Brain–Computer and Brain-to-Brain Interfaces for Communication

2021 ◽  
pp. 112-144
Author(s):  
Walter Glannon
Keyword(s):  
Motor Impairment ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Collaborative Problem Solving ◽  
Cognitive Capacity ◽  
Artificial Nutrition ◽  
Mediated Communication ◽  
Artificial Nutrition And Hydration ◽  
Life Sustaining Treatment ◽  
Minimally Conscious

This chapter explores how a brain–computer interface (BCI) could allow some patients with locked-in syndrome, amyotrophic lateral sclerosis, or in the minimally conscious state to reliably communicate with others. BCI-mediated communication may enable these patients to clearly express their wishes when they cannot communicate because of motor impairment. Depending on their cognitive capacity for reasoning and decision-making, some patients could use a BCI to express their wishes about life-sustaining treatment and meet criteria of informed consent. Patients who could use a BCI to communicate could decide for themselves whether they want to continue or discontinue artificial nutrition and hydration, ventilation, or other life-sustaining interventions and act in their own best interests. The chapter also discusses how brain-to-brain interfaces may enable communication between brains and minds in a social network of collaborative problem-solving in visuomotor and cognitive tasks.

Facts, Lies, and Videotapes: The Permanent Vegetative State and the Sad Case of Terri Schiavo

2005 ◽  
Vol 33 (2) ◽  
pp. 363-371 ◽  
Author(s):  
Ronald Cranford
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
The United States ◽  
Conscious State ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Legal Cases ◽  
Normal Manner ◽  
Nutrition And Hydration ◽  
Minimally Conscious

Right to die legal cases in the United States have evolved over the last 25 years, beginning with the Karen Quinlan case in 1975. Different substantive and procedural issues have been raised in these cases, and society's thinking has changed as a result of the far more complex legal issues that appear today as opposed to the simplistic views raised in early landmark cases. Many of the early cases involved patients in a vegetative state, but more recently patients who were in a minimally conscious state have been the center of attention. Early cases involved the withdrawal of respirators and other sophisticated technology, but later cases centered on the withdrawal of artificial nutrition and hydration, and even whether it was permissible for competent patients to stop eating and drinking in a normal manner. Initial cases pitted families who argued for withdrawal of treatment, usually against the attending physicians and hospitals and/or the state or federal government, who argued for continuation of treatment.

Food as Love: Ethical and Moral Dilemmas in Withdrawal of Artificial Nutrition and Hydration in the Minimally Conscious State

2021 ◽  
pp. 082585972110143
Author(s):  
Kelley Finch Newcomer ◽  
Robert L. Fine ◽  
Antoinette Fidelia Newman
Keyword(s):  
Interpersonal Relationships ◽  
Health Care Professionals ◽  
Brain Injuries ◽  
Minimally Conscious State ◽  
Moral Dilemmas ◽  
Conscious State ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Minimally Conscious

Supportive Palliative Care and Hospice professionals frequently attend to Minimally Conscious State (MCS) patients near the end of life and in so doing, face decisions over maintenance or withdrawal of artificial nutrition and hydration. Although both withholding and withdrawal of artificial nutrition and hydration (ANH) in such circumstances are considered by experts in ethics and law to be acceptable, not all families nor health care professionals agree. This paper will explore basic aspects of serious brain injuries, especially MCS, the psychological role of food in interpersonal relationships, and lessons from clinical ethics that can help in goals of care discussions about withdrawal of ANH.

scholarly journals Neurophysiological Indicators of Residual Cognitive Capacity in the Minimally Conscious State

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Solveig L. Hauger ◽  
Caroline Schnakers ◽  
Stein Andersson ◽  
Frank Becker ◽  
Torgeir Moberget ◽  
...  
Keyword(s):  
Minimally Conscious State ◽  
Event Related Potentials ◽  
Conscious State ◽  
Cognitive Capacity ◽  
Healthy Controls ◽  
Individual Patient Level ◽  
Patient Level ◽  
Counting Task ◽  
Related Potentials ◽  
Minimally Conscious

Background. The diagnostic usefulness of electrophysiological methods in assessing disorders of consciousness (DoC) remains to be established on an individual patient level, and there is need to determine what constitutes robust experimental paradigm to elicit electrophysiological indices of covert cognitive capacity.Objectives. Two tasks encompassing active and passive conditions were explored in an event-related potentials (ERP) study. The task robustness was studied in healthy controls, and their utility to detect covert signs of command-following on an individual patient level was investigated in patients in a minimally conscious state (MCS).Methods. Twenty healthy controls and 20 MCS patients participated. The active tasks included (1) listening for a change of pitch in the subject’s own name (SON) and (2) counting SON, both contrasted to passive conditions. Midline ERPs are reported.Results. A larger P3 response was detected in the counting task compared to active listening to pitch change in the healthy controls. On an individual level, the counting task revealed a higher rate of responders among both healthy subjects and MCS patients.Conclusion. ERP paradigms involving actively counting SON represent a robust paradigm in probing for volitional cognition in minimally conscious patients and add important diagnostic information in some patients.

It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness

2019 ◽  
Vol 45 (4) ◽  
pp. 265-270 ◽  
Author(s):  
Charles Foster
Keyword(s):  
Vegetative State ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Best Interests ◽  
Legal Analysis ◽  
Best Interest ◽  
Degree Of Certainty ◽  
Life Sustaining Treatment ◽  
Medical Fact ◽  
Minimally Conscious

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient’s best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive.

Promoting Engagement, Requests and Choice by a Man with Post-Coma Pervasive Motor Impairment and Minimally Conscious State through a Technology-Based Program

2008 ◽  
Vol 20 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Giulio E. Lancioni ◽  
Marta Olivetti Belardinelli ◽  
Fabrizio Stasolla ◽  
Nirbhay N. Singh ◽  
Mark F. O’Reilly ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Minimally Conscious State ◽  
Conscious State ◽  
Minimally Conscious

Disabilities and Well-Being

2019 ◽  
pp. 121-137
Author(s):  
Joshua Shepherd
Keyword(s):  
Broad Class ◽  
Minimally Conscious State ◽  
Well Being ◽  
Conscious State ◽  
Minimally Conscious

This chapter argues for a normative distinction between disabilities that are inherently negative with respect to well-being and disabilities that are inherently neutral. After clarifying terms, the author discusses recent arguments according to which possession of a disability is inherently neutral with respect to well-being. He notes that although these arguments are compelling, they are only intended to cover certain disabilities and, in fact, that there exists a broad class regarding which they do not apply. He then discusses two problem cases: locked-in syndrome and the minimally conscious state, and explains why these are cases in which possession of these disabilities makes one worse off overall. He argues that disabilities that significantly impair control over one’s situation tend to be inherently negative with respect to well-being; other disabilities do not. The upshot is that we must draw an important normative distinction between disabilities that undermine this kind of control and disabilities that do not.

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