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May 2017

The Catch-22 of Neuroimaging, Disorders of Consciousness, and End-of-Life Decisions

Author Affiliations
  • 1The National Core for Neuroethics, Division of Neurology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
JAMA Neurol. 2017;74(5):501-502. doi:10.1001/jamaneurol.2016.5994

In 2016, Canada passed legislation to legalize medical assistance in death (MAID) for patients with severe, irremediable conditions. The passage of this law follows those of Switzerland, Belgium, the Netherlands, Luxembourg, and 5 US states that allow patients to choose to die given specific criteria intended to uphold the principles of beneficence, human rights and dignity, and justice.1 It signals progress in the arena of end-of-life (EOL) decision making and opens new discussions about competence and communication where technology, human intervention, or both are needed as intermediaries. We consider the case where the legitimacy of technology-assisted, medically assisted dying is tested and, however seemingly far-fetched, is already in the public eye. This specific context pertains to patients with brain injuries in whom functional magnetic resonance imaging that relies on blood oxygen levels in particular brain regions, or electrophysiological measurements from the scalp, have been used to reveal signals that are interpreted as consciousness.

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