Skip to main content
    • Aa
    • Aa

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.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

JL Bernat . Chronic disorders of consciousness. Lancet 2006;367(9517):1181–92.

JT Giacino , S Ashwal , NL Childs , R Cranford , B Jennett , DI Katz , et al. The minimally conscious state: Definition and diagnostic criteria. Neurology 2002;58(3):349–53.

AM Owen , MR Coleman , M Boly , MH Davis , S Laureys , JD Pickard . Detecting awareness in the vegetative state. Science 2006;313:1402.

MM Monti , A Vanhaudenhuyse , MR Coleman , M Boly , JD Pickard , L Tshibanda , et al. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 2010;362(7):579–89.

JC Bardin , JJ Fins , DI Katz , J Hersh , LA Heier , K Tabelow , et al. Dissociations between behavioural and functional magnetic resonance imaging-based evaluations of cognitive function after brain injury. Brain 2011;134:769–82.

A Hampshire , BL Parkin , R Cusack , D Fernández-Espejo , J Allanson , E Kamau , et al. Assessing residual reasoning ability in overtly non-communicative patients using fMRI. NeuroImage: Clinical 2013;2(1):174–83.

D Fernández-Espejo , AM Owen . Detecting awareness after severe brain injury. Nature Reviews Neuroscience 2013;14(11):801–9.

TK Chan , GL Tipoe . Should we continue treatment for M? The benefits of living. Journal of Medical Ethics 2014;40:131–3.

DJ Wilkinson , G Kahane , J Savulescu . “Neglected personhood” and neglected questions: Remarks on the moral significance of consciousness. American Journal of Bioethics Neuroscience 2008;8(9):31–3.

JJ Fins . Being conscious of their burden: Severe brain injury and the two cultures challenge. Annals of the New York Academy of Science 2009;1157:131–47.

PS Appelbaum . Assessment of patients’ competence to consent to treatment. New England Journal of Medicine 2007;357:1834–40.

J Kulynych . Legal and ethical issues in neuroimaging research: Human subjects protection, medical privacy, and the public communication of research results. Brain and Cognition 2002;50:345–57.

WJ Winslade . Severe brain injury: Recognizing the limits of treatment and exploring the frontiers of research. Cambridge Quarterly of Healthcare Ethics 2007;16:161–8.

JJ Fins , J Illes , JL Bernat , J Hirsch , S Laureys , E Murphy . Neuroimaging and disorders of consciousness: Envisioning an ethical research agenda. American Journal of Bioethics Neuroscience 2008;8(9):312.

DJ Wilkinson , G Kahane , M Horne , J Savulescu . Functional neuroimaging and withdrawal of life-sustaining treatment from vegetative patients. Journal of Medical Ethics 2009 Aug;35(8):508–11.

JJ Fins . Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness. New York: Cambridge University Press; 2015.

C Simpson . Decision-making capacity and informed consent to participate in research by cognitively impaired individuals. Applied Nursing Research 2010;23(4):221–6.

WC Thompson . Evaluating the admissibility of new genetic identification tests: Lessons from the “DNA War.” Journal of Law and Criminology 1993;84(1):22104.

C Rodrigue , RJ Riopelle , JL Bernat , E Racine . Perspectives and experience of healthcare professionals on diagnosis, prognosis, and end-of-life decision making in patients with disorders of consciousness. Neuroethics 2013;6(1):2536.

E Racine , M-J Dion , CAC Wijman , J Illes , MG Lansberg . Profiles of neurological outcome prediction among intensivists. Neurocritical Care 2009;11(3):345–52.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 17
Total number of PDF views: 97 *
Loading metrics...

Abstract views

Total abstract views: 396 *
Loading metrics...

* Views captured on Cambridge Core between 16th September 2016 - 18th August 2017. This data will be updated every 24 hours.