/*PenDragn: Ellen Goodman: Vegetative Mind Games: Hope or Trap*/

9.17.2006

Ellen Goodman: Vegetative Mind Games: Hope or Trap

OF ALL the headlines on the story, this one took the prize for provocation: ``Woman in Vegetative State Plays Tennis in Her Head." I suppose this is what happens when science throws up a startling piece of new research and the media slams it into the court of public opinion.

In Britain, researchers have reported that a totally unresponsive 23-year-old woman showed signs of awareness on a brain-imaging test. When asked to imagine playing tennis, her brain lit up the same neural pathways as a healthy brain. When asked to imagine walking through her house, the MRI revealed changes in specific brain regions that mimicked healthy people.

The exuberant lead researcher, Adrian Owen, said the results ``confirmed beyond any doubt that she was consciously aware of herself and her surroundings." A colleague even raised the possibility that some vegetative patients have ``a rich and complex internal life." Tennis in her head.

What are we to make of this? An editorial in Science magazine, which published the research, was quick to warn that this case is nothing like that of Terri Schiavo. The British woman has something Terri did not have: a cortex. She suffered an injury, not a lack of oxygen. She was in her unresponsive condition for five months, not 15 years. She was not in a persistent vegetative state.

Nevertheless, those who play politics in their heads have found this research useful. Terri's father, Robert Schindler, declared game, set, match in the controversy: ``This new case is not surprising to our family."

But what about the rest of us ? What about those of us who believed all along that Terri was, ironically, one of the easy cases. Surely, as one bioethicist said, this research creates another shade of gray in the understanding of gray matter. And in decisions that revolve around life and death.

We don't know if similar patients will show the same level of awareness. Indeed, there are some who believe the British researchers overinterpreted what they saw. But an estimated 6,000 Americans are in a vegetative state and another 100,000 Americans exist in some state of partial consciousness. We know there is a bell curve of consciousness, a range of symptoms and prospects for recovery among such patients. A 23-year-old accident victim has a different prognosis than an 88-year-old stroke victim.

But we do not know whether the researchers who suggest that vegetative patients may be aware of themselves and their surroundings have given us a hopeful story line or a horror story.

As University of Pennsylvania bioethicist Art Caplan says, ``It's not necessarily good news that someone might have some form of consciousness but not be able to interact emotionally, socially or communicate in any way shape or form. To spend your life dimly aware but unable to let anyone know you are in there is more the subject of Stephen King or Edgar Allan Poe than some sort of medical hope."


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