title: Ethical and Clinical Considerations at the Intersection of Functional Neuroimaging and Disorders of Consciousness.
abstract: 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.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Byram
authors.forename: Grace
authors.initials: G
authors.lastname: Lee
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Owen
authors.forename: Urs
authors.initials: U
authors.lastname: Ribary
authors.forename: A Jon
authors.initials: AJ
authors.lastname: Stoessl
authors.forename: Andrea
authors.initials: A
authors.lastname: Townson
authors.forename: Judy
authors.initials: J
authors.lastname: Illes
mesh_terms: D026688:Bioethical Issues; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003071:Cognition; D003243:Consciousness; D003244:Consciousness Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003657:Decision Making; D004644:Emotions; D059907:Functional Neuroimaging / Q000941:ethics*; D006801:Humans; D007258:Informed Consent; D016743:Mental Competency; D026684:Personal Autonomy
keywords: brain injury; covert consciousness; informed consent; legal capacity; neuroethics; neuroimaging