Whether patients in a vegetative state are conscious and aware of their surroundings is a question that has long troubled families and doctors. Recent functional MRI (fMRI) studies involving a 23-year-old woman who sustained a severe traumatic brain injury have indicated that she might be aware of her surroundings and able to carry out mental tasks, prompting hopes that patients in vegetative states could one day communicate with those around them.

During an fMRI study, Adrian Owen et al. gave the patient spoken instructions to imagine walking around rooms at home or playing tennis. Owen described the neural reponses as “indistinguishable” from healthy volunteers, and claims that “her decision to work with us when asked represents a clear act of intent ... she was consciously aware of herself and her surroundings” (The Times, 8 September 2006). Writing in the same issue of Science, Lionel Naccache of the Cognitive Neuroimaging Unit in Orsay, France, agrees that “the fMRI findings indicate the existence of a rich mental life.”

However, Owens himself points out that “all vegetative patients are different: they have damage done to different parts of their brains and their chances of recovery are different” (BBC News Online, 7 September 2006). Paul Matthews, at the University of Oxford, goes further: “When patients are in a vegetative state they can react to stimuli but not in a truly meaningful way ... Response to stimuli, even complex linguistic stimuli, does not provide evidence of a decision to respond” (The Times, 8 September 2006).

Regardless of the precise extent of awareness indicated by this study, as Naccache puts it: “this single case makes a strong argument for the development of fMRI and other neurophysiological tools ... to evaluate cognition in such patients”, and might help to make decisions about patient care.