Bioethics Blogs

Law, Perception, and Cultural Cognition Near the End of Life

My colleague Kathy Cerminara has published the following article in the Washburn Law Review: “Law, Perception, and Cultural Cognition Near the End of Life.”  From the introduction:

In the
decade since Schiavo, neuroscience has developed in leaps and bounds, paving
the way to further questions about the “fact” of a VS diagnosis.
Neuroscientists have begun reporting success in using brain imagery to capture
the structure and function of the brains of patients with disorders of
consciousness, such as VS. 

Tools such as functional magnetic resonance imaging
(“fMRI”) and electroencephalograms (“EEGs”) suggest that the clinical
diagnostic criteria used to determine whether a patient is in a VS may be
flawed. Such flaws may result in some diagnoses that are arrived at correctly
yet are factually inaccurate, indicating that a patient is in a VS when he or
she is actually in a minimally conscious state (“MCS”).

Neurologist Dr. James Bernat
has noted, “[t]he public has become both fascinated by states of
unconsciousness and skeptical of the ability of clinicians to diagnose them
correctly, treat them properly, and issue prognoses accurately.”

This
skepticism opens up space for discussion into which we must proceed cautiously
because of the potential to read these studies as support for opinion in the
guise of fact. Ms. Schiavo’s brother, Bobby Schindler, for example, has
described fMRI techniques as demonstrating that “an ‘unscientific, inaccurate’
diagnosis of unresponsive patients [in VS] is being used as a ‘criterion to
kill.’” 

Yet, neuroscientists
themselves caution that their research is not advanced enough to accurately
describe such diagnoses as unscientific or inaccurate, even if public opinion
or social consensus favored the use of them “to kill.” Because of the emotional
nature of the life-or-death issues involved, future disputes over VS are
inevitable, and they easily could
become as hotly contested as those that erupted during the final years of Ms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.