Patients in a vegetative state appear to awaken after a coma but show no signs of awareness of self or their environment. Though their eyes are open, they have no purposeful actions, explained Dr. Allan Ropper, a neurologist at Brigham and Women's Hospital in Boston, who wrote an accompanying editorial. Their behavior is limited to reflexive behaviors, such as roving eye movements, swallowing or yawning.
The minimally conscious state is a newer term that describes patients with very limited and erratic verbal or motor responses to a spoken voice or other external stimuli.
The research raises provocative questions about the nature of consciousness and self-awareness, Ropper said.
Even if brain scans show hints of residual consciousness, "the question is, what does it mean? That is what people are going to have to grapple with," Ropper said. "It has to do with what you think life is and what is a meaningful life. Those are social, cultural and theological questions."
Ropper also cautioned against families gleaning a false sense of hope. Evidence of consciousness was found in only a small percentage of patients. And all of those were patients who had suffered traumatic brain injury, not "anoxic" brain injury caused by a lack of oxygen from, say, cardiac arrest.
The ultimate hope is that brain scans could one day enable some level of communication, said Dr. Joseph Fins, a professor of medicine and public health and chief of the division of medical ethics at Weill Cornell Medical College in New York City.
"Restoring communication is the holy grail," Fins said. "The thing that families overwhelmingly want is for their loved one to be able to express their wishes, and to know that their loved one is not in pain. These are things that could profoundly impact the decisions of families found in the difficult situation of caring for someone who is veget
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