MindHacks is reporting on
Salon's new series
Mind Reader, by neurologist
Robert Burton.
Burton's first column discusses the possibility of consciousness in a vegetative state. As
Salon is correct to point out, this has major ramifications, if so.
In a recent article in the Archives of Neurology, a team of British and Belgian neuroscientists describe a clinically unconscious accident victim who can, on command, imagine herself playing tennis and walking around her house. By showing that her functional brain imaging studies (fMRI) are indistinguishable from those of healthy volunteers performing the same mental tasks, the researchers claim that the young woman's fMRI "confirmed beyond any doubt that she was consciously aware of herself and her surroundings, and was willfully following instructions given to her, despite her diagnosis of a vegetative state."
Naturally this calls to mind the
Terry Schiavo case.
Salon notes
Yet the study's conclusions are not beyond a doubt. There are plenty of questions about whether this young woman is conscious and capable of choice...While inside an fMRI scanner, the unresponsive woman was asked by the researchers to perform three mental tests: relax, imagine playing tennis, and imagine walking around the various rooms in her home. The tasks were chosen because of their ability to activate different areas of the brain. Imagining playing tennis would light up the supplementary motor area, a region involved in imagining as well as performing coordinated movements. In contrast, imagining moving from room to room in a house activated those regions, such as the posterior parietal lobe, that contribute to imaginary or real spatial navigation. At first glance, the results are startling. The patient was able to activate the same general brain regions as conscious volunteers serving as controls in the test; according to the authors, the images were statistically indistinguishable.
But is she "conscious"? The answer to this question will have tremendous consequences. Burton points out
Tens of thousands of patients in a persistent vegetative state linger in long-term care facilities. Others remain under the radar, being cared for at home by their families. The estimated annual cost of medical treatment for them is between $1 billion and $7 billion a year. Once larger numbers of patients are evaluated via fMRI, it is quite likely that we will find others with similar degrees of activation on a variety of mental tasks. Family members will be asked to understand, interpret and act on the scan reports. I cannot imagine a worse medical nightmare than being told that a clinically unconscious spouse or child has been shown on fMRI to have an active imagination and substantial self-awareness, especially when the findings don't alter the grim prognosis or substantiate the value of greater rehabilitative efforts. Before putting a family through such agonizing dilemmas, we neurologists should be reasonably certain that what the fMRI shows does correspond to actual mental states in the seemingly unconscious.
I heartily concur with Burton on this. I think part of the problem at hand is that we have no definition of "consciousness." The very mystery of it is what drew me into the field in the first place. In many ways, this is no different from the problem I blogged about yesterday facing Israel, over
how to define "death."Even if we use the quick and dirty definitions above, "aware of one's surroundings" and "capable of choice", we are entering a huge minefield. A
Roomba, to a degree, is "aware" of its surroundings. As for "capable of choice,"
that debate has been raging for centuries.
There are two other issues at hand here, which both resolve around being the person diagnosed with being in a persistent vegetative state. Does the person want to live, or does the person want to die? Being unable to communicate these wishes is a horrifying thought.
On the one hand, there is the Johnny Got His Gun scenario, where the narrator of Dalton Trumbo's book is a veteran whose face and limbs have been lost in the war. He is painfully aware, but unable to communicate his desire for death to the outside world, until he figures out to bob his head on a pillow in morse code.
On the other hand, there's what I call the Stephen Hawking scenario. What if computer technology had not been what it was, to enable Stephen Hawking to communicate? How would he be have been treated?
The one thing the Terry Schiavo case, hammered home for me was the need to set up a living will. I think ultimately, despite whether this research pans out or not, until some sort of technology exists to allow for communication, beyond the simple mirroring of brain states, the best we can hope to do is to make sure our wishes are known well in advance.
Defining "life", "death", and "consciousness" becomes trickier and trickier with each passing day. This whole exercise shows just how much is tied up in how we use these words.
Burton is correct to point out that
Consciousness isn't generated by a specific brain area that can be directly visualized. The fMRI can show us the precursors of a perception: It cannot tell us if the person is actually aware of that perception.
While there are certainly neurophysical
correlates of consciousness, we cannot safely say that consciousness is a
result of these correlates anymore than we can say a radio somehow mysteriously "generates" music. We can remove large chunks of brain and cause a cessation of consciousness. I can also remove large chunks of radio and cause a cessation of music.
Here's a link (
.pdf) to the article Burton is discussing.