Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-26T12:26:10.358Z Has data issue: false hasContentIssue false
  • English
  • Français

Do New Neuroimaging Findings Challenge the Ethical Basis of Advance Directives in Disorders of Consciousness?

Published online by Cambridge University Press:  10 September 2018

ORSOLYA FRIEDRICH ,
ANDREAS WOLKENSTEIN ,
RALF J. JOX ,
NIEK ROGGER  and
CLAUDIA BOZZARO
Get access Rights & Permissions [Opens in a new window]

Abstract:

Some authors have questioned the moral authority of advance directives (ADs) in cases in which it is not clear if the author of the AD is identical to the person to whom it later applies. This article focuses on the question of whether the latest results of neuroimaging studies have moral significance with regard to the moral authority of ADs in patients with disorders of consciousness (DOCs). Some neuroimaging findings could provide novel insights into the question of whether patients with DOCs exhibit sufficient psychological continuity to be ascribed diachronic personal identity. If those studies were to indicate that psychological continuity is present, they could justify the moral authority of ADs in patients with DOCs. This holds at least if respect for self-determination is considered as the foundation for the moral authority of ADs. The non-identity thesis in DOCs could no longer be applied, in line with clinical and social practice.

Keywords

disorders of consciousnessadvance directivespersonal identitypsychological continuityneuroimaging
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Special Issue 4: Clinical Neuroethics , October 2018 , pp. 675 - 685
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

We thank Mary Clare O’Donnell for editing the manuscript.

References

Notes

1. Owen, AM, Coleman, MR. Detecting awareness in the vegetative state. Annals of the New York Academy of Sciences 2008;1129:130–8.CrossRefGoogle ScholarPubMed

2. Owen, AM, Coleman, MR. Functional neuroimaging of the vegetative state. Nature Reviews Neuroscience 2008;9(3):235–43.CrossRefGoogle ScholarPubMed

3. Kahane, G, Savulescu, J. Brain damage and the moral significance of consciousness. The Journal of Medicine and Philosophy 2009;34(1):6–26.Google Scholar

4. Blustein, J. Choosing for others as continuing a life story: The problem of personal identity revisited. Journal of Law, Medicine & Ethics 1999;27(1):20–31.CrossRefGoogle ScholarPubMed

5. Buchanan, A, Brock, D. Deciding for Others: The Ethics of Surrogate Decision Making. New York: Cambridge University Press; 1989.Google Scholar

6. See note 5, Buchanan, Brock 1989.

7. DeGrazia, D. Human Identity and Bioethics. New York: Cambridge University Press; 2005.CrossRefGoogle Scholar

8. McMahan, J. The Ethics of Killing: Problems at the Margins of Life. New York: Oxford University Press; 2002.CrossRefGoogle Scholar

9. Parfit, D. Reasons and Persons. Oxford: Oxford University Press; 1984.Google Scholar

10. Bernat, JL. Chronic disorders of consciousness. Lancet 2006;367(9517):1181–92.CrossRefGoogle ScholarPubMed

11. Friedrich, O, Jox, RJ. Disorders of consciousness and the use of neurotechnologies—An ethical perspective. In: Johnson, LSR, Karen, S, eds. The Routledge Handbook of Neuroethics. London: Routledge; 2017:85–102.CrossRefGoogle Scholar

12. Laureys, S, Celesia, GG, Cohadon, F, Lavrijsen, J, Leon-Carrion, J, Sannita, WG, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Medicine 2010;8:68.CrossRefGoogle ScholarPubMed

13. Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet 1972;1(7753):734–7.

14. See note 11, Friedrich, Jox 2017.

15. Guldenmund, P, Soddu, A, Baquero, K, Vanhaudenhuyse, A, Bruno, MA, Gosseries, O, et al. Structural brain injury in patients with disorders of consciousness: A voxel-based morphometry study. Brain Injury 2016;30(3):343–52.CrossRefGoogle ScholarPubMed

16. See note 11, Friedrich, Jox 2017.

17. See note 11, Friedrich, Jox 2017.

18. Bender, A, Jox, RJ, Grill, E, Straube, A, Lule, D. Persistent vegetative state and minimally conscious state: a systematic review and meta-analysis of diagnostic procedures. Deutsches Ärzteblatt International. 2015;112(14):235–42.Google ScholarPubMed

19. See note 18, Bender et al. 2015.

20. Jox, RJ, Bernat, JL, Laureys, S, Racine, E. Disorders of consciousness: responding to requests for novel diagnostic and therapeutic interventions. The Lancet Neurology 2012;11(8):732–8.CrossRefGoogle ScholarPubMed

21. Giacino, JT, Fins, JJ, Laureys, S, Schiff, ND. Disorders of consciousness after acquired brain injury: the state of the science. Nature Reviews. Neurology 2014;10(2):99–114.CrossRefGoogle ScholarPubMed

22. Fins, JJ, Illes, J, Bernat, JL, Hirsch, J, Laureys, S, Murphy, E. Neuroimaging and disorders of consciousness: Envisioning an ethical research agenda. American Journal of Bioethics 2008;8(9):3–12.CrossRefGoogle ScholarPubMed

23. Fisher, CE, Appelbaum, PS. Diagnosing consciousness: Neuroimaging, law, and the vegetative state. Journal of Law Medicine & Ethics 2010;38(2):374–85.CrossRefGoogle ScholarPubMed

24. Stender, J, Gosseries, O, Bruno, MA, Charland-Verville, V, Vanhaudenhuyse, A, Demertzi, A, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: A clinical validation study. Lancet 2014;384(9942):514–25.CrossRefGoogle ScholarPubMed

25. Naci, L, Monti, MM, Cruse, D, Kubler, A, Sorger, B, Goebel, R, et al. Brain–computer interfaces for communication with nonresponsive patients. Annals of Neurologt 2012;72(3):312–23.CrossRefGoogle ScholarPubMed

26. See note 11, Friedrich, Jox 2017.

27. Bonebakker, AE, Bonke, B, Klein, J, Wolters, G, Stijnen, T, Passchier, J, et al. Information processing during general anesthesia: Evidence for unconscious memory. Memory & Cognition 1996;24(6):766–76.CrossRefGoogle ScholarPubMed

28. Davis, MH, Coleman, MR, Absalom, AR, Rodd, JM, Johnsrude, IS, Matta, BF, et al. Dissociating speech perception and comprehension at reduced levels of awareness. Proceedings of the National Academy of Sciences of the United State of America 2007;104(41):16,032–7.CrossRefGoogle Scholar

29. Gosseries, O, Di, H, Laureys, S, Boly, M. Measuring consciousness in severely damaged brains. Annual Review of Neuroscience 2014;37:457–78.CrossRefGoogle ScholarPubMed

30. See note 29, Gosseries et al. 2014.

31. See note 23, Fisher, Appelbaum 2010.

32. Hohwy, J, Reutens, D. A case for increased caution in end of life decisions for disorders of consciousness. Monash Bioethics Review 2009;28(2):14:1–12.Google Scholar

33. Block, N. Consciousness and cognitive access. Proceedings of the Aristotelian Society 2008;108:289–317.CrossRefGoogle Scholar

34. See note 32, Hohwy, Reutens 2009.

35. Gallagher, S, Dan, Z. Phenomenological approaches to self-consciousness. In: Zalta, EN, ed. Stanford Encyclopedia of Philosophy. Stanford: Metaphysics Research Laboratory; 2015.Google Scholar

36. Manary, R. Intentionality and consciousness. In: Banks, WP, ed. Encyclopedia of Consciousness. Oxford: Elsevier; 2009:417–29.CrossRefGoogle Scholar

37. Siewert, C. Consciousness and intentionality. In: Zalta, EN, ed. The Stanford Encyclopedia of Philosophy; Stanford: Metaphysics Research Laboratory; 2011.Google Scholar

38. See note 23, Fisher, Appelbaum 2010.

39. See note 29, Gosseries et al. 2014.

40. See note 29, Gosseries et al. 2014.

41. See note 29, Gosseries et al. 2014.

42. See note 29, Gosseries et al. 2014.

43. See note 23, Fisher, Appelbaum 2010.

44. See note 29, Gosseries et al. 2014.

45. Monti, MM, Vanhaudenhuyse, A, Coleman, MR, Boly, M, Pickard, JD, Tshibanda, L, et al. Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 2010;362(7):579–89.CrossRefGoogle ScholarPubMed

46. See note 45, Monti et al. 2010.

47. Di, HB, Yu, SM, Weng, XC, Laureys, S, Yu, D, Li, JQ, et al. Cerebral response to patient’s own name in the vegetative and minimally conscious states. Neurology 2007;68(12):895–9.CrossRefGoogle ScholarPubMed

48. Staffen, W, Kronbichler, M, Aichhorn, M, Mair, A, Ladurner, G. Selective brain activity in response to one’s own name in the persistent vegetative state. Journal of Neurology, Neurosurgery, and Psychiatry 2006;77(12):1383–4.CrossRefGoogle ScholarPubMed

49. Perrin, F, Schnakers, C, Schabus, M, Degueldre, C, Goldman, S, Bredart, S, et al. Brain response to one’s own name in vegetative state, minimally conscious state, and locked-in syndrome. Archives of Neurology 2006;63(4):562–9.CrossRefGoogle ScholarPubMed

50. See note 29, Gosseries et al. 2014.

51. See note 45, Monti et al. 2010.

52. Giacino, JT, Hirsch, J, Schiff, N, Laureys, S. Functional neuroimaging applications for assessment and rehabilitation planning in patients with disorders of consciousness. Archives of Physical Medicine and Rehabilitation 2006;87:67–76.CrossRefGoogle ScholarPubMed

53. Gill-Thwaites, H. Lotteries, loopholes and luck: Misdiagnosis in the vegetative state patient. Brain Injury 2006;20(13–14):1321–8.CrossRefGoogle ScholarPubMed

54. See note 23, Fisher, Appelbaum 2010.

55. See note 3, Kahane, Savulescu 2009.

56. Wilkinson, DJ, Kahane, G, Horne, M, Savulescu, J. Functional neuroimaging and withdrawal of life-sustaining treatment from vegetative patients. Journal of Medical Ethics 2009;35(8):508–11.CrossRefGoogle ScholarPubMed

57. See note 23, Fisher, Appelbaum 2010.

58. See note 32, Hohwy, Reutens 2009.

59. See note 32, Hohwy, Reutens 2009.

60. Friedrich, O. Knowledge of partial awareness in disorders of consciousness: Implications for ethical evaluations? Neuroethics 2013;6(1):13–23.CrossRefGoogle ScholarPubMed

61. Davis, JK. The concept of precedent autonomy. Bioethics 2002;16(2):114–33.CrossRefGoogle ScholarPubMed

62. Mental Capacity Act 2005. London: The National Archives; 2012; available at https://www.legislation.gov.uk/ukpga/2005/9/contents (last accessed 3 June 2018).Google Scholar

63. See note 5, Buchanan, Brock 1989.

64. See note 7, DeGrazia 2005.

65. See note 61, Davis 2002.

66. Furberg, E. Advance directives and personal identity: What is the problem? Journal of Medicine and Philosophy 2012;37(1):60–73.CrossRefGoogle ScholarPubMed

67. Buford, C. Advancing an advance directive debate. Bioethics 2008;22(8):423–30.CrossRefGoogle ScholarPubMed

68. See note 4, Blustein 1999.

69. See note 5, Buchanan, Brock 1989.

70. See note 7, DeGrazia 2005.

71. See note 67, Buford 2008.

72. Dresser, RS, Robertson, JA. Quality of life and non-treatment decisions for incompetent patients: A critique of the orthodox approach. Journal of Law, Medicine & Ethics 1989;17(3):234–44.Google ScholarPubMed

73. See note 66, Furberg 2012.

74. See note 66, Furberg 2012.

75. See note 66, Furberg 2012.

76. Dworkin, G. The Theory and Practice of Autonomy. Cambridge: Cambridge University Press; 1988.CrossRefGoogle Scholar

77. Buchanan, A. Advance directives and the personal identity problem. Philosophy and Public Affairs 1988;17(4):277–302.Google ScholarPubMed

78. See note 5, Buchanan, Brock 1989.

79. See note 7, DeGrazia 2005.

80. See note 9, Parfit 1984.

81. See note 66, Furberg 2012.

82. Dresser, R. Advance directives, self-determination, and personal identity. In: Hackler, C, Moseley, R, Vawter, DE, eds. Advance Directives in Medicine. New York: Praeger; 1989:155–70.Google Scholar

83. Kuczewski, MG. Whose will is it, anyway? A discussion of advance directives, personal identity, and consensus in medical ethics. Bioethics 1994;8(1):27–48.CrossRefGoogle ScholarPubMed

84. Locke, J. An Essay Concerning Human Understanding. Original Edition 1689. Oxford: Oxford University Press; 2008.Google Scholar

85. Noonan, H. Personal Identity. London: Routledge; 2003.Google Scholar

86. See note 85, Noonan 2003.

87. See note 85, Noonan 2003.

88. See note 85, Noonan 2003.

89. Williams, BAO. Personal identity and individuation. Proceedings of the Aristotelian Society 1957;67:229–52.CrossRefGoogle Scholar

90. See note 85, Noonan 2003.

91. See note 85, Noonan 2003.

92. See note 84, Locke 2008.

93. See note 85, Noonan 2003, at 9.

94. See note 85, Noonan 2003.

95. See note 85, Noonan 2003.

96. Shoemaker, S. Identity, Cause, and Mind. Philosophical Essays. Cambridge: Cambridge University Press; 1984.Google Scholar

97. See note 85, Noonan 2003, at 10.

98. See note 85, Noonan 2003.

99. See note 9, Parfit 1984, at 206.

100. See note 9, Parfit 1984, at 206.

101. See note 9, Parfit 1984.

102. See note 85, Noonan 2003.

103. See note 7, DeGrazia 2005.

104. See note 8, McMahan 2002.

105. See note 5, Buchanan, Brock 1989.

106. See note 7, DeGrazia 2005.

107. See note 7, DeGrazia 2005.

108. Bayne, T. The Unity of Consciousness. Oxford: Oxford University Press; 2012.Google Scholar

109. See note 108, Bayne 2012, at 146.

110. Metzinger, T. Conscious Experience. Paderborn: Ferdinand Schoningh; 1995.Google Scholar

111. Northoff, G. Qualia and the ventral prefrontal cortical function ’neurophenomenological’ hypothesis. Journal of Consciousness Studies 2003;10(8):14–48.Google Scholar

112. Heinzel, A, Moerth, S, Northoff, G. The central role of anterior cortical midline structures in emotional feeling and consciousness. Psyche 2010;16(2):23–47.Google Scholar

113. Chalmers, DJ. The Conscious Mind: In Search of a Fundamental Theory. New York/Oxford: Oxford University Press; 1996.Google Scholar

114. Nagel, T. What is it like to be a bat? Philosophical Review 1974;83:435–50.CrossRefGoogle Scholar

115. See note 108, Bayne 2012.

116. See note 108, Bayne 2012, at 144.

117. See note 108, Bayne 2012.