Tuesday, January 27, 2015

Coma Awareness

The brain is still an organ with many mysteries yet to be solved.  It controls our very lives and allows us to have consciousness. However, what happens when it is injured, forcing the person with the injury to become comatose or in a vegetative state? Are they clinically "dead?"  Are they aware of anything in that state?  Well the events surrounding Godfrey Catanus who was a youth pastor in Southern California may shed some light.

Catanus was in a very bad accident.  Doctors had to remove over 3 feet of his intenstine.  However, that was not his only issue.  His brain was hemorrhaging forcing him to endure nine hours of surgery.  He was medically-induced into a coma in order to keep him stable; however, doctors did not guarantee if he would every wake out of it. Unfortunately this was the case.  Catanus did not come out of his medically-induced coma.

He would then be part of a study by the Northwestern Medicine and Hine VA Hospital which tested to see if patients in a comatose state are indeed aware.  He along with 15 other coma patients had their brains scanned after being separated into two groups.  The first group heard only silence or unfamiliar voices.  These showed little or no brain activity.  The second group with eight patients heard via headphones pre-recorded stories or messages from relatives or loved ones.  Brain scans for the latter showed a lot of brain activity.  Moreover, these patients showed a significant increase in recovery.  The study showed that those in comatose states are aware and do hear.  When they are visited and addressed by relatives via speech, they recovery faster according to the study.

This study is interesting indeed and shows that people are still persons even in a comatose state. Ten
years ago, Terri Schiavo was starved to death after her husband -who claimed she wanted to die- was granted an order from Circuit Court Judge, George W. Greer of the Pinellas-Pasco's Sixth Judicial Court.  She was left for 13 days without any food and died due to complications of starvation and dehydration. Father Frank Pavone and others tried hard to prevent her death, but the Judge saw it differently and did not value the life of Terri.  This case brought about a big debate especially in philosophical circles.

  • What is a person?  
  • Does a person cease to be when in a coma or when "brain dead?"  

Years later another interesting case occurred which got little media attention. Scott Routley was in a serious car accident that left him in a vegetative state.

For all intent and purpose, he was "dead." However, neuroscientist Adrian Owen was able to determine via MRI scans that Routley was communicating with him via the MRI.  Owen stated:
"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."
The discovery was so astounding that Owen remarked that medical textbooks would have to be rewritten in regards to patients in vegetative states.  Routley's own doctor, Prof Bryan Young from University Hospital in London stated that the results from the scan has "overturned all the behavioral assessments that had been made over the years."

In one of the episodes of AMC's "The Walking Dead," a character, "Milton Mamet" who was a
scientist, studied an elderly patient who was dying of cancer.  He used Pavlov's Classical Conditioning format by having the elderly patient associate an old record with music from his era along with a sound he made by banging a metallic cup that made a soft bell sound along with a humming vibration.  As he did this, he showed the elderly man photos of his wife and other loved ones.  "Milton" was testing to see if the consciousness remains even after a patient dies and turns into a "walker/biter" or zombie.  His experiment showed otherwise as the elderly patient tried to bite him and showed no sign of consciousness of memory.

Consciousness is a concept that is often debated in philosophy, psychology, neuroscience and even theology.  No one really understands fully what it is or how it works.  It is believed to be the work of biochemistry via neurons firing synapses in the frontal lobe.  Some philosophers and theologians believe the biochemistry is just part of it and that in reality an ethereal immaterial metaphysical soul ("mind stuff" colloquial term for Descartes' theory) is what drives the biochemistry.  This new study along with previous ones may one day give us a complete scientific answer as to what consciousness is since so far, these studies have shown that consciousness can survive even if the brain - which houses it - is damaged.

Hopefully Catanus' and Routley's stories will help prevent any future Schiavo scenarios where the appearance of a vegetative state is equated to the person being dead or having ceased to be a person.  The Catholic Church teaches that in these cases, those who are deemed not able to make a full recovery during a comatose or vegetative state can be deprive of extraordinary means of life support (medication, treatment, therapies).  However, he or she may not be deprived or ordinary means of life support (food, water, bathes, being placed in comfortable physical position).   Saint John Paul II as Pope stated this during a speech to physicians:

"I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. 
The obligation to provide the "normal care due to the sick in such cases" (1) includes, in fact, the use of nutrition and hydration (2). The evaluation of probabilities, founded on waning hopes for recovery when the vegetative state is prolonged beyond a year, cannot ethically justify the cessation or interruption of minimal care for the patient, including nutrition and hydration. Death by starvation or dehydration is, in fact, the only possible outcome as a result of their withdrawal. In this sense it ends up becoming, if done knowingly and willingly, true and proper euthanasia by omission. 
In this regard, I recall what I wrote in the Encyclical Evangelium Vitae making it clear that "by euthanasia in the true and proper sense must be understood an action or omission which by its very nature and intention brings about death, with the purpose of eliminating all pain"; such an act is always "a serious violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person" (n. 65).  [Pope John Paul II, To the Congress on Life-Sustaining Treatments and Vegetative State, 20 March 2004)
(1) Congregation for the Doctrine of the Faith, Iura et Bona, p. IV
(2) cf. Pontifical Council "Cor Unum", Dans le Cadre, 2, 4, 4; Pontifical Council for Pastoral Assistance to Health Care Workers,Charter of Health Care Workers, n. 120."       












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