Day 3: Steven Laureys – Eyes Wide Open, Brain Wide Shut? (un)consciousness in the vegetative state

hospitalG120706_228x228This year’s David Kopf Lecture on Neuroethics was given by Steven Laureys from the University of Liege. Dr. Laureys is both a clinician (neurologist) and a scientist, and has written extensively on clinical, and more recently, ethical issues regarding disorders of consciousness (DOC). Consciousness, in particular human consciousness, is one of the most perplexing issues in philosophy of mind and clinical neurology. This topic has actually been on the periphery of my own awareness recently, since Thomas Metzinger and some of his colleagues recently visited our research group.

As SfN-ers flooded into the lecture space, members of Laureys’ COMA Science group handed out surveys for everyone to complete. The survey asked some very sensitive, but no less important on people’s views on disorders of consciousness and what they would do if found to be in a vegetative state. Laureys went through this survey with the audience, after he had made his case for each of the following sections:

(1) The Search for the Neural Correlates of Consciousness; (2) Clinical and Treatment Issues; (3) Ethical Issues. I will briefly describe each of these sections and attempt to summarize Dr. Laureys talk.

1. The Search for the Neural Correlates of Consciousness

Laureys claimed that consciousness can be reduced to two main components: wakefulness and awareness. Indeed, these are both scientific and neuro-philosophical notions. How ought both constructs be defined? What does it mean to be aware? He reviewed the recent imaging literature with regard to Persistent Vegetative State and the more recently constructed, Minimally Conscious State.

2. Clinical and Treatment Issues

Among the tough issues in clinical neurology, a major challenge is that there is no universally accepted criteria for diagnosing the vegetative state. Part of this challenge relates back to the problem of consciousness. Laureys reported on studies by Adrian Owen and others in which levels of activation similar to controls were observed using fMRI who met the criteria for the vegetative state. He used this data to argue that perhaps some individuals in the VS may retain some consciousness. Laureys also argued that patients with DOC can feel pain, which was based on studies (e.g., this one) that observed low level disconnected cortical activation. This indicates, he claimed, that the individual in the study may actually have retained some consciousness in order to “feel” pain. True, while the potential capacity for pain may exist, this does not mean that the individual is subjectively experiencing pain, and if so, to what degree. Second, just because the capacity for pain may exist – in some – it does not mean the subjective experience of suffering also exists.

3. Ethical Issues

Laureys presented a lot of interesting data during the course of his presentation, some of which I have referred to here. Unfortunately, his discussion of the ethical issues were minimal (he did refer briefly to the notion of quality of life). He did, however, refer to a fascinating case where an individual with Locked-in Syndrome was about to be euthanized (permissible in Belgium) and requested that her organs be donated, but did not go deep into the ethics of that case. I was anticipating that Laureys would offer some concrete ethical recommendations for clinical practice and research, but unfortunately that was not the case.  Laureys did, however, refer to a recent paper he co-authored published in the American Journal of Bioethics-Neuroscience calling for an ethical research agenda in DOC.

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