title: Neuroethics, neuroimaging, and disorders of consciousness: promise or peril?
abstract: The advent of powerful neuroimaging tools such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) has begun to redefine how we diagnose, define, and understand disorders of consciousness such as the vegetative and minimally conscious states. In my paper, I review how research using these methods is both elucidating these brain states and creating diagnostic dilemmas related to their classification as the specificity and sensitivity of traditional behavior-based assessments are weighed against sensitive but not yet fully validated neuroimaging data. I also consider how these methods are being studied as potential communication vectors for therapeutic use in subjects who heretofore have been thought to be unresponsive or minimally conscious. I conclude by considering the ethical challenges posed by novel diagnostic and therapeutic neuroimaging applications and contextualize these scientific developments against the broader needs of patients and families touched by severe brain injury.
authors.affiliation: Division of Medical Ethics, New York Presbyterian-Weill Cornell Medical Center, 435 East 70th Street, Suite 4-J, New York, NY 10021, USA. jjfins@med.cornell.edu
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Fins
mesh_terms: D000818:Animals; D001921:Brain / Q000503:physiopathology*; D001926:Brain Death / Q000175:diagnosis / Q000503:physiopathology; D001931:Brain Mapping / Q000941:ethics / Q000379:methods; D003128:Coma / Q000175:diagnosis; D003243:Consciousness; D003951:Diagnostic Errors; D003952:Diagnostic Imaging / Q000941:ethics / Q000379:methods; D003943:Diagnostic Techniques, Neurological / Q000941:ethics; D006801:Humans; D028701:Patient Rights; D018458:Persistent Vegetative State / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D014474:Unconsciousness / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology