Patients in 'vegetative state' able to communicate

Dr Adrian Owen

Dr Adrian Owen

Ethical questions have been raised by a groundbreaking new study which has discovered  that some patients who are completely paralysed,  are able to respond to communication and even answer questions. 

Over three years, scientists from Britain and Belgium studied 23 patients diagnosed as being in a vegetative state, using a technique called functional magnetic resonance imaging (fMRI) which detects large flows of blood to different regions of the brain.

Their research proved that some patients were conscious, but unable to communicate. When they asked patients questions, they could detect a change in brain activity in some patients.

One 29-year-old  man learned to answer "yes or no" questions by thinking about playing tennis when he wanted to answer yes, because that would produce activity in the part of the brain that controls arm movements.

He would think about moving around the rooms of his house when he wanted to answer no, showing a different type of activity on the brain scans.

The work was led by Dr Steven Laureys at the University of Liège and Dr Adrian Owen of the Medical Research Council in Cambridge  and a Belgian team at the University of Liege.

Dr Owen said: "We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts."

Dr Owen says this opened  the way to involving such patients in their future treatment decisions: "You could ask if patients were in pain and if so prescribe painkillers and you could go on to ask them about their emotional state."

Dr Helen Gill, a consultant at The Royal Hospital for Neurodisability in London welcomed the new research. She told the BBC:  "It's very useful if you have a scan which can show some activity but you need a detailed sensory assessment as well. A lot of patients are slipping through the net and this adds another layer to ensure patients are assessed correctly."

She said the hospital  had done a study of 60 patients admitted with a diagnosis of vegetative state and 43% of those were able to communicate.

The new understanding raises an ethical issue. Currently it is lawful to allow patients in a permanent vegetative state to die by withdrawing all treatment, but if a patient showed they could respond it would not be, even if they made it clear that was what they wanted.

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