Cognitive Motor Dissociation and Spiritual Physical Association

“Cognitive motor dissociation” of patients, such as those who suffered stroke or traumatic brain injury, means they are limited in their ability to respond behaviorally to commands. Case reports of patients with cognitive motor dissociation who regain ability to purposefully interact with the world, such as descriptions in popular culture like Awakenings by Oliver Sacks (2013) or Ghost Boy (Pistorius 2013), give us glimpses into their experience. After recovering their ability to respond and communicate, such patients often describe a helplessness and frustration with being treated as less than human when they could not interact with people in a meaningful way.

A recent paper by Schiff et al., Cognitive Motor Dissociation in Disorders of Consciousness (Bodien et al. 2024), identified that some patients with brain injury who are generally considered unresponsive have identifiable and quantifiable responses via brain monitoring. These patients with cognitive motor dissociation demonstrated brain activity via the technology of functional magnetic resonance imaging (fMRI) or electroencephalography (EEG). This recent paper found that 25% of these patients demonstrated brain activity via fMRI or EEG.

Understanding that these patients can demonstrate consciousness emphasizes the identity of the individual beyond the pathology. While the methodology and observable findings of the research are novel, the underlying principle of respect for patients’ inherent dignity as human persons, regardless of perceived ability or lack thereof, is steeped in our Catholic Christian worldview. In a recent message to promote Christian unity, Pope Francis emphasizes the dignity of the individual. As he notes, “changes brought about by the technological revolution […] are forcing men and women of today to rethink their identity, their role in the world and society, and their vocation to transcendence.” He emphasizes “in light of the teaching of the Sacred Scripture and Christian tradition, it is necessary to reiterate that every human being is endowed with dignity by simply existing, as a spiritual entity, created by God and destined for a filial relationship with Him (cf. Eph 1: 4-5), regardless of whether or not they act in accordance with this dignity, the socio-economic situations in which they live, or their existential conditions” (The Vatican 2024a).

As Catholic physicians, we are called to imitate the Heavenly Physician. As Catholics, we respect life from the moment of conception until natural death. The Church is known worldwide for its charitable care to the most vulnerable of our communities: the neglected, the ill, the abandoned. We are motivated in our service of others because we strive to reflect the love that Christ has for His Mystical Body in attending to our brothers and sisters in Him. This recent paper underscores our calling as Catholic physicians and other healthcare professionals to recognize the inherent dignity of the patient before us, regardless of physical ability or inability, regardless of whether or not they can communicate intelligibly, regardless of whether or not we can perceive their cognitive function. We do not need an fMRI or EEG to remind us that “[e]very human person possesses an infinite dignity, inalienably grounded in his or her very being, which prevails in and beyond every circumstance, state, or situation the person may ever encounter. This principle, which is fully recognizable even by reason alone, underlies the primacy of the human person and the protection of human rights” (The Vatican 2024b).