A brilliant, intense Brit now at Western University in London Ontario, documents, in layman’s terms, the work he and his teams have undertaken to explore the boundaries of consciousness and what it means to be alive as a human being. Using a variety of innovative neuroimaging techniques that have garnered worldwide attention, they conclusively show that some people with no other means of communicating that they are alive, thinking, and capable of diverse emotions, are in fact, aware, are still “in there,” locked in a body unable to communicate by any of the usual means.
But the techniques are not foolproof and occasional patients in a “persistent vegetative state” who repeatedly do not show any responsiveness or awareness of their surroundings, using the most advanced technologies to communicate, later evolve into a state approaching mental normality. Family members, it seems, often are the best judges of who is aware in this Gray Zone after devastating brain injuries, even if they misinterpret what they are seeing. And the possibility that the comatose unresponsive individual is listening, understanding, seeing feeling, smelling, etc. should be the default assumption of everyone who cares for him or her.
This work is fraught with ethical, legal, and philosophical dilemmas with no easy answers which the author acknowledges. Like almost all modern neuroscientists, Owen seems optimistically confident that computer-brain interfaces will in the future vastly enhance the quality of life for those whose brains seem unable to communicate with the outside world, but all such predictions are, at best, guesses.
The discussion of the limitations of advance directives is insightful. How could I possibly know that I would want my family to help me die given the endless possibilities of the exact injuries leading to my non- communicative state, until I am actually there? Many patients in a persistent vegetative state communicate, via technology, that they are quite happy, have a good quality of life, and do not want to die.
As I read of this work, I feel grateful that I was never involved in the decisions about donors for organ transplantation, only working with recipients and potential recipients. Donors who fulfill criteria for brain death present few of the ethical problems that the later practice of DCD, (donation after cardiac death) pose. In this practice, someone who does not fulfill criteria for brain death, but for whom the decision has been made to withdraw life support and donate organs after their hearts have stopped beating, may become a donor. How can all involved be sure that the non-communicative person did not want to continue living? At least the transplant professionals are not directly involved in those decisions. I do not envy those professionals and family members charged with making such difficult decisions.
The discussion of societal consciousness, group consciousness, or “cosmic consciousness” reminded me of another London, Ontario professional, Dr. Richard Maurice Bucke, a nineteenth century psychiatrist who developed a theory of cosmic consciousness that never caught on. His biography by my late friend, Dr. Peter Rechnitzer, was a fun read.
The writing is clear and easy to understand even though it is absolutely humourless and less than lyrical. I think this book will be of continuing interest to philosophers, ethicists, and neuroscientists (and those of us who aspire to be at least amateurs in those fields). And kudos to my alma mater for having recruited him away from more prestigious institutions. Thanks, Maria Moore, for the suggestion.
The Passionate Reader 