Anybody There? // People aren’t cucumbers

“Is anyone there? Can you hear me?” You’re shouting at the rubble from a collapsed building. There’s no reply, but then… was that tapping?

You have an idea. “If you can understand me,” you yell, “tap once.” A single tap. “If you’re injured,” you then say, “tap twice.” Two taps. There’s someone there.

Such scenes have taken place after natural disasters. But it’s an apt metaphor, too, for finding a human being struggling to be heard through the rubble of a body that it can’t control.

BBC’s Science Focus Magazine recently featured an essay by British neuroscientist Dr. Adrian M. Owen, who recounted the case of a woman who was hit by two cars in 2005 and suffered a massive brain injury, leaving her in a “wakefulness without awareness” state commonly called “vegetative.” Such patients can open their eyes but remain non-responsive to any form of external prompting or stimulation.

Dr. Owen employed something called functional magnetic resonance imaging (fMRI), which shows activity across brain regions, to see how the patient’s brain might react to spoken questions. While she was in an fMRI scanner, he asked her to imagine waving her arms in the air, as if she were playing tennis. A part of her brain known as the premotor cortex “lit up” in exactly the same way as it does in healthy brain-scanned people asked the same question.

Several other vegetative patients, at least one of whom who had been in that condition for more than a decade, while being fMRI scanned, were posed a series of factual yes-or-no questions, like whether they had a parent or sibling with a certain name, and asked to respond “yes” by imagining playing tennis and “no” by imagining walking through their homes. They “answered” accurately, and then were able to communicate responses to other questions about their preferences and experiences.

It’s estimated that there are between 15,000 and 40,000 “persistent vegetative state” patients in the US alone, and an independent scientific review concluded that between 20 and 25 percent of them are aware, despite their outward unconscious appearance, listening silently to every conversation at their bedside and every decision being made in their presence about them.

In 2006, the journal Science published Dr. Owen’s report of his discovery that at least some patients in a persistent vegetative state are in fact fully aware.

Today, he is making the case that “To fail to test for consciousness using technologies like fMRI is to deprive tens of thousands of brain-injured patients worldwide of an important benefit: the opportunity to make themselves heard, to communicate with their clinical team and their relatives, and to contribute to decisions about life-preserving treatment, rehabilitation and other interventions.”

“By failing to make these scans available,” he continues, “we abandon them.” And it is “high time [that] we allow them access to these technologies so they might once again take their place among us in the land of the living.”

There has been opposition to the import of the findings. In the same issue of Science that published Dr. Owen’s report, Harvard neurologist Dr. Allan H. Ropper editorized that “Physicians and society are not ready for ‘I have brain activation, therefore I am.’ That would seriously put Descartes before the horse.” Quite the punster, that chipper Dr. Ropper; but the issue is rather serious.

University of Glasgow Professor of Law and Ethics Sheila McLean raised a different concern. She asked: “If recovery truly is impossible, is it compassionate to keep people alive in this condition?”

“Frankly,” she suggested, “the only thing worse than being in a vegetative state must be being in one, but being aware.”

For some, perhaps. But is a physically curtailed life meaningless? Does movement define the import of being human?

Are things like mechilah, teshuvah, ahavah and human interaction worth less than talking, running and jumping? We all know the answer: they are worth infinitely more.

And so, to return to the scene of the natural disaster. What would we think of someone who looks down at the immobile rubble, listens to the tapping and then…just walks away?

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