The materialistic premise supposes that a patient’s reduced brain activity indicates that the mind is beginning to approach nonexistence. Such persons may not be brain dead, but they have a life that is close enough to death to allow us to treat them with a certain disregard. For the Catholic, this overlooks the enduring presence of the soul and its two spiritual powers of intellect and will. St. Thomas Aquinas is our best guide to exploring the implications of this view for patients in states of diminished consciousness. The externally observable activity of the brain, even when dramatically lessened, does not represent any loss of the powers of the soul, which continue to function through a combination of natural and divine influences.