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How should we infer consciousness in unresponsive patients?

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Consciousness as subjective experience can only be inferred third-personally; a list of operational indicators is used to guide recognition in hard cases, including disorders of consciousness.

Source

Indicators and criteria of consciousness: ethical implications for the care of behaviourally unresponsive patients

Farisco M, Pennartz C, Annen J, et al. · BMC medical ethics · 2022

doi.org/10.1186/s12910-022-00770-3Read the full paper ↗13 citationscc by

What they did

Starting from a recently introduced indicator list (also aimed at non-human and other challenging cases), the authors spell ethical implications for DoC care when imaging or behaviour under-determines awareness.

What they found

Assessing others’ consciousness is inferential: we rely on subjective reports or proxies. Activity in (named) systems has been found in some behaviourally unresponsive patients. Indicators are not the same as a metaphysical definition of consciousness.

The limits

What it doesn't show

This is neuroethics of criteria, not a new fMRI series. It does not settle every DoC treatment duty.

Key terms

Consciousness
Subjective experience, identifiable from outside only by inference.
Operational indicators
A practical list that facilitates recognising consciousness in challenging cases.
DoC
Disorders of consciousness; behaviourally unresponsive patients with unknown awareness.
Third-person inference
We assess others’ experience via reports or proxies, never by direct inspection.

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Consciousness here is?

Common questions

Why inference?

Subjective experience is only available third-personally via an inferential process.

What do they start from?

A recently introduced list of operational indicators.

Clinical target?

Ethical implications for care of behaviourally unresponsive patients.

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