Mind over matter:

A case of life and death

Today's column touches on an unusual subject. A story that I read last week on the Der Spiegel Germany and Guardian UK moved me so much that I decided to write on the issue. That is the story of Rom Houben of Belgium, who was in a 'coma' for 23 years and was thought of only as a 'vegetable'. Brain dead, in other words.

But he wasn't. The Guardian described his harrowing tale: "He saw his doctors and nurses as they visited him during their daily rounds; he listened to the conversations of his carers; he heard his mother deliver the news to him that his father had died. But he could do nothing. He was unable to communicate with his doctors or family. He could not move his head or weep, he could only listen.

Doctors presumed he was in a vegetative state following a near-fatal car crash in 1983. They believed he could feel nothing and hear nothing. For 23 years."

His saviour was neurologist Steven Laureys, who decided to take a radical look at the state of diagnosed coma patients. Using a state-of-the-art scanning system, Laureys found to his amazement that Houben's brain was functioning almost normally.

Laureys, a neurologist at the University of Liege in Belgium, published a study in BMC Neurology earlier this year saying Houben could be one of many cases of falsely diagnosed comas around the world. He discovered that although Houben was completely paralysed, he was also completely conscious - it was just that he was unable to communicate the fact. Houben now communicates with one finger and a special touch screen on his wheelchair.

Laureys concluded that coma patients are misdiagnosed "on a disturbingly regular basis". He examined 44 patients believed to be in a vegetative state, and found that 18 of them responded to communication. He suggests that patients suspected of being in a non-reversible coma should be "tested 10 times" and that comas, like sleep, have different stages and need to be monitored.

This story is slowly stirring up a hornet's nest of issues connected with life, death, comatose states and even euthanasia. The implications are simply too glaring to ignore. The findings are likely to reopen the debate over when the decision should be made to terminate the lives of those in comas who appear to be unconscious but may have almost fully-functioning brains. Previously too, there have been reports of coma victims who have revived and in some cases, regained full normality.

There are many accident and stroke victims in hospitals around the island who have suffered the same fate. They appear to be 'dead', fed by IV and oral tubes and kept 'alive' by life support systems. Just how do you guess that such a person could have a perfectly functioning brain ?

Doctors use an internationally-accepted scale to monitor a coma victim's state over the years. Known as the Glasgow Coma Scale, it requires assessment of the eyes, verbal and motor responses. But it is still possible to miss signs that the brain is still functioning.Just how do you deal with such a situation? That is a question that will confront doctors, caregivers and relatives of victims worldwide in the light of this discovery. Who has the power to decide over life ? Who can decide that someone in a coma can no longer feel anything ? Just when do you pull the plug out or stop feeding a comatose person ? What if he or she is very much alive, trapped in their own body but unable to say so ?

The last time such a controversy erupted was when American Terri Schiavo's life support was withdrawn in 2005 after 15 years in a coma. That episode too raised many of the same questions and the medical world itself as well as the public is still divided over the issues.

On the other hand, there are other practical and logistical issues as well.

Is it right to keep someone in a virtually vegetative state in a public or private hospital for years on end, whereas such facilities could be used for a patient who could actually show signs of recovery ? Doesn't it also prolong the agony of relatives who see a lifeless soul who could never really be the same person again ?Again, we come to the fundamental question of life. A coma patient is alive in the strictest sense of the word. Doesn't pulling the plug on the life support system or starving the person amount to killing him or her ? Just who should decide to end a life ? Is such a life worthless ?

This also brings us to the controversial subject of euthanasia. What if someone who is terminally ill or virtually a vegetable, but still able to communicate slightly decides that life is no longer worth living ? A few countries do permit such patients to end their own lives with medical assistance but in most other countries, it is considered a crime or at least ethically unacceptable.

Proponents of euthanasia argue that terminally ill or critically injured patients should be given the right to choose between life and death. They say that if someone cannot ever recover from a serious illness to lead a normal life, euthanasia could be the best way out. It ends the pain of the patients and also the suffering of relatives, they say.

Opponents of euthanasia note that no one, not even the patient himself or herself, should be permitted to take a life. They say that such a course of action amounts to plain and simple murder, even with the patient's consent, since someone has to switch off life support systems and/or end feeding.

What is clear is that medical science - and our minds - are far from deciphering the fine line between life and death. We are still debating whether a fetus can be described as a 'life' in the first few weeks. We are still wondering whether a comatose person is alive in the strictest sense of the word. As Houben's case amply demonstrates, we are still far from understanding all about these vital issues. Life is a mystery, albeit a wonderful one. Medical science and technology can help us understand some aspects of it, but Nature is not likely to reveal all anytime soon.