful data in making decisions now about what we are going to, or would, really want to do about living or dying in such a state?

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  1. There are a few things to consider here:

    1) If the brain scan can pick up responses to verbal cues, it opens the possibility for obtaining some type of consent or input from the patient when decisions are being made about life support. Is it guaranteed to work? No. Will it pose tricky questions about the nature of consent? Absolutely.

    But anything that brings us closer to communication with the patient in a situation like this is A Good Thing. The thorniest issues come when somebody has to make a decision for another person, so any means of communication with the person about whom the decisions are being made is a step toward helping resolve some of those issues. (The best situation, of course, is still a living will, or advance directive, or whatever you want to call it.)

    2) It also opens up the possibility of trying and testing therapies for the patient in the vegetative state. If the brain is responding to stimuli, and there’s actually a way to observe that objectively then you can contemplate trying to stimulate and interact with a person in hope of eventually waking him or her up. And you can get some concrete feedback on whether the therapy is having any sort of effect.

    There are no easy answers in a situation where a person is unable to communicate his or her desires but a decision nonetheless has to be made. Still, I see some hope in this work.

  2. With all the toxic waste, fissile materials, and gamma rays we have in this country, why don’t any of these brain accidents ever make your brain any better? It’s always loss of depth perception, persistent vegetative states, diminished motor control; never mind control powers, exponential IQ increases, ability to kill your enemies with mind rockets… And they call this a forward-looking nation!

  3. I’ll settle for X-Ray vision.

  4. Tim,

    I read about this on Wikipedia. I think your wish was granted sometime back in the 60s. This guy sounds sort of scary, though. I’m not too happy about him roaming free.

  5. You’re hitting a straw man here. The question about Schiavo was never her humanity: it was about her rights to not be kept alive indefinately by others.

    And look at this case: a coma converted into a VS, but it’s still only been five months. Patients have been known to improve, albiet rarely, up to a year after this. And as the doctors themselves say: this is a phenomenon of one. Brain injuries are all pretty different. What we have here are internal responses to stimuli that may or may not have any awareness attached to them at all. Pretty thin gruel overall.

  6. Isn’t it possible that people in these vegetative states are living out full and productive lives in 1973?

    (Am I the only one who watches Life On Mars?)

  7. highnumber:

    I would’ve referenced this guy, who, like the folks in question in the article, can’t move.

    Kevin

  8. And look at this case: a coma converted into a VS, but it’s still only been five months. Patients have been known to improve, albiet rarely, up to a year after this.

    That is exactly right. Terri Schiavo was in a Permanent Vegetative State, not a Persistent one. Her autopsy showed almost no cerebral cortex left, including the centers that would permit vision. All that hoopla about her tracking balloons and appearing happy when she “saw” her mother enter the room, was wishful thinking at best, propaganda at worst.

  9. I’d say what you want is to be happy for your needs. When you’re not, it’s time to put a DNR sign out.

    The value of consciousness is something adolescents obsess over.

  10. Forgetting the medical terms, possible procedures and advancements (Forgetting = I’m not smart enough to discuss such things or care too), I know this:

    We will be faced with unprecedented medical issues in the near future. As medical technology increases so will the cost and the desire to have the best care, no matter who is paying.

    So, does life have a value?

    2009:

    A national vote was held on two choices:

    1. The most care a person can receive is 1 aspirin. N0 vote was 94%.

    2. The least care a person can receive is the total resources (including more national debt if necessary) of the US. No expense will be denied. NO vote was 93% (near death voters were 7% for).

    Give the two extremes, someone needs to draw a line on reasonable care for one more breath.

    Maybe like a credit card limit. You make the choices.

  11. “Or, given that none of us beforehand can know experientially what it is like to be in a persistent vegetative state with or without such MRI reactions, does this give us any more useful data in making decisions now about what we are going to, or would, really want to do about living or dying in such a state?”

    Hogwash. Just ask your average DMV employee what it’s like.

  12. I’d say what you want is to be happy for your needs. When you’re not, it’s time to put a DNR sign out. The value of consciousness is something adolescents obsess over.

    I think I agree with you. If someone wants to go right now, regardless if they are conscious or not, I say let ’em. On the other hand, if they want to be kept on life support for all eternity whether or not their brain seems to be alive, good for them.

    Two weeks ago I had to watch my wife’s uncle pull the plug on his daughter. My wife’s 20 year old cousin, the mother of a 4 month old daughter, had been in the hospital being treated for leukemia for about 4 weeks. The bone marrow sample on Monday was all clear, and they were going to release her on Sunday. Friday she came down with an infection and entered a coma. Saturday morning we got the call to hurry to the hospital to say goodbye because she was brain-dead and the plug would be pulled that day. Needless to say, the day was beyond heartwrenching. I cannot say that he made the right or wrong decision. It was not mine to make, but I have made it clear to my family that if I am on life support, I do not want the plug pulled, ever. Maybe that’s selfish, but I would not hold it against them if they made the same decision for themselves. Life seems too precious to me to ever let it go, no matter how little the chance of recovery.

  13. I’m generally with you, highnumber, but what I worry about is if you have some awareness but absolutely no way to communicate or move.

    Of course it could just be like one long-ass DMT trip, which may or may not be so bad.

    Or maybe there’s just nothing, which wouldn’t be so bad, either, mostly like death, I would imagine.

    Actually, that’d be a great way to mess with a religious person…keep them alive so they can’t go meet their maker. But how would they know you were tormenting them thusly? (I’m kidding, I have no desire to torture or punish anyone, really, so religious types, don’t be offended.) 🙂

  14. People act as if Shivo was conscious that it would be a case to keeping her alive.

    Has anyone ever actually sat and though what it would be like to be conscious for 15 years (much less 50 or 60) staring at a wall? Having an itch that you’ll never be able to scratch? If these people are conscious, isn’t it more likely that they are in some kind of torturous pain then feelings of well being and hapiness?

  15. Why handicap the living. People need to die with dignity and free those they say they care about.

  16. Herself, She-Who-Pays-The-Bills, is a world class geneticist/recombinantDNA/protien detector research scientist. Fortunately for me, she’s easily amused….I asked her how come she, a punk rocker from the earliest daze, a hell raiser/doper/pervert /lateniteDJ rocknroller got so far so fast in her field.
    It seems in her grad years at UW/Madison she opened a big freezer & got knocked cold by the ill stored corpse of a radioactive frozen goat.
    After that, she says, everything got easier……….

  17. So they say specific bits of her brain lit up when asked to think about tennis, and suggested that this was because she could hear and understand the doctors.

    If thinking about different sorts of things light up different bits of brain, couldn’t they just say, “We’re going to ask you a series of yes/no questions while we watch your brain activity. For ‘yes,’ think about tennis. For ‘no,’ think about peach cobbler. For ‘maybe,’ think about Beethoven.”?

    That way they could get a much better idea of whether she’s really understanding what they’re saying… and maybe actually communicate with the poor woman.

    Disclaimer: I know very little about neuroscience, and am therefore talking out of my posterior.

  18. If thinking about different sorts of things light up different bits of brain, couldn’t they just say, “We’re going to ask you a series of yes/no questions while we watch your brain activity. For ‘yes,’ think about tennis. For ‘no,’ think about peach cobbler. For ‘maybe,’ think about Beethoven.”?

    Jake-

    That’s what the researchers plan to do next. To understand why they didn’t publish that, you have o understand the context of scientific publication. This is really hot stuff. Not the sort of stuff you want to sit on. They published these results as a Brevia (brief article) in Science, which is one of the 2 most important scientific journals. My guess is that they got this data, replicated it in a few different experiments under different conditions, and then ran like hell to publish it ASAP.

    Mind you, I’m not suggesting that it’s sloppy work. Far from it. I’m just suggesting that what we’re seeing is probably the very first publishable piece of a much larger research project, and we’ll probably hear a lot more about it in the coming months.

  19. What if reliable communication turns out to be possible, not only with the quasi-living, but with the indisputably dead? That is, what if we develop ways shown scientifically to produce human-consciousness-type responses from some possibly-though-not-necessarily-identifiable entity without need of any human body mediating it?

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