Consciousness is not binary; it's gradual, with many dimensions. While that might seem like a consideration to be pondered by philosophers, it can have major real-world implications.
In 2009, a 21-year-old woman was assessed by the team of Dr Laureys at the University Hospital of Liège in Belgium. She was considered comatose on arrival. But a recording of her brain’s electrical activity showed she could respond to her name in a list of random names. Her brain activity responded to simple questions — she was hearing, understanding and doing what she was asked to do. In other cases, she would have been deemed comatose or vegetative but her brain showed she was conscious, yet suffering from a total locked-in syndrome with no means of speaking or moving. The moment was significant as clinicians were discussing end-of-life decisions with her family at the time. She subsequently recovered and was eventually able to control a wheelchair.
There has been a historical misconception that consciousness is either ‘all or nothing’ — that comatose or vegetative patients are completely unaware. Clinicians sometimes fail to recognise minimal signs of consciousness after a coma. And often it’s the family who first realises there's more going on in the brain of a patient. Consciousness is possible, despite not visibly appearing to be. Patients who exist in the shades of consciousness receive little attention — a literally silent epidemic.
