Signs of awareness while in vegetative state: hope or horror?

The Baltimore Sun

BOSTON -- Of all the headlines on the story, this one took the prize for provocation: "Woman in Vegetative State Plays Tennis in Her Head."

I suppose this is what happens when science throws up a startling piece of new research, and the media slams it into the court of public opinion. In Britain, researchers have reported that a totally unresponsive 23-year-old woman showed signs of awareness on a brain-imaging test. When asked to imagine playing tennis, her brain lit up the same neural pathways as a healthy brain. When asked to imagine walking through her house, the MRI revealed changes in specific brain regions that mimicked healthy people.

The exuberant lead researcher, Adrian Owen, said the results "confirmed beyond any doubt that she was consciously aware of herself and her surroundings." A colleague even raised the possibility that some vegetative patients have "a rich and complex internal life."

What are we to make of this? An editorial in Science magazine, where the research was published, warned that this case is nothing like that of Terri Schiavo. The British woman has something Mrs. Schiavo did not have: a cortex. She suffered an injury, not a lack of oxygen. She was in her unresponsive condition for five months, not 15 years. She was not in a persistent vegetative state.

Nevertheless, those who play politics in their heads have found this research useful. The pathways to the pro-life blogs describing Mrs. Schiavo's death as murder also lit up. Mrs. Schiavo's father, Robert Schindler, declared game, set, match in the controversy: "This new case is not surprising to our family."

But what about the rest of us, who were fully aware that Mrs. Schiavo had no inner life, rich or poor? What about those of us who believed all along that Mrs. Schiavo was, ironically, one of the easy cases? Surely, as one bioethicist said, this research creates another shade of gray in the understanding of gray matter. And in decisions that revolve around life and death.

We don't know if similar patients will show the same level of awareness. Indeed, there are some who believe that the British researchers overinterpreted what they saw. But an estimated 6,000 Americans are in a vegetative state, and another 100,000 Americans exist in some state of partial consciousness. We know there is a bell curve of consciousness, a range of symptoms and prospects for recovery among such patients.

But we do not know whether the researchers who suggest that vegetative patients may be "aware" of themselves and their surroundings have given us a hopeful storyline or a horror story.

As University of Pennsylvania bioethicist Art Caplan says, "It's not necessarily good news that someone might have some form of consciousness but not be able to interact emotionally, socially or communicate in any way, shape or form. To spend your life dimly aware but unable to let anyone know you are in there is more the subject of Stephen King or Edgar Allan Poe than some sort of medical hope."

For families left with the hard choices about life and death, about treatment and nontreatment, this research, says Mr. Caplan, "will generate more guilt than light."

How often science drives ethics into a ditch. If doctors can eventually determine which people can "come back" and how far, the technology may be worth the emotional and financial price. But this is unlikely to make hard decisions any easier.

No MRI can say whether that "rich inner life" is a tapestry of hope or a nightmare. Which cliche fits a locked-up awareness: "While there's life, there's hope" or "a fate worse than death"? The researchers, in all their enthusiasm, cannot answer the fundamental question that was raised by the Schiavo case: Would you want to live like this?

Nearly a year after the accident, the British patient had advanced into a state of minimal consciousness. She could follow a mirror with her eyes. But no machine can tell her family or doctors whether she wanted to live "like this." The deep family conversations that were prompted by Terri Schiavo's fate are not simplified by this science, but, rather, expanded.

"Woman in Vegetative State Plays Tennis in Her Head." But is it a game or a trap?

Ellen Goodman is a columnist for The Boston Globe. Her column appears Mondays in The Sun. Her e-mail address is

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