A Belgian neurologist has discovered that a man believed to be living in a persistent vegetative state (PVS) for 23 years was really conscious. “I screamed, but there was nothing to hear,” was the astonishing headline in London's Daily Mail. Rom Houben was 23 when he was paralyzed in a car accident. He appeared to be completely unresponsive.

After he was examined by Steven Laureys, a Belgian neurologist, however, doctors realised that he was actually conscious. Still almost completely paralyzed, he can move his right hand slightly, which enables him to communicate. With a speech therapist supporting his hand, Houben can spell words out on an on-screen keyboard. He is even writing a book.

For Dr Laureys this case confirms his theory that many PVS patients are wrongly diagnosed -- up to 43%, he says, in an open-access article in BMC-Neurology. When he gave Houben an MRI scan, it was apparent that most of his brain was intact. Tragically, despite many examinations, the doctors had missed it. "Once someone is stamped as being 'not conscious,' it becomes very difficult to get rid of that label," says Laureys.  Furthermore, proper testing takes many hours -- hours that medical personnel don't have, especially if a patient is in a nursing home or at home in the care of relatives.

There were some sceptics. Art Caplan, a bioethicist from the University of Pennsylvania, wrote that the story just doesn't add up. "The technique of having someone point your finger to a keyboard is called facilitated communication. Sadly, it has been shown time and again to be unreliable. There is something of the ouiji board about the whole thing." Furthermore, he says, 23 years in "solitary confinement" must surely have damaged his capacity for communication, but according to press reports, he is quite lucid.

Freelance libertarian bioethicist Jacob M. Appel used the unsettling story to make a different point. If indeed there are many patients who are locked-in and unable to communicate, "such circumstances might present the rare occasions when active euthanasia is morally justified without overt consent." The quality of their life would be so horrendous that they should be allowed to die.

Julian Savulescu and Guy Kahane, of Oxford University, developed this argument in the Journal of Medicine and Philosophy earlier this year. In their view, euthanasia might be a moral duty.

"It is far from obvious that such lives are still worth living. If so, then even if using fMRI we can establish that brain-damaged patients still enjoy phenomenal consciousness and a significant measure of sapience, terminating these patients’ lives might be morally required, not merely permissible."  --Der Spiegel, Nov 25;