Che effetto fa essere in “stato vegetativo”? Il problema della coscienza fra neuroscienze e bioetica

Since 1972, when Bryan Jennet and Fred Plum coined for the first time the expression “vegetative state”, they distinguished “wakefulness” from “awareness”, equalizing “consciousness” with observable responses to behavioral stimuli. Recent advances in brain imaging applied to diagnosis of severe brain injury, by enabling us to go beyond observable behavior, are challenging the well-established opinion that vegetative state patients would not be conscious. The moral question of autonomy or of a patient’s best interest to continue living or not, indeed, depends on their capacity to realize cost and benefits of their own condition. Regardless of ethical issues about advance directives, withholding or withdrawing nutrition and hydration, the use of functional magnetic resonance imaging brings about bioethical debate to focus on restricted question whether these patients are conscious or not, by diverting our attention from some hidden presuppositions of debate, as equivalence between higher brain and consciousness. Focusing on such equivalence, this paper challenges the socalled “cortico-centric perspective”, by arguing that we can detect possible responses to stimuli, not their condition, namely consciousness itself. As subjective experience, indeed, consciousness escapes objective scientific observation, usually being detectable through wider and complicated assessment at the bedside. If consciousness is “the most complex and impenetrable human property” (A. Damasio), the growing use of brain imaging to detect it should be scaled down.