Age In Health

26/05/2026

One in five people diagnosed as being in a persistent vegetative state may be conscious.

That is not a speculative claim. It is the conclusion of neuroscientist Adrian Owen, who found a way to communicate with people the world had written off as unreachable — using fMRI scanners and the simple act of imagining playing tennis.

Some of those people had been lying in silence for years. Aware. Present. Unable to make themselves known.

This raises a question that I think the Mental Capacity Act 2005 has never adequately confronted: if we cannot reliably establish who is conscious, how can we reliably establish who lacks capacity?

The MCA's functional test is built on recognisable responses — delivered in a form, at a moment, through a medium the assessor can identify. Owen's research shows how fragile that requirement is.

Thirty-five years ago, during the Tony Bland case, someone asked an expert who was certain that people in PVS lacked all consciousness and awareness: "How do you know?"

He had no answer.

Neither, I would argue, do we — not with the confidence the law assumes.

My latest piece for Age In Health explores what Owen's work means for capacity law, and for everyone who works in care.

👉 https://garrycostain.substack.com/p/how-do-you-know

What a neuroscientist's conversations with the unconscious reveal about a law we think we understand

23/05/2026

I've been writing about the Mental Capacity Act for some time. My concern has always been the same: the Act can too easily become a prescription for paternalism dressed up as protection.

My latest article approaches that concern from an unexpected direction — through sleep paralysis, a Hillsborough victim, and a neuroscientist who learned to communicate with people in persistent vegetative states.

Adrian Owen's research shows that around one in five people diagnosed as vegetative are conscious and aware. One patient answered questions about his family. One confirmed he was not in pain after twelve years. One was asked whether he wanted to die — and his brain produced an answer too complex for the binary protocol to decode.

The Mental Capacity Act's functional test rests on the assumption that absence of recognisable response is evidence of absence of inner life. Owen's work shows that assumption is unreliable. If it is unreliable in the most extreme cases, we should not be comfortable assuming it holds in less extreme ones.

The full article is here: https://garrycostain.substack.com/p/how-do-you-know

What a neuroscientist's conversations with the unconscious reveal about a law we think we understand

06/05/2026

The Prisoner ran for just 17 episodes in 1967. Number Six spends every one of them insisting on the same thing:

"I am not a number. I am a free man."

It's a line that sounds dramatic. Theatrical, even. Until you sit in the back of a car with someone who's just come out of hospital and realise they've understood it completely — without ever having watched the show.

Tom had been fit, robust, independent. A man who hadn't seen a doctor since birth. Nine months of tests, referrals, consultants, medications, and bypass surgery later, he came home a different person. Not because of the illness. Not because of the operation.

Because the system had processed him. Filed him. Named his legs without naming him.

In my new piece for Age In Health, I use Tom's story to think about something we rarely discuss openly in health and care: the damage that isn't on the discharge summary. The self that doesn't come home with the body.

For those of us working in care settings, this isn't abstract. Every interaction is either an act of recognition or an act of erasure. We don't always get to choose which — but we always get to be aware of it.

https://garrycostain.substack.com/p/those-bastards-made-me-into-a-patient

On personhood, the medical gaze, and the self that doesn't come home

05/05/2026

https://garrycostain.substack.com/p/those-bastards-made-me-into-a-patient

On personhood, the medical gaze, and the self that doesn't come home

04/05/2026

"Those bastards have made me into a patient."

That's what Tom said, after surgery that had gone better than anyone dared hope.

He wasn't angry about the operation. He wasn't angry that his body had let him down. He was angry about something harder to name — and harder to recover from.

In my latest piece for Age in Health, I explore what Tom's words reveal about the medical gaze, Sartrean existentialism, and the self that doesn't quite come home from hospital.

Sartre famously wrote "Hell is other people." But he didn't mean that people are annoying. He meant that other people define us — and that we may come to see ourselves as they see us. The medical gaze is a particularly powerful version of that. Under it, Tom stopped being Tom. He became a case. A set of legs. A number.

This matters deeply in care. It matters for how we talk to people, how we structure assessments, and how we think about dignity and personhood — not as abstract values on a wall, but as something real that can be damaged and lost.

If you work in health, social care, or simply think about what it means to be human: I'd love you to read this.

On personhood, the medical gaze, and the self that doesn't come home

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