Practical and Ethical Considerations in Consciousness Restoration
Tabitha Moses is a second year MD/PhD (Translational Neuro-science) Candidate at Wayne State University School of Medicine. She earned a BA in Cognitive Science and Philosophy and an MS in Biotechnology from The Johns Hopkins University. Her research focuses on substance use, mental illness, and emerging neurotechnologies. Her current interests in neuroethics include the concepts of treatment and enhancement and how these relate to our use of new technologies as well as how we define disability.
Concerns about the capacity for consent and what defines a true consent demand conversation. Recently, for instance, the widespread story of a man with a do not resuscitate tattoo sparked discussion about ways in which a person is able to provide consent when unconscious. This is a hard question to answer, and first we must understand the types of consciousness and how they are currently defined. Brain death is an irreversible, total loss of brain function with a complete loss of consciousness and reflexive behavior (1). The vegetative state (also referred to as unresponsive wakefulness syndrome (2) is described as a state wherein the person is not brain dead but also does not demonstrate any awareness. People who are minimally conscious may appear to be in a vegetative state but, when tested, demonstrate an awareness of self and others. Minimally conscious states are the basis for the recent discoveries of communication through MRI with people who had been thought to be in vegetative states (3,4). To define full consciousness is perhaps the most difficult. It is a topic that has been long-debated by philosophers and scientists; however, in medicine, to be fully conscious is most frequently defined as to be aware of oneself, one’s surroundings, and to have the ability to respond to stimuli (5). This is often measured in healthcare settings using the Glasgow Coma Scale (GCS), which rates patients on eye opening, motor responsiveness, and verbal responsiveness. Based on our present definitions and understanding, while brain death is currently a permanent, irreparable state, it is possible for people who are in a vegetative state to transition into a higher level of consciousness (6).
|Image courtesy of Pixabay.
We do not have a good way to measure consciousness objectively (7). Caplan argued that until we can understand both the science and the ethics of this problem, we should not move forward with consciousness-altering technologies such as Deep Brain Stimulation (DBS) and other emerging technologies.
|Image courtesy of Wikimedia Commons.
Caplan reminded us that our understanding of personhood and identity will also have to change. Currently, a human subject in research is a living person. If we are to include those declared brain dead in research with the intent of reviving their consciousness, we need to consider how this impacts our understanding of a human subject. Furthermore, we must consider the potential destruction of personhood. By altering the brain in such a significant manner, we are changing a person’s identity and we do not currently know the ethical or practical impacts of these changes.
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Moses, T. (2018). Practical and Ethical Considerations in Consciousness Restoration. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2018/03/practical-and-ethical-considerations-in.html