More Studies Show Patients With Severe Brain Injuries are Not “Vegetables”
We’ve run a bundle of fascinating stories over the years about people who suffered severe brain injuries, were thought to be unresponsive, but who prove to be aware of their surroundings. This diagnosis is particular sensitive when the patient is said to be in a “vegetative” or “minimally conscious” state.
The latest contribution to this ongoing discussion is Dr. Daniela J. Lamas. The very disturbing headline to her New York Times opinion piece is “The Terrifying Realization That an Unresponsive Patient Is Still in There.”
Dr. Lamas begins by telling us she is sometimes called in to consult at a long-term-care hospital which houses patients with severe brain injuries.
“As I place my stethoscope on the patient’s chest, often without a word, I reassure myself that at least the patient is unaware,” she writes. “Her personhood is gone. She is not in there any longer.”
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Then the big however…
But an increasing body of research indicates that patients who have suffered catastrophic brain injuries experience a far more complicated reality. A provocative large study published last year in The New England Journal of Medicine suggests that at least one-fourth of people who appear unresponsive actually are conscious enough to understand language. As a doctor who sometimes sees patients like this, these findings are, in a word, terrifying.
Studies like this raise the possibility that there are tens of thousands of men and women locked inside their minds, isolated to a degree I cannot even imagine. They are voiceless and largely invisible, with some of them being cared for in nursing facilities. [Underlining added].
Dr. Lamas writes about the dilemmas involved when deciding whether to “withdraw life-prolonging support,” meaning, for example, “the surgical insertion of a tracheostomy tube.” She doesn’t want to get the family false hope, she writes, but also she “never wants to withdraw life-prolonging support too early.”
That’s why Dr. Lamas read the recent New England Journal of Medicine study [www.nejm.org/doi/full/10.
Neurologists queried nearly 250 unresponsive patients while monitoring them with brain imaging or brain-wave monitoring. The patients were asked to imagine themselves doing activities, such as playing tennis or swimming — complex cognitive tasks that require sustained attention. One would assume that people who appear completely unaware of the outside world, unable even to squeeze hands when asked, would not be able to understand or follow such a request.
And yet the brain imaging suggested that one-quarter of the patients heard the instructions and followed them — a sign that they are exhibiting what some neurologists might call covert consciousness. Given the difficulty of the test itself, the researchers believe the one-fourth figure is an underestimate of how many patients were experiencing some level of consciousness.
She writes that “Patients were tested a median of eight months after their brain injuries.”
In other words, many of them could have been living with covert consciousness for quite a while, aware enough to understand language but without any ability to express it. “How many people are lying in bed, getting ignored, and the staff are talking about them as if they’re not there, not putting books on tape or the TV on?” asked Brian Edlow, a critical care neurologist at the Massachusetts General Hospital and an author of the New England Journal of Medicine study.
But doctors tend to be impatient with patients they can’t “fix,” doubly so with uncommunicative patients with massive brain injuries. In other words, they fall prey to what Dr. Nicholas Schiff calls “futility bias”–that “even if we knew what these patients were going through, there is still no way to really help them.”
The remainder of Dr. Lamas’s essay is demonstrating that “this is no longer true.”
For patients who are truly locked in (meaning their cognitive abilities are completely preserved but they are unable to move because of a specific stroke or a neuromuscular disease, such as amyotrophic lateral sclerosis, or A.L.S.), researchers are testing what is called an intracortical brain-computer interface.
What about those patients who are covertly conscious? They haven’t tried this technology on them yet, Dr. Lamas wrote.
Since these are patients who have had brain injuries, any communication would probably be imperfect. But we will not know how much is possible until we try, which is why Dr. Schiff and his team are working on research protocols that could one day offer these patients a voice.
There are doctors, like Dr. Schiff, who have devoted their professional lives to reaching these patients.
“It’s not OK to know this and to do nothing.”
LifeNews.com Note: Dave Andrusko is the editor of National Right to Life News and an author and editor of several books on abortion topics. This post originally appeared in at National Right to Life News Today —- an online column on pro-life issues.
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