Is there a consciousness confidence crisis?

Trauma to the brain can result in patients being in a vegetative or minimally conscious state – awake but unable to communicate with the people around them. Or so doctors thought.

In a recent study, doctors were able to communicate with a man who had been in a vegetative state for several years by ‘reading’ his thoughts. They used functional magnetic resonance imaging (fMRI) to study his brain activity in response to a set of questions about his family, but because he was unable to answer yes or no, the patient was asked to envisage different scenes.

He was asked to think of playing tennis – a motor activity controlled by the right side of the brain – to answer yes, and to answer no he was told to visualise moving from room to room in his home, a creative activity associated with the left side of the brain.

A healthy person was asked to do the same with the two tasks producing different patterns of brain activity. The brain activity of the patient matched that of the healthy person, and he answered five of the six questions correctly, showing no response on the final question.

Dr Adrian Owen, from the Medical Research Council in Cambridge, who co-authored the report said: “We were astonished when we saw the results of the patient’s scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts.”

This patient was thought to be in a vegetative state – unable to do things on command, like following an object with their eyes – but the study shows he was minimally conscious, showing signs of awareness, albeit minimal and intermittent.

While the research presents a huge leap in the scientific understanding of how the brain works, it also provokes questions about what patients are aware of. Can they feel pain? Are they mentally capable of communicating with people around them, but let down by their body? It also raises the question of when life support and treatment should be withdrawn.

This is often a heart-wrenching decision for a family to make, especially since they have no way of receiving communication from their loved one, and no way of knowing what they are aware of. Most doctors advise that a patient receives no further treatment after a year because the chances of a recovery are virtually zero, but this new study shows that – although he may never be able to do everything he once did – the patient was sufficiently conscious to answer questions asked of him.

While the Brain Injury Association of America will now recommend families ask for fMRI after a serious brain injury, we should remember that there’s still a long way to go. When asked to imagine the tennis and house scenes, only five out of 54 patients had brain patterns matching a healthy person’s and only one patient was asked specific questions. Experts are quick to point out the results can’t necessarily be translated across the board – not all vegetative brains will hold signs of awareness, and it’s not clear what level of consciousness and mental abilities the patients have, but this is surely a positive step for a group of people who’d previously been given up on.