Someone needs to rewrite Johnny Got His Gun for the modern era. In a recent article in the New England Journal of Medicine entitled “Willful Modulation of Brain Activity in Disorders of Consciousness” researchers used fMRI machines to attempt to determine the level of awareness in persistent vegetative patients.
The researchers put people in brain scanners and, in one condition, asked them to imagine standing still on a tennis court while swinging an arm to “hit the ball” back and forth to an imagined instructor, and in the other, to imagine navigating the streets of a familiar city or to imagine walking from room to room in their home. These were chosen because they show distinct patterns of brain activity on a scan. (via Mind Hacks).
Out of 54 patients only 5 showed patterns of distinct brain activity. This sort of research has been done before but in this study they took it a step further.
One patient, who had been in a vegetative state since a traffic accident seven years ago, was asked a series of six yes or no questions about simple personal details such as: “Do you have any sisters? Is your father’s name Thomas? Is your father’s name Alexander?” The researchers instructed the patient to imagine tennis for yes and walking for no.
To blind against the effect of bias, the researchers who asked the questions did not know the answers and they each ended question with neutral word “answer.” Also, the results of the fMRI was read by researchers who were not aware of the questions asked.
The patient’s brain activity indicated the correct answer for 5 out of 6 questions—the last question resulted in no measurable activity to correlate with a response. Now statistically anyone can get 3 out of 6 yes/no questions right, but given the fact that the patient was seemingly able to follow instructions something was going on. This doesn’t mean that the patient is fully conscious and trapped in his body. Something is going on up there but given the state of the patient his level of awareness is likely fleeting and limited at best.
All this sets up an odd legal quandary as vegetative patients already exist in a legal grey area. Most legal statutes rule that it must be ruled by a medical authority that no recovery is possible before—to be crude—the plug is pulled. This sort of evidence casts more light on the state of the individual but it also makes the situation even more unclear: What if the other 49 patients never played tennis before? What if they didn’t quite understand the question? What if they are deaf?
And what if… what if they had asked the patient if he wanted to continue living like this… and what if he said “No.”
Would this classify him as minimally conscious rather than permanently vegetative? If so they would no longer be allowed to abide by his wishes. Maybe this isn’t a modern telling of Johnny Got His Gun, maybe it’s actually Catch 22.