Abstract Details

Title An Ethical Approach to Detecting Covert Consciousness

Topic Practice, Policy, and Ethics

Presentation(s) P17 - Poster Session 17 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-004

Objective To develop an ethical roadmap for responsible research and translation of advanced neurotechnologies to detect covert consciousness in settings of uncertainty.

Background

Shortcomings of the bedside behavioral examination in reliably detecting consciousness generate profound dilemmas for clinicians and surrogates facing decisions about continuation of life-sustaining therapy, pain control, prognostication, and resource allocation in patients with disorders of consciousness (DoC). Novel neuroimaging and electrophysiologic techniques that aim to improve diagnostic accuracy for patients with DoC are under investigation, yet little is known about ethical concerns surrounding their use.

Design/Methods

We applied normative philosophical, historical and ethical analysis to identify and critically evaluate ethical implications of emerging neurotechnologies for detecting covert consciousness in research and clinical settings.

Results

Four neuroethical principles emerged through initial normative analysis to guide responsible translation of neurotechnologies for the detection of consciousness in clinical practice: (1) promote equity in neurotechnology access; (2) embed neuroethics research to capture perspectives of patients, surrogates, clinicians and researchers to inform emerging clinical paradigms; (3) communicate uncertainty about data yielded by novel neurotechnologies with clinical teams, patients and surrogates, while acknowledging the meaningful diagnostic and prognostic information that they could uncover; (4) sensitize DoC nosology and diagnostic criteria to breakthroughs in neurotechnology. Democratizing access to optimal DoC care requires a multilevel approach to facilitate equitable dissemination and adoption of neurotechnologies. Commitment to making pipelines open-access, interoperable and scalable may help ensure that technologies do not remain siloed at their source.

Conclusions Development and deployment of novel neurotechnologies to detect covert consciousness promises to improve the accuracy of diagnosis and prognosis for patients with DoC, but raises a host of novel ethical challenges that we identified and which require further study. Promoting equity in neurotechnology access, communicating uncertainty, embedding neuroethics research, and optimizing DoC nosology are key steps to ensure responsible clinical translation.

Authors/Disclosures
Michael Young, MD (Massachusetts General Hospital, Brigham, Harvard) PRESENTER	The institution of Dr. Young has received research support from NIH/NINDS. The institution of Dr. Young has received research support from Department of Defense. The institution of Dr. Young has received research support from Chen Institute.
Yelena Bodien, PhD (Spaulding Rehabilitation Hospital)	The institution of Dr. Bodien has received research support from NIH and NINDS. Dr. Bodien has received personal compensation in the range of $500-$4,999 for serving as a Co-inventor for the Updated Coma Recovery Scale-Revised with Spaulding Rehabilitation Hospital.
Joseph T. Giacino, PhD	The institution of Dr. Giacino has received research support from National Institute on Disability, Independent Living and Rehabilitation Research. The institution of Dr. Giacino has received research support from National Institute on Neurological Disorders and Stroke. The institution of Dr. Giacino has received research support from Department of Defense. The institution of Dr. Giacino has received research support from SameYou Foundation. Dr. Giacino has received intellectual property interests from a discovery or technology relating to health care.
Leigh R. Hochberg, MD, PhD, FAAN (Massachusetts General Hospital)	The institution of Dr. Hochberg has received research support from The MGH Translational Research Center has a clinical research support agreement (CRSA) with Axoft, Neuralink, Neurobionics, Precision Neuro, Synchron, and Reach Neuro, for which LRH provides consultative input. LRH is a non-compensated member of the Board of Directors of a nonprofit assistive communication device technology foundation (Speak Your Mind Foundation). Mass General Brigham (MGB) is convening the Implantable Brain-Computer Interface Collaborative Community (iBCI-CC); charitable gift agreements to MGB, including those received to date from Paradromics, Synchron, Precision Neuro, Neuralink, and Blackrock Neurotech, support the iBCI-CC, for which LRH provides effort.. The institution of Dr. Hochberg has received research support from Dr. Hochberg also receives research support from the US Department of Veterans Affairs and the National Institutes of Health.. Dr. Hochberg has received intellectual property interests from a discovery or technology relating to health care.
Brian Edlow, MD	Dr. Edlow has received research support from NIH.

��ɫ��

��ɫ��