Consciousness, Intention, and Command Following in the Vegetative State

Some vegetative state patients show fMRI responses similar to those of healthy controls when instructed to perform mental imagery tasks. Many authors have argued that this provides evidence that such patients are in fact conscious, as response to commands requires intentional agency. I argue for an alternative reading, on which responsive patients have a deficit similar to that seen in severe forms of akinetic mutism. Akinetic mutism is marked by the inability to form and maintain intentions to act. Responsive patients are likely still conscious. However, the route to this conclusion does not support attributions of intentional agency. I argue that aspects of consciousness, rather than broad diagnostic categories, are the more appropriate target of empirical investigation. Investigating aspects of consciousness provides a better method for investigating profound disorders of consciousness.