British Section of the World Federation of Doctors Who Respect Human Life

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Daily Mail (London)

Breakthrough intensifies ethical dilemma over switching off life support

A BRITISH woman left in a vegetative state after a road accident has astonished doctors by responding to their voices even though she appears unconscious.

Using brain scans, experts discovered the 23-year-old can imagine playing tennis when she is asked because the part of the brain linked to upper body movement goes into action.

And when asked to think about walking around her home, a different part of the brain shows increased activity.

The medical community describes the finding as 'spectacular' and 'remarkable', while the team who made the breakthrough say it could help doctors improve diagnosis of so-called persistent vegetative state, or PVS.

It will intensify the debate over whether patients unconscious for long spells should have their life support switched off.

It is seen as evidence that doctors should never give up hope that a brain-damaged The state is deemed to be persistent if it lasts for longer than 30 days. The outlook for patients varies widely depending on the cause and severity of the brain damage. Some die, some recover well and others remain locked in the state with little change.

Generpatient could recover. And it will give hope to victims' families that when they talk, their loved one might be able to hear their words after all.

The debate was fuelled by the case of brain- damaged American woman Terri Schiavo, who died last year following a prolonged legal battle over whether doctors were allowed to withdraw her feeding tube after 15 years.

In the case of the young British woman, who suffered a head injury, she had been in PVS for five months when the brain tests began. PVS is different from coma in that although victims seem totally unconscious and unaware, there are some signs the brain is functioning.

ally the longer in a vegetative condition, the worse the chances of recovery and the greater the likelihood of long-term disabilities.

In the latest case, reported in the journal Science, the unnamed woman was involved in a road accident in July 2005 and initially was in a deep coma.

However she later opened her eyes and appeared to be following sleep cycles, but did not react to anything around her.

Five months later doctors scanned her brain using Magnetic Resonance Imaging for signs of awareness. Dr Adrian Owen and his team at the Medical Research Council's Cognition and Brain Sciences Unit in Cambridge had previously carried out tests on healthy people which showed that when asked to think about playing tennis the part of the brain linked to upper body movement fired up in response.

And if asked to think about walking around their home, the brain area linked to spatial mapping showed increased activity.

To their amazement the brain patterns that the PVS woman showed were identical. She was repeatedly able to flick between the different thoughts when requested over a five-minute period.

'We think this is unambiguous evidence that she is not only aware of what she is being asked to do but also of herself doing it,' said Dr Owen.

He cautioned that from this one case it could not be concluded that all patients in a vegetative state have the same level of awareness.

But the findings raise serious ethical questions for doctors, as treatment can be withdrawn to end the life of PVS patients.

The break with a previous blanket ban on such mercy killing came with the watershed Tony Bland case in 1993. A victim of the 1989 Hillsborough disaster, he remained in hospital for four years in a persistent vegetative state. He died after Appeal Court judges ruled that providing him with food and water amounted to treatment.

Such treatment, they ruled, could be withdrawn if to do so was in the patient's 'best interests'.

The woman involved in the latest test results would not have her treatment withdrawn, because her condition is relatively mild on the case of PVS and the possibility of recovery remains, however small.

However more serious patients with no chance of recovery might still have the same responses to external stimuli as the woman yet find their treatment withdrawn.

A spokesman for the antieuthanasia group Care Not Killing, said: 'This illustrates that even in the most apparently hopeless circumstances, where there is life there is hope.

'This poor woman is apparently mentally alert despite being physically paralysed and there must be at least a chance that modern medical science can give her the hope of at least a partial recovery.

'Cases of this kind underline the reasons why life is precious and must be protected. We need more research and a better understanding of brain injuries and coma so patients of this kind can be nursed back to health.'

Neuroscientist Dr Narender Ramnani of Royal Holloway University in London, said the study suggested the woman 'and perhaps many other patients like her might be quite capable of decisionmaking and have a rich and complex internal life.

'Given that such patients might be conscious and capable of making their own decisions, is it acceptable for others to terminate their lives without the consent of these patients?'

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