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Ethical and Clinical Considerations at the Intersection of Functional Neuroimaging and Disorders of Consciousness: The Experts Weigh In


Recent neuroimaging research on disorders of consciousness provides direct evidence of covert consciousness otherwise not detected clinically in a subset of severely brain-injured patients. These findings have motivated strategic development of binary communication paradigms, from which researchers interpret voluntary modulations in brain activity to glean information about patients’ residual cognitive functions and emotions. The discovery of such responsiveness raises ethical and legal issues concerning the exercise of autonomy and capacity for decisionmaking on matters such as healthcare, involvement in research, and end of life. These advances have generated demands for access to the technology against a complex background of continued scientific advancement, questions about just allocation of healthcare resources, and unresolved legal issues. Interviews with professionals whose work is relevant to patients with disorders of consciousness reveal priorities concerning further basic research, legal and policy issues, and clinical considerations.

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Conflict of interest: GL, ACB, UR, AJS, and AT have nothing to disclose. AMO received research support from a Canada Excellence Research Chairs grant, Canadian Institutes of Health Research (CIHR) grant, Canada Foundation for Innovation grant, National Sciences and Engineering Research Council (NSERC) Discovery grant, James S. McDonnell Foundation grant, and NSERC Research Tools and Instruments grant. JI received support from the University of British Columbia, CIHR grant: EOG #120257 and CNE #85117. JI and AMO both hold grant support on the topic of neuroimaging and disorders of consciousness from the CIHR.

We thank the experts who contributed their time and insight to this study. This study was supported by the Canadian Institutes of Health Research: EOG #120257 and CNE #85117. AMO received research support from a Canada Excellence Research Chairs grant, Canadian Institutes of Health Research (CIHR) grant, Canada Foundation for Innovation grant, National Sciences and Engineering Research Council (NSERC) Discovery grant, James S. McDonnell Foundation grant, and NSERC Research Tools and Instruments grant. UR received research support from BC LEEF (Leading Edge Endowment Fund) and a Canada Foundation for Innovation (CFI) and Operating (CFI-IOF) grant.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
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