Diagnostic Benefit of the Doubt

Vegetative Patient Shows Signs of Awareness, Study Says (NYT)

"A severely brain-damaged woman in an unresponsive, vegetative state showed clear signs of conscious awareness on brain imaging tests, researchers are reporting today, in a finding that could have far-reaching consequences for how unconscious patients are cared for and diagnosed."

We should not generalize this case-study too much. Still, if there were a scientific test that showed that a DNA test used to convict murderers on death row may be inaccurate, wouldn't there be plenty of people shouting for us to reconsidering our protocols for testing crime scenes? And if we try to protect suspected murderers to that degree, shouldn't we be perhaps be a little more careful in offing patients? Just a thought.

Addendum: Here's WaPo's version of the story .

4 thoughts on “Diagnostic Benefit of the Doubt

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  2. Rob

    In the past, I’ve noted the one problem in this area is the definition of “vegetative state.” In one notable case, a patient recovered from a supposed vegetative state, while a review of his chart showed a mishmash of diagnoses; vegetative state tended to be given by doctors without experience with such patients or who spent little time with the patient, while other doctors with better experience and/or time with the patient gave him a much better diagnosis.

    Inter-rater reliability is obviously a problem. Better diagnostic criteria (functional MRI might become more common as a result), longer time before a hopeless Dx would be given and I’d suspect documentation in some form of devastating brain injury would be included. In this case, it’s worth noting the amount of brain injury was unusually small for a Dx of “vegetative state.”

    Mrs. Schiavo would not have responded to these tests, as we now know those sections of her brain no longer existed. MRI would have been contraindicated for her because of the presence of a metalic implant — a shunt, if I remember right. Use of non-metalic implants in such patients might introduce a new cost/benefit ratio to some therapies.

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  4. Peter

    The woman in the study could not communicate with the researchers, and there was no way to know whether her subjective experience was anything like what healthy people call consciousness.

    Seems like that sorta keeps this from becoming a real issue for the PVS debate. At the very least, it implicates the problem identifying consciousness from an objective perspective by observing brain activity and reminds us that it may be possible to have two brains that appear objectively to be doing the same things, but which present different subjective responses and provide different “subjective experience” (if you believe there is some part within the brain that does the experiencing).

    Also, if the mere observation of brain activity where the brain itself is unable to communicate should count as the existence of a conscious individual, then it would seem reasonable to drop arguments against artificial intelligence like the infamous “Chinese Room” argument. Isn’t the observation of brain activity without subjective experience pretty much what that argument is about? If you grant personhood to people in this state, then why not grant personhood to computers on the grounds that their electronic activity can be observed without knowing whether they have a subjective experience of it?

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