By Dave Andrusko

Part Two discusses PPFA's weak response to Tim and Pam Tebow's Super Bowl ad. Please send your comments both parts to daveandrusko@gmail.com. If you'd like, follow me on http://twitter.com/daveha.

Researchers in Britain and Belgium have offered "a study to rekindle debate over life-sustaining care for those with grievous brain injuries," finding that some "patients thought to be in a persistent vegetative state showed brain activity indicating awareness, intent and, in at least one case, a wish to communicate," the Los Angeles Times reports today.

In a moment I'll talk about this in the context of Terri Schiavo, who was severely brain-injured and subsequently starved and dehydrated to death in spite of magnificent efforts by her siblings and her parents. First, the nuts and bolts of The New England Journal of Medicine (NEJM) study which appeared online Wednesday.

[By far the two best accounts of this immensely important work that I found were at www.washingtonpost.com/wp-dyn/content/article/2010/02/03/AR2010020302887.html?hpid=topnews; and http://online.wsj.com/article/SB10001424052748704259304575043494009308442.html?mod=googlenews_wsj. Please read them!]

MRI scan shows different responses in the brain after the patient is asked different questions.

A quick summary is that four of 23 patients "diagnosed as being in a vegetative state showed signs of consciousness on brain-imaging tests," according to the Wall Street Journal's Amy Dockser Marcus.

"Even more significantly, one patient was able to answer yes and no questions using the researchers' technique--indicating the potential for communication with people previously considered unresponsive."

Marcus quotes Joseph J. Fins, chief of the medical-ethics division at Weill Cornell Medical College, New York, who was not involved in this study. "There has been a kind of nihilism towards these patients," he said. "This represents a cultural shift."

The latter sentiment is most likely an exaggeration. But it is clear (as Marcus writes) that "The study is part of a growing body of work changing how people think about the vegetative state."

Dr. Adrian Owen is one of the co-author of the research. The study built on earlier work by Owen and his colleagues.

In 2006, when a young woman--thought to be in a vegetative state--was placed in a functional magnetic resonance imaging scanner, her brain responded identically to a normal brain when asked to imagine herself exploring her home or playing tennis, according to Owen and his colleagues. (See www.nrlc.org/news_and_views/September06/nv090806Part1.html)

Not surprising Own and researchers at the University of Liege in Belgium then heard from many other families eager to see if their own loved one would respond. The study discusses what they found in the first 54 patients. Twenty three had been diagnosed as being in a "vegetative state" and 31 whose diagnosis was minimal consciousness.

The idea was to compare the patients' responses with how the brains of normal volunteers put in the fMRIs fired up when asked to imagine themselves hitting a tennis ball or exploring their house room by room. (The fMRI technique highlights areas of the brain that receive increased blood flow when in use.)

Five of the patients responded identically. Four had been diagnosed as being in a vegetative state; one was thought to be minimally conscious.

The more sensational headlines found in some accounts--"'Vegetative state' man responds to questions," as CNN put it--talked about what happened next. Researchers tried to communicate with one patient, a 29-year-old man in Belgium, asking him to think about tennis, if his answer was "yes," and imagine touring his house, if the answer was "no."

He was then asked a series of yes/no questions about his life (e.g., his name) and got them all right! "He could produce no communication with his body," Owen told the Washington Post. "But he could systematically and repeatedly change his brain activity to indicate yes or no with 100 percent accuracy."

"Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years, it provided the patient with a way of communicating his thoughts to the outside world," Owen told CNN.

The NEJM study needs to be placed in context. It comes "two months after a Belgian car crash victim whose condition was misdiagnosed as a vegetative state for 23 years was revealed to have been conscious the whole time," wrote CNN's Peter Wilkinson. (See www.nrlc.org/News_and_Views/Nov09/nv112309part2.html)

At a minimum the recent research has thrown into question "the current bedside test for diagnosing mental state: checking whether patients' eyes can track objects, and carefully looking for any signs -- eye blinks, finger twitches -- in response to questions or commands," according to the New York Times. That's part of the good news.

Of course, as is always the case, some responded by asking whether this might open a channel to inquire whether the person wanted to die! Others said this awareness applied only to a certain category of people with severe brain injuries, and certainly not Terri Schiavo!

Bioethicist Wesley J. Smith noted how every time such research is published, we are told somehow Terri's case is "different." On his blog today he responded in two ways.

First, referring to the autopsy performed on Terri, Smith notes, "The report said her brain was consistent with either a PVS or minimally consciousness, and moreover, that such decisions are clinical, not subject to being decided upon autopsy."

Second, as Smith keenly observes, "But this is the point. Conscious or unconscious, people should not have to earn the right to receive basic sustenance. What we did to Terri Schiavo was a blight on the legal system and bioethics.

Pretending otherwise won't make that stain go away."