# An Ethical Approach to Detecting Covert Consciousness

> **NIH NIH F32** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $77,006

## Abstract

Project Summary
Alarming shortcomings of the bedside behavioral examination in reliably detecting consciousness generate
profound dilemmas for clinicians and families facing decisions about continuation of life-sustaining therapy, pain
control, prognostication, and resource allocation in patients with disorders of consciousness (DoC). Given the
prognostic relevance of early behavioral recovery of consciousness for long-term functional outcomes, whether
or not a patient is considered conscious is often the primary determinant of whether life-sustaining therapy is
continued, whether neurorehabilitation is offered, and whether insurance provides continued coverage. While
still in nascent stages of research, use of next-generation neurotechnologies including functional magnetic
resonance imaging (fMRI) and electroencephalography (EEG) to search for covert consciousness (i.e.
consciousness that is undetectable on bedside behavioral examination) in this vulnerable population portends a
paradigm shift in diagnosis and management of patients with DoC. As such, next-generation neurotechnologies
were recognized as potential diagnostic tools for patients with DoC in the recently updated DoC Practice
Recommendations of the American Academy of Neurology. Similarly, our group recently showed that advanced
neurotechnologies can be used to detect covert consciousness in patients with acute DoC in the intensive care
unit. Despite these research advances, little is known about ethical concerns surrounding research and use of
these next-generation neurotechnologies and sharing of the sensitive data that they yield. Since data pertaining
to presence of consciousness and its likelihood of recovery will often be uniquely influential in deciding whether
and how to proceed with life-sustaining care, ethically-informed and responsible handling of these data is of
immense importance. This project will combine ethical analysis with qualitative research methodology including
semi-structured interviews to answer two questions: (a) What are the ethical concerns and related perspectives
among key stakeholder groups, including patients, surrogates, clinicians, and researchers, surrounding the use
of novel neurotechnologies to detect consciousness in patients who appear behaviorally unresponsive? (Aim 1)
and (b) How do these key stakeholder groups perceive the optimal approach to data-sharing of uncertain
information generated through next-generation neurotechnologies to detect consciousness? (Aim 2). These data
will guide the development of an evidence-based framework for ethically-responsible research and use of next-
generation neurotechnologies to detect consciousness (Aim 3), and thus advance the high-priority BRAIN
Initiative goal of considering ethical implications of neuroscience research.

## Key facts

- **NIH application ID:** 9990274
- **Project number:** 1F32MH123001-01
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Michael J Young
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $77,006
- **Award type:** 1
- **Project period:** 2021-02-18 → 2023-02-17

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9990274

## Citation

> US National Institutes of Health, RePORTER application 9990274, An Ethical Approach to Detecting Covert Consciousness (1F32MH123001-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9990274. Licensed CC0.

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