PVS Patients Communicate: BBC Report
A BBC Panorama Report to be broadcast later tonight, follows several patients in persistent vegetative state. It highlights the cases of two Canadian patients, Scott Routley and Steven Graham, who, whilst appearing to be in persistent vegetative state (PVS) have been able to answer questions, and even to show that they have laid down new memories. Using fMRI scanners, Prof Adrian Owen and his team analyse the patients’ brain activity and say:
“Scott has been able to show he has a conscious, thinking mind. We have scanned him several times and his pattern of brain activity shows he is clearly choosing to answer our questions. We believe he knows who and where he is.”
According to the BBC, Prof Bryan Young, Mr Routley’s neurologist said “the scan results overturned all the behavioural assessments“:
“I was impressed and amazed that he was able to show these cognitive responses. He had the clinical picture of a typical vegetative patient and showed no spontaneous movements that looked meaningful.
Clinical criteria for PVS will clearly need to be revised in the light of this information. However, this research does not answer deep ethical questions about what should be done. These patients have profound brain injuries and their lives are extremely restricted. How will we evaluate their desires? What should we do if they wish to die? We will still need to do the ethical work to evaluate the implications of what they want, particularly whether they wish to live or die.
This is one step towards an answer to te question of how we should care for people with severe brain injuries, but it is not the solution. Not only do we need to know what they want, we also need to know how limited medical resources should be fairly distributed and what constitutes a rational desire to die.