Alive Inside with Andrew Peterson

As we learn more and more about the brain, researchers are developing new neuroscientific methods that can help diagnose patients with traumatic brain injury. For example, some of these methods might even be able to tell us that patients who otherwise appear unresponsive are actually still "alive inside". That's an amazing idea, but the story doesn't stop there. As such technology develops, it raises a number of ethical questions about how it works and how to use. In this paper, Andrew and his coauthors investigate the benefits, harms, and costs of using neuroimaging to detect human consciousness.

Links and Resources

• Andrew Peterson
• The paper
• Experiences of family of individuals in a locked in, minimally conscious state, or vegetative state with the health care system
• Ethical issues in neuroimaging after serious brain injury with Charles Weijer
• Practice guideline update recommendations summary: Disorders of consciousness
• Jason Karlawish
• Adrian Owen

Paper Quotes

The practice guideline update is a milestone in the history of neurology. Recommendations to use investigational neuroimaging methods are but one aspect of the guideline, and there is a need for further normative analysis of its rich content. We encourage continued debate on these issues. Bringing clarity to the underlying ethics of caring for brain‐injured patients can assist clinicians and health care institutions as they incorporate the guideline in clinical practice.

We think that investigational neuroimaging could facilitate access to opportunity for DoC patients. As the guideline highlights, investigational neuroimaging could function as a gatekeeper for continued rehabilitation, and it might also be used as a neural prosthetic, based on future technical improvements. Neuroimaging assessment could also inform clinical decisions that best reflect a patient’s values, even if pursuing those values are inconsistent with standard notions of quality of life. Opportunity‐based frameworks for healthcare justice still require conceptual refinement, and further work needs to be done to thoroughly apply such a framework to the DoC context. However, we believe that this is a promising avenue of future research to explicate the justice claims that DoC patients (or other disabled populations) have to investigational neuroimaging and other novel therapies.