Neuroimaging and neuroethics: clinical and policy considerations

Neuroimaging is providing a window on severe brain injury and mechanisms of recovery in patients with consciousness disorders. This brief essay will consider the ethical implications of these developments for clinical diagnosis, emerging therapeutics and health policy.

Over the past year, functional imaging has led to two dramatic findings with the potential to alter how clinicians categorize severe brain injury and understand mechanisms of recovery. One paper reported a neuroimaging response in a patient who was behaviorally in the vegetative state. Another described structural changes in a patient with late emergence from the minimally conscious state.

Research into functional imaging and disorders of consciousness have the potential to elucidate mechanisms of brain recovery and refine their diagnostic nosology. These distinctions are becoming increasingly important given the potential of emerging therapeutic approaches to the minimally conscious state. Despite this promise the refinement of descriptive categories such as the vegetative and minimally conscious states is not without some degree of peril. Investigators and clinicians need to appreciate the uncertainty that will be engendered as diagnostic categories are redrawn and resist the premature dissemination of neuroimaging technology before its ethical implications for clinical practice are well understood.