Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. 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.
We aim to improve the medical care and understanding of disorders of consciousness following an acute insult such as coma, vegetative state, minimally conscious state or locked-in syndrome. Coma Science Group Cyclotron Research Center & Neurology Dept University of Liège
Parichehr Salasel believed that where there was life, there was hope. Two doctors at Toronto’s Sunnybrook Health Sciences Centre disagreed, saying that it is in the best interests of her husband, Hassan Rasouli, who is in a permanent vegetative state, to be taken off life support and provided with palliative care until his death. The seven-month medical conflict over Mr. Rasouli’s fate ended on Wednesday when Ontario’s top court took Ms. Salasel’s side in a ruling that is expected to reignite for Canadians the emotional issue of how to handle end-of-life decisions and whether extraordinary medical interventions save lives or merely prolong dying.
The Supreme Court of Canada will go ahead later this year and set a legal framework for when patients in a vegetative state can be withdrawn from life support. The court rejected a request this morning from the family of a severely ill Toronto man, Hassan Rasouli, to withdraw the case from its docket on the grounds that Mr. Rasouli recently passed into a higher degree of consciousness.
The family of a man left in a vegetative state after a heart attack has made an eleventh hour appeal for doctors to do all they can to keep him alive as they await a vital court ruling. Tomorrow, the court of protection in London will be asked to rule in a dispute over whether it is in "the best interests" of the severely brain-damaged man, who is from the Greater Manchester area, to continue to receive life-saving treatment if his condition deteriorates. Pennine Acute Hospitals NHS Trust claim it is not in the best interests to offer the man, known only as L, ventilation or resuscitation if his condition worsens and he suffers "a life-threatening event", such as another heart attack. But his family disagree and say they, not the trust, must be given the right to decide on his care.
A hospital trust can withhold life-saving treatment from a severely brain-damaged Muslim man if his condition deteriorates, a court has ruled. Doctors argued it would be unfair to resuscitate the patient, known as Mr L, if his condition worsened. His family, of Greater Manchester, said that was against their Muslim faith. At the Court of Protection, Mr Justice Moylan said it would be lawful to withhold treatment as it would not prolong life "in any meaningful way". He added: "It would result in death being characterised by a series of harmful interventions without any realistic prospect of such treatment producing any benefit."
A woman left with irreversible brain damage and diagnosed as being in a permanent vegetative state is to be allowed to die with dignity after a judge dismissed reports by two “shocked” therapy assistants that she may have repeatedly whispered the word "die". Mr Justice Roderic Wood, sitting in the Court of Protection in London, ruled that "J", 56, who suffered a catastrophic heart attack in September 2010, is in a permanent vegetative state (PVS) "with no sense of awareness and no prospect of recovery".
This application concerns AW, a 57-year-old woman who is in a permanent vegetative state. It is made by the NHS Trust responsible for her care, which seeks a declaration that it is lawful and in her best interests to withdraw active medical treatment, including specifically artificial nutrition and hydration, albeit that this will lead to AW's death. The application is supported by AW's family, by all the medical staff who look after her, by the evidence of the expert witnesses who have reported, and by the Official Solicitor on behalf of AW herself.
National clinical guidelines on the care of people in a vegetative or minimally conscious state, following severe brain injury These long-awaited guidelines will be a major contribution to clinical and ethical standards of care for this group of patients, not only in the UK but internationally. For England and Wales, they provide much needed clarity on legal decision-making. You can buy a print copy of the guidelines (130 pp, £15) from our online shop, or download a free PDF below. The guidelines were developed by a panel of experts in the field, who have organised complicated and wide-ranging information into six coherent sections: 1 Defining criteria and terminology 2 Assessment, diagnosis and monitoring 3 Acute to longer-term management 4 Ethical and medico-legal issues 5 End-of-life issues 6 Service organisation and commissioning Each section is followed by a set of clear recommendations.