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A beautifully told story with colorful characters out of epic tradition, a tight and complex plot, and solid pacing. -- Booklist, starred review of On the Razor's Edge

Great writing, vivid scenarios, and thoughtful commentary ... the stories will linger after the last page is turned. -- Publisher's Weekly, on Captive Dreams

Thursday, July 19, 2012

Even More Ethically Fraught

 In The Instrumentality of the Brain, we noted a boy born without a cerebellum -- the part of the brain that controls motor skills, balance and emotions -- and who "has the MRI of a vegetable"; yet who has learned to walk and interact.  He is also missing his pons, the part of the brain stem that controls basic functions, such as sleeping and breathing.  And yet he breathes and sleeps just fine.

No brainer: The brain of the patient (left)
compared to a normal MRI scan (right)
Other cases are known, such as the French civil servant, whose brain was virtually absent, reduced to a thin layer around the skull, a condition known as Dandy-Walker syndrome.  Pause here for jokes about civil servants.  Or Frenchmen.  But he functioned more or less normally in society despite having water where his brain should have been. 

 The British neurologist John Lorber reported on the case of a slightly hydrocephalic math student with an IQ of 126, who also was almost lacking in brains (cf. Is the brain really necessary).

The current sexy thing among the cognoscenti is the use of fMRI to "prove" that there is no free will, a topic which, for some reason seems to obsess the likes of Jerry Coyne.  Or at least the brain atoms collectively known as Jerry Coyne.  It seems that at least some of these folks believe that by attacking free will, they are attacking religion; but they are actually attacking humanism.

It all stems from the belief that the brain "is" the mind and is unique among organs.  All other organs are instruments used by the organism.  But the brain somehow is the organ that uses an organism.  Very mysterious, even miraculous; but there is no accounting for deep-held beliefs.  Others, like Nagel and Searle, although naturalists themselves, contend that the brain cannot possibly be the mind.  To which Coyne, Dennet, Churchward, et al. respond that they do not have a mind.  Which sort of settles the controversy, at least in their minds.  Oops. 

A Sword Has Two Edges

A recent story surprisingly featured on a Huffington Post site is "Mark Ellis Locked-In Syndrome: Father Learns To Talk Again By Copying Baby Daughter."  Here we learn that
Ellis had a stroke at 22, which put him into a coma, The Telegraph reported. After he came out of the coma, he was only able to communicate by moving his eyes -- and doctors said a blood clot in his brainstem severely lowered his chances of being able to move his body again, according to The Telegraph.
...
But after undergoing speech therapy and physiotherapy -- and with encouragement from his therapist to try to copy his daughter, who was in a babbling stage -- Ellis was able to improve his speaking ability, the Daily Mail reported.
"He started to make the same sounds, and then the words came too," Amy told The Sun
 Well, it's not the first time a vegetable woke up.  But have we ever talked to a vegetable?

A New Way to Blink Your Eyes

A recent article in Nature entitled "Neuroscience: The Mindreader" tells us:
Adrian Owen still gets animated when he talks about patient 23. The patient was only 24 years old when his life was devastated by a car accident. Alive but unresponsive, he had been languishing in what neurologists refer to as a vegetative state for five years, when Owen, a neuro-scientist then at the University of Cambridge, UK, and his colleagues at the University of Li├Ęge in Belgium, put him into a functional magnetic resonance imaging (fMRI) machine and started asking him questions.
Incredibly, he provided answers.
Thinking about playing tennis (left)
Thinking about walking through the house (right)
Vegetative Patient 23 was told to respond to questions by imagining one of two physical activities, playing tennis and walking through their house:
When healthy, conscious adults imagine playing tennis, they consistently show activation in a region of the motor cortex called the supplementary motor area, and when they think about navigating through a house, they generate activity in the parahippocampal gyrus, right in the centre of the brain.
The patient was told that to answer "yes" he should imagine playing tennis; to answer "no" he should imagine walking through his house.  This would cause one of two distinct brain regions to light up.  Then he was asked questions the answers to which were unknown to the technician reading the scans.  These questions were asked multiple times with rests in between in order to eliminate spurious results.  The patient "answered" five of the six questions correctly.  On the sixth, there was no discernible response. 

The fusiform face area (FFA) is activated when people see a familiar face.  In an earlier experiment, a patient named Kate Bainbridge was diagnosed as being in a vegetative state after a viral infection had first put her in a coma.
When the team showed Bainbridge familiar faces and scanned her brain, “it lit up like a Christmas tree, especially the FFA”, says Owen. “That was the beginning of everything.” Bainbridge was found to have significant brain function and responded well to rehabilitation. In 2010, still in a wheelchair but otherwise active, she wrote to thank Owen for the brain scan. “It scares me to think of what might have happened to me if I had not had mine,” she wrote. “It was like magic, it found me.”
She had cause to be scared.  Ask Terri Schiavo, who had virtually no brain left and was diagnosed in a persistent vegetative state until her husband wanted to get on with his life.  There have been other cases of people spontaneously emerging from such states, whether they relapse or not. Some patients in full coma report on awakening that they had been aware the whole time.  (Not all.  It depends on the nature of the coma.) 

Owen and colleagues have more recently devised a less expensive and less time-consuming method using EEG.  This method does not scan as deeply into the brain and so imaginary toe-wiggling and fist-making were used instead of imaginary tennis and imaginary house tours.  They found that 3 of the 16 vegetative state patients showed signs of awareness when scanned by EEG. 

So This Was All Over the Evening News, Right?

Actually, some neuroscientists were concerned that this would make it harder to off granny or starve your vegetative spouse to death.  The Nature article reports:
Owen's [fMRI] methods raise more difficult dilemmas. One is whether they should influence a family's or clinician's decision to end a life. If a patient answers questions and demonstrates some form of consciousness, he or she moves from the 'possibly allowed to die' category to the 'not generally allowed to die' category, says Owens. Nachev [another researcher] says that claiming consciousness for these patients puts families in an awkward position. Some will be given hope and solace that their relative is still 'in there somewhere'. Others will be burdened by the prospect of keeping them alive on the basis of what might be ambiguous signs of communication. 

Even more ethically fraught is whether the question should be put to the patients themselves.
Well, we can't have that, can we.   Ambiguous signs of communication?  Ethically fraught?  What are we supposed to do if we aren't sure whether there is a human being in our crosshairs or not?  Pull the trigger because it might be a deer?  

Are zombies conscious or not? Are Jerry Coyne
and Dan Dennett in the crowd shown?
The reaction to Owens' experiments is that the fMRI scans do not necessarily prove the patient is conscious.  Of course, a person sleeping at the end of the day is not conscious, either; but never mind that.  Owens counters that responding to commands and questions is an undeniably conscious activity.

“In the end if they say they have no reason to believe the patient is conscious, I say 'fine, but I have no reason to believe you are either'.”  

Which is true.  The Turing Test is inconclusive.  See Searle's Chinese Room for instruction.  Ultimately, the state of being conscious can only be judged by the person experiencing the consciousness, and some of our friends on the fringe are anxious to show that they themselves are not.

But I love how precise and reliable fMRIs are when they "prove" that there is no free will, but must suddenly be viewed with caution when they seem to prove vegetative patients are aware.

8 comments:

  1. Well if the brain is so unimportant, why did the Enterprise spend so much time chasing Spock's brain? Huh? What about that?

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    Replies
    1. Any possible answer would be pure spockulation.

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  2. So...

    If, as in these examples, one could function as a civil servant with so little brain tissue, then perhaps the "we use only 10% of our brain" meme may have some merit.

    JJB

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    Replies
    1. I was a civil servant. Perhaps I shouldn't take this one any further!!

      Delete
  3. This is additional evidence that we must register and license all neuropsychologists.

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    Replies
    1. Well, perhaps not licensed but classed as tea-leaf readers. They so fascinated with the images from their new toy they figure the pretty pictures MUST mean something.
      "Look! We've found the cause of violence, just check out the brain areas that light up playing video games!"
      Um, you mean the same ones as playing chess.

      I'll be more impressed when they can identify locked-in patients who are most likely to awake, or better yet, figure out HOW to wake them.

      Delete
    2. Um, they *are* awake. They're just not awake in the same way that you are.

      Delete
  4. I've always been fascinated by cases where people lacking any semblance of normal, vital brain structures are able to think and act more or less normally. Just a single one of these cases ought to suffice to totally debunk the idea that we fundamentally understand how the mind works based on MRIs, and to cast tremendous doubt on the mechanistic understanding of biology, evolution, and even matter itself. But proponents of that view seem to just rationalize these things away, and to think that they don't "count" for whatever reason.

    ReplyDelete