Patient 23

June 15, 2012 7:33 AM

"Adrian Owen still gets animated when he talks about patient 23. The patient was only 24 years old when his life was devastated by a car accident. Alive but unresponsive, he had been languishing in what neurologists refer to as a vegetative state for five years, when Owen, a neuro-scientist then at the University of Cambridge, UK, and his colleagues at the University of Liège in Belgium, put him into a functional magnetic resonance imaging (fMRI) machine and started asking him questions. Incredibly, he provided answers."
posted by jquinby (31 comments total)

This is fascinating. Thanks for sharing.
posted by Kokopuff at 7:55 AM on June 15, 2012

This is why my (evolving and as-yet not finalized) advanced health care directive is turning into a lengthy manual. With flowcharts.
posted by ClaudiaCenter at 8:11 AM on June 15, 2012 [7 favorites]

Very interesting! This kind of research expands our awareness of forms of human communication and of the human need to communicate.
posted by mareli at 8:13 AM on June 15, 2012

I don't want to think about what it's like to be aware enough to answer those questions but yet your existence looks like "a vegetative state."
posted by ThatCanadianGirl at 8:20 AM on June 15, 2012 [14 favorites]

Disconnected, or trapped? Years of sitting there understanding everything around you but unable to respond would suck so bad.
posted by Meatbomb at 8:32 AM on June 15, 2012 [1 favorite]

This is terrifying. Thanks for sharing.
posted by barnacles at 8:32 AM on June 15, 2012 [1 favorite]

This is precisely why I've taken pains to explain to my family that I don't *care* if there's a chance that some form of consciousness is still extant; if I've suffered such extensive brain damage that I'll be unable to practice an intellectually demanding profession, I don't wish to live. Full stop. Life as someone with a double-digit IQ would be entirely unacceptable for me.
posted by Mr. Excellent at 8:42 AM on June 15, 2012 [2 favorites]

Complicating the whole fascinating questions is that you may not actually be "conscious" even if parts of the brain are lighting up. There's a bunch of cognitive processes that a fully healthy brain engages in that you have no conscious experience of--and a brain damaged and in coma complicates that complication even more. We're in the dark about a lot of this stuff.
posted by Drastic at 8:44 AM on June 15, 2012

Life as someone with a double-digit IQ would be entirely unacceptable for me.

It's not so bad, really.
posted by BitterOldPunk at 9:10 AM on June 15, 2012 [59 favorites]

Yeah, but you don't know what you're missing never having been of Mr. Excellent's intellectual caliber.
posted by Meatbomb at 9:16 AM on June 15, 2012 [6 favorites]

some might say even better, no? ignorance is bliss/correlation of high iq with drug/alcohol abuse/potential for mental illness
posted by lulz at 9:18 AM on June 15, 2012

What Drastic said. I've had a number of head injuries, and had certain kinds of cognitive function gone. (As far as I know, they're all back, and if they aren't, well, I don't know enough to miss them).

I'd like to think I was lucky enough to be in a dream or Matrix state where sure, I could respond to external stimuli (pictures, questions) but not be bothered by being in a "vegetative state" in a hospital because I don't perceive the hospital situation.

No guarantees, though. I don't do well with being in an out of my control situation.
posted by tilde at 9:19 AM on June 15, 2012

Is it really ethical NOT to ask someone if they'd like to be taken off life support? How is that different from denying someone the ability to file a Do Not Resuscitate order?
posted by fbo at 9:46 AM on June 15, 2012 [1 favorite]

If they asked and the person said yes, that would be assisted suicide, which is not legal in all jurisdictions.
posted by ThatCanadianGirl at 10:09 AM on June 15, 2012

fbo, I think (and please someone correct me if I'm wrong) that they're really not 100% certain than the answers are indicative of what we call consciousness. Maybe it's different sort of consciousness? Maybe our concept is wrong? What if the persons being asked are not, in their current state, capable of really understanding death?
posted by AmandaA at 10:21 AM on June 15, 2012

Is it really ethical NOT to ask someone if they'd like to be taken off life support? How is that different from denying someone the ability to file a Do Not Resuscitate order?

Yes.

Filing a DNR order is a decision that's hedged around with protocol, where the patient obviously has the right to refuse treatment, but the medical staff needs to be sure that is honest desire. Which is easy enough to do with a fully conscious, fully with it patient, not so much with somebody where nobody yet is sure they actually understand and are responding to this question. The process needs to be far better understood and guidelines need to be written to be able to do so.
posted by MartinWisse at 10:59 AM on June 15, 2012 [1 favorite]

After refining their methods, the researchers asked patient 23 to use that capability to answer yes-or-no questions: imagine playing tennis for yes, navigating the house for no. They then asked about things that the technicians scoring the brain scans couldn't possibly know.

Finally, a scientific study that relies on verifiable non-subjective data! With the way a lot of psychology articles tend to draw wild conclusions from specious data, I was anticipating that this latest one might involve a voodoo bag. But real science?!? That's CRAZY.
posted by wolfdreams01 at 12:25 PM on June 15, 2012

Metallica, anyone? Or rather Dalton Trumbo.
posted by exogenous at 1:00 PM on June 15, 2012 [2 favorites]

I hope they never use this to ask people if they want to die. In my experience (which may not be the same as yours, etc) doctors are very insistent about DNRs, going so far as to browbeat and intimidate patients into signing them, then doing the same to family when the patient won't acquiesce. Someone like this who has already suffered a terrible misfortune and can't communicate, locked in their own heads, maybe confused about what's going on... It would be all too easy to get them to agree to anything.
posted by Kevin Street at 2:09 PM on June 15, 2012

[...] patient 23, for logistic and financial reasons, was assessed only once.

How cruel. Then again, maybe patient 23 typically has major short term memory deficits, and has no recollection of that brief flirt with hope.
posted by de at 3:39 PM on June 15, 2012 [1 favorite]

Previously (it may even qualify as a double post). Even previouslier.

The same University of Liège team round Steven Laureys is always involved in these stories. That doesn't increase my trust.
posted by Skeptic at 4:40 PM on June 15, 2012

/sits in corner with blanket over head, rocks, gibbers
posted by obiwanwasabi at 5:49 PM on June 15, 2012

Kevin Street : I hope they never use this to ask people if they want to die. [...] Someone like this who has already suffered a terrible misfortune and can't communicate, locked in their own heads, maybe confused about what's going on... It would be all too easy to get them to agree to anything.

Seriously? Seriously???

I can think of no better argument in favor of euthanasia than this experiment. If any of you ever find me in such a state, please please please smash my head in with the nearest available brick.

Sweet Jesus, that must suck beyond any normal human ability to... to... to imagine how much something sucks!
posted by pla at 7:17 PM on June 15, 2012 [1 favorite]

If any of you ever find me in such a state, please please please smash my head in with the nearest available brick.

Seriously. I have sleep paralysis sometimes and ending up like this is my worst nightmare.
posted by fshgrl at 11:01 PM on June 15, 2012 [3 favorites]

I hope they never use this to ask people if they want to die. In my experience (which may not be the same as yours, etc) doctors are very insistent about DNRs, going so far as to browbeat and intimidate patients into signing them, then doing the same to family when the patient won't acquiesce.

What the hell? Where do you come from that this is not considered grounds for disbarment as soon as the first couple of complaints turn up? I'm hanging around with NHS doctors and nurses, and we were all appalled at the very concept.

Note: you should complain about this if the people concerned have not been disbarred.
posted by jaduncan at 2:12 AM on June 16, 2012

Damnit, legal documents all night and tired == bad. Being struck off rather than disbarred, of course.
posted by jaduncan at 2:13 AM on June 16, 2012

I too suffer from frequent sleep paralysis. Becoming paralyzed and remaining conscious is literally my worst nightmare. Please please kill me should I have the misfortune to end up in that state.

(This is one of the reasons I had such a difficult time reading/watching The Diving Bell and the Butterfly)
posted by pugh at 3:03 AM on June 16, 2012 [1 favorite]

I just watched The Diving Bell and the Butterfly the other day which is an incredible depiction of locked in syndrome.
posted by h00py at 6:28 AM on June 16, 2012

...keep the bedsores down for me, and I'll take care of the inner landscape for myself. Stay in touch, but don't bother me with election news. Just let me know when MIB IV comes out.
posted by mule98J at 10:49 AM on June 16, 2012 [1 favorite]

[...] patient 23, for logistic and financial reasons, was assessed only once.

Okay....Okay....I'm really okay, but I have some questions:

I wonder why they don't call back?

Can you figure out a way to hook me up to HBO?

Please, would you scratch my nose?
posted by mule98J at 10:55 AM on June 16, 2012

If you want to see an incredibly and brutally powerful film about assisted suicide, watch The Sea Inside. I watched it for an ethics class once, and it just drained me (in a good way).
posted by OverlappingElvis at 4:38 PM on June 16, 2012