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Biotech Medicine

"Vegetative State" Patients Can Communicate 347

Posted by samzenpus
from the hello-in-there dept.
Kittenman writes "The BBC is carrying a story about researchers in the UK and Belgium who can detect the thinking processes within a patient previously thought to be in a vegetative state. The researchers ask the patient verbally to think in certain ways to indicate a 'yes', in other ways to indicate a 'no' — and have successfully communicated with 4 out of 23 patients previously thought to be in a coma."
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"Vegetative State" Patients Can Communicate

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  • Confusion of terms (Score:5, Insightful)

    by Compholio (770966) on Thursday February 04, 2010 @12:05PM (#31023150)

    ... and have successfully communicated with 4 out of 23 patients previously thought to be in a coma.

    A vegetative state is by definition where there is no detectable awareness. You could legitimately say that they were "previously thought to be in a vegetative state," but if you detect awareness then they are in a coma.

  • Terrible fear (Score:3, Insightful)

    by Thyamine (531612) <[moc.snogardfo] [ta] [enimayht]> on Thursday February 04, 2010 @12:06PM (#31023170) Homepage Journal
    This is one of those terrible fears. It's great that they have found a way to communicate with someone in this state, but at the same time this type of story makes me ponder how horrific that must be for the person.
  • Great! (Score:5, Insightful)

    by Itninja (937614) on Thursday February 04, 2010 @12:06PM (#31023172) Homepage
    So all they have to do is live in an MRI machine for the rest of their lives and they can communicate. Problem solved!
  • False Positive (Score:3, Insightful)

    by BrotherBeal (1100283) on Thursday February 04, 2010 @12:08PM (#31023214)
    I'm not a neuroscientist, but it seems to me that 4 out of 23 is a pretty low success rate, especially given the kind of indirection the researchers were resorting to in order to elicit the signals they were looking for. How do we know, for example, that a patient doesn't have some kind of spurious activity in the brain area they're using to signal "A"? For that matter, how can we distinguish between "no answer" and a deliberate "B" in the absence of such activity? How can we assume that the patient, who by definition has brain damage, is capable of understanding the question correctly and answering correctly? I agree, this is better than absolutely no communication, but I'm curious how they intend to control for factors like these.
  • by KneelBeforeZod (1527235) on Thursday February 04, 2010 @12:11PM (#31023248)

    you mean 'Catatonic', right? That's how you would describe this condition.

  • Euthanasia (Score:5, Insightful)

    by Thiez (1281866) on Thursday February 04, 2010 @12:11PM (#31023252)

    > It does raise many ethical issues - for example - 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.

    It seems kinda silly that you're only allowed to die when you're unable to make that decision. To me it seems cruel to keep someone alive in a vegetative state just because they have enough of their conciousness left to want to end it. Yay for legalized euthanasia in the Netherlands.

  • Re:4 out of 23? (Score:2, Insightful)

    by stubob (204064) on Thursday February 04, 2010 @12:13PM (#31023278) Homepage

    Not to mention replies to résumés.

  • Take a closer look (Score:5, Insightful)

    by ZuchinniOne (1617763) on Thursday February 04, 2010 @12:15PM (#31023310)

    5 of 54 patients who underwent this procedure. Showed a possible response.

    3 of those 5 it turned out showed awareness to normal stimuli and were either mislabeled by doctors, or their condition changed.

    So basically that leaves 2 patients out of 51 seeming to "be able to modulate their brain activity". And only ONE of those was able to "correctly answer 5 of 6 yes/no questions"

    This could be legit, but there is also PLENTY of room for statistical chance to have created this "result".

    The bottom line is that too much of a big deal is being made out of a tiny kernel of good data in a mountain of null results.

  • Re:False Positive (Score:3, Insightful)

    by Thiez (1281866) on Thursday February 04, 2010 @12:17PM (#31023338)

    > How can we assume that the patient, who by definition has brain damage, is capable of understanding the question correctly and answering correctly?

    That one seems rather easy, you ask them many questions and see how many of the answers make any sense. If a large part of them make sense, it is a reasonable to conclude the patient understood and was able to answer. Of course this would disqualify patients who are able to understand the question but unable to answer, and those who would be able to answer but cannot understand the question, and those who drift in and out of conciousness...

  • Re:Euthanasia (Score:5, Insightful)

    by Xelios (822510) on Thursday February 04, 2010 @12:21PM (#31023376)
    Relative: "Oh, I just don't know what he would want! I can't make this decision for him..."
    Doctor: "Well, thanks to recent breakthroughs we may be able to ask him directly. Lets just get him into this MRI..."
    Doctor: "The results are clear, we were able to communicate with him and he was very adamant about stopping all treatment. He clearly does not want to live out his remaining days in this state, and I don't think anyone could blame him for that."
    Relative: "If that's his wish then yes, lets stop all treatment."
    Doctor: "I'm sorry m'aam, but that's no longer an option..."

    It may have been funny if it weren't so sad...
  • by Anonymous Coward on Thursday February 04, 2010 @12:35PM (#31023544)

    Oh; and I really worry about decisions made before active MRI and other techniques came about, I think some horrible things have happened.

    I'd say that's pretty much a given. What's worse, being effectively paralyzed with no means of communication at all (until now) for years and years, or starving to death for a few weeks? Sounds horrible either way.

  • Re:Euthanasia (Score:3, Insightful)

    by MrNemesis (587188) on Thursday February 04, 2010 @12:47PM (#31023702) Homepage Journal

    Hopefully this'll be available outside of the UK but this is Terry Pratchett giving a lecture on his Alzheimers and legalised euthanasia from a few days ago: http://www.bbc.co.uk/programmes/b00qmfgn [bbc.co.uk]. Guardian article covering the same subject here http://www.guardian.co.uk/society/2010/feb/02/terry-pratchett-assisted-suicide-tribunal [guardian.co.uk]

    Pratchett has done alot to provoke intelligent debate on assisted suicide and related matters, thankfully without much in the way of people shouting him down - I'm a firm believer that one should be able to put a "Please kill me nicely" card in their wallet/will, in the same way that people use donor cards to say "Yep, why the hell not use my liver as I'm not really in a position to care about it any more". Lying on a bed in a hospital for the last five years of my life, forgotten by and an embarrassment to my friends and family is my idea of hell.

    Note that I don't know anyone who's been in a coma or a PVS but I know for damn sure that the person and the flesh and blood they used to live in aren't the same thing.

    http://www.thedailymash.co.uk/news/society/opponents-of-assisted-suicide-still-convinced-it's-any-of-their-business-201002012428/ [thedailymash.co.uk]

  • by Omestes (471991) <omestes AT gmail DOT com> on Thursday February 04, 2010 @01:29PM (#31024218) Homepage Journal

    If I was in a permanent vegetative state I would love it if someone disconnected me, especially if I was conscious. Being awake in what is essentially a dead body sounds like a small slice of hell to me.

    While it may not have saved Terri I'm pretty sure it will save some others.

    Save them from what? A life where they are completely dependent on machines to keep them alive (being nothing more than a burden to their families), a life where they can't communicate or do any of the things that they love? I have a hard time picturing anyone who being forced to be in this state would find this saved. Hell, even if your religious or personal views accept the "alive at any cost" value, you can't change your mind and tell them to shut down the machines.

    I feel no sympathy for the people in a permanent vegative state who lost their lives before the advent of this technology, I feel more sorry for the ones who didn't.

    Yes, living wills, and informing your loved ones to remove you from life support in such cases are very important. But as the Schivo case proved, it doesn't really matter when religious politics become involved. Your living will is only as valid as the willingness of your relatives to honor it.

  • by Hatta (162192) on Thursday February 04, 2010 @01:33PM (#31024280) Journal

    While it may not have saved Terri I'm pretty sure it will save some others.

    Save them from what? I'm pretty sure living out the rest of your life unable to move, communicating only through blinks would be worse than the alternative.

  • by electrosoccertux (874415) on Thursday February 04, 2010 @01:40PM (#31024386)

    Considering that Schiavo had no cerebral cortex, it's pretty much a given that she had no awareness. The article doesn't say all patients in a vegetative state are aware, just that some are, or more to the point, have been misdiagnosed.

    If that's the case then at least kill her in the chance that we were wrong and she was conscious. No point in making someone starve.
    But nobody had the balls to do this...

  • Re:Terrible fear (Score:4, Insightful)

    by CorporateSuit (1319461) on Thursday February 04, 2010 @01:59PM (#31024630)
    Every boy should go through a Metallica phase. Every boy.
  • by TheCRAIGGERS (909877) on Thursday February 04, 2010 @02:11PM (#31024790)

    If this were available to you in that state, you could consent to the disconnect.

    I doubt it. If you had enough cognitive thought to ask to be disconnected, it would likely be argued that you were asking for assisted suicide. Which sadly is not legal.

    Today, you would probably have more luck getting disconnected if you just ignored the questions and pretended to be dead.

  • Re:Euthanasia (Score:3, Insightful)

    by Reality Master 101 (179095) <RealityMaster101@@@gmail...com> on Thursday February 04, 2010 @02:30PM (#31025040) Homepage Journal

    I've actually never understood this attitude about wanting to end everything. Yeah, granted, life would suck compared to what it could have been, but on the other hand, if you die, you are GONE FOREVER. There is nothing on the other side. You simply cease to exist, and it's as if you had never existed. All your consciousness is gone.

    I can see wanting to check out if you're in constant pain and will never recover, but if you have your thoughts, you can at least think and have some hope of someday recovering. And if you can hear, you can occasionally get news of the outside world.

    I would want to stick around just to see what happens.

  • by Black Parrot (19622) on Thursday February 04, 2010 @02:49PM (#31025270)

    Considering that Schiavo had no cerebral cortex, it's pretty much a given that she had no awareness.

    Given that most of Schiavo's "supporters" think awareness is caused by souls rather than brains, I don't think facts about her condition are going to have much influence on their views.

  • by Anonymous Coward on Thursday February 04, 2010 @03:13PM (#31025536)

    Considering that Schiavo had no cerebral cortex, it's pretty much a given that she had no awareness.

    Given that most of Schiavo's "supporters" think awareness is caused by souls rather than brains, I don't think facts about her condition are going to have much influence on their views.

    Strawman much?

    Boy, I bet you now feel so much better about a decision that resulted in starving a living human being to death now that you got a gratuitous bash against religion in. Why, you're so superior to "them".

    I'd really love to see the response of all the people who wanted to pull the plug on Schiavo if Florida decided it would be OK to conduct executions by starvation.

  • by frank_adrian314159 (469671) on Thursday February 04, 2010 @04:22PM (#31026348) Homepage

    I like to think and contemplate, which if I was still capable of doing so, I'd like to continue that rather than die.

    Really? Then you're not really thinking it through. You want to continue living? When you can't move. When you can't adjust the bedclothes that you're put under, even when you're roasting or freezing. When you can't feed yourself and the liquid nutrient they feed you gives you unbearable heartburn because you're not elevated enough. When you can't scratch that itch - for hours. When the cramps because your arm is in the wrong position continues for hours. When the bedsores burn. When you have no actual data input other than the Oxygen network that your aide has tuned your TV to. When you can't actually see the screen, but can only hear the voices drone on hour after hour (because they didn't prop your head in the right direction). When you go slowly mad, minute after minute, hour after hour, day after day, year after year. Yes... sounds lovely. Hope you enjoy your stay in Hell. Glad I don't need to make that choice.

  • by Omestes (471991) <omestes AT gmail DOT com> on Thursday February 04, 2010 @04:57PM (#31026864) Homepage Journal

    And that is your choice...

    Though what happens when the money runs out?

    I ask out of genuine curiosity.

  • by Chris Burke (6130) on Thursday February 04, 2010 @05:37PM (#31027384) Homepage

    If that's the case then at least kill her in the chance that we were wrong and she was conscious.

    I don't care about that "if". Either way, if you're going to remove the feeding tube and effectively kill her, then have the balls to actually do it and kill her. This bullshit rationalization they used, like "Oh we're not killing her, we're only removing what keeps her alive! So if she doesn't miraculously recover and starves to death, that's just God's will!" was a coward's way out. Fuck that bullshit.

For God's sake, stop researching for a while and begin to think!

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