Disorders of consciousness and communication: ethical motivations and enabling varieties of consciousness

Envisaged extensions of a functional magnetic resonance imaging (fMRI) technique allowing communication with patients affected by disorders of consciousness are here examined in connection with subjective symptom reporting, informed consent, and continued medical care decision-making. The principles of medical beneficence, personal autonomy protection, and the right to participate in social life are isolated as appropriate sources of ethical motivations for the use of fMRI-enabled communication. Consciousness requirements for each communicative context are identified on the basis of qualitative distinctions between the access, phenomenal, and narrative varieties of consciousness. Ethically motivated uses of FMRI-enabled communication are hierarchically organized in terms of progressively more demanding consciousness requirements for successful communication. The outcomes of this analysis can be used to curb unrealistic expectations of these new scientific developments, and to promote mutual trust between medical doctors, patient surrogates and families.