It is widely reported that a new type of brain scan has detected mental awareness in a women who had been diagnosed as being in a "persistent vegetative state:"

 According to all the tests, the young woman was deep in a
"vegetative state" — completely unresponsive and unaware of her
surroundings. But then a team of scientists decided to do an
unprecedented experiment, employing sophisticated technology to try to
peer behind the veil of her brain injury for any signs of conscious
awareness.

Without any hint that she might have a sense of what
was happening, the researchers put the woman in a scanner that detects
brain activity and told her that in a few minutes they would say the
word "tennis," signaling her to imagine she was serving, volleying and
chasing down balls. When they did, the neurologists were shocked to see
her brain "light up" exactly as an uninjured person’s would. It
happened again and again. And the doctors got the same result when they
repeatedly cued her to picture herself wandering, room to room, through
her own home.

"I was absolutely stunned," said Adrian M. Owen, a British
neurologist who led the team reporting the case in today’s issue of the
journal Science. "We had no idea whether she would understand our
instructions. But this showed that she is aware."

    Researchers are quick to point out that this study is based on one person and cannot be readily generalized to others.  But, as might be expected, the name Terri Schiavo has already been mentioned in relation to this news; I imagine Haleigh Poutre will soon be brought into the discussion.

    For me, the key question raised by this sort of apparent technological advance is: what difference does it make for our ethical judgments about individuals and end of life situations?  And my first, preliminary answer is: not much.

     Essentially what this research does is to understand in a bit more detail the experiences of brain-impaired people.  Terms like "persistent vegetative state" have always been, and can only be, vague statements of general clinical conditions.  There is, obviously, a wide range of individual experience within that general category, just like "cerebral palsy."  "Vegetative state" is not a black and white, clearly demarcated condition.  It is a fairly wide continuum of physical reality.  As such, it is not particularly helpful when it comes to determining how to care for disabled people.

    What matters in making care decisions (and I am basing my thinking here on Confucian and Taoist ethics) are, first, the personal wishes of the individual involved and, second, the informed consideration of those closest to the individual involved.  Death is, first and foremost, a personal and social act, not a technologically determined state.  So, as we find ourselves moving toward death, be that quickly or slowly, the personal and the social should determine how the end is confronted.

     If a person wishes to say (in the relevant legal documents) that she wants to forgo aggressive care (and what "aggressive" means can be specified by the individual), even if she is still aware, that is, and should be, acceptable.  A Taoist might want to just let go of medical interventions and allow the unfolding of the end of life to proceed unimpeded.

    Should the personal wishes of an individual be unclear or not fully specified, a health care proxy should manage the end of life questions.  If I were in such a situation (and I have been), I think it is a good and necessary thing to involve other family members and friends, in the decision-making.  That is what a Confucian sensibility would value.  If families cannot come to a reasonable consensus (as was the case with Schiavo), then the legal would trump the ideal, and the formally recognized health care proxy should make the call.

     Nowhere in all of this is there room for strictly applied, universal definitions of appropriate care.  "Right to life" advocates have to recognize that there is dignity in how someone may die, not just in maintaining someone’s life.  In the song "Seasons of Love," one of the answers to the question "how do you measure the life of a woman or a man," is "in the way that she died."  That’s right.  Both Taoists and Confucians would agree.

     So, the new technological breakthrough is largely irrelevant to the Schiavo and Poutre cases.  In the latter, it seems to me that what needs to be done now is the appointment of a health care proxy other than the immediate family members, who failed so terribly before Haleigh nearly died.  It seems that her medical condition has improved, but there is still much we do not know.  What is clear, however, is that her continued care will be very expensive, and it is a cost that should be borne by the society at large if the proxy determines that that is in Haleigh’s best interest, which seems like a fairly obvious outcome.

    I just hope the "right to life" people, who were so quick to condemn state agencies earlier in Haleigh’s saga will now call for enhanced state support (and, to be honest, that means taxes) that will allow all people with significant disabilities their rights to life.