There's a sobering, if not scary, story in the Feb 3 issue of the New England Journal of Medicine. British and Belgian physicians have been able to use brain scans to communicate with patients thought to be in a vegetative state. By monitoring brain activity, and asking the subjects to imagine one kind of activity if the answer to a question was 'yes' and to imagine another type of activity if the answer was 'no', they were clearly able to get responses from a high fraction of subjects (conscious controls were used as comparisons).
As usual, the hyperbolizing science press, in this case our favorite, the BBC, said that scans "unlocked" vegetative patients. From the headine, one envisioned them getting up and going out for a spot of tennis. But there's no such thing. What the scans did was allow researchers to communicate with these suffering people. They are still 'locked' from normal activity, brain or physical. Too bad, since these are important and interesting findings that didn't need the exaggeration treatment that journalists simply can't refrain from.
This has obvious implications for many aspects of supposed vegetative states, not least being that associated with decisions to withdraw care and allow the patient to die. But some deeper questions might also be asked, and they have to do with how these results are being interpreted. The key question is whether these individuals were conscious or not.
Given the patients' clear responsiveness to decision-making tasks (answering questions), one might assume that this implied consciousness. Indeed one commenter quoted in the NY Times report on this story says it opens new a new window into human consciousness. But that may not be so. Many experiments on humans who have had surgery that impaired one of their hemispheres, or separated their two hemispheres, have shown that rational, responsive, decision-making capability exists independent of consciousness. Other recent work shows that conscious awareness may monitor, but comes split seconds after decisions are made by the brain. In other words, brains can think without being conscious. Apparently the NEJM ran a commentary by a Dr Ropper, who does not claim this has to do with consciousness--'identity' is the word he used, which seems to us to reflect a proper reserve.
The fact that brains can think without being 'conscious' is interesting and relates not just to the question of what consciousness actually is and how we can ever know that, but also what sort of consciousness other organisms, ranging from apes to ants, may have. They all clearly make decisions and act rationally. They can solve problems, coordinate action with others, and evaluate their circumstances. And they respond. But are they 'conscious'? Can they be asked if they wish to life or die?
Who knows. But the responsiveness of people in vegetative states raises this question along with the ethical questions about euthanasia and so on. For example, suppose it could be shown that these unfortunate people are not conscious, but that their unconscious brains are functioning. Should we ask those partially aware brains if they want to live or die?