New Imaging Technologies at the End of Life: Promises and Ethical Challenges
Recent studies with functional Magnetic Resonance Imaging (fMRI) suggest that we might detect consciousness in vegetative patients with a minimally conscious state. Theologically, these developments invite us to re-think consciousness, identity, and care by focusing on relationality.
Andrea Vicini, S.J., M.D., is an Associate Professor of Moral Theology and Bioethics at the Faculty of Theology of Southern Italy: S. Luigi (Naples, Italy). He is currently Visiting Assistant Professor and was formerly Gasson Chair (2009-2010) at Boston College. A practicing pediatrician, he received his Medical Degree and specialization in pediatrics from the University of Bologna (Bologna, Italy), a Bachelors in Theology from Centre Sevres (Paris, France), a Licentiate in Sacred Theology from the Weston Jesuit School of Theology, a Ph.D. in Theological Ethics from Boston College, and a second doctorate in Sacred Theology at the Faculty of Theology of Southern Italy. He has taught in Italy, Albania, Mexico, Chad, France, and in the United States. A lecturer and member of important associations of moral theologians and bioethicists (in Italy, Europe and the United States), his research interests include: fundamental moral theology, biotechnologies, reproductive technologies, end of life issues, medical ethics, genetics, and environmental issues.
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.
Bauby, J.D., The Diving Bell and the Butterfly, New York: A.A. Knopf, 1997.
Taylor, Jill Bolte, My Stroke of Insight: A Brain Scientist's Personal Journey, Penguin Group, June 2008.
Dworschak, M., "My Second Birth: Discovering Life in Vegetative Patients," Der Spiegel (2009).
Dworschak, M., "Neurological Rescue Mission: Communicating with Those Trapped within Their Brains," Der Spiegel (2010).
Fernandez, M., "Hit by a Truck and Given Up for Dead, a Woman Fights Back," New York Times, 21 December 2010.
Hotz, Robert Lee, "Atlas Gives Scientists New View of the Brain," Wall Street Journal, 13 April 2011.
Jennings, B., "The Ordeal of Reminding: Traumatic Brain Injury and the Goals of Care," Hastings Center Report 36, No.2 (2006): 29-37.
Martone, M., "Decisionmaking Issues in the Rehabilitation Process," Hastings Center Report 31, No.2 (2001): 36-41.
Martone, M., "Making Health Care Decisions without a Prognosis: Life in a Brain Trauma Unit," Annual of the Society of Christian Ethics 20, (2000): 309-327.
Martone, M., Over the Waterfall, CreateSpace, 2011.
Martone, M., "What Does Society Owe Those Who Are Minimally Conscious?," Journal of the Society of Christian Ethics 26, No.2 (2006): 201-217.
Monti, M.M., A. Vanhaudenhuyse, M.R. Coleman, M. Boly, J.D. Pickard, L. Tshibanda, A.M. Owen, and S. Laureys, "Willful Modulation of Brain Activity in Disorders of Consciousness," New England Journal of Medicine 330, No.21 (1994): 1499-1508.
Clark, Meghan, Traumatic Brain Injury & Christian Hope, Catholic Moral Theology, March 28, 2011.
In the News
Traumatic Brain Injury has been labeled the "signature injury" of the wars in Afghanistan and Iraq. In a recent 3 part article, Barbara Mannino explores the science, personal, and policy aspects of this injury ("Growing Threat to Soldiers: Traumatic Brain Injury," March 09, 2011, FOXBusiness).