Show Us You Are Here

It is one of the oldest philosophical questions, knowing the conscious existence of another. As noted earlier, each of us can attest to our own existence but cannot say with certainty that another exists. And this seems to suffice in most cases because those of us who are conscious and can speak and affirm our conscious self can defend our interests and choices. Though it is theoretically suspect, in a practical sense, the communication of one's own consciousness becomes a safeguard of one's prerogatives and rights.

We have, however, seen the horrible consequences for patients who may have been conscious but have been unable to communicate and therefore assert themselves after brain injury. Without the ability to communicate they have been vulnerable from their entry into the emergency room, all the way through the ICU and chronic care. Ignored, neglected, and mistaken as unconscious, they were relegated to custodial care and worse. The entreaties of their loved ones generally went for naught until a few of them were properly diagnosed and shown to be minimally conscious through careful examination and sometimes ancillary neuroimaging tests.

To ensure that the fate of the next generation of minimally conscious patients is better than the current one, neuroscience will need to enable Maggie and others like her to communicate and show that they are here, and deserve a hearing. Science needs to enable them to more fully demonstrate, through their interactions, that they remain part of a human community, a community that is bound together through communication, reminders of our reciprocal obligations to this population of patients.

Advancing an ethical agenda of obligation will require some requisite degree of scientific “proof” of their conscious presence. These “manifestations of self” will need to occur on a more predictive and consistent basis. Only then will there be clarity about society's responsibilities, so that at a minimum a conscious being is never again mistaken for one who is not and that the maximal potential of each patient is achieved.