Abstract:Until now, communication with vegetative patients has been thought of to be impossible. Recent developments in neuroimaging have led to the discovery of convert consciousness in patients who have been clinically diagnosed as vegetative. Research has provided evidence of awareness that has prompted an attempt at communication through the use of imaging techniques and a patient’s wilful modulation of brain activity. In this paper, the bioethical implications of developments in neuroimaging are discussed at length to provide an argument to develop this research further. The discovery of residual brain activity and the ability for patients to communicate through answering simple yes or no questions has raised ethical and legal issues concerning a patient’s autonomy regarding the end of life choices. A critical analysis of various studies relating to bioethics as well as neuroscience led to the discovery that neuroimaging provides a method of communication to a population of patients that are often forgotten by the medical and healthy community (Fins 2015). However, it has also highlighted the technical and ethical issues surrounding end of life choices are far from being established.
While the benefits of functional neuroimaging are clear, and the practice will likely see an increasing role in the assessment of vegetative patients, caution of the interpretation of neuroimaging findings are warranted especially when applied to end of of life wishes. This paper calls for neuroimaging to be researched further, so that patients who are showing signs of consciousness can be found to have the level of awareness necessary to be considered for personhood.If an individual is unable to express his/her thoughts through physical representation, does this mean they no longer have the right to decide to withdraw or continue life-sustaining treatment? Extreme brain trauma can lead to a disorder of consciousness (DoC) that manifests either as a vegetative state (VS) or minimally conscious state (MCS). These patients are defined as being unable to express their preferences, as they no longer respond to physical command requirements. DoC patients are deemed no longer aware nor conscious.Owen et al. (2006) challenged this conclusion by displaying that patients previously misdiagnosed as being in a VS may not be in such a state. Using functional magnetic resonance imaging (fMRI), Owen and Coleman (2008) found that some VS patients can “modulate neural states in response to spoken commands”.
Their discovery could lead to redefining many concepts, i.e. it may challenge our view of consciousness and what it means under these circumstances.
Redefining these individuals as conscious demands that we ask the moral question: (if we observe awareness) then must we not demand moral equality? This notion of moral equality then infers a patient’s autonomy to decide between their choice to prolong life or their wish to end it.Present evidence suggests that discovering awareness may have a knock-on effect on the way in which we treat and view these patients as individuals. Advances in neuroimaging have the potential to alter end-of-life conversations between patients and families. Thus it may provide further clarity on their wants and needs, specifically their choice to prolong life or end treatment.This research paper will firstly begin by examining the current medical practice towards patients with DoC and why it may be considered out of date and unethical.
Secondly, after examining current medical practice, it is then essential to explore the groundbreaking research that uncovered convert consciousness and the proceeding research that may influence the ethical considerations surrounding DoC patients. Once current research is investigated, moral theories will be considered by explicitly looking at competence, autonomy, and personhood. This research will provide the basis for which to evaluate whether there are ethical and scientific grounds for patients with DoC to decide to withdraw or continue life. The paper will conclude by stating possible avenues for future research that may provide stronger evidence for an already morally controversial question. Jennett and Plum (1972) first described the term vegetative state as those whose “vegetative, mindless state” persisted longer than a couple of weeks (Jennett and Plum 1972).
Later the broad term was divided into persistent VS ( VS longer than three months) and permanent VS (VS persisted more than 12 months) (Dye 2000). Some physicians criticise the term “vegetative” stating that vegetative implies the individual is a “vegetable” and therefore may be considered no longer human, which may have effects on how we view and treat such patients (Bruno et al. 2011).