Farisco Michele, Pennartz Cyriel, Annen Jitka, Cecconi Benedetta, Evers Kathinka
Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.
Science and Society Unit, Biogem, Biology and Molecular Genetics Research Institute, Ariano Irpino, AV, Italy.
BMC Med Ethics. 2022 Mar 21;23(1):30. doi: 10.1186/s12910-022-00770-3.
Assessing consciousness in other subjects, particularly in non-verbal and behaviourally disabled subjects (e.g., patients with disorders of consciousness), is notoriously challenging but increasingly urgent. The high rate of misdiagnosis among disorders of consciousness raises the need for new perspectives in order to inspire new technical and clinical approaches.
We take as a starting point a recently introduced list of operational indicators of consciousness that facilitates its recognition in challenging cases like non-human animals and Artificial Intelligence to explore their relevance to disorders of consciousness and their potential ethical impact on the diagnosis and healthcare of relevant patients. Indicators of consciousness mean particular capacities that can be deduced from observing the behaviour or cognitive performance of the subject in question (or from neural correlates of such performance) and that do not define a hard threshold in deciding about the presence of consciousness, but can be used to infer a graded measure based on the consistency amongst the different indicators. The indicators of consciousness under consideration offer a potential useful strategy for identifying and assessing residual consciousness in patients with disorders of consciousness, setting the theoretical stage for an operationalization and quantification of relevant brain activity.
Our heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and the need for a refined taxonomy of disorders of consciousness.
评估其他对象的意识，尤其是非言语和行为障碍对象（例如意识障碍患者），极具挑战性，但紧迫性日益增加。意识障碍的误诊率很高，因此需要新的视角来激发新的技术和临床方法。
我们以最近引入的意识操作指标清单为出发点，该清单有助于在非人类动物和人工智能等具有挑战性的案例中识别意识，以探讨其与意识障碍的相关性以及对相关患者诊断和医疗保健的潜在伦理影响。意识指标是指可以从观察相关对象的行为或认知表现（或此类表现的神经关联）中推导出来的特定能力，在判定意识是否存在时，这些指标并未定义一个硬性阈值，但可用于根据不同指标之间的一致性推断出一个分级度量。所考虑的意识指标为识别和评估意识障碍患者的残余意识提供了一种潜在有用的策略，为相关脑活动的操作化和量化奠定了理论基础。
我们的启发式分析支持以下结论：将已识别的意识指标应用于意识障碍可能会激发新的策略，以评估三个非常紧迫的问题：意识障碍的误诊；检测意识及其障碍的金标准的必要性；以及对意识障碍进行精细分类的必要性。
