IT TOOK Jean-Dominique Bauby hundreds of thousands of blinks to dictate his book about how a stroke had left him paralysed yet still aware. Now comes the remarkable news that neuroscientists have communicated with a man presumed to be in a vegetative state, by studying the activity in his brain with functional magnetic resonance imaging, fMRI.
Vegetative usually means awake but unresponsive and devoid of intellectual activity. However, a handful of people have defied that diagnosis. The Anglo-Belgian team led by and describe how they scanned the brain of one of the group as he thought of one of two different activities 鈥� tennis and navigating his way round his house. Different brain areas lit up, depending on whether he wanted to answer yes or no to questions about his family (see 鈥淕iving a voice to the voiceless鈥�).
To discover awareness in someone who is supposedly vegetative will be unsettling for friends and family. But surely ignorance can鈥檛 be preferable to understanding their plight. Some argue that the discovery that a 鈥渧egetative鈥� person actually possesses a degree of consciousness suggests they can suffer and may increase pressure . However, this research now offers a way to ask someone if they wish to end their life. The ethical issues surrounding assent to suicide will be just same as for someone who is terminally ill. The central question remains: are they capable of making a life-or-death decision and deciding their own fate.
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鈥淭he central question remains: are these individuals capable of deciding their own fate鈥�
Bauby had locked-in syndrome, which means his mind was intact but trapped inside an almost useless body. But many other people exist in a twilight zone between consciousness and coma. The new study underlines arguments by bioethicists such as , that scanners will be , on which there is little consensus at the moment.
Excitement about the ability to communicate with some people who have been unreachable until now should also be tempered by pragmatism. Doctors will now need to find cheap ways to read if these patients are to have any chance of rejoining society.
Many groups around the world, including the one led by Owen and Laureys, are now working on cheaper and more portable alternatives to fMRI, based on EEG recordings.
In the short term, the study will ease fears that we may be withdrawing life support when there is a chance of recovery. At least now there is a way to respond to these patients鈥� needs, even if we do not know how to make them happy. In this of consciousness science, we can explore the twilight zone.