Yesterday, my boyfriend sent me a NYtimes.com article on brain activity in people in apparent vegatative state. The study the article discusses examines the possibility that some people in a vegatative state – that is, people who have opened their eyes and for this reason are not in a coma, but who give no further response to their surroundings -, may be able to communicate in simple “Yes”or “No” answers by showing distinct brain activity on MRIs. Note that this capacity is likely pretty rare, so it isn’t like all people in a vegetative state would be able to communicate if we just gave them the technology (that is, an MRI scanner to track brain activity) and training to. I am not even going to look at the sensationalist pro-life commentaties with little if any scientific merit that will undoubtedly come out, and as it appears, Terri Schiavo doesn’t have a thing to do with it, because this capacity cannot possibly have been present in her. However, what the study does say is that clinical judgment may not be sufficient to determine that a person is a “vegetable”.
What, however, is the problem with this study? What would actually be wrong with the possibility that a few “vegetative” patients can learn to communicate with technology? That this technology – and the extended nursing and medical care patients would need if allowed to live longer – is so expensive that they presumably don’t deserve it? That it is creeping to know that people presumed to be “vegetables” might be able to communicate after all, and might be able to make their wishes known despite our previous conception that they can’t? That our former conception that someone who merely “vegetates” is not worth living, is being challenged? In reality, that isn’t true, since we don’t need hidden abilities to question this presumption: why is it that (meaningful) communication is always presumed to be a preqequisite for human worth, anyway? I have never understood the concept of PVS, in that I believed that, if a person could be fed through a feeding tube, why would they be considered “brain dead”? Since having studied neuropsychology, I realized that what is really meant by PVS, is not a coma, but the (perceived) inability to do anything other than consuming food and hydration. That would’ve been obvious from the term “vegetative”, but it wasn’t to me.
Now of course this study does provide some challenge to the idea that people who cannot clinically be found to communicate, are “vegetables”. In fact, I am surprised to find out that, until now, only clinical judgment was used to assess people for “vegetative” state, because clinical judgment could create massive errors. Of course, it is useful – brain scanning may not have any real-life validity, after all -, but it isn’t the only possible way of determining activity and potentially cognitive skill. For example, when I first read about a patient with what is called locked-in syndrome, I always wondered how doctors would diagnose this, as opposed to vegetative state, in a blind person. LIS is characterized by total paralysis except for upward eye movement, but cognitive abilities are usually intact. It is usually assessed by a clinician by determining a person’s ability to track a light beam. Clinical judgment would obviously not be sufficient in diagnosing this condition in a blind person, so I do have to wonder whether one has ever been reported and, if so, whether brain scanning techniques have helped.
Brain scanning and the potential hidden abilities this can reveal, however, do not challenge any preconceived notion that meaningful communication is required for human worth. This is really at least as troubling as the possibility that advanced technology could reveal hidden abilities that are missed on clinical evaluation. Are we somehow imposing abled standards on profoundly disabled people’s quality of life if we judge them worthless without meaningful (by our own standards) interaction? What about the inherent ableism in the notion that merely “vegetating” is equivalent enough to death that euthanasia could be provided? We cannot consult someone in a PVS on this matter, of course – at least, not someone who cannot be found to communicate even with current technology -, and the Terri Schiavo case did illustrate the potential problems with advance directives. In this sense, the “right-to-die” controversy will always be political, no matter how far medical technology will go.
