Neuroethics and the Minimally Conscious State

http://goo.gl/Dct74z

Drawing on his personal interactions with families touched by brain injury and breakthrough findings in the neuroscience literature, Dr. Fins compared the MCS to a flickering lightbulb: neural circuits are intact, but like the lightbulb, but they aren’t always “on.” Occasional reports of seemingly conscious behaviors, such as tracking moving objects with their eyes or reaching for a nearby cup, give hope to families of MCS patients, but these physical actions are not always reliably reproduced.

However, much of what doctors once perceived as wishful thinking from families actually has been supported by multiple neuroscience methodologies. Diffusion tensor imaging (DTI), a brain scan sensitive to white matter structure that researchers use to study connectivity, was used with early MCS patients to reveal the surprising plasticity due to the formation of new connections between old neurons. Furthermore, a breakthrough functional imaging study published in 2006 by Adrian Owen and colleagues showed integrative reactions in the brain of a young women who, behaviorally, was believed to be in a PVS. When the woman was given verbal instructions inside the scanner to imagine herself playing tennis and walking through her home, Owen observed activation in motor and spatial regions of her brain, respectively, which was consistent with brain activity in healthy controls.

Taking into account this experimental evidence about the minimally conscious brain, Fins argued that patients face the challenge of having “dynamic brains in a static healthcare system.” As scientists and physicians learn more about the remarkable cognitive abilities of MCS patients, there is a growing obligation for neuroscience to help these persons, otherwise sequestered from the broader human community, communicate with the outside world. To address the challenges of MCS, Fins advocates for the use of neuroimaging as a neuroprosthetic communication tool; the administration of drugs that can alter brain states and speed the recovery of MCS patients; and the application of thalamic deep brain stimulation as a therapeutic intervention.