Neuroethics and Neuroimaging: Moving Toward Transparency

Abstract

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice.

Keywords:

• disorders of consciousness
• the persistent vegetative state (PVS)
• the minimally conscious state (MCS)
• coma
• neuroimaging
• ethics
• neuroethics
• brain injury
• clinical pragmatism

Dr. Fins is a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (Minds Apart: Severe Brain Injury and Health Policy) and also gratefully acknowledges support from the Charles A. Dana Foundation (Mending the Brain, Minding our Ethics II) and the Buster Foundation (Neuroethics and Disorders of Consciousness) as well as appreciation to the Greenwall Foundation for its support of the conference and to the conference participants for their collegiality and insights.

An earlier version of this article was delivered at the Working Meeting on Ethics Neuroimaging and Limited States of Consciousness at Stanford University on June 28, 2007.