There is something disturbing about medical terminology that associates humans with vegetables. Now, according to new research, some patients that doctors have long described as being in a “persistent vegetative state” (PVS) – inert but living victims of major brain injury – may actually be acutely aware of their circumstances. Using imaging technology they can even answer questions about who and where they are.
Researchers at Western University in Ontario, Canada scanned the brains of three brain-injured patients using functional MRI technology, and reported their startling findings in JAMA Nature in August. One has been classified PVS for 12 years, and the other two were classified as in a “minimally conscious state” (MCS). Yet the MRI scans showed that all three could focus and follow instructions in the same way as healthy controls. Two of the patients could respond accurately to yes/no questions such as “Is your name Steven?” and “Are you in a supermarket?” and “Are you in a hospital?” (One patient was not questioned.)
“The patient’s brain activity in the communication scans not only further corroborated that he was, indeed, consciously aware but also revealed that he had far richer cognitive resources than could be assumed based on his clinical diagnosis,” the study says.
Is that why they scream?
The researchers believe it is the first study of its kind to “communicate” with mentally non-responsive patients. Indeed, the findings horrifyingly suggest that a large number – thousands – of the hundreds of thousands of PVS and MCS patients that hospital staff have treated over time could hear and comprehend discussions it was assumed they could not. It also explains why some of them cry, smile, and scream without apparent reason.
Some have even survived to describe the horror. Kate Adamson’s book recounts the agony of being nearly starved to death, and operated on without adequate anaesthesia, because doctors misdiagnosed her unresponsiveness after a stroke as unawareness and decided to end her life by starvation – a common enough decision in hospitals.
Shouldn’t we ask them first?
Terry Schiavo, a famously controversial PVS patient, was starved and dehydrated to death by court order in 2005 after a lengthy public battle – before imaging research took off. A 2006 study in Nature was reportedly the first of its kind to show that a PVS woman asked to imagine walking through her home and playing tennis produced MRI imagery of the tasks that was indistinguishable from that of healthy people.
In an era of increasing financial pressure on healthcare, some may wish this sort of science, and the ethical questions it raises, would just go away, but it may be just beginning to advance. Meantime, doctors might think twice before they call their patients “vegetative.” Instead they could perhaps ask PVS patients if they want to be starved to death.
- Making Every Word Count for Non-Responsive Patients, JAMA Neurology, Aug. 12, 2013