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Wednesday, August 01, 2007

Returning people from minimally consciousness

BBC reports on a new technique for returning people from a state of minimum consciousness:

Treatment of a 38-year-old man with a severe brain injury enabled him to use words and gestures, chew and swallow and drink from a cup, say US doctors.

Before the stimulation, done through electrodes implanted in his brain, he could only make slight eye or finger movements, the team report in Nature.

[snip]

Within 48 hours of the first stimulation, the patient was able to keep his eyes open, turn his head, and utter words.

After several treatments he is now able to perform complex tasks such as brushing his hair, although with difficulty due to severe immobility caused by his condition.

And can chew and swallows his food where before he needed a feeding tube.

Further tests on 12 patients have gained FDA approval. The researchers say if these results are replicated, it could change the standard of care for such patients, most of whom have to be cared for in long-term nursing facilities.

RTWT™

This raises the question of what would have happened if Terri Shiavo had been granted this opportunity for recovery.

That question in my mind exposes the Achilles’ Heel of the practice of euthanasia (especially when it is practiced with a good measure of political theatre): Unless you can definitively state that a person can never be returned to a near normal state of consciousness, it is better to take the more cautious approach and assume that in the future an as yet undiscovered technology might return that person to a (near) normal life.

In the end, our understanding of consciousness and what is required physiologically for that state to occur is very very limited.  The human brain is known to be highly redundant, and has a greater plasticity (ability to “rewire itself") than previously given credit for.  (See this post by Rob for a clinical example.)

Comments

a similar treatment did not help Terri Schiavo, the Florida woman in a vegetative state

Americans are in a minimally conscious state, 112,000 to 280,000.
WOOF on August 1, 2007 at 04:26 pm

a similar treatment did not help Terri Schiavo, the Florida woman in a vegetative state

hasn’t worked on Woof yet either.


What’s going to happen to US industry when the global warming extremists like John McCain double the price of electricity?  I would think all these factories will close and set up in countries where they aren’t scared of technology.


The Whistler's signature
The Whistler on August 1, 2007 at 04:31 pm

Woof is right but nevertheless this is an amazing result for this condition.


Conservatives are not necessarily stupid, but most stupid people are conservatives.

John Stuart Mill

MikeAdamson on August 1, 2007 at 04:43 pm

hasn’t worked on Woof yet either.

Writes Whistler, in a minimally conscious state.

WOOF on August 1, 2007 at 05:03 pm

Huh?


What’s going to happen to US industry when the global warming extremists like John McCain double the price of electricity?  I would think all these factories will close and set up in countries where they aren’t scared of technology.


The Whistler's signature
The Whistler on August 1, 2007 at 05:09 pm

Well done Whistle.

WOOF on August 1, 2007 at 05:22 pm

smile


What’s going to happen to US industry when the global warming extremists like John McCain double the price of electricity?  I would think all these factories will close and set up in countries where they aren’t scared of technology.


The Whistler's signature
The Whistler on August 1, 2007 at 05:31 pm

As I understand it, this particular treatment (using deep-brain stimulation) is the first of its type, at least in terms of the area of the brain that is being stimulated, for subjects in a minimal state of consciousness.

Of course in Shiavo’s case, there was argument among the medical types over whether she was vegetative or minimally conscious… I’m pretty skeptical about current methods for testing, which have to do with the individuals peripheral response.  This has recently been demonstrated to be a very poor predictor of underlying consciousness, as was shown bythis study.

Until we can define consciousness in a more rigorous and objectively testable manner, I think all due caution is needed in diagnosing individuals as beyond possible treatment.

Carrick on August 1, 2007 at 05:53 pm

Dou’t get me started on the Terri Schiavo debacle.  Her ‘loving’ husband never gave her a chance for recovery denying her the therapy she needed.  Then we have her being cold-bloodingly killed by dehydration something for which you could do serious jail time if you did that to a sick animal.

Anyway the term ‘vegetative state’ is a purely bullshit term used to denigrate a person who is comatose or minimally aware. [It’s easier to kill a vegetable than a person]


You don’t have to be a moron to be a liberal Democrat but it sure helps.

docdave on August 1, 2007 at 08:21 pm

The Whistler .. When Carrick posted this topic the first thing I wanted to say was ... Whoa, so there is hope for some around here after all. But, I had just got done telling you I was going to be serious, (Although, I noticed you threw in a gibe) wink


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Anna on August 1, 2007 at 11:12 pm
Avatar for Dave

Unless you can definitively state that a person can never be returned to a near normal state of consciousness, it is better to take the more cautious approach and assume that in the future an as yet undiscovered technology might return that person to a (near) normal life.

OK. So now if I could just find one single person on death row who was wrongly convicted, we can get rid of capital punishment too. Because, as a wise man once paraphrased:

“Unless you can definitively state that a person is 100% guilty of the crime he was alleged to commit, it is better to take the more cautious approach and assume that in the future an as yet undiscovered technology might be able to prove conclusively the true identity of the murderer.”

Dave on August 2, 2007 at 02:33 pm

Dave:

OK. So now if I could just find one single person on death row who was wrongly convicted, we can get rid of capital punishment too.

This is a bit of a logical stretch, of course.

I wasn’t really advocating that we shouldn’t keep people alive who are truly brain dead, just that the evidence clearly shows that the current physiologically based exams for state of consciousness are quite obviously measuring something besides state of consciousness. 

Basically you’re looking for a deliberative peripheral response to a physical stimulus.  There are lots of things that can go wrong that would lead to vegetative diagnosis besides a lack of consciousness.  The BBC study (and others btw with similar conclusions) makes that clear.

The comparison with capital punishment doesn’t work because jury trials are at least 90% accurate (probably more like 95-98%) in properly convicting a person of a crime.  Is that too high a wrongful death rate?  I think so personally.  But the consciousness assays we have been discussing is much worse than 90%, perhaps as low as a 20% accuracy.

The “science” of consciousness is just that poorly understood (and it is very poorly funded by the way, given the large 100k+ people who are in a “vegetative” state)…

Carrick on August 2, 2007 at 08:17 pm
Avatar for Lestat

Her ‘loving’ husband never gave her a chance for recovery denying her the therapy she needed.

Her loving husband cared for her and made sure she never had a bed sore in all the time she was vegatative.  Very unusual.  She had virtually no frontal lobe when she was autopsied, she would not have benefited from this if she was still alive. 

Why is it so hard to believe that she told her husband tht she did not want to live as a vegatable.  Most people tell their spouses that.

Lestat on August 2, 2007 at 08:31 pm

Lestat, that autopsy argument doesn’t wash, because we don’t know how much of the brain is redundant, and how much function could (given the right chance) could be shifted to another part of the brain.  In fact, the parts of her brain that were damaged are precisely the ones that would have been needed to get an other than vegetative state diagnosis.

As to the other, I’ve already pointed out that the tests they use to determine vegetative state are fatally flawed.  Therefore while her wishes may be to be euthanized if she were in a true coma, we can’t say whether that is really the case or not, based on very real medical uncertainties about what defines the state of consciousness.

Carrick on August 2, 2007 at 08:43 pm

Lestat - Her loving husband cared for her and made sure she never had a bed sore in all the time she was vegatative.

Did he do that before or after he took her care money and used it to buy presents for his girlfriend? Gee, what a loving husband. I’m sure his wife would have wanted her care money stolen from her to be spent on his new girlfriend.

You defend some real creeps Lestat.

likwidshoe on August 2, 2007 at 11:00 pm

Dave - OK. So now if I could just find one single person on death row who was wrongly convicted, we can get rid of capital punishment too.

It’s funny watching you defend life.

So,..how’s that whole ‘euthanasia up to age 12’ viewpoint working out for you?

likwidshoe on August 2, 2007 at 11:04 pm

Her loving husband cared for her

Yeah, Michael cared for her so much he isolated her from everyone including her parents who wanted to take her under their care thus saving her life.  A real loving guy, that Michael..

By the way, one of the big lies often told about Terri was that she was comatose.  She was never comatose and was at least minimally aware not a vegetable.  Perhaps the darkest secret about Terri is how she got into that mind compromised position.


You don’t have to be a moron to be a liberal Democrat but it sure helps.

docdave on August 2, 2007 at 11:30 pm
Avatar for Dave

Perhaps the darkest secret about Terri is how she got into that mind compromised position.

Could it have been.....

..... Murrrrder?

Likwidshoe:

So,..how’s that whole ‘euthanasia up to age 12’ viewpoint working out for you?

We’re making significant progress in certain European countries, particularly the Netherlands, which has instituted the Groningen Protocol in cases of infant euthanasia. Hopefully we’ll see the same reforms instituted in America in the near future. I have faith in the altruism of the American people--they’ll do the right thing.
Dave on August 3, 2007 at 10:31 am

This raises the question of what would have happened if Terri Shiavo had been granted this opportunity for recovery. Carrick

Is this trick question ?

Uh, she coulda become a conservative blogger ?
Is that it ?

james on September 1, 2007 at 10:39 pm

More cynical smarm from James, who mistakes it for reason.

Carrick on September 1, 2007 at 10:51 pm

Dou’t get me started on the Terri Schiavo debacle.  Her ‘loving’ husband never gave her a chance for recovery denying her the therapy she needed.  Then we have her being cold-bloodingly killed by dehydration something for which you could do serious jail time if you did that to a sick animal.

Terri Schiavo’s husband was a piece of shit. I don’t know what else to use to describe him.


Check out:
Goon’s North Dakota Red Neck
Goon’s World

goon on September 1, 2007 at 11:26 pm

Dave - I have faith in the altruism of the American people--they’ll do the right thing.

Hopefully they’ll spare your own child.

You heartless bastard.

likwidshoe on September 1, 2007 at 11:43 pm

For you, Dave, it’s isn’t a child; it’s a lump of cells.


Hope and change, in a free world, are the private possessions of motivated individuals.

robert108 on September 1, 2007 at 11:49 pm
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