The Utility- and Use–of Neurotechnology to Recover Consciousness: Technical and Neuroethical Considerations in Approaching the “Hard Question” of Neuroscience

In any attempt to recover a loss, it becomes important to assess what is lost, and to what extent. In clinical medicine, evaluation of loss of particular function(s) is fundamental to both diagnosis, and planning possible interventions that may be restorative. The term diagnosis is etymologically derived from the Greek diagignoskein, “to discern.” The root of the word, gign ́̄ oskein (γιγνώσκειν) means “to learn”; the implication being that one must gain knowledge about those aspects of the thing(s) that are important for it to be distinguished, identified and characterized. If, however, the focus of discernment is the clinical assessment of consciousness in a patient who is unable to respond and/or communicate through speech or overt behavior, then the act of discernment becomes complicated, given that the cardinal characteristics of consciousness are subjectivity and self-transparency, and to that extent not viable for direct objective evaluation. Indeed, consciousness remains the elusive, proverbial “hard question” of neuroscience, and in many ways, this is exactly the point. However, it is a question and problem that cannot simply be ignored, ascribed to mere speculative explanations, or devalued. To the contrary, it must be confronted, as the discernment of consciousness is not merely a philosophical matter, but also of practical importance in, notably, neurological diagnoses, prognoses and clinical care of patients with disorders of consciousness (DoC), such as coma, minimal consciousness or persistent unresponsive states. Such considerations of diagnosis and care are not limited to the clinical milieu. They generate ethico-legal issues that conjoin other professions (e.g., law, politics) and the public in ongoing discourse and deliberation about how such patients are, or should be regarded (e.g., with respect to their capacity for sentience; ethical concerns about quality of life; legal standing, etc.,) and treated in both the shortand the long-term, inclusive of current debates about the use of brain-machine interfaces (as focal to this thematic issue), continuity and quality of care, and the justification of life-sustaining measures. Despite considerable progress in neuroscience, the nature of consciousness (i.e., what might be viewed in Aristotelian terms as its “efficient cause”1) remains unknown. There are numerous theories, but at best these remain hypothetical, if not wholly notional, and often focus on some particular aspect of consciousness rather than on consciousness per se (Farisco et al., 2015). But if and when taken with information that posits putative brain substrates and functions involved in conscious processes (i.e., what may be more of an attempt at describing “material” or