Cogito Ergo Sum (I Think, Therefore I Am); Comatose Patients Think and Communicate

by Mark Henry

The medical world was stunned last week by a study published in a prestigious medical journal revealing that a number of patients diagnosed as being in a vegetative state could actually think and communicate. Experts are calling the study a “game changer” that will prompt changes in how patients in coma-like states will be treated in the future.

The study was evaluated in the February 3, 2010 issue of the New England Journal of Medicine in an article aptly titled “Cogito Ergo Sum (I think, therefore I am) by MRI”. Doctors scanned a man’s brain while asking him questions like “is your father’s name Thomas”. They were astonished when the results of the scan showed that the man was able to think “yes” or “no’ answers by consciously changing his brain activity.

The author of the article, Dr. Allan M. Roper, said that the findings will make it “difficult to tell families confidently that their unresponsive loved ones are not in there somewhere.”

This study is re-igniting a controversy in the Catholic pro-life community about the medical profession’s using diagnostic terms like “brain death”, “vegetative state” and “minimally conscious state” to justify denying life sustaining medical care to a patient. This controversy is not just about semantics as the use of such terms to describe a patient’s medical condition can be a life or death matter. This is because any one of these diagnosis’s can result in a patient’s death by dehydration, their organs being harvested or suffering another form of medically induced death.

Dr. Paul Byrne, organizer of the February 2009 Signs of Life Conference in Rome, has long been an opponent of the brain death standard. When interviewed for this article, Dr. Byrne pointed out that while official Catholic teachings prohibit the taking of a person’s vital organs before death there remains much support for the brain death criteria within the Vatican.

According to Dr. Byrne, for many decades now medical professionals have supported “brain death” as the standard for determining when a person has died and their organs can be removed. Among the many criticisms of the brain death standard is that a person can be pronounced dead even though their heart is beating, they are breathing, they can digest food and even carry a child to term.

To most of us, such a person would be considered alive. However, if such a person was in a coma then under prevailing medical practice this person could be pronounced “brain dead” and their organs could be removed. According to Dr. Byrne, an organ donor’s vital organs are usually removed without giving then anesthesia. To support his point that “brain dead” patients are not really dead, Dr. Byrne points out that doctors who remove organs from such patients often see the patient move, their heart beat jump and their blood pressure rise rapidly during the organ incision.

When medical workers see an unanaesthetized patient’s physical reaction to the removal of their organs it can traumatize them. For that reason, organ donors in the U.S. are often injected with a paralyzing drug to control the patient and reduce trauma to the medical staff. How's that for misdirected compassion?

In light of these and other revelations, the Vatican’s support for brain death may be changing. In September 2008, Professor Lucetta Scaraffia, Vice-President of the Italian Association for Science and Life and a member of the Italian National Committee on Bio-Ethics, wrote a front page article in the Vatican newspaper L’Observatore Romano that was highly critical of the brain death standard.

While such a writing is not by any stretch considered Magisterial teaching, it is an indicator that the Vatican may be reassessing its support of the brain death standard.

Bobby Schindler, brother of Terri Schindler Schiavo, also weighed in on this development. When I interviewed Schindler, he said the story adds to the growing evidence critical of the persistent vegetative state ("PVS") diagnosis. Schindler also voiced his objection to using the PVS standard when diagnosing and treating people with severe head injuries.

In the case of Schindler’s sister, Terri, Schindler said that the doctor’s diagnosis that she was in a persistent vegetative state paved the way for denying her food and water resulting in her tragic death by dehydration.

The New England Journal of Medicine’s article will hopefully trigger a groundswell of support to change how doctor’s diagnose and treat people with serious brain injuries. This study will certainly be welcome news for families who have compassionately cared for brain injured loved ones in the face of a medical establishment that far too often treats these patients and their families cavalierly, without empathy and without the medical attention they need and deserve.

During the United States Conference of Catholic Bishop's annual meeting in 2009, the Bishops commendably adopted new guidelines requiring the provision of nutrition and hydration to patients in a persistent vegetative state. Let us hope and pray that this study discussed in the New England Journal of Medicine will be a light on the path to encourage the Church to continue further down this road and adopt new policies that protect helpless brain injured persons who desperately need the Church to be a vocal moral ally in their corner.

The Church could advance the Culture of Life by voicing disapproval of the medical establishment’s harsh approaches to dealing with people who are diagnosed as brain dead, in a persistent vegetative state or who are minimally conscious. A good starting point would be Magisterial teaching which categorically rejects the morally bankrupt “brain death” criteria and expunges the dehumanizing phrase “vegetative state" from Catholic health care lexicon.