Diagnosing Consciousness: Neuroimaging,Law,and the Vegetative State

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Though for discussion of withdrawal of life saving therapy in light of these developments, see Wilkinson D. J. Kahane G. Horne M. Savulescu J. , “Functional Neuroimaging and Withdrawal of Life-Sustaining Treatment from Vegetative Patients,” Journal of Medical Ethics 35, no. 8 (2009): 508–511.

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See Block , supra note 18, at 206.

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See Owen Coleman , supra note 14.

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Boly M. Coleman M. R. Davis M. H. Hampshire A. Bor D. Moonen G. Maquet P. A. Pickard J. D. Laureys S. Owen A. M. , “When Thoughts Become Action: An fMRI Paradigm to Study Volitional Brain Activity in Non-Communicative Brain Injured Patients,” Neuroimage 36, no. 3 (2007): 979–992.

See Monti , supra note 2.

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See Meisel Cerminara , supra note 5, at 6–125.

Henceforth, we use the term “unconscious state” or “unconsciousness” to refer to the formal state-law definition of consciousness, though it bears noting that states vary in these overall labels; i.e., some incorrectly use the term “persistent VS” instead of “permanent VS” or “permanent unconsciousness.” In these cases, the accompanying state-law definition might bear little resemblance to the clinical definition of VS.

See Meisel Cerminara , supra note 5, at 6–128.1.

A note on methods: Our aim was to identify explicit state-laws definitions of consciousness, which are found most frequently in advance directive or surrogate decisionmaking statues. To generate this list we took as our starting point the thorough review of Meisel , supra note 5, which we supplemented with our own review of primary sources. Many end-of-life statutes do not provide such a definition (e.g., Alaska Stat. § 13.52, which does not explicitly define a vegetative state or other conditions having to do with consciousness). While we attempted to be as exhaustive as possible in this review, it is difficult to determine with certainty the absence of a law about a particular topic.

Cruzan v. Director , Missouri Department of Health. 261 U.S.344 (1990).

Me. Rev. Stat. Ann. tit. 18-A § 5–801(s) (West 2009).

S.C. Code Ann. § 44-77-20(7) (1976).

Idaho Code Ann. § 39–4502(10) (2009).

See Skene , supra note 3.

Ala. Code § 22–8A-3(10) (1975); 755 Ill. Comp. Stat. Ann. 40/10 (West 2009).

Wis. Stat. Ann. § 154.01(5m).

See Meisel Cerminara , supra note 5, at 7–83.

Fla. Stat § 765.101(12) (West 2006).

Ala. Code § 22–8A-3(10) (1975).

S.D. Codified Laws § 34–12D-1(7).

Fla. Stat § § 765.101(12) (West 2006).

Ga. Code Ann. § 31-32-2(13) (West 2009); Va. Code Ann. § 54.1–2982 (West 2009).

Ga. Code Ann. § 31-32-2(13) (West 2009).

755 Ill. Comp. Stat. Ann. 40/10 (West 2009).

Conn. Gen. Stat. Ann. § 19a-570(10) (West 2009); Ga. Code Ann. § 31-32-2.

See Jong , supra note 23.

See Menon , supra note 24; see Schiff , supra note 26.

Ohio Rev. Code Ann. § 1337.11(V) (West 2009).

Ala. Code § 22–8A-3(10) (1975); 755 Ill. Comp. Stat. Ann. 40/10 (West 2009); Ark. Code. Ann. § 20-17-201(6) (West 2009).

See Laureys , supra note 29.

See Coleman , supra note 35.

See Davis , supra note 36.

Fla. Stat § 765.101(12) (West 2006); Ala. Code § 22–8A-3(10) (1975); Conn. Gen. Stat. Ann. § 19a-570(10) (West 2009); Ga. Code Ann. § 31-32-2(13) (West 2009); 755 Ill. Comp. Stat. Ann. 40/10 (West 2009)

Ala. Code § 22–8A-4 (1975)

Ala. Code § 22–8A-3(10) (1975)

See Carey B. , “Trace of Thought Is Found in ‘Vegetative’ Patient,” The New York Times, February 4, 2010, at A1; Groopman J. , “Silent Minds,” The New Yorker, October 15, 2007, at 38–43; and supra note 1.

See Schnakers , supra note 35.

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For an extensive review of other technologies that might be used for this purpose, see the recent theme issue of Progress in Brain Research on “Coma Science: Clinical and Ethical Implications,” especially Tshibanda L. Vanhaudenhuyse A. Galanaud D. Boly M. Laureys S. Puybasset L. , “Magnetic Resonance Spectroscopy and Diffusion Tensor Imaging in Coma Survivors: Promises and Pitfalls,” Progress in Brain Research 177 (2009): 215–229.

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See Tshibanda , supra note 79.

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Neb. Rev. Stat. § 20–403(6) (West 2009); Me. Rev. Stat. Ann. tit. 18-A § 5–801(s) (West 2009).

Kahane G. Savulescu J. , “Brain Damage and the Moral Significance of Consciousness,” The Journal of Medicine and Philosophy 34, no. 1 (2009): 6–26.

See Meisel Cerminara , supra note 3, at 4–74.

Levy N. Savulescu J. , “Moral Significance of Phenomenal Consciousness,” Progress in Brain Research 177 (2009): 361–370.

Id., at 367.

Id., at 368. Note that this conception of access consciousness (originally defined as the state of having mental information available for reasoning, the control of action, and reporting, see Block, supra note 15) also invokes the issues of chronicity and prognosis, which, while beyond the scope of this paper, may have significant ethical and legal relevance. For example, the fixed futility of the vegetative state is one of the foundational justifications of right-to-die movement in the United States, as reviewed in Fins J. J. , “The Ethics of Measuring and Modulating Consciousness: The Imperative of Minding Time,” Progress in Brain Research 177 (2009): 371–82.

See Wilkinson , supra note 4.

See Skene , supra note 3.

See Laureys , supra note 39.

Lulé D. Zickler C. Häcker S. Bruno M. A. Demertzi A. Pellas F. Laureys S. Kübler A. , “Life Can Be Worth Living in Locked-In Syndrome,” Progress in Brain Research 177 (2009): 339–351.

Dennett D.C. , Consciousness Explained (Boston: Little, Brown and Co., 1991).

AL: Ala. Code § 22–8A-3(10) (1975); AR: Ark. Code. Ann. § 20-17-201(6) (West 2009); CT: Conn. Gen. Stat. Ann. § 19a-570(10) (West 2009); DE: Del. Code Ann. Tit. 16, “2501 (r) (1) (West 2009); FL: Fla. Stat § 765.101(12) (West 2009); GA: Ga. Code Ann. § 31-32-2(13) (West 2009); ID: Idaho Code Ann. § 39–4502(10) (2009); IL: 755 Ill. Comp. Stat. Ann. 40/10 (West 2009); MD: Md. Code Ann., [Health-Gen.] § 5–601(q) (West 2009); ME: Me. Rev. Stat. Ann. tit. 18-A § 5–801(s) (West 2009); NE: Neb. Rev. Stat. § 20–403(6) (West 2009); NH: N.H. Rev. Stat. Ann. § 137-J:2(XVII) (2009); NJ: N.J. Stat. Ann. § 26:2H-55 (West 2009); OH: Ohio Rev. Code Ann. § 1337.11(V) (West 2009); OR: Or. Rev. Stat § 127.505(19) (West 2009); PA: 20 Pa. Cons. Stat. Ann. § 5422 (West 2009); SC: S.C. Code Ann. § 44-77-20(7) (1976); SD: S.D. Codified Laws § 4–12D-1(7) (2009); VA: Va. Code Ann. § 54.1–2982 (West 2009); WI: Wis. Stat. Ann. § 154.01(5m) (West 2009); WV: W. Va. Code § 16-30-3(s) (West 2009).