In his book, Into the Gray Zone, neuroscientist Dr. Adrian Owen reveals the amazing results of his team's research with patients diagnosed to be in a "persistent vegetative state" (or PVS). There are many articles and videos available online that discuss various aspects of his findings, but the book is a much more in-depth and fascinating account.
His initial findings that Kate, "Patient 1," who appeared totally unresponsive, nevertheless had a completely normal brain response to testing shocked not just his team but the medical world. In successive research, his team has found that some 20% of patients with a PVS diagnosis whom they have scanned are in fact "vibrantly" conscious and aware. This number might even increase as detection methods improve.
Owen does engage with the implications of his research to the care of patients, and raises important concerns and challenges to the status quo, which often treats such patients as if they were potted plants or furniture rather than persons.
A couple of illustrative quotes follow. The first is part of his summary of a study by another researcher, Stephen Laureys.
While most of us declare that we would not want to live if we were "locked in" following a brain injury, only 7 percent of the entire group surveyed by Laureys and his team expressed a wish for euthanasia, suggesting that our preconceived notions about what we might think if the worst was to happen are false. On the contrary, most locked-in patients are reasonably satisfied with their quality of life ....
This study questions whether any of us are in a position to judge what we might want to happen to us following a serious brain injury. Is it dangerous, then, to make an advanced directive? Imagine the nightmare of leaving a "do not resuscitate" order and being conscious as it was carried out against your (current) will.
Into the Gray Zone, pp 186-7.
In the next paragraph, Owen does make what I think is an elementary error, when he says that with rapidly advancing technology, we will soon be able to make contact with patients and assess their wishes soon after a brain injury. Such a time, when the person has not yet had time to come to terms with what has happened, is a terrible time to ask life or death questions!
This next quote is truly astounding, and takes a lot of humility for a neuroscientist to admit:
We finally had absolutely unassailable evidence that a patient could appear entirely vegetative, yet remain absolutely conscious, experiencing life down to the very last detail without any of us even knowing it. Think about it. How else could Juan describe the inside of an fMRI scanner unless he'd been there and awake when we pushed him into it? ... The only explanation was that Juan had defied medical opinion and continued to monitor and remember the world around him for many months, all the while appearing to be in a vegetative state. What was perhaps most remarkable about this feat was just how good Juan's memory for that period was. His brain had been starved of oxygen and sustained massive damage. How was that possible?
The more I thought about Juan, the more I realized how little we still understood about consciousness and its many faces. We'd thrown everything we had at Juan, every type of brain scan, every newfangled technique we had at our disposal; yet we had failed to spot consciousness where consciousness clearly existed, in spades. ... This haunting reminder of the resiliency of consciousness forced me to reflect anew on the nature of being, the meaning of what it means to be alive, and whether anyone can be said to be irretrievably lost.
Into the Gray Zone, p 215
Owen has managed to convey rather complex concepts in a very readable manner. I highly recommend Into the Gray Zone to anyone interested in consciousness, brain injury, or end-of-life issues.