Functional MRI Raises Questions

As I write this the scientists at the Medical Research Council Cognition and Brain Sciences Unit (MRC) in Cambridge, England are conducting a test. They are using a new technique, called the functional M.R.I., to peer inside the human brain (Benedict NY Times). This new equipment is allowing them to map the regions of the brain that are stimulated when a patient is put to different tests. By comparing the reaction of a healthy, uninjured brain to that of someone who has been in an accident the scientists can tell what type of damage has occurred.
This brings a whole new level of diagnosing ability when it comes to brain damaged patients. For years physicians have had only the educated guess to rely on as a tool to determine whether a patient was cognizant of what was happening, could feel pain, or had any understanding of them self whatsoever. Through the use of this new software many of these questions can know be answered. The diagnosing physician can have real-time evidence as to the extent of a patient’s injury, and will therefore be better able to perform treatment.
If this new scanning technique can offer as much information as Dr. Adrian Owen, the MRC’s lead brain researcher says it will, then its going to force much of the medical community to rethink some major issues (Benedict NY Times). Specifically, the issue of physician assisted euthanasia, and many of the concerns regarding patient autonomy and the role of decision maker. If patients that previously were thought to be in a “vegetative” state can be shown to have a significant amount of brain function, should that change how they are cared for? Would a situation similar to that of the “Terri Schiavo Case” be handled differently if there could have been evidence of pronounced brain function?
Members of the medical community have differing opinions as to what the impact of the functional M.R.I. will be. It is undecided as to what extent this new technology should be used, and whether it can be fully trusted as a diagnosing tool. Anatomically speaking there is more going on in the brain then just electrical currents passing from neuron to neuron. Dr. Owen admits that this new software doesn’t solve the entire puzzle, but provides a significant piece (Benedict NY Times). Patients who suffer severe brain damage due to oxygen deprivation may show brain activity on the scan, but will never regain consciousness or function as normal, healthy human beings.
Regardless, this new technology gives the medical community a stronger scientific basis to make their case against what often times becomes a discussion of moral and ethical behavior. Euthanasia, the treatment of patients in a “vegetative” state, and even the level at which autonomy of the patient should be deciphered all have to be re-examined due to these recent breakthroughs. Dr. Joseph Fins, chief of the medical ethics division at NY Presbyterian Hospital, said it best, “For now I think what this study does is to create another shade of gray in the understanding of gray matter.”

-Peter A. Beaulieu

Mental Activity Seen in a Brain Gravely Injured, Benedict Carey, September 8, 2006: NY Times (http://www.nytimes.com/2006/09/08/science/08brain.html)