Uncertainty

The relatively brief history of disorders of consciousness has seen two epistemic eras—the first was marked by certainty, both ethical and epistemic, about the vegetative state. The second era has been notable for its epistemic and ethical uncertainty. This chapter looks at the 21st century neuroscientific revolution in disorders of consciousness and its ongoing reverberations. Uncertainty about these disorders continues to increase. There are ontological and epistemic doubts about behavioral diagnosis, which looks for the contents of consciousness, or local states of consciousness, while trying to capture the global states of consciousness that are of most diagnostic and ethical interest. The scientific and medical uncertainty, and the high rate of misdiagnosis, complicate ethical decision-making for patients with these disorders.