The crux of the article:

More often, brain-injured patients are more conscious than they appear because physical problems limit their responses. Their muscles often become permanently clenched in contracture so they cannot move their arms and legs. They may be deaf or blind, unaware of a neurologist’s questions. They may be in too much pain to pay attention. Just staying awake with an underaroused brain is difficult, and many patients receive muscle-relaxing drugs that make them even sleepier.

Have we been killing people? The answer is almost certainly yes. After a brain injury, doctors may paint a dim picture of the future, and families may withdraw care. But it is increasingly difficult to predict who will linger in limbo and who will make strides.

And sometimes doctors just fail to catch a patient’s subtle or rare fluctuations in awareness. These people are like a Rorschach test, Schiff says; where families see signs of cognition, doctors may see only wishful thinking. “There’s a kind of complacency about it—‘What you see is what you get,’ ” he adds. “Some people don’t have the intellectual curiosity or imagination to anticipate some of the things you might find when you start looking.” Three separate studies, the most recent in 2009, indicate that up to 41 percent of people diagnosed as being in a vegetative state are, when more carefully examined, found to be at least partly aware.

Underestimating consciousness can have tragic consequences. Vegetative patients probably do not feel pain, but imaging experiments indicate that minimally conscious patients do, even if they cannot always react to it. In a European survey, 66 percent of health-care professionals said they thought it was permissible to remove a feeding tube from someone who had been in a vegetative state for more than a year, but only 28 percent felt that way for patients who were minimally conscious. When Schiff gave a grand rounds talk to a group of medical students, residents, and doctors last spring (video), a young neurologist brought up the elephant in the room. “We’re asked early on, when the patient is still in the intensive care unit, what the prognosis is for meaningful recovery for a patient who seems vegetative,” he said. “The family often withdraws care when we say there’s no chance. Have we been killing people?”

The article talks about the work of dedicated doctors and scientists who are working to help a damaged brain rejuvenate and give their owners a chance to live again. http://discovermagazine.com/2011/mar.../article_print