New Imaging Technologies at the End of Life: Promises and Ethical Challenges
Each year two million Americans suffer some form of traumatic brain injury (TBI); nearly 375,000 of these require hospitalization, 60,000 die and another 2,000 are left in a permanent unconscious state. To shed light on the ethics of this public health issue, the Boisi Center invited Andrea Vicini, S.J., a medical doctor (pediatrician) and theological ethicist, to discuss his work in the field. Currently a visiting professor at BC, this summer he will leave his post at the Pontifical Faculty of Theology of Southern Italy to become an associate professor of Christian ethics at the BC School of Theology and Ministry.
Fr. Vicini’s work in bioethics involves a new imaging technology, functional magnetic resonance imaging (fMRI), which attempts to differentiate between different states of consciousness by measuring blood flow in the brain. Among the goals of fMRI research is to evaluate the likelihood of recovery from TBIs, but the present state of knowledge and technology leads to misdiagnosis rates of 40% or more. As medical research improves fMRI usefulness in this area, Fr. Vicini said, ethicists must address issues concerning the well-being and desires of the patient, the wishes of the family and the uncertainty involved in assessing consciousness.
Long-term brain injuries can place incredible stress on patients’ families and loved ones, not least because of the uncertainty and difficulty in assessing levels of consciousness. Fr. Vicini argued that end-of-life care should therefore be evaluated from three perspectives: consciousness, relational identity, and care. In evaluating a TBI patient’s state of consciousness (coma, vegetative state, minimally conscious state, or “locked-in syndrome”) and the likelihood of recovery, fMRI testing will eventually be extremely helpful. Relational identity involves considering the needs of a patient and their family and crafting a care plan well suited to the needs of both. Finally, the concept of care addresses not only strictly medical care but also holistic care that can take place outside the hospital setting.
In the lively Q & A session that followed, participants raised concerns about the prohibitive cost of this diagnostic tool for a majority of patients. Many in the audience empathized with the difficulty of making end-of-life care decisions and all agreed that these situations bring a certain humility to the practice of medicine, sometimes thought to have all the answers in the modern age.