Advancing the science of consciousness: From ethics to clinical care

Abstract

Significant advances in the scientific investigation of the neurobiology of consciousness have been slow to be translated into clinical settings, limited by a lack of generally agreed working definition (e.g., what is consciousness?) and methodology (e.g., how to identify reliable biomarkers/indicators of consciousness? How to improve sensitivity and specificity of the technological identification of consciousness?). In the present paper we aim at proposing potential strategies for reducing the gap between research, clinical practice, and patients’ and their caregivers’ needs regarding disorders of consciousness. By implementing a multidisciplinary (i.e., involving different disciplines) and multiperspective (i.e., involving different stakeholders) approach, the paper focuses on disorders of consciousness: it starts from the review of some of the most promising measures of consciousness from brain activity (i.e., electrophysiology and spectral measures, measures of functional connectivity, complexity-based measures). Next the paper introduces brain responses to illusions as a possible new indicator of consciousness (i.e., a feature that facilitates the attribution of consciousness), and illustrates a possible clinical operationalization of the indicators of consciousness through the case of virtual reality. Finally, the paper analyses a set of urgent ethical issues and describes a model for assessing and dealing with those issues, concluding by elaborating key recommendations for improving the clinical treatment of patients with disorders of consciousness through a better translation of research into clinics