Weill Cornell Medical College, New York, NY.
J Cogn Neurosci. 2024 Jul 1;36(8):1667-1674. doi: 10.1162/jocn_a_02157.
In this article, we consider the intersection of cognitive motor dissociation (CMD) and artificial intelligence (AI), hence when CMD meets AI. In covert consciousness, there is a discordance between the observed behavior, the traditional bedside mode of assessment, and the response to volitional commands as depicted by neuroimaging or EEG studies. This alphabet soup of acronyms represents both the promise and peril of nascent technology in covert consciousness. On the diagnostic side, there is the complexity and uncertainty of identifying the discordance between cognitive activity and overt behavior. On the therapeutic side, when AI is used to generate speech, there is the possibility of misrepresenting the thoughts and intentions of those who are otherwise voiceless. This concordance of factors makes the application of AI to CMD worthy of deeper consideration. We offer this analysis in the spirit of anticipatory governance, a prudential process by which one plans to prevent or mitigate unintended consequences of novel technology. We first consider the normative challenges posed by CMD for clinical practice, neuroethics, and the law. We then explore the history of covert consciousness and the relationship of severe brain injury to the right-to-die movement, before introducing three biographies of brain injury that highlight the potential impact of disability bias or ableism in clinical practice, assistive technology, and translational research. Subsequently, we explore how AI might give voice to conscious individuals who are unable to communicate and the ethical challenges that this technology must overcome to promote human flourishing drawing upon what Nussbaum and Sen have described as a "capabilities approach" to promote normative reasoning.
本文探讨了认知运动分离（CMD）和人工智能（AI）的交集，即 CMD 与 AI 的相遇。在隐性意识中，观察到的行为、传统的床边评估模式以及神经影像学或 EEG 研究所示的对意志命令的反应之间存在不一致。这些首字母缩略词代表了新兴技术在隐性意识中的承诺和危险。在诊断方面，识别认知活动与外在行为之间的不一致存在复杂性和不确定性。在治疗方面，当 AI 用于生成言语时，就有可能歪曲那些本来无法发声的人的思想和意图。这些因素的一致性使得将 AI 应用于 CMD 值得更深入的考虑。我们提供此分析是为了体现前瞻性治理的精神，这是一种谨慎的过程，通过该过程可以计划预防或减轻新技术的意外后果。我们首先考虑 CMD 对临床实践、神经伦理学和法律提出的规范性挑战。然后，我们探讨了隐性意识的历史以及严重脑损伤与安乐死运动的关系，之后介绍了三个脑损伤的传记，重点介绍了残疾偏见或能力歧视在临床实践、辅助技术和转化研究中的潜在影响。随后，我们探讨了 AI 如何为无法交流的有意识个体发声，以及该技术必须克服哪些伦理挑战才能促进人类繁荣，并借鉴 Nussbaum 和 Sen 所描述的“能力方法”来促进规范性推理。
