Wednesday, February 20, 2013

Ethics, Logic and Vegetative States on a First Date

So, you’re on a first date and you’ve just finished discussing your favorite movies, how many siblings you have et cetera. The next natural topic of discussion will be “how do you feel about functional neuroimaging of the vegetative state?” Don’t be intimidated. Here are three guidelines to follow so that your discussion is intellectually stimulating and does not get stuck in a mire of cognitive biases and gaps in logic.

fMRI Communication? (Source)

  1. Avoid the Availability Heuristic: Your date has most likely read over Owen and Coleman’s 2008 review of functional MRI’s ability to upgrade patients from vegetative states to non-behavioral minimally conscious states (Owen and Coleman 2008). It would be impossible for both of you not to think about the 43% chance of misdiagnosis if you’re in a vegetative state (Owen and Coleman 2008). Telling him/her that more recent studies have decreased these misdiagnoses to 41% probably won’t help (Schnakers 2009) It’s important to remember that just because the stories of patients displaying higher cognitive abilities, despite being diagnosed as being in a vegetative state is saliently memorable, does not mean that this is a common occurrence (Coleman, Rodd et al. 2007) (Owen 2006; Boly 2007). Just because they are deemed to have cognitive capabilities, doesn’t mean that they are experiencing “locked-in” syndrome, a terrifying situation in which an individual is fully conscious but unable to move or speak (Owen and Coleman 2008). Don’t assume that everyone who is deemed to be vegetative state is trapped in mental solitary confinement. That’s illogical and not helpful.

  2. False Dilemma or the Black-or-White Fallacy: You’re date might think you’re a pessimist, but you have to tell him/her that this diagnostic tool is going to be extremely limited at first. These researchers probably receive full inboxes daily from desperate family members looking for hope. Someone will have to decide who will be scanned and who will not. “That’s not fair,” your date says and the best response is this: “I’m sorry, but life isn’t fair. There’s no way that everybody can be scanned and it’s irrational to deny fMRI scanning until availability is ubiquitous. Let’s not make this an all-or-nothing choice. I think the correct choice is c) some people get scanned and benefit from the technology. This is better than no one getting scanned. In the mean time, this has to be. But there’s hope, a rising tide lifts all boats.” And this isn’t a foolproof diagnostic tool. Do you know how easy it is for healthy participants to fall asleep in a scanner? Now imagine that you have a traumatic brain injury. False-negative findings are a high likelihood with traumatic brain injury patients (Owen and Coleman 2008).

  3. Emotions: Your date might go for the jugular of any difficult ethical discussion: pathos/emotions. Queue the violins, apply the soft focus and listen to a tragic tail of one of your loved ones being in a terrible accident. Listen and imagine the fear and sadness that’s felt by anyone who has experienced this type of tragedy. “How would you feel if your [mother, uncle, sister] was in this situation? Wouldn’t you want to keep them alive as long as possible? Would you just give up on them?”… and then snap out of it. You’ll have to explain to your date that it’s natural for topics like this to be emotionally charged due to religious beliefs, personal fears and extrapolations. The fact remains that when you are not emotionally involved is the best time to think about difficult ethical issues. Logic goes out the window when emotions are involved. Families and loved ones in these horrible situations deserve support, help and empathy. Prolonging states of grief, denial or false hope will not help them. If you don’t feel a drink thrown in your face, continue your date.
With these tips in mind enjoy getting to know your date and their opinions on this ethical issue, free from logical pitfalls. You are two individuals with full cognitive capacities, unlike the hypothetical individuals in vegetative states you are discussing. Honor those suffering from traumatic brain injury by using your logical capacities to their full extent, while you have them.

--Amielle Moreno


Want to cite this post?
Moreno, A. (2012). Ethics, Logic and Vegetative States on a First Date. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/02/ethics-logic-and-vegetative-states-on.html


Works Cited

Boly, M. (2007). "When thoughts become actions: an fMRI paradigm to study volitional brain activity in non-communicative brain injured patients." Neuroimage 36: 979-992.

Coleman, M. R., J. M. Rodd, et al. (2007). "Do vegetative patients retain aspects of language comprehension? Evidence from fMRI." Brain 130(Pt 10): 2494-2507.

Owen, A. M. (2006). "Detecting awareness in the vegetative state." Science 313(1402).

Owen, A. M. and M. R. Coleman (2008). "Functional neuroimaging of the vegetative state." Nature 9: 235.

Schnakers, C. V., A.; Giacino, J.; Ventura, M.; Boly, M.; Majerus, S; Moonen, G.; Laureys, S (2009). "Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment." BMC Neurology 9(35).

1 comment:

Zi said...

Thank you for this post. I can't tell you how many of my evening plans have gone awry when she brought up Coleman's review paper and I was still stuck on her comment about Lebron being the best of all time.