Most animals have mental states of one sort or another, but few species share our capacity for self-awareness. We are aware of our own mental states via introspection, and we are aware of the mental states of our fellow human beings on the basis of what they do and say. This chapter is not concerned with these traditional forms of mind-reading—forms whose origins predate the beginnings of recorded history—but with the prospects of a rather different and significantly more recent form (...) of ‘mind-reading’: the capacity to reliably ascribe mental states to a creature on the basis of information derived from information about their brain states. (shrink)

Recent studies using functional magnetic resonance imaging of patients in a vegetative state have raised the possibility that such patients retain some degree of consciousness. In this paper, the ethical implications of such findings are outlined, in particular in relation to decisions about withdrawing life-sustaining treatment. It is sometimes assumed that if there is evidence of consciousness, treatment should not be withdrawn. But, paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. (...) Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings. (shrink)

Consciousness in experimental subjects is typically inferred from reports and other forms of voluntary behaviour. A wealth of everyday experience confirms that healthy subjects do not ordinarily behave in these ways unless they are conscious. Investigation of consciousness in vegetative state patients has been based on the search for neural evidence that such broad functional capacities are preserved in some vegetative state patients. We call this the standard approach. To date, the results of the standard approach have suggested that some (...) vegetative state patients might indeed be conscious, although they fall short of being demonstrative. The fact that some vegetative state patients show evidence of consciousness according to the standard approach is remarkable, for the standard approach to consciousness is rather conservative, and leaves open the pressing question of how to ascertain whether patients who fail such tests are conscious or not. We argue for a cluster-based ‘natural kind’ methodology that is adequate to that task, both as a replacement for the approach that currently informs research into the presence or absence of consciousness in vegetative state patients and as a methodology for the science of consciousness more generally. 1. Introduction2. The Vegetative State3. The Standard Approach4. The Natural Kind Methodology5. Is Consciousness a Special Case? 5.1 Is consciousness a natural kind?5.2 A special obstacle?6. Conclusion. (shrink)

Some vegetative state patients show fMRI responses similar to those of healthy controls when instructed to perform mental imagery tasks. Many authors have argued that this provides evidence that such patients are in fact conscious, as response to commands requires intentional agency. I argue for an alternative reading, on which responsive patients have a deficit similar to that seen in severe forms of akinetic mutism. Akinetic mutism is marked by the inability to form and maintain intentions to act. Responsive patients (...) are likely still conscious. However, the route to this conclusion does not support attributions of intentional agency. I argue that aspects of consciousness, rather than broad diagnostic categories, are the more appropriate target of empirical investigation. Investigating aspects of consciousness provides a better method for investigating profound disorders of consciousness. 1 Introduction2 Responses in the Vegetative State2.1 The imaging evidence2.2 The need for models3 Responsive Patients and Akinetic Mutism3.1 Akinetic mutism3.2 Akinetic mutism as a deficit in intentions3.3 Arguments for the link3.4 Interim conclusion4 Other Models4.1 A deficit in ability?4.2 Modular intentions?5 Consciousness and Method5.1 Are they conscious?5.2 Aspects versus levels. (shrink)

Disorders of consciousness include coma, the vegetative state and the minimally conscious state. Such patients are often regarded as unconscious. This has consequences for end of life decisions for these patients: it is much easier to justify withdrawing life support for unconscious than conscious patients. Recent brain imaging research has however suggested that some patients may in fact be conscious.

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology (...) about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice. (shrink)