#1. The distinction drawn between patients supposedly in a minimally conscious state (MCS) and those said to be in a persistent vegetative state (PVS) is nowhere near as clear cut and easy to parse as the article that appeared in places like MedPage Today suggests. (More about that below.) And

#2. An e-mail exchange I had several years ago with a very prominent bioethicist, sparked by the case of Terri Schindler Schiavo, but not about her. He passionately made the case that if severely brain-damaged patients can experience pain, their "artificially administered nutrition and hydration "ought to be stopped. More bluntly, they ought to be dehydrated and starved to death.
Back to #1. According to MedPage Today, "Patients in a minimally conscious state appear to have brain activity that indicates they can feel pain, researchers here [Liege, Belgium] reported.

PET scans detected activation of regions of the brain known collectively as the pain matrix that was no different than the activity observed in control patients [i.e., healthy patients]. ... The findings they concluded, 'might be objective evidence of a potential pain perception capacity in patients [in a minimally conscious state], which supports the idea that these patients need analgesic treatment.'"

Following electrical stimulation, researchers compared brain activity in five MCS patients, 15 PVS patients , and 15 healthy people. The researchers focused on brain areas responsible for pain sensation.

"The MCS patients showed the same level of activity in these areas as healthy people and significantly more activity than PVS patients," according to MedPage Today. Let's think about this for a second.

As noted, the distinctions between minimally conscious and persistent vegetative are blurry and inherently subjective. The PVS label is a notoriously imprecise diagnosis applied to individuals who have, typically, emerged from a coma so as to have sleep-wake cycles, but have been believed to demonstrate no conscious awareness, only reflexive activity.

And as we have reported in this space and National Right to Life News, in 2006 a study that used functional magnetic resonance imaging found that a patient diagnosed to be in a PVS had brain activity "indistinguishable from that of healthy volunteers."

Studies like this new one out of Belgium--and especially summaries of their results--demand the ability to read between the lines. For example, after stating that it "was generally agreed" that PVS patients "were unlikely to perceive pain," the very next sentence in the MedPage Today story is "although PET was widely available and easy to use, its utility was limited. A better option for assessing pain in an individual patient, he [Javier Provencio, M.D.] said, would be functional MRI. Dr. [Melanie] Baly and colleagues noted that PET did not 'enable us to identify reliably activation maps in individual patients. Functional MRI can tackle this problem because many more scans would be acquired per patient; these studies are ongoing.'"

That could easily be read to mean that the lower tech PET [Positron emission tomography] scans are not nearly as reliable as functional MRIs which may well show more activity in "brain areas responsible for pain sensation" in PVS patients than suspected.

The stark alternatives for what we do with this knowledge were illustrated in my back and forth with the bioethicist. His default position always is death. Yours and mine is always life.

Part One