On June 26, 2019, Columbia University published a study in which researchers used a technique to analyze standard EEG. Data collected from 104 unresponsive patients to look for patient-specific brain activity, indicating that they could understand instructions to move their hands. Read our article on the issue HERE. This year, BBC Science Focus Magazine published a review of the successful application of diverse techniques to detect consciousness in these patients and treat them, entitled Vegetative states: Is anybody in there? (January 30, 2020).

unresponsive patients bioethical dilemmaThe study asked how many unresponsive patients there are and what doctors are doing. “It’s hard to gauge how many people are currently in a persistent vegetative state, languishing in a care-home bed, their inner lives a mystery. The causes of their brain injuries are diverse – from oxygen starvation (which could be due to stroke, heart attack, near-drowning, and more) to trauma caused by a blow to the head – and there is no central register. But neuroscientists estimate there are thousands in the UK, and they are increasing in number, as doctors get better at saving lives in the aftermath of brain injuries.”

Brain and mind discoveries have made some progress to understand the still enigmatic mind of an unresponsive patient.

“Thankfully, neurologists and doctors are also getting better at figuring out what is going on in these patients’ minds. ’There have been massive discoveries over the last 15 years,’ says Adrian Owen, a professor at the Brain And Mind Institute at Canada’s Western University. The first of these, he says, was ‘a 2006 paper where we showed that some of these patients are actually aware, and then the 2010 paper where we started to communicate with some of them.”

“From the data so far, 15 to 20 percent of patients show signs of concealed consciousness, and researchers are now making great strides in diagnosing the condition, understanding its mechanics and even working on treatments that could increase the chances of rehabilitation.”

Bioethical concerns

Perhaps the question that has more ethical implications in unresponsive patients is whether they are conscious, for which doctors have an encouraging reply, explained in the following paragraph:

First steps to detecting consciousness

“So how can doctors tell if there is concealed consciousness? Owen has developed a method using an fMRI scanner. He asks a series of questions: to answer ‘Yes’, the patient imagines they’re playing tennis, while to answer ‘No’ they take a mental stroll around their home. If they’re conscious, different areas in the brain will light up: motor activity for ‘Yes’ versus spatial awareness for ‘No’.

“It’s in intensive care units (ICU) where doctors and families often have to decide whether a patient has prospects for survival or whether life support should be turned off – and mistakes will have inevitably been made. But now, says Adrian Owen, “we can apply these techniques in the ICU, maybe a week after their injury, and both diagnose them more accurately and make predictions about who’s going to recover and who isn’t.” In our opinion, much remains to be done in this field of medicine, and the maximum of prudence should be necessary when it comes to making decisions about these patients.

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