Dramatic advances in communication with people in a minimally conscious state have provoked questions central to our ideas about what makes life worth living
TERRI SCHIAVO died after 15 years spent in a state that many fear as much or more than death itself.
In 1990, Schiavo suffered a heart attack that left her in a persistent vegetative state. With no clear record of her wishes, her fate became the subject of a bitter dispute that pitted her husband against her parents, divided US public opinion and prompted the intervention of president George W. Bush before being settled by the US Supreme Court in 2005.
Sadly, the Schiavo family's heartache is not unique. In fact, it is becoming more common. Last year, for example, a UK court ruled against resuscitating a devout Muslim who was in a minimally conscious state. His family had argued that he would have preferred to live on, believing this to be God's will.
Few people make "living wills" that specify how they would like to be treated in such situations. Once in a vegetative or minimally conscious state, they cannot express their wishes themselves, leaving physicians and family with the unenviable duty of choosing a course of action.
This scenario is about to become more fraught still. This week brings news of a remarkable discovery: stimulating the brains of people in such conditions can rouse them, for short periods, to the point where they can answer simple questions (see "Brain zap rouses people from years of vegetative state").
This discovery has clear medical benefits: it should help doctors to make better assessments of patients' conditions. The hope is that researchers will be able to extend the stimulation, resulting in more significant brain activity and even, perhaps, a return to something resembling an acceptable quality of life.
Before then, there is a host of ethical issues. No one has yet asked the obvious questions: are you suffering? Do you want to live, or die? These questions will one day be asked, even if we don't yet know how to interpret any answers. We may not know any time soon. The only way to dictate our fate is to decide and record what we consider to be a life worth living.
This article appeared in print under the headline "Decision, decisions"
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