Consciousness in Persistent Vegetative States

A study published last week in the New England Journal of Medicine concludes that 40% of diagnoses of brain disorders are misdiagnoses. These are people diagnosed with conditions such as being in a persistent vegetative state, which is often taken as sufficient for removal of life support because of the assumption that no person remains.

This study finds that a significant percentage of people who are diagnosed as being in such a state are not only conscious but can even be made to communicate simple “yes” or “no” by being told to think about some concrete thing if they mean “yes” and a different concrete thing if they mean “no”. Different parts of their brain would be active if they were conscious and given these instructions, and that could be detected, A number of these patients were thus able to communicate after being declared to have brains of jello with no possibility of consciousness.

This calls for a massive rethinking of how we should interpret what’s going on in persistent vegetative state diagnoses. Either there are different conditions that look the same for all that can be detected (prior to this new method of detecting consciousness, anyway), or the one state that’s been called a persistent vegetative state is fully compatible with consciousness, despite what doctors have assumed. Our courts have relied on that judgment to excuse what turns out to be the killing of a conscious human being. This new research raises the standards pretty steeply for when we should make life-or-death decisions based on such diagnoses.

The LifeNews article about this study includes a suggestion in the opposite direction. If these patients can indicate, consent, can’t they be asked if they want to die? The doctor the article quotes as being interested in this does acknowledge that there are still problems with consent. I don’t think the article shows much awareness of how significant such problems are. It’s notoriously difficult to know when someone has rationally consented even if they can communicate in complete sentences, and this doctor thinks he can get patients who can only use this roundabout method to give legal consent to being killed? How will they determine whether the person is being rational in consenting? Congress prohibited the selling of organs, because it’s too easy for people at the lower end in terms of income to be manipulated into giving up their organs. Shouldn’t we extend at least as much courtesy to those who might be manipulated into giving up their lives?

[cross-posted at Parableman]