Persistent Vegetative State – Buddhist View

 September 18, 2020; revised September 19, 2020

Some people in “persistent vegetative state” may have awareness per Buddha Dhamma. (1). As long as the physical body is alive, there is life. (2). Depending on the extent of brain damage, awareness of the external world may or may not be there.

What Is a “Vegetative State” or Unresponsive Wakefulness Syndrome?

1. A persistent vegetative state is when a person is awake but showing no signs of awareness for an extended time. Such a patient may have awoken from a coma, but still don’t seem to have regained awareness (Refs. 1,2).

  • Ref. 1 states, “A vegetative state is when a person is awake but showing no signs of awareness.”
  • According to Ref. 2, a person in a vegetative state “completely lack cognitive function.”
  • The term “vegetative state” may have come from “vegetable-like” in the sense that the body is obviously alive, but does not show any sign of awareness. A vegetable is also “alive,” but of course, does not have any awareness.
  • But there is a clear difference between “being aware” and “being able to communicate that one is aware“. Some people classified to be in a “vegetative state” may be aware but not able to communicate that they are aware. This difference is VERY CLEAR in the Buddhist explanation.
There Could be Awareness in a Person Classified to be in a “Vegetative State”

2. Scientists are beginning to realize that there is a “thinking being” in a human body in a “persistent vegetative state.” In 2010, it was proposed to refer to this condition as unresponsive wakefulness syndrome or UWS (Ref. 3.)

  • However, many still consider ANY person in a vegetative state to be “clinically dead.” Disconnecting life-support is legally allowed.
  • In Buddha Dhamma, the issues become much clear. The gandhabba is fully alive inside. Since the brain’s areas controlling body movement and speech are disabled, it cannot show awareness. But depending on the condition of the other areas of the brain, it may or may not be aware of the surroundings. That means a person in a vegetative state COULD BE fully aware of his/her surroundings just like a normal person.
  • Progress in neuroscience now makes it possible to check whether such a person is aware of the surroundings, even if he/she cannot express that via speech or bodily movements. We will discuss that below. Let us first discuss the general picture per Buddha Dhamma.
A Person in a Persistent Vegetative State – Buddhist Explanation

3. In the previous post, we described the workings of the gandhabba (mental body) and the physical body where the brain plays a significant role.

  • One part of the brain (neocortex) provides the gandhabba with the sensory inputs coming through the physical sense faculties (eyes, ears, nose, tongue, body.)
  • There is a separate brain circuit (brain stem) that controls speech and bodily movements. Per gandhabba‘s instructions, that part of the brain controls the movement of body parts.
  • We discussed those two aspects using an analogy of a military tank operated by a soldier. Here, an onboard computer has two circuits: One to bring in external video and audio to the soldier. The other part of the computer-controlled circuit drives the tank and fires the guns mounted on the soldier’s tank per instructions. See, “Gandhabba in a Human Body – an Analogy.”
“Vegetative State” is Proper Terminology If the Brain Is Fully Damaged

4. If there is extensive damage to the onboard computer and all circuits under its control, the soldier is completely isolated. He/she would not be able to see/hear what is happening outside OR to drive the tank or fire its guns.

  • Similarly, if the brain is fully damaged, the gandhabba will not be able to see, hear, taste, smell, or touch (It will also not be able to recall any past events as we will discuss later.) Furthermore, since the brain cannot help with speech or other body movements, the gandhabba cannot show any life sign.
  • However, the soldier inside the tank is alive. Similarly, the gandhabba inside the physical body is also fully alive.
  • It is because that the gandhabba is alive that the physical body stays alive. The physical body can be in that “persistent vegetative state” as long as the gandhabba stays inside AND the physical body is on life-support (food and water provided.)  
  • Thus, the term “vegetative state” is appropriate in this case, since the gandhabba cannot respond AND is totally unaware of what is going on. In Abhidhamma terminology, the mind is in the bhavaṅga state. There are no “active thoughts” or citta vithi.
If Only the Brain Stem Damaged, Gandhabba May Have “Awareness”

5. Now, let us consider the second possible scenario. If only the brain stem is damaged, that person may see and hear but is incapable of moving body parts to respond to them.

  • In the military tank analogy, this is similar to when the computer circuits for driving and firing of guns are damaged. The video and audio equipment are working, so that the soldier can see and hear what is going on outside, but is unable to move the tank or fire its guns. To someone looking from outside, the military tank appears to be totally disabled.
  • Similarly, some people who appear to be in persistent vegetative states may be fully aware of what is going on. They have no abilities of body movements and cannot speak or move even a finger. Thus, they are unable to express anything with words or bodily movements.
  • The following video is about a woman in a vegetative state for two years and was able to recover. During those two years, she heard and saw what was going on. However, there was “no sign of life” in her other than her vital signs.

 

 

Gandhabba of a Person in a Persistent Vegetative State is Fully Alive in All Cases

6. Therefore, as long as the body’s vital functions are intact, the gandhabba inside is alive and well. In other words, the fact that the physical body does not decay MEANS that the gandhabba inside is alive.

  • Of course, if life-support disconnected the physical body will die. Then the gandhabba would move out of the dead body.
  • Some people in a “vegetative state” may not be able to think in addition to not being able to respond. That is a “strong vegetative state,” as discussed in #4. That is similar to a living being in the asañña realm with no thoughts or perceptions.
  • On the other hand, some who are classified to be in a “persistent vegetative state” may be fully aware of what is happening, as discussed in #5.
  • The following amazing video describes the accounts of three people who were in vegetative states for years per #5. They recovered and say that they were able to see or hear everything. But they were incapable of even moving a finger, let alone talk, so they could not acknowledge that they knew what was happening.

  • Imagine being in a situation like that! Totally helpless. That is one example of anatta nature! This is why anatta means much more than just “impermanence.” One can get into situations where one loses any control over one’s situation. Most animals are like that throughout their lives. They have to bear whatever happens.
Is There a Way to Check if a Person In a Vegetative Stats Is Aware of Surroundings?

7. It would be horrible to discontinue life-support for a person who cannot communicate but is fully aware of what is happening. As we saw in the above video, some people in persistent vegetative states CAN see and hear everything. They cannot speak or even make bodily gestures to indicate that they can see and hear.

  • Imagine being in such a situation. In some cases, the medical staff and even the family members may be talking about taking away life support! That would be a cruel punishment even though not intended.
  • But new imaging technology developments have made it possible to find out whether a given patient is aware, even though unable to communicate. The following video explains the technology. A Neuroscientist Used fMRI to Communicate With People in a Vegetative State:

  • According to this doctor, about 1 in 5 patients (from a sample of several hundred in his study) were fully aware! Hopefully, this technique will be adopted in the future before deciding to remove life support.
  • Note that the thirst person discussed in the video in #6 (@9.06) underwent this brain scan diagnosis.
The Buddhist Explanations Are Very Clear on Many Moral Issues

8. The prevalent “materialistic view” is making it difficult to understand some critical moral issues with clarity. What we discussed above is just one example.

  • Another actively-debated issue is related to the fact that there is no clear understanding of the conception of a baby per materialistic view. The only thing that is universally accepted is that the conception STARTS with the formation of a single cell (zygote) when a sperm cell joins an egg cell in the mother’s womb.
  • But that zygote is inert. When does it become alive? Some people even say it is not alive until it is born! Yet, one can clearly see that the baby is alive in the womb with the heart pumping.
  • In the Buddhist view, the situation is crystal clear. The inert zygote becomes alive when a gandhabba “descends to the womb” (okkanti) and merges with that zygote. That normally happens within a day or two of sexual intercourse. Thus, the time of conception is well-defined. See, “Buddhist Explanations of Conception, Abortion, and Contraception.”
References

1. Brain Foundation article: “Vegetative State (Unresponsive Wakefulness Syndrome)

2. Wikipedia article: “Persistent vegetative state

3. S. Laureys et al., “Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome (2010)

4. An insightful summary;

5. Here is a longer video on two subjects. One was in the vegetative state for 20 years before recovering. She recovered in 2004 but remembers others talking about the terrorist attack on 9/11/2001 (@34:30.)

All relevant posts at the subsection, “Buddha Dhamma – A Scientific Approach.” Posts on the connection between the brain and gandhabba (mental body) at “Brain and the Gandhabba.”

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