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The future of consciousness imaging

The British and Belgian team's conclusion that the young English patient is "beyond any doubt" aware has sparked scientific controversy, but neurologists agree on one point: Her remarkable story strengthens the case for the use of fMRI as a diagnostic tool in the absence of external signs of responsiveness.

The concern remains that with time and additional testing, brain scans might prove unreliable and might even raise false hopes in futile cases. But there is widespread optimism that Dr. Owen's claim might be true—that he and his team "have found a way to show that a patient is aware when existing clinical methods have been unable to provide that information."43

In addition to its potential diagnostic uses, Owen, Laureys, and colleagues believe fMRI could prove therapeutically powerful. The young English woman's demonstrable mental actions, they argue, suggest "a method by which some noncommunicative patients, including those diagnosed as vegetative, minimally conscious, or locked in, may be able to use their residual cognitive capabilities to communicate their thoughts to those around them by modulating their own neural activity."44

A patient's thoughts could show up on-screen in ways that might be understood by others—a heartening prospect for families and friends of patients like Kate Bainbridge and Nick Chisholm, who may spend excruciating months or years hoping and praying for their loved one's recovery. Even if fMRI fails as a communication device, it might ensure that patients receive the most appropriate care for their condition, as soon after their injury as medically possible.

At the other end of the spectrum are patients who, tragically, will not get better. For these patients, high-tech life support maintains their body without promoting meaningful recovery. The arrival of powerful life-extending technologies in the 1960s and 1970s provided new hope for seriously ill and injured patients who might recover with time, but there was a new problem. These machines could, in the words of Supreme Court Justice Antonin Scalia in the 1990 Nancy Cruzan verdict, "keep the human body alive for longer than any reasonable person would want to inhabit it." Families were faced with the unbearable decision of when, if ever, to withdraw medical care from a loved one.

What parent would not sympathize with the heartache of Nancy Cruzan's father? Nancy—whose car flipped on an icy, deserted road in the winter of 1983 and threw her facedown in a watery ditch—suffered severe brain damage due to oxygen starvation, just as Theresa Schiavo would several years later. Mr. Cruzan, faced with the horrific choice of whether or not to remove his daughter from life support, mourned, "If only the ambulance had arrived five minutes earlier or five minutes later."45

Loved ones face precisely the same agonizing dilemma today. The fMRI scan answered a question for the young English patient's loved ones, a question that torments family and friends at the bedsides of comatose and vegetative patients everywhere. "Can she hear what I am saying?"

In this extraordinary case, the answer appears to be "Yes."

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