Hidden signs of consciousness in comatose patients.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

As we approach the 20 Anniversary of Terri Schiavo's death by dehydration, I found it important to publish information about a study that shows that large numbers of people in a comatose state have hidden consciousness.

Chris Malone, the assistant science editor for the Daily Mail reported on March 3, 2025 that:

Scientists have discovered a hidden sign of consciousness in comatose patients that shows they can hear and understand the world around them.

The study found bursts of organized, fast frequencies in the patient's overnight brain recordings - indicating normal sleep patterns. The unique activity often appeared before doctors detected signs of 'hidden consciousness' - a level of awareness among people who appear to still be in a coma.

Researchers at Columbia University analyzed 226 recent comatose patients, observing a third displayed the bursts - a phenomenon scientists call 'sleep spindles.'

Therefore a third of the comatose patients showed signs of consciousness. Malone further reported that:

Among those displaying sleep spindles, 76 percent showed some level of consciousness before leaving the hospital and over 40 percent recovered some of their neurological function.

Malone reports that the research shows signs of hope:

Lead author Jan Claassen, a professor of neurology, said that this discovery provides new hope for families with critically injured loved ones.

'We're at an exciting crossroad in neurocritical care where we know that many patients appear to be unconscious, but some are recovering without our knowledge,' said Claassen.

'We're starting to lift the lid a little bit and find some signs of recovery as it's happening,' the lead study author continued.

Previous articles on this topic:

• Media still can't get facts right about Terri Schiavo (Link).
• Study finds that 25% of unresponsive patients have hidden consciousness (Link).
• Surprising new test for predicting recovery from coma (Link).
• Medical experts now agree that severely brain injured patients are often misdiagnosed (Link).
• Persistently unconscious patient awakens after 15 years (Link).

Woman awakens from coma on the same day that life-support was to be withdrawn.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I have listened, over the years, to many people who have contacted to discuss whether they should discontinue life-sustaining treatment for a person when they are the Power of Attorney for Personal Care.

Bettina Lerman

These are never easy discussions. In these circumstances I will listen to the concerns of the decision maker and ask questions to help them assess what the person would have wanted if they were capable of making the decision or discuss what is the best decision. I only discuss the issues, people have to make decisions for themselves.

Michelle Butterfield, reported for Global News on a 69-year-old Florida woman who came out of coma, related to COVID-19, on the same day as the family had agreed to remove her from life-support. Butterfield reported:

Bettina Lerman’s family had already made funeral arrangements and had picked out a casket and headstone for the 69-year-old woman. They were preparing to say goodbye after doctors said it didn’t look like she would ever wake up.

“We had a family meeting with the hospital because my mother wasn’t waking up. No matter what they (did), they couldn’t get her to wake up,” Andrew Lerman, Bettina’s son, told CNN. “They said that her lungs are completely destroyed. There’s irreversible damage — that it’s just not going to happen.”

The family was picking up her headstone on Oct. 29 when they received a call from the hospital.

“There’s nothing wrong. Your mother woke up,” the doctor told Andrew, more than four weeks after she was first placed on the ventilator.

Withdrawing life-sustaining treatment is different than euthanasia or assisted suicide. When asked, I will usually advise the person to ask for more time. Medical professionals are not always right and sometimes a person needs a little more time to awaken.

For instance, a few years ago, a close family member had a profound heart attack. Doctors urged her husband to withdraw life-sustaining treatment, telling him that she would not likely come out of coma, and if she did she would never be the same. 

Her husband insisted on continuing treatment. She not only came out of coma but she fully recovered and remains healthy today.

I am not suggesting that recovery is always possible, but patience and time can save lives.

Surprising New Test for Predicting Recovery after Coma

This article was written by Nancy Valko and published on her blog on August 25, 2020.

Nancy Valko

By Nancy Valko

An April 29, 2020 Nature Journal article titled “Olfactory sniffing signals consciousness in unresponsive patients with brain injuries” found that nasal response to odors (sniffing) by 43 severely brain-injured patients predicted the likelihood of recovery and long-term survival.

According to Noam Sobel, PhD, of the Weizmann Institute of Science in Rehovot, Israel, one of the authors of the article and speaking to MedpageToday:

“If you sniff at an odorant, then it’s 100% you will regain consciousness to at least a minimal level, and you will likely live for years,” he told MedPage Today. “If you don’t sniff at an odorant, that is a bad sign, but not all hope is lost.” (Emphasis added)

Amazingly, he said that 37.5% of the unresponsive patients who didn’t sniff did eventually regain consciousness.

Dr. Giacino, PhD of Harvard Medical School who helped write the 2018 American Academy of Neurology guidance on disorders of consciousness told Medpage that this study is “a cleverly and carefully designed study that adds another much-needed tool to the consciousness-detection toolbox” even though “Between 30% and 60% of patients who sustain severe TBI (traumatic brain injury) have diminished or complete loss of smell due to the mechanics of the injury.”)

He also noted that, based on available evidence, about four in 10 patients who are deemed unconscious on bedside examination actually retain conscious awareness and that “A significant portion of these patients have covert consciousness — preserved cognitive function that cannot be expressed through speech or movement.” (Emphasis added)

Why Is This Study So Important?

As Dr. Giacino said in the Medpage article:

“Published evidence from Canada in a large cohort of ICU patients with traumatic brain injury [TBI] found that approximately 70% of the deaths were due to withdrawal of treatment and in about 60% of cases, the decision to stop treatment was made within 72 hours,” he said. “It’s possible that a positive sniff test might delay this decision, which is important since we know that about 20% of TBI patients who survive what appears to be catastrophic injury recover to a functionally-independent level by 5 years post-injury.” (Emphasis added)

As we have seen over the past decades, whether or not a severely brain-injured person is or can become conscious has become a life and death matter. We have seen this in the cases of Nancy Cruzan, Terri Schiavo and Zach Dunlap even though, as I wrote in my August 18, 2018 blog, “Medical Experts Now Agree that Severely Brain-injured Patients are Often Misdiagnosed and May Recover”.

This Issue Has Been Close To My Heart For Decades.

Just before Drs. Jennet and Plum invented the term “persistent vegetative state” in 1972, I started working with many comatose patients as a young ICU nurse. Despite the skepticism of my colleagues, I talked to these patients as if they were awake because I believed it was worth doing, especially if it is true that hearing is the last sense to go. And why not do it to respect the patient as a person?

Then one day a 17 year old young man I will call “Mike” was admitted to our ICU in a coma and on a ventilator after a horrific car accident. The neurosurgeon who examined him predicted he would be dead by morning or become a “vegetable.” The doctor recommended that he not be resuscitated if his heart stopped.

But “Mike” didn’t die and almost 2 years later returned to our ICU fully recovered and told us that he would only respond to me at first and refused to respond to the doctor because he was angry when heard the doctor call him a “vegetable” when the doctor assumed ‘Mike” was comatose!

After that, every nurse was told to treat all our coma patients as if they were fully awake. We were rewarded when several other coma patients later woke up.

Over the years, I’ve written about several other patients like “Jack”, “Katie” and “Chris” in comas or “persistent vegetative states” who regained full or some consciousness with verbal and physical stimulation. I have also recommended Jane Hoyt’s wonderful 1994 pamphlet “A Gentle Approach-Interacting with a Person who is Semi-Conscious or Presumed in Coma” to help families and others stimulate consciousness. Personally, I have only seen one person who did not improve from the so-called “vegetative” state during the approximately two years I saw him.

Conclusion

But I never even thought to give any of my patients a sniff test. What a simple test for medical professionals to do!

And even though this study is small and needs to be replicated and validated, I believe it is further evidence that we need to reevaluate our current medical ethics and laws that allow life-sustaining treatment to be withdrawn from people with severe brain injuries on the premise that such brain-injured people have no “quality of life” and that such injuries are routinely hopeless.

And I hope that the sniff test can become a standard part of all medical evaluations of people with severe brain injuries.

Chinese man awakens after 5 years of coma. His wife provided total and loving care.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

A Chinese man, Li Zhihua from Xiangyang in Hubei Province, woke up from a 5 year Coma thanks to his wife literally caring for him night and day. 

Tracy You reported on August 22 for the Mailonline:

According to reports, Mr Li was knocked down by a motorbike in August, 2013, while riding a scooter to work.

Describing his condition, Dr Wan Qing'an told reporters: 'When he was taken to the hospital, he was in a vegetative state. He could not respond to anything.'

His wife, 57-year-old Zhang Guihuan, recalled: 'The doctor told me it was possible that he would be in a persistent vegetative state.'

She said she was not willing to accept the diagnosis and wanted to prove the doctors wrong.

According to the article, his loving wife was persistent.

Day in day out, the determined spouse stayed next to Mr Li's bed to chat with him and play his favourite songs, hoping his condition would improve.

'These things were very helpful to stimulate his nervous system,' Dr Wan said.

The strong-willed woman slept only two to three hours a day and looked after Mr Li in every aspect possible. As a result, she lost 10 kilograms (22 pounds) during the course.

Ms Zhang said in order to feed her husband, she had to carefully put food into his month and then gently pressed his tongue to let him know that he could eat.

Mr Li miraculously regained his conscious last year. 

This story shows how love can lead someone to provide care. In this case, her care enabled her husband to recover.

This case also shows how providing stimulation and care may lead to someone recovering from a head injury.
 
In 2004 I attended a conference on Persistent Vegetative State whereby a doctor who ran an "awakening center" spoke about what they did to have such a high success rate in awakening patients in coma.

Vincent Lambert: Death by discrimination

This article was published by Toujours Vivant - Not Dead Yet on July 16, 2019.

Taylor Hyatt

By Taylor Hyatt - Policy Analyst & Outreach Coordinator, Toujours Vivant-Not Dead Yet

Vincent Lambert died recently.

For the past few weeks, all eyes have been on the French courts as they determined his fate. Mr. Lambert was severely injured in a car accident in 2008. Various news reports described him as “quadriplegic” with a brain injury, in a “vegetative state,” in a minimally conscious state, or used multiple terms to describe his condition. The phrase used most consistently throughout the media coverage, “right to die,” does not capture what the case was really about: disability rights.

Vincent Lambert

After the accident, Mr. Lambert used a feeding tube, but could still breathe without assistance. He could not speak, nor did he appear to respond to questions or commands. He had cycles of sleeping and waking, where he opened his eyes, moved his limbs and sometimes smiled or cried. In 2011 he was evaluated by the Coma Science Group at the Liège University Hospital in Belgium, which determined that he was in a “minimally conscious, plus” state and recommended that attempts be made to find a way to communicate with him. He subsequently received physiotherapy for one year, and 87 sessions with a speech/language therapist, which were deemed “unsuccessful.” Evaluations done in 2014 and 2018 by a team of doctors affiliated with the hospital in Rehms where Mr. Lambert was treated described his condition as “vegetative,” a view that was still contested at the time of his death.

Mr. Lambert had no directive in place expressing what he wished to happen if he ever became incapacitated. A bitter family feud arose as a result. Mr. Lambert’s wife Rachel, and six of his eight siblings, maintained that he would not want to live with a severe cognitive disability. The two remaining siblings joined their Catholic parents, Pierre and Viviane Lambert, in fighting to continue the tube feeding. Since 2013, Mr. Lambert’s parents have appealed to various authorities on multiple occasions using different legal arguments, including the European Court of Human Rights (under Article 2 of its convention, the Right to Life) and the United Nations Committee on the Rights of Persons with Disabilities. Article 25 of the Convention on the Rights of Persons with Disabilities calls on states to “prevent discriminatory denial of…food and fluids on the basis of disability.”

The Court of Cassation – the highest applicable appeals court in France – finally ordered that his feeding tube be removed on July 2 of this year. Anyone familiar with Terri Schiavo’s story will see multiple parallels between the two cases, and the questions raised therein.

The campaign to withdraw food and fluids was prompted by Mr. Lambert’s supposed “resistance” to care he was receiving. As Kevin Yuill pointed out, this points to an inconsistency in the position of those advocating the withdrawal of food and fluids; was Mr. Lambert capable of having and expressing an opinion about his care through his behaviour, and therefore possessing the right to refuse care? Or was he in a vegetative state, in which case his movements should be interpreted as reflexive and meaningless?

Another crucial issue raised by the Lambert case is the idea that disabled people must meet a certain threshold of functioning, or potential for improvement, in order to justify their existence and to receive the necessities of life (food and fluids). The view that death is preferable to severe disability led to a modification of France’s Public Health Code in February of 2016 to allow for the passive euthanasia of people like Mr. Lambert who were receiving “artificial life support” (tube feeding). The law allows treatments that are “unnecessary” or “disproportionate” to be stopped; in Mr. Lambert’s case food and fluids were deemed to be “unnecessary” and “disproportionate” because he was unlikely to achieve a certain level of functioning.

As well, the record is unclear as to what kind of ongoing rehabilitative care Mr. Lambert received, aside from the physiotherapy and speech/language sessions recommended by the Coma Science group three years after his injury. The team who evaluated Mr. Lambert in 2014 and 2018 noted that his condition had deteriorated; can that be linked to the kind of care he was (or was not) receiving?

Finally, the question of whether a feeding tube constitutes “artificial” life support was not sufficiently addressed. Not Dead Yet raised this question in the California Supreme Court in the Wendland case in 2000; if a person receives nutrition through a tube taken by mouth, that is not medical treatment; why should that same tube be considered “medical treatment” because it goes into the person’s stomach?

If nothing else, courts should have given more weight to the fact that death is permanent. Mr. Lambert’s life changed drastically after the accident. Requiring the support of family and professionals does not make a person’s life “pointless” or “a waste of resources.” When Mr. Lambert’s wife no longer wished to care for him, calling for his death was not a humane response – especially when his parents were willing to take over. We only get one chance at life.

Another disabled person starved and dehydrated to death while the world watched. I take some solace in the fact that he was sedated when his feeding tube came out, though this does not make his fate right or less unnerving. May Vincent Lambert rest in peace.

• We mourn the death of Vincent Lambert while thankful that an agreement will protect the life of Hannah Cement.

Windsor man who was expected to die, is now home.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Don Brunelle

A Windsor Ontario man, who was expected to die, returned home last week, after living through three months of treatment including weeks in Coma. CBC news reported:

A 64-year-old Windsor man who fought for his life in hospital for three months following a harrowing car crash arrived home Friday to a hero's welcome, his body battered but his spirit unbroken. 

Don Brunelle was a passenger in a corvette that struck a cement hydro pole at close to 200 km/hr on May 26 in Wheatley. The driver was charged with drunk, stunt and reckless driving. Brunelle was in a medically induced coma for weeks. Doctors did not expect him to survive. 

His wife Brenda maintained a vigil at his bedside and remained unrelentingly positive. 

"I refused to believe what all the doctors — and I mean all of them — were telling me about how sick he was," Brenda said. "I asked all of that conversation about him not surviving this crash be taken outside of his room." 

"I'm just very grateful that I'm on the road to getting my life back with all my friends," he said.

This is a story of hope, but this story also causes us to question, what if Don had stated, in a legal document, that he would not want to live this way?

The Canadian government is researching the expansion of euthanasia to include incompetent people who had previously asked to be killed by euthanasia, when living with certain medical conditions.

The CBC article reports his wife, Brenda as saying.

"I think our battle now begins,"

"I think this is day one of his recovery. I think we're out of the hospital phase now."​

Thank you Brenda for showing us how to have hope.

A 4-year-old girl in coma is recovering

By Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

Botelho family.

The story of Gemma Botelho, a 4-year-old girl who is recovering after being in coma, is a story of hope and a story of caution.

According to an article in CNN:

Shortly after arriving at the emergency room on December 17, Gemma went into cardiac arrest. For 45 minutes doctors and nurses performed CPR, but her heart wouldn't start. Doctors and nurses filled the room, asking her parents to wait outside the door. 

"We heard beeping, and then no beeping," said her mother, Lejla Szabo, a model in Miami. "She was just flatlining. We really felt that we had lost her." 

Her husband, Alexander Botelho, who works in the hospitality industry, turned to her. "He told me we just had to look back and appreciate those 4½ years we had with her," she remembered. 

On Friday (Dec 18) ... Gemma flew to All Children's Hospital Johns Hopkins Medicine, 250 miles away in St. Petersburg. 

Friday and Saturday Gemma's heart quivered uselessly. Doctors prepared to put her on a list for a new heart but there were no guarantees it would arrive in time to save Gemma's life. 

On the Sunday before Christmas, as their daughter lay in intensive care, Szabo, who is from Hungary, and Botelho, who's from Brazil, organized friends to say prayers for Gemma at Catholic Masses in their home countries as well as in Argentina, Italy, Miami and Boston. 

That night, Szabo and Botelho finally heard good news: Gemma's heart was beginning to beat again. 

Two days later, her heart was working well enough that her pediatric heart surgeon, Dr. Jeffrey Jacobs, and his team at All Children's Hospital removed her from life support. 

The heart surgeon said he can't explain what caused her heart to start again. 

"Sometimes we don't understand everything that happens in medicine," said Jacobs, director of the Johns Hopkins All Children's Heart Institute.

According to the article, Gemma was given a 1% chance of recovery.

This story is also about being cautious. Often families and medical professionals will give up on a person who is in coma too quickly and agree to withdraw all treatment and care, including food and water causing death by dehydration rather than a natural death caused by the medical condition.

Unconscious Patient Heard Push to Stop Care

This article was published on Wesley Smith's blog on October 21, 2014.

By Wesley Smith

Wesley Smith

Sometimes, I think, the medical system is in too big a rush to assume that people with brain damage are out and gone.

This is the fruit of a “quality of life” value system that increasingly infects medicine. Human life matters far less now than the supposed quality of the life expected to be lived.

That’s very dangerous. Here’s an example: An Australian woman had a stroke. She appeared completely unconscious, but was really awake and aware. And she heard the push by her medical team to end life support. From the story:

The story of Edwarda O'Bara, a story of love and commitment

An article written by Wayne Drash for CNN and published on December 23 recounts the love of a mother and family for their daughter and sister who lived in a comatose condition for 42 years. The article that was titled: Comatose since Christmas 1969: A tale of unconditional love and miracles focuses on the life and love of the O'Bara family for Edwarda who went into diabetic shock on January 3, 1970 and became comatose.

Family and friends, Edwarda's 51st birthday.

Edwarda was cared for, around the clock at home, by her mother Kathryn (Kaye) until she died in March 2008 and more recently she was cared for by her younger sister Colleen until Edwarda recently died on November 21, 2012.

This is a difficult story to consider outside of the concept of the love of a person for another person or in this case, for their child or sister.

The story of unconditional love for Edwarda includes religious overtones that many people would immediately reject. It is true that religious experiences are private and personal.  The greatest miracle was the care, love and  commitment that the O'Bara family provided Edwarda. 

It is wrong that some people have suggested that the family was somehow causing Edwarda to suffer. This is a story of love and commitment.

It is particularly distressing that the Hemlock Society thought that it was part of their mandate to try to convince the O'Bara family to stop caring for Edwarda. The story states:

"The Hemlock Society phoned often, pleading with the mother to let her daughter die. The day after Christmas in 1981 someone called to say he was going to put Edwarda out of her misery. A few hours later three bullets were fired into the home. No one was hurt."

Colleen caring for her sister Edwarda

Why would the Hemlock Society care that Edwarda's family were willing to love and care for her. Wasn't it their choice? The family cared for Edwarda, they weren't harming her.

The Hemlock Society changed its name to Compassion & Choices a few years ago.

In 1970, when Edwarda became Comatose, there was very little knowledge about the awareness of a person who is considered Persistent Vegetative State or Comatose. Today, researchers are learning a lot more about these conditions.

The story quotes Stephen Mayer, a professor of neurology and neurological surgery at Columbia University, who has treated many comatose patients over the years. The story states

"He says new research suggests that patients in persistent vegetative states may perceive what's around them in a way that doctors didn't previously understand. 

"The best evidence of that are people who don't follow commands and appear to be vegetative, but after several years they wake up and start following commands," says Mayer. 

Mayer, who did not treat Edwarda, says it's possible "she was perceiving what was going on around her to some extent over those 40 years, but not really able to communicate to us in a way that we can believe. And maybe the daily contact, the voices, the touches with her loved ones gave her reason to live." 

"One thing I've learned over the years as somebody who treats people in a coma and tries to save them," he says, "is there's something very important about human contact with the people that bring meaning to your life, your loved ones."

A mother caring for her daughter.

Kathryn believed that to the fullest.

The love and commitment to care for Edwarda was a counter-cultural message that needs to be upheld as an example of the true dignity of human beings. I would rather live in a world that is willing to care for its most vulnerable members than a world that views its most vulnerable members as expendable.

The O'Bara family went above and beyond what was required or expected of them. 

Their love and commitment should be celebrated and emulated.

Sleeping pill awakens unconscious person.

Wesley Smith

The following comment was written by Wesley Smith and published on his blog. Link to the original comment.

Some time ago, doctors discovered that Ambien could bring apparently unconscious patients back to awareness, although the effect would sometimes fade as the drug wore off.  A case in South Africa has repeated the phenomenon. From the News 24 story:

After reading a report in City Press last month, his wife, Nomfundo, insisted that he be given a prescription for the sleeping pill Stilnox, which has the opposite effect on those with brain injuries. It worked – and brought him out of a seven-year coma… 

For the past seven years, Nomfundo has visited her husband in East London’s Newhaven Hospital, hoping for signs that the  man she had known before the accident was still inside his body. “His eyes, he couldn’t follow any direction. For instance, if you were talking to him, even if you move from this angle to that angle, he\doesn’t follow you. He couldn’t talk. Not at all,” she said. Nqinana’s doctors said he’d probably remain that way. 

But on August 12, family friend Nceba Mokoena came across an article in  City Press about a miracle recovery made by another car crash victim, hundreds of kilometres away in Gauteng Louis Viljoen was given the sleeping pill by chance by his mother, Sienie. She had noticed he wasn’t sleeping peacefully and asked her doctor if she  could give him half a sleeping tablet. After she did, Louis opened his eyes and said “Hello Mamma”, his first words in five years.

He’s going home soon. What we don’t know about the brain…