“To the medical world, …the hundreds of thousands of …Americans who suffer from impaired consciousness present a mystery. Traditionally, there have essentially been only two ways to classify them: as comatose (eyes closed and responses limited to basic reflexes) or vegetative (eyes opening and closing in a cycle of sleeping and waking but without any sign of awareness). In either case, it has been assumed that they have no high-level thought. But Schiff, Hirsch and a small group of like-minded researchers are studying (such patients) and finding that the truth is far more complicated. Their evidence suggests that even after an injury that leaves a brain badly damaged, even after months or years with little sign of consciousness, people may still be capable of complex mental activity. ”If I say, ‘Touch your nose,’ and you touch your nose, and then I say ‘Touch your nose’ six more times, and you don’t do it, how do we account for the one time you did?” asks Joseph T. Giacino, a neuropsychologist who collaborates with Schiff and Hirsch.

Last year in the journal Neurology, Giacino and 10 co-authors accounted for that touch of the nose — and other enigmatic hints of awareness they have observed — by proposing a new category of consciousness: the minimally conscious state. By their reckoning, a vast number of people who might once have been considered vegetative actually have hidden reserves of mental activity. And as the study of Rios suggests, brain scans may be able to help scientists eavesdrop on their inner world. ”It’s free speech for people who have no speech,” Hirsch says.

The implications of this research, both for medical ethics and practical policy, are potentially huge. Traumatic brain injuries are a significant health problem in the United States, but the study and treatment of them are clouded with a sense of hopelessness, a feeling that consciousness is too mysterious to be understood. When faced with patients in a vegetative state, doctors can do little more than wait to see if they wake up. No treatment has ever been definitively shown to help patients recover consciousness, and doctors can’t predict which patients will emerge from a vegetative state and which won’t. If patients don’t show signs of recovery in a few weeks, they usually wind up at home with their families or in nursing homes, and they rarely see a neurologist again. In 1976, in a famous court case, the parents of Karen Ann Quinlan, a woman who had been in a vegetative state for about a year, won the right to take her off a ventilator (after which she lived until 1985). ”There’s a point where people give up” and discontinue aggressive treatment, says Joseph J. Fins, chief of the division of medical ethics at Weill Medical College. ”The question is, Are we giving up too soon on the ones who might become more functional?” Schiff and his colleagues say that the answer, in too many cases, may be yes.” NY Times Magazine