Slashdot Mirror
Vegetative State Man 'Talks' By Brain Scan
c0lo writes "'Severely brain-injured Scott Routley hasn't spoken in 12 years. None of his physical assessments since then have shown any sign of awareness, or ability to communicate, thus being diagnosed as vegetative (vegetative patients emerge from a coma into a condition where they have periods awake, with their eyes open, but have no perception of themselves or the outside world).' Scott Routley was asked questions while having his brain activity scanned in an fMRI machine. British neuroscientist Prof Adrian Owen said Mr Routley was clearly not vegetative. '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.' As a consequence, medical textbooks would need to be updated to include Prof Owen's techniques, because only observational assessments (as opposed to using mind-readers) of Mr. Routley have continued to suggest he is vegetative. Functional MRI machines are expensive (up to $2 million), but it's quite possible that a portable high-end EEG machine, costing about $75,000, can be used at a patient's bedside. Phillip K. Dick's world is one step closer."
Must be pretty boring to be conscious but unable to do anything at all.
Will they ask him if he wants to die?
If God forks the Universe every time you roll a die, he'd better have a damned good memory.
Sounds like a great use for something like this. But, have fun getting insurance to cover it...
How does one charge $75,000 bucks for something that can be found in the land of open source?
http://openeeg.sourceforge.net/buildeeg/
Having to work for a living is the root of all evil.
If even a small percentage of people suffering with "Locked-in" Syndrome are reachable it will be a major win. Think "Johnny Got His Gun" or "The Diving Bell And The Butterfly" for cinematic examples of "Locked-in" Syndrome.
I deny that I have not avoided attaining the opposite of that which I do not want.
While watching "The Diving Bell and the Butterfly", it occurred to me that knowing morse code would give you the best chance of communicating from this frightening state.
Big win for the London, Ontario area, not to mention UWO, who also recently announced good news on HIV vaccine tests.
Oh dear!
“He’s not deformed, he’s just drunk!”
Most of the time they just kill them without asking.
But is it to release you from the burden or them? Seems like a question that can be asked of them now.
Comment removed based on user account deletion
Fuck you.
Never, ever turn me off.
How about we find away to communicate instead of just killing them?
hmm?
You are a small minded, mean SOB.
Gosh, someone provokes god in the same sentence as killing people. I'm shocked I tell you. Yes I am aware I might be committing the genetic fallacy.
The Kruger Dunning explains most post on
I'm not even sure why they let vegetative people live if they've been in that condition for so long. If they're truly unconscious then they're already gone, and if they're not you definitely want to kill them. It makes me sick that we even *potentially* leave people in such a state for so long.
You cannot say that someone else should die, without asking them, simply because **you** imagine you would want to in that situation. That would violate just about every single code of ethics imaginable. The situation changes a bit if they have previously expressed a desire not to be kept alive in such a situation (which is often followed, although mind you even in that case, it's hard to know if they really meant it, since they had no prior experience with which to make an educated judgment), but to presume that another should die because of what you think or want is one of the grossest violations of human rights possible.
"None can love freedom heartily, but good men; the rest love not freedom, but license." --John Milton
So consider some other form of torture. Maybe a person is impaled every hour for years. Would you find it just as unethical then to assume they'd want to be put out of their misery if there was little hope of alleviating their pain (assuming you couldn't communicate)? My point here is that there is a line. Maybe you don't agree with my line, but throwing out "gross violations of human rights" is a little far fetched. I expect most people would not want to be locked in their own mind for years.
fMRI has problems and is very subject to interpretation, misuse and manipulation.
For example the now classic dead fish fMRI tests:
http://www.wired.com/wiredscience/2009/09/fmrisalmon/
I am very skeptical of this until it has been repeated, tested and evaluated in other settings by different researchers.
For some reason when reading the story, it really reminded me of "facilitated communication" which is a terrible, cruel scam non-communicative and vegetative or near vegetative state people are subject to. I realize this is different, but really not very different.
Wax on, wax off baby!
The trouble is that not choosing isn't an option. And, if a patient cannot communicate or is too young/brain-damaged/mentally ill/etc. to communicate their preference, you can't usefully ask(this particular case, apparently, now may be able to communicate, solving the ethical problem).
This puts you in the position of being forced to act on somebody else, without having access to their opinion. What, then, do you base your actions on? Do you do unto them as you would do unto you? Do you do some polling and do unto them as a statistically representative sample of demographically similar people would do unto themselves? Do you flip a coin?
The problem is that there isn't a 'default' position. Either way, you make the choice for them and impose it on them.
I have a legal document that tells my family to pull the plug in such a case. I don't care who thinks I'm a "quitter".
Bruce Perens.
This work might also have implications for non-verbal autistic people, who historically were presumed to be severely retarded.
Just because they got results, doesn't mean that there's any conscious thought going on.
Case in point: http://www.wired.com/wiredscience/2009/09/fmrisalmon/
"So, as the fish sat in the scanner, they showed it “a series of photographs depicting human individuals in social situations.” To maintain the rigor of the protocol (and perhaps because it was hilarious), the salmon, just like a human test subject, “was asked to determine what emotion the individual in the photo must have been experiencing.”
The salmon, as Bennett’s poster on the test dryly notes, “was not alive at the time of scanning.”
If that were all that had occurred, the salmon scanning would simply live on in Dartmouth lore as a “crowning achievement in terms of ridiculous objects to scan.” But the fish had a surprise in store. When they got around to analyzing the voxel (think: 3-D or “volumetric” pixel) data, the voxels representing the area where the salmon’s tiny brain sat showed evidence of activity. In the fMRI scan, it looked like the dead salmon was actually thinking about the pictures it had been shown."
Both the BBC and the Star articles claims this is a first. But it's not.
Back in 1998, my dad had a brain aneurysm (his second, the first was a ruptured brain aneurysm when he was a teenager that he survived without any impairment othe than an aneurysm clip on his left carotid arterty) that required a coil embolization (a new technique at the time, he was the 7th patient they had done at this hospital). After placing the coils, a clot broke free resulting in a stroke. He was recovering well and was almost fully functional, when two weeks later when he developed hydrocephalus, so they placed a ventriculostomy to relieve the pressure. Two days after that while doing a CT to check the placement of the catheter, they found an infection in his brain stem (later to also note that he had developed a left ear infection), which required a craniotomy. That resulted in him being in a coma and on a ventilator.
The only directive he had ever given me was that he didn't want to live on a machine... That ventilator weighed heavily on me. The doctors told me that he had three days to come out of his coma or he probably never would. In an effort to try to get any type of response out of him, they would twist his nipples so hard that they bled. My sister's 14th birthday was on day 5 of the affair and I decided that there was a difference between living on a machine and recovering from a serious incident for a few days. If he didn't come out of the coma, I would pull him off the ventilator on day 7 - just in case he hung on, I didn't want him to die on my sister's birthday.
He woke up on day 3 and ended up on the ventilator for about a week. It was that incident that finalized his brain damage, Essentially, he was a 41 year old that lost the entire top half of the right side of his brain. He wasn't moving his left side at all, he wasn't able to talk well, his short term memory was totally gone, he couldn't even sit up without falling over and could barely swallow a pureed and thickened diet. After 2.5 months of trying to get him stable enough to leave, he went to rehab where he stayed for another 2.5 months.
After rehab, he came home to live with me... and he regained almost all of his mental faculties. He could walk with assistance, having regained most of the major muscle control in his left leg, but his primary long term deficits were the loss of his left arm and the neglect of the left side of his field of vision. The kicker? He remembers every word that was said to him while he was in a coma. The doctors can't believe that the person they see corresponds to the brain imaging that they're looking at... while they expect that amount of plasticity in a younger individual, it's extremely rare in an adult. Needless to say, he was pretty happy with his life, though he faced the usual depression and whatnot that comes with such a significant change in his lifestyle.
Fast forward to this year... he had mastoiditis in the same ear as that infection back in 1998 and took two courses of antibiotics to get rid of it. Five months later, he went blind and started exhibiting stroke symptoms. I took him to the hospital and he was diagnosed with an abscess in his occiptal lobe (visual cortex) that penetrated the ventricles, causing ventriculits. To do imaging and a lumbar puncture, they ended up needing to sedate him and he ended up on a ventilator. Broad spectrum antibiotics (flagyl, vancomycin, and ceftriaxone) were started that night. A week in, he was, once again, no longer responding to pain.
Once again, I was stuck with confronting my father being on a ventilator and essentially in a coma. Once again, the doctors came through telling me that the odds of survival weren't very good and that, given the previous brain damage to the other side of his brain, now that both sides were involved and with little reserve brain left, he almost certainly wouldn't recover.... but there was still a chance that, if I stopped treatment, he could survive, though it wasn't likely. I decided that my dad would want the only option that gave him any chance of an outcome worse than death, so I co
Don't leave your mind so open that your brain falls out. Don't close it so much that you cut off the blood.
Didn't they do something likethis in an episode of Perception, where they told a vegative guy to think of two different things to represent YES and NO, and then went through the alphabet until they got a name?
Actually, the BBC gave a link to the NEJM article. What have they done with those 5 patients since then?
http://www.nejm.org/doi/full/10.1056/NEJMoa0905370
Willful Modulation of Brain Activity in Disorders of Consciousness
Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D.
N Engl J Med 2010; 362:579-589
February 18, 2010
DOI: 10.1056/NEJMoa0905370
Results
Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.
Conclusions
These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
You think that's bad, go read "Make Room, Make Room" by Harry Harrison, and then go subject yourself to "Soylent Green."
That is the bloody poster child for Hollywood fapping not only all over the book's story, but also the meaning of the story, the order of the story, the characters in the story... worst SF movie ever made, hands down, because it didn't just suck, it was the magical transformation from a book that most definitely did not suck, to a movie with absolutely no redeeming value whatsoever that was *also* an insult to its inspiration. Horrific.
I've fallen off your lawn, and I can't get up.
If you don't know, it doesn't matter. Why is it 'sick'?
If you do know, there is hope.
Persistent Volume manager for Kubernetes - https://github.com/dwimsey/openshift-pvmanager
Book -> Movie -> Song
Oh and the concept is hardly original because the book was inspired by reading of the Prince of Wales visiting a real life soldier who had been similarly wounded.
Reality->Book -> Movie -> Song
Gosh, it is almost as if people get inspiration from other people. THIEFS!
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
Of course, you can always make things worse theorizing but in this case, they guy can read and now also answer.
In a civilized country, he would just get an MRI machine since that is what he needs and we can affords it with our means. Oh wait, that is communism right. Yeah, the Romney thing is to let him suffer because euthanasia also isn't allowed.
It is not like providing a 2 million dollar/euro machine for every vegetative person is going to break any countries economy.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
You wouldn't need to say "expect" unless you knew you were a weasel trying to project YOUR opinion on "most" people (most is another weasel word).
It is simply not up to you and thank goodness for that. Their are no simple answers on this and most certainly not ones based on one persons opinion who isn't in that situation.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
http://en.wikipedia.org/wiki/The_Diving_Bell_and_the_Butterfly
probably based on this, book written by author in this state.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
People say easily "I would want to die if I was like that" but when you are like that... quality of life is not hard set. When you get older, you know you are going downhill one way or another. Ask a youngster who says he rather be dead then in a wheelchair how he feels about a walker. To most young people, old age is a horror but when you get there, you find that there is more to live then perfect health. Would you want to see your grandchild even if both of you were in diapers? That is real life.
I can respect people who say "enough" and wish to die but until you are there, you cannot tell and you cannot speak for someone else. I had to sit by twice as someone died knowing that resuscitation was pointless and unwanted and I could see it was but I wanted them with me longer and people don't die easily even if they want it to end.
Until you are there, you just can't talk about it. And you can't make others understand because nobody wants to truly consider death. And I can't blame them.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
You mean consciousness not conscience. It's the difference between Jiminy Cricket and the sound of crickets.
On the other hand, if you want to see a film interpretation of the above idea, see the Torchwood mini-series Miracle Day. It fills your head with all sorts of scary questions.
He must be in severe pain. Unless his injuries have left him with no ability to feel his body, he would likely be in agony.
You cannot say that someone else should die, without asking them, simply because **you** imagine you would want to in that situation. That would violate just about every single code of ethics imaginable.
Actually, one could argue it's supported by the moral codes of most religions, as they all tend to feature some form of reciprocity. Of course, this would be a simplistic argument since any one religion you look at will have other principals, philosophies, and fads affecting how this gets interpreted and applied.
Personally, while I think the Golden Rule has significant weaknesses as a moral guideline, I think it can be helpful in situations like this where you don't have the ability to communicate with the other person. Even if you feel uncomfortable answering the death question (as we all should), someone who is exercising power-of-attorney is going to have to use their own reactions to a judge/make guesses about the other person's thoughts and desires in how to deal with a specific situation.
-1, Too Many Layers Of Abstraction
(*in Morse code*) "Kill me....Kill me...Kill me...."
Johnny Got His Gun
http://en.wikipedia.org/wiki/Johnny_Got_His_Gun_(film)
What have they done with those 5 patients since then?
however, it remained impossible to establish any form of communication at the bedside.
Sounds like all they've done is frustrate the hell out of them, but I hope I'm wrong.
the fact that so many people are kept alive like this and live for years unable to do anything; or the fact that many of the people like this that were allowed to die may have wanted to go on and wait for a breakthrough, that they may have been aware that they were dying...
Treat this man with the respect you'd treat a dog, I say, and euthanize him. This is unbelievably arrogant and cold medicine.