9/08/2006

Bioethicists take note

One of the bigger areas in bioethics is the cluster of questions involving the end of life, such as, Is euthanasia morally permissible? Some folks are attracted to the idea that, if a person is in a vegetative state, then they may lack conscious awareness, and as a result, euthanasia may be permitted for certain vegetative patients.

A new article in Science looks like it provides evidence that undermines one of the above premises, namely, that patients in vegetative states are not conscious. Here's the abstract:
We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.
The authors of course do not claim that every (or even many) vegetative patients maintain this level of consciousness. Furthermore, they recognize that some people may not consider even this amount of brain activity to amount to conscious thought. But their next step is an encouraging one: developing a battery of fMRI tests to determine whether a particular patient has this degree of consciousness or not -- so we no longer have to guess at whether someone who's been unresponsive for 5 months (as their test subject had) is conscious or not.

UPDATE: I now see that Brains not only beat me to this story, but Pete Mandik has much more insightful commentary on it too. Oh well.

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5 Comments:

At 13/9/06, Blogger Stephen Rowntree said...

The entire issue hinges on autonomy, what a person is and when they are not what that 'is'.

Philosophers, ethicists and biologist (geneticists, too) make all these assumptions about conscious states etc, without first determining what a person 'is', or more to the point, what we mean by autonomy.

A close fried of mine recently submitted her doctoral thesis in philosophy on just this issue, having first started out asking the ethical questions that should come after the principal one, what do we mean when we say autonomy.

 
At 14/9/06, Blogger Stephen Rowntree said...

I am a first year PhD student at the Dominican College/University here in Ottawa, Canada, having done my MA at Carleton University and BA(Hons) at York University in Toronto.

My MA thesis title was, believe it or not (I seldom do), 'Joyce's Ulysses, a Schopenhauerian and Freudian Reading'. As you will no doubt see should you link to my blog(s), I am also a poet and writer of fiction, or what I refer to as grammacide.

 
At 14/9/06, Blogger GF-A said...

Hi Stephen --

Thanks for the comment. You are certainly right that issues of autonomy are central to bioethical questions; but the problem with a patient in a permanent vegitative state is that they apparently lack most of the usual characteristics of an autonomous agent. The usual/ standard attempt to circumvent this problem is to use what's often called "substituted judgment": a family member (or close friend) attempts to judge what the patient would want in that situation. (The contrast is with what the family members want in the situation.)

And I think a relevant and useful piece of information for a family member trying to exercise substituted judgment is whether one is conscious (or quasi-/ semi-conscious) in a permanent vegitative state.

 
At 14/9/06, Anonymous Anonymous said...

Interesting, I was discussing the notion of self-consciousness today with respect to faith, more precisely, having faith and being capable of receiving faith.

My point was that imbiciles (and I use the clinical/pathological term here) and schizophrenics have no or limited self-consciousness, and are therefore incapable of receiving or accepting faith, raising the problem of secular and non-secular authorities.

We are studying the school of thought of Salamanca, and not being a Catholic, I find the entire exercise facinating, if not troubling. I suppose a return to Aquinas might be in order.

Stephen Rowntree

 
At 23/9/06, Blogger Levi said...

Scientists out of South Africa are reporting that zolpidem (Ambien) can awaken people in a PVS (News story here). Paper: Transient Improvement of Spinocerebellar Ataxia with Zolpidem link. Further info here. Even if the scope of drug is found to be low, notice "Other experts stress, however, that people are sometimes misdiagnosed as being in a permanent vegetative state" in the NewScientist article, this is still an amazing find. Hell, even if only the people who are misdiagnosed as having PVS are the ones waking, then this drug would be helpful in reliably establishing whether one is really in a PVS.

 

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