Abstract

Patients with disordered consciousness due to brain injury pose medical and ethical challenges. Rates of clinical misdiagnosis of “vegetative”/unresponsive, minimally conscious and locked-in syndrome states remain challengingly high. Clinical misdiagnosis raises profound ethical concerns in terms of medical management, treatment of pain, and end-of-life decisions. Therefore, valid diagnosis is of utmost importance in clinical settings. A number of neuroimaging and electrophysiology studies now suggest that some behaviorally “vegetative state” patients may nevertheless show atypical cortical activation during resting state conditions; in some cases, they are able to follow commands or even communicate through willfully modified brain activity. Advances in investigating disorders of consciousness with neuroimaging techniques promise to lead to a more accurate understanding of individual patients’ cognitive abilities and to shed light on the gray zones of these clinical conditions. The formulation of an ethical framework which will strike a balance between the protection of these patients and further research on disorders of consciousness is an ethical, clinical, and scientific demand.