Brain-computer interfaces in end-of-life decision-making

Brain-computer interfaces (BCIs) may enable some patients with brain injuries preventing verbal or gestural communication to communicate through brain activity alone. Cognitive impairment in the minimally conscious state (MCS), however, would appear to preclude patients in this state from meeting the requirements of informed consent and decision-making about life-sustaining care. Yet some patients at the higher end of the MCS spectrum may have enough awareness to understand their condition, experience pleasure or pain and suffering and enough cognitive capacity to express wishes through a BCI to continue or end their experience. A weaker concept of informed consent and decisional capacity confirmed through a repeated and consistent pattern of affirmative or negative responses to questions about quality of life and artificial nutrition and hydration (ANH) may justify these responses as sufficiently informed decisions about care. Failure to take these responses as autonomous decisions may harm these patients by failing to respect their autonomy and act in their best interests. It could also be unfair to deny them the right to make these decisions just because they are unable to express them through ordinary means.