In 2006, the neuroscientist Adrian Owen and his colleagues they noted and reported what happened when a woman reduced to a neurovegetative state was asked to imagine playing tennis. His brain showed a path of activity quite similar to that of a healthy person.
"He wasn't entirely absent," Owen writes in his book In the gray area. A neuroscientist explores the boundary between life and death. "He replied, he did what we asked."
It has been since the late 90s that Owen has been hunting for signs of consciousness in people who are now considered to be devoid of them. His patients have disorders due to accidents, brain damage. Someone is there for other situations that have involved oxygen deprivation of the brain. Disorders of consciousness are different from a coma: in vegetative states or those with minimal signals, people are awake but not present. They may have their eyes open, they move them occasionally: there are "almost" there, but that "almost" makes the difference.
Someone is still with us
Owen and others have presented studies showing how from 15 to 17% of patients with consciousness disorders can produce brain responses such as the woman who was asked to imagine tennis. An important step, which however leaves a lot of anger: we know that some of these people are there, somewhere, but we don't know how to bring them back here.
Un paper published last week in the magazine The Neuroscience of Consciousness examined a breakup proposal. Give psilocybin, the active ingredient found in hallucinogenic mushrooms (and being studied by a brand new medical branch) to induce the recovery of consciousness, or the ability to manifest it.
Andrew Peterson, assistant professor at George Mason University's Institute for Philosophy and Public Policy, said his instinctive reaction to reading the proposal was one of dismay, but then it got his attention.
The idea of giving psilocybin to these patients is based on theories concerning the relationship between brain complexity and consciousness. Complexity is the level at which different brain regions come to communicate with each other, and low levels of awareness are associated with less complexity.
Psychedelia seems to increase complexity levels beyond the limits of normalcy, as he says Gregory Scott, a neurologist at Imperial College London and co-author of the paper proposing the use of psilocybin. There is no definitive scientific evidence that states of consciousness "improve" with the use of the substance, but a large number of cases show several examples of increased brain complexity. That's why Scott and his colleague Robin Carhart-Harris they proposed a test.
Trials would serve to measure the therapeutic value of psilocybin, and show us something new about consciousness. Psilocybin interacts with a particular serotonin receptor, and increases neuronal activity in relation to it. Many of these neurons are concentrated in points believed to be involved in the formation of consciousness, and seeing the presence of responses to stimuli would confirm that these are crucial areas of the brain.
Scott and Carhart-Harris recommend extreme caution and testing initially on healthy subjects in the state of sleep or sedation, to see how much psilocybin intervenes on consciousness in these states. In case of positive results, the researchers plan to extend the tests to patients in a neurovegetative state.
The reason is absolutely (and rightly so) ethics. There are currently no tests, and it would be a crime to practice them on people who are unwilling and unable to show any discomfort or suffering. Psilocybin has been rated as a "breakthrough therapy" by the FDA for test results on depressed and drug-refractory patients. However, patients in an autonomic state are something else.
The ethical risks of the experiment
First of all, there is the possibility that this autonomic state is a protection from the discomfort and suffering of having lost the cognitive abilities necessary to live. If those patients do not currently have conscience, it is by no means certain that finding it would be a cause for happiness. It could be the other way around, and it could be a cruel prison for them.
Ditto in case of anxiety or frightening effects, which patients in that state would suffer without being able to react in any way.
"Just because relatives and friends of patients, or public opinion would like to bring them back with us, doesn't mean that doctors feel empowered to practice everything on them," says Owen. However, in the case of positive responses in healthy subjects, Owen himself would not give up on proceeding. because giving up a cause like that would still be a crime. 20 years of new knowledge on the subject would not have happened if he himself had given up fighting.
And then, let's be honest: these are people who would have died 20 or 30 years ago. Today they are still there in those beds because medicine has made enormous progress (even with radical machines that put death on standby for those who should already be dead, such as ECMO).