There’s been an earthquake. The pile of rubble doesn’t stir. Then a faint tapping emerges from within it. You shout “Can you hear me?” More tapping. “Tap once.” One tap. “Tap twice.” Two taps.

There’s someone there.

The scene stands as a compelling metaphor for a hospitalized human being struggling to communicate though the rubble of a devastated body.

Back in 2010, I wrote an essay about how researchers, using functional magnetic resonance imaging (fMRI), which identifies active brain regions during tasks, were able to show that patients diagnosed as “vegetative”—what a terrible word to use for a living human being—were in fact able to communicate.

The New York Times finally caught up with the news last week, in a 9,000-word piece in its Sunday Magazine that laid out the saga of a woman whose husband, after a devastating cardiac arrest, had been written off as permanently unconscious. She insisted on exploring whether he might, despite his inability to respond physically, still be “in there.” She believes he is. And, while the subject of the Times story has not yet been tested by fMRI, the report makes clear that writing off “vegetative state” patients as unconscious is unconscionable.

About time the world learned that lack of response doesn’t equate with lack of life.
Back in 2006, the authors of an article in a National Institutes of Health journal presented this abstract of their report:

“We used functional magnetic resonance imaging to demonstrate preserved conscious awareness in a patient fulfilling the criteria for a diagnosis of vegetative state. When asked to imagine playing tennis or moving around her home, the patient activated predicted cortical areas in a manner indistinguishable from that of healthy volunteers.”

When a person is thinking about active movement, cells in one area of the brain become active; when he visualizes navigating a familiar area, a different area shows cellular activity.

In a subsequent experiment, researchers, in addition to asking unresponsive patients to imagine playing tennis or walking through their homes, posed a series of factual yes-or-no questions. They instructed each patient to respond by imagining playing tennis for “yes” and walking through their homes for “no.” Four of the 54 tested patients were able to respond entirely accurately.

Left for us to speculate is whether some even more sensitive future technology might one day reveal consciousness even in patients whose brains cannot generate signals detectable by current methods.

Some, in 2010, were not convinced that even fMRI-responsive patients are, in fact, meaningfully alive. In an editorial in The New England Journal of Medicine that year, neurologist Dr. Allan H. Ropper warned against overinterpreting neural activity with “identity.” He asserted that “Physicians and society are not ready for ‘I have brain activation, therefore I am.’ That would seriously put Descartes before the horse.” Quite the joker, that Dr. Ropper; the issue, though, is rather serious.

University of Glasgow Professor of Law and Ethics Sheila McLean, less dismissive than Dr. Ropper, nevertheless asks, “If recovery truly is impossible, is it compassionate to keep people alive in this condition?”

That question assumes that bodily control is the determinant of life-worthiness.

It’s an insulting assumption. A paralyzed human being who can communicate, even rudimentarily, might still engage important matters, things like mechilah, teshuvah, hakaras hatov, and ahavas Hashem. He can still enjoy visits from family and friends, music and news about his interests. He can still “recite” in his mind the words of Krias Shema and daven and listen to a shiur. Are such vital encounters worth less than running and jumping…or even speaking?

Professor McLean notes that “the consequence of a diagnosis of permanent vegetative state is that it can be lawful to withdraw assisted nutrition and hydration,” resulting, of course, in the patient’s death.

Is ending a life of a mind less objectionable that ending that of a basketball player?
To address Ms. McLean’s observation, a 2011 study in the British Medical Journal examined people who were cognitively healthy but able to communicate through eye movement. The paper found that the large majority of the “locked-in” patients were happy, and, surprisingly, that those who were locked in for longer were more likely to be so.

Back to the earthquake aftermath. Imagine someone hearing some faint tapping… and just walking away…

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