Hope for Comatose Patients: The Science of Consciousness

The Uncertainty of Consciousness:

Comatose

In life, we always face various uncertainties that baffle our minds; whether it be from simple choices in our every day lives or from important decisions involving the question between life and death. The world of medicine is no stranger to the confusions of life in which, it encounters one of the hardest question in medical ethics: what is the right thing to do? The main theme that we are going to look focuses on the decision making in comatose patients. Indeed, it is a tough decision especially when we consider the the best treatment plan for the patient. To unlock the mystery of whether or not a patient is still likely to recover from a coma, we must look at this dilemma through the lens of consciousness. 

In the scientific community, numerous research are accomplished and are still on-going to tackle the neuroscience of consciousness. For the case of coma, it is important to determine the state of consciousness of the patient in order to assess the appropriate treatment plan. Daniel Bor (2012), a cognitive neuroscientist, unravels the science behind consciousness in his book "The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning." He emphasizes the relationship between interfering brain functions and consciousness, especially  when certain brain damage is involved where it can have long term effects to our consciousness. For instance, he describes the three types of diagnosis of a patient in a coma, or as he describes--being robbed of ones consciousness. First, the patient is in coma when he or she is "entirely unconscious with eyes persistently closed." Second, when the patient has a functioning sleep-wake cycle but shows no signs of awareness, he or she is in a vegetative state. Lastly, if the patient can show small signs of awareness (ie. eye movements and arm movements), then he or she is said to be in minimally conscious state. Bor is fully aware of the difficulty in distinguishing between a patient in vegetative state and minimally conscious state. The right diagnosis will provide either hope or a false hope to family members; thus, the physician's assessment is critical. However, an interesting concept is presented by Bor in determining consciousness through communication via a brain scanner. He implies that even though a patient may appear to be unconscious, there is a possibility to tap their brain's potential to react and communicate by assessing their brain activity when asked several questions. Moreover, this concept was tested on young man was in a vegetative state for five years as he answered correctly to personal questions from his selective brain activity. Mary-Ann Russon (2014) writes in her article, "Hidden Consciousness in Vegetative Patients Could Be Detected by Simple Bedside Test," about how this concept is being used in medicine today. She notes in her article about how research has shown similarities between the brain activity patterns of healthy patients and vegetative patients. Furthermore, she presents key studies that show how unconscious patients can respond to questions as seen on their brain imaging results. For example, when the patient is asked to imagine a scenario like playing tennis, the region of the brain responsible for movement will light up in the brain scanner. This is a remarkable breakthrough in medicine and neuroscience, in which it may aid in solving the issues of consciousness for someone in a coma. This will allow for future studies involving the significance of these brain patterns and the likelihood of recovery for patients in a vegetative state. 

It is true, however, that it is still a mystery when it comes to making the "right" decisions. It's mostly subjective at this point and the waiting game continues. And yet, new technologies and scientific discoveries are rising to provide the best care possible for patients who are being robbed of their consciousness. The contribution of neuroscience may be the first step, but it can certainly open the doors to numerous solutions and breakthroughs along the way. Perhaps most important, it is the provision of hope that matters. 

References:

Bor, Daniel. The Ravenous Brain: How the New Science of Consciousness Explains Our Insatiable Search for Meaning. New York: Basic, 2012. Print

Russon, Mary-Ann. "Hidden Consciousness in Vegetative Patients Could Be Detected by Simple Bedside Test." International Business Times, N.p., 17 Oct. 2014. Web. 17 Oct. 2014

<http://www.ibtimes.co.uk/hidden-consciousness-vegetative-patients-could-be-detected-by-simple-bedside-test-1470540>