A new thematic review in the journal Brain provides a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and proposes an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population.
The authors (including Fins and Truog) begin with an overview of the field of neuroethics: what it is, its history and evolution in the context of biomedical ethics at large. They explore nomenclature used in disorders of consciousness, covering categories such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness, and the confusional state.
The authors then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery, and ethical issues that arise within the context of caring for persons with disorders of consciousness.
Finally, the authors conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
Bottom of Figure 1 in the review article indicates that the human brain function of wakefulness (which is only one of the components of consciousness, others include internal and external awareness) is linked with brainstem reflexes. The circuitry of consciousness are structurally distinct and functionally independent from brainstem reflexes in the human brain. The McMath case illustrates this independence in humans. The bottom part of Figure 1 in the article illustrates prevailing misunderstandings and misconceptions about consciousness and its dependence on presence of brainstem reflexes. They are independent brain functions.
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