Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness

Abstract

Along with their potential benefits, recent technological advances in neuroimaging and electroencephalographic assessment of brain-injured patients have brought to light uncertainty in diagnosing disorders of consciousness. Such technologies highlight the difficulty in determining the presence or absence of consciousness, and in particular the distinction between the minimally conscious state (MCS) and the vegetative state (VS). We describe the ethical importance of this diagnostic distinction, discuss how these delineations have been affected by recent technological advances, and explore the resulting ethical challenges. We then propose a potential means of addressing these diagnostic dilemmas—namely, by stipulating demonstrable interactive capacity as a standard threshold for assessing consciousness—in order to guide the ethical management of patients whose state of consciousness remains uncertain.